Essay on the Classification of the Insane

by M. Allen

INTRODUCTORY OBSERVATIONS.

As in the foregoing Essay on Classification, I have several times stated my objections against writers on Insanity selecting only extreme cases, by which, I conceive, impressions of horror against the Insane are increased to their prejudice; I shall, therefore, for the express purpose of exhibiting a fair specimen of the general character of the insane collectively, in their worst and most revolting state, add, in an Appendix to this Essay, about twenty of the oldest in age as well as in the duration of the disease, and of course of the most incurable cases, taken in regular rotation from the Register Book of the oldest Asylum in the kingdom, excepting Bedlam; containing, at the time the living characters were described, about one hundred of the same class. Now though these are taken from among those who had suffered all the brutalizing influence of the old and neglected system of treatment, yet they do not, as a whole, exhibit so shocking a picture as previous popular prejudice would imagine. Notwithstanding this truth, it is proper to state, that they are incomparably a worse picture, than the same number would make, taken with equal fidelity and correctness, from among my own patients, admitted within the period of my own exclusive superintendance,—this would, therefore, be much better calculated to correct this injurious prejudice than that which I now give for this purpose: but they are too recent to be so introduced; yet as this would be a very striking contrast illustrating the effects of different treatment, I shall be prepared, should I live long enough for time to throw his dark veil over their memory, with the same number of cases, taken and described on the same principle.

I am the more anxious to do this at present, and fulfil this my future intention, because it may perhaps be laid to my charge, that in adducing cases illustrative of the principles contained in this Essay on Classification, as well as those which, from similar reasons, I may have hereafter to introduce, that I have been guilty, and may be guilty of the same error of selecting peculiar and extreme cases for my purpose; but I have been led into this, from the feeling that circumstances had forced upon me, however contrary to my previous intentions, something of a defensive attitude.

These are the reasons which have been my inducements in adding this Appendix; at the same time, to make the cases, in this naked form, as interesting and as useful as possible, I have not only drawn them with the most minute attention to truth, but to each I have appended some appropriate and useful observation.

Previous, then, to my entering upon the important subject mentioned at the end of this Essay, I shall now introduce these cases as a faithful portraiture of the Insane.

No. 1.—Admitted 1782; aged 76.

There is nothing recorded of this case, from which any correct information of the causes of the malady, or of its nature, when admitted, or of its progress since that period, can be drawn. Some of his relations are insane, and many of them exceedingly eccentric. His friends accuse some nurse of an improper application for the itch; yet, notwithstanding this accusation, the disease was gradual in its approach. He was gay when at Cambridge, and lost considerable sums at the gaming table. There is reason to believe that he had always been eccentric; and I have been told, that in his youth, he was proverbially called the proud and polite man. [114a] Whether this be correct or not, it is certain, that even now, though so little mind remains, he is soonest roused and offended, though otherwise very good-natured, by whatever questions his own importance.

Though, like many old men, he is fond of dozing away his time in bed, he has, notwithstanding, seasons of greater animation, when he seems more busily occupied with his own thoughts, often talking to himself; repeating very correctly passages committed to memory, probably forty years ago. [114b]

At these periods, unless teased or vexed in the way already stated, he is very good-natured and polite; and from his general manners, and particularly in the modulation of his voice, he still appears, in spite of the coarseness of his dress, [114c] the remains of a perfect gentleman. At these times, he is, for the most part, very happy, laughing and playing like a little child; and his very mischievous tricks—throwing stones, writing on the walls, tearing his clothes in order to make some little fanciful change and decoration of his dress, seem to be done rather as resources for regular employment or amusement, than from any malicious design or delight to be mischievous.

OBSERVATION I.

The slight changes or states of excitement described in this case, are in my opinion, the mere fluctuation of his animal spirits. I shall hereafter make further remarks (see ob. 5) on this subject; and therefore, in the mean time, (to obviate the objections which may be brought against this view,) I shall only observe that when we consider the defective and uncontrolled state of mind, [115] in these old and incurable cases of insanity, any change or increase of their animal spirits must, though perhaps depending on causes which equally affect the sane, display itself in them, in a very different manner.

No. 2.—Admitted 1785; aged 67.

There is no statement of this case on record, from which any satisfactory information can be derived; nor have I been able to obtain any account of his former life, or the nature or treatment of his case. There has been nothing of late years to distinguish his case from many old ones, whose minds have sunk into the torpid state, except it be, which is scarcely worthy of notice, that he has sometimes stood on his head to say his prayers; sometimes spit in his pocket; and, when provoked, used indecent language; otherwise his state of mind has not, for many years, exhibited any observable alteration. [116] He will be best known when I say, that he is singled out from the rest, as a little, timid, old-looking man, uniformly sitting in a moping, creeping posture.

OBSERVATION II.

This man is not more of an idiot than the one just described, yet there is much less appearance of mind about him; but his mental powers had not formerly been so much evolved and improved by education; and the mind, like the soil we tread on, once properly broken up and cultivated, will, in defiance of neglect, long retain traces of its former improved state. Besides his want of early culture, being one of the middle class of patients, he was wholly left without mental food or exercise. There was, under the old system, a complete sacrifice of the lowest, utter neglect of the middle, for the sake of the higher class of patients; so that there was, with the middle class, for the most part, no intellectual interest excited by social converse and attention; nor, on the other hand, were the malignant passions kept alive by brutal treatment: and hence we now find amongst this class, the greatest proportion [117] of those whose minds have sunk into torpid inactivity; and not so much because they are lost, but because, from their want of excitement, they have too long continued in this motionless state. It is true, that their minds may, by the first attack, have undergone some great shock, to derange or paralyse the more perfect performance of its functions; but it is certain, that afterwards, no means were used to resuscitate or feed the powers of the mind into renewed vigour and activity. Few, even in the perfect possession of their faculties, could bear to be excluded from the air and sunshine of social life, and mingle only with beings in this melancholy state, without feeling its effects upon them. We are not to wonder, then, that those whose spirits have thus been prematurely entombed within them, should have become almost as dead to themselves and the world, as if the soul had already left them. To prevent these consequences, I shall state all that I think ought to be done, in another number of this work; which I conceive is the most interesting part in the treatment of insanity.

No. 3.—Admitted 1787.

There is nothing on record about this case, nor have I been able to obtain any information of his previous history.

His mind is not in so defective or deranged a state, as strangers and superficial observers are, from appearances, apt to imagine. It is true, he seems stupid and churlish, always silent unless spoken to, and then he answers with abruptness and impatience, in a murmuring, grumbling, and almost unintelligible manner, putting his words oddly together, like a child, or one unused, or too lazy, to articulate, and not that his answers are absolutely irrational.

He plays well at draughts and whist, but his doing so appears to depend more on old habits, [119a] than on the present exercise of his faculties; which, though, as already observed, they are not wholly lost, yet, from his torpor, age, and the natural obstinacy of his disposition, he is disinclined to exert himself out of his usual course: and though his constant habits of employment and amusement in the house, make up for him a considerable stock of felicity, and aid in procuring the degree of health and spirits he enjoys, and the degree of mind he still possesses; yet he is so extremely obstinate and tenacious of his own mode of procedure, that any attempts to oppose him, will arouse his temper into fits of angry passion. [119b]

OBSERVATION III.

There is nothing particular to observe here, unless it be the obvious remark, that from his age and confinement for such a number of years, among beings who, for the most part, have no commerce with right feelings and thoughts, it is wonderful that any thing like powers of mind should still remain; or that he should, excluded from the excitement and collision of the world, possess any inclination to exercise them; but this is most probably owing to the amusements and employments already stated; and for the sake of drawing attention to this fact, have I been induced to make any observation on this case.

No. 4.—Admitted 1787.

There is no statement of this case on record; but I have been informed, it was the consequence of injury on the head. He is a hopeless, and the most striking, case of idiotcy, at present in the house: a poor, simple, innocent, dangling, pouting, starved-looking creature, with a bluish red nose, and his head hanging forwards, saliva running over his falling lip—generally moving about to gratify his childish curiosity. Yet, as little mind as there is about him, still even he has fluctuations of the animal spirits: sometimes he is depressed and miserable; at other times he is animated and happy. When depressed, he for the most part repeats, in a feeble, plaintive tone,—“poor creature.” When animated and happy, he will throw his arms about in a most laughable manner, to the great amusement of other patients; so much so, that it is impossible to convey any conception of it, unless it be by making an old person try to imitate the frisky movements of an infant’s arms. These exhibitions are of rare occurrence. He will mumble over a tune very correctly, [121a] but has seldom any words. He is pleased with striking objects, particularly such as have glaring colours about them; and women, or their dress, arrest his attention. [121b]

No. 5.—Admitted 1791.

There is likewise no statement of this case on record, from which any satisfactory information can be drawn.

His personal appearance, and moping manners, were so very like the case described, No. 2, that it was common for those in the house to mistake the one for the other. He, like many other old and incurable cases, sat in a solitary, half-dozing state, his head reclining against the fire-guard, and seemed, when roused, like one who wakened out of his sleep unrefreshed. He was most remarkable for his extreme good nature, and excellent disposition. [122a] When on his death-bed, his gratitude and affection to his attendant (who was certainly an excellent nurse) were very pleasing. He had been long sinking from disease of the lungs, constantly coughing and spitting; and, latterly, purulent matter, in a very great quantity. He died on the 13th April, 1822.

No. 6.—Admitted 1791.

There is no statement of his case, and I have not been able to collect much information about him. It is said, he received a severe wound, and the mark remains on the upper back part of his head. [122b] Report says, that he fancied himself in love with a farmer’s daughter, and walked whole nights before her father’s door, without the slightest previous acquaintance with the object of his choice. This would seem rather the effect than the cause—a common mistake; they are constantly confounded together, or mistaken for each other. It is certain, that his neighbours were obliged to send him to a place of confinement, for this reason—whenever he saw any cattle in a poor pasture, he, from the impulse of his nature, invariably removed them into a better.

He is well known through the house, and even through the town; and on this account, I feel some hesitation and difficulty in attempting to describe his case.

He is a general favourite, and every one meets him, and he meets every one, with a welcome, good-natured smile, and he appears so much pleased to entertain them with some extraordinary ridiculous tale, that a stranger would suppose he talked absurdly, on purpose to amuse him. [123] Notwithstanding all his talk, he is most industrious, and the most useful man in the house; does his work most correctly and systematically; delights in going upon errands amongst his acquaintances in town, always delivering the messages properly; and the moment he has done so, begins with his own strange nonsense, to the great delight of his hearers. His spirits are always even, he has regular exercise, and his good nature is proverbial; nothing vexes him, unless it be, threatening that another shall be employed instead of him, to do the work he has been in the habit of doing for his favourites in the house.—His delight is, night or day, to be of service to others, so that his energies are wholly and regularly expended in being useful, making himself happy, and pleasing all who come near him.

OBSERVATION IV.

Probably his astonishing correctness in delivering messages, &c., in the midst of so much apparent confusion of mind, may be thus explained:—From the pre-eminence of his good nature, the desire to please still retains some hold over the rest of his faculties, and, perhaps, also over the extreme extravagance of his conversation, which may arise from the same cause. We have only to imagine, that his erroneous tales were, in the first instance, listened to (a fact, this, of injudicious treatment, which is too common,) with seeming assent and delight, until he found, from daily experience, that to please others, he had only to encourage his foolish thoughts, and utter them, and then the habit would insensibly grow upon him, until it became inveterate; and hence is explained another singularity about him,—that in his present manner of talking, it appears as if he were talking absurdly for the very purpose of amusing others. It is now, however, certain, that it would be not only useless, but cruel, to try, by direct means, to prevent it. Yet, though we are not to tease and vex him, by contradiction, or by refusing to listen to his tales; it ought to be remembered, that in this and all other cases, we ought never, on any account, to violate the truth.

Though we should never forget to exercise prudence, we must be careful that truth still presides at the helm, otherwise it may degenerate into cunning; then what we call prudence, is vicious and mischievous; and yet, men persuade themselves while doing so, that some evil is avoided, or some good is secured. No power of the mind should ever be so exercised, as to require the suspension or sacrifice of another. To exercise every virtue in its place, and to give to each “its relative and appropriate share,” is the perfection at which we should ever aim. This principle, as it is the best prevention, so also it is the best remedy in the cure, of insanity.

No. 7.—Admitted 1792.

No statement of this case, from which any information can be drawn: it is, however, certain, that insanity is in the family.

Among the old cases, we have none that arrests the attention of strangers so much as this, and he never fails to attract the gaze of idle curiosity. His habits of circumgyration, with sudden stops and starts,—his strange air of abstractedness, a sort of excogitative look, apparently puzzled to find something out,—odd way of talking to himself, as if he himself were some other person, saying, “what a noise the fellow makes,” “I think the fellow’s a fool,” and striking his face in apparent anger,—strange mode of mentioning names once familiar to him,—putting a question,—seeming to listen, and giving an answer quite foreign to it, are most striking, and such as no descriptive powers can enable another to conceive, without seeing him. When noticed or teased, and sometimes without, he strikes and scratches, in a way that would seem either like a bad habit that had been taught him; or half frolic and half mischief, and which, by provocation, becomes more serious; otherwise, he is sensible of kind treatment; and now, from increasing age, and perhaps from being, on the whole, less teased, he exhibits less of this disposition. This state of continued exertion and restlessness, is followed by a proportional degree of depression, and, after being recruited by sleep, returns. These regular alternate states of excitement and restlessness, of depression and sleep, last each for several days, and this for many years’ duration. When most excited, he makes a strange loud singing noise, stamps with his feet, strikes his head and face, and exhibits various incommunicable indications of surprise, pleasure, or anger, just as his mind happens to be agitated, like one in a dream, with the floating and shattered images of times gone by, passing confusedly through his mind.

OBSERVATION V.

I am unable to ascertain, from any traditionary treatment of this case, whether the habit of gyration originated in some diseased imagination; or was merely, as I believe is more frequently the case, a habit which he had acquired from long confinement in a small space. This habit was common in former times, when they were confined in cells, and had no airing grounds; and yet some writers, without attending to this circumstance, have called it a symptom common to insanity! in this way, many things have been called symptoms, which have been, in fact, indications of improper treatment. The peculiar states of excitement and depression, so striking in this case, and which is so common with the old insane, as to have been called the chronic type of the incurable, I shall endeavour to show, how, in many instances, it may be explained on a different principle.

Dr. Halloran, in his practical observations on Insanity, says,—“Chronic insanity is that form of the disease, which, having passed through the acute and convalescent stages, has assumed the more permanent character, and is known by the frequent exacerbation of the original accession; also, finally, under circumstances of less violence, and with symptoms subacute in relation to the primary affection.” He adds,—“There are few Practioners of the most ordinary discernment, who will not feel themselves disposed to acknowledge that cases of insanity, precisely of this form, compose the greater majority of those committed to their care.” He further says,—“That these paroxysms are for the most part periodical in their approach; for though of shorter duration, they continue pertinaciously unyielding.”

From the observations which I have to suggest, it will be seen, that I conceive in some instances, in opposition to Dr. Halloran, and some others, that the chronic type, or the paroxysms of some of the permanently insane, are merely an exhibition of the irregular increase in the stock of their animal spirits, and not an exacerbation or new accession of the disease: and that even, in many cases, where the alternating changes of excitement and depression are most striking, I believe they first originated in those fluctuations of the animal spirits, common to all of us; in some instances, it is true, (and the case last described is one,) singularly modified, not merely by the state of mental alienation, but by circumstances connected with their confinement. Before, however, I endeavour to explain these singular modifications, it appears necessary to premise some observations on one of the causes which conspires to produce them, which cause is connected with the atmosphere.

But as I intend to devote an Essay on Atmospheric influence, I shall content myself with asserting, in the mean time, that there is some common cause, or causes, assigned either to atmospherical changes, or co-ordinate with these changes, affecting the animal spirits of the sane and the insane—of the healthy and diseased, (in all, the manifestation is according to individual state,) is generally, and indeed, I might perhaps say, universally admitted, that the fact will require no further proof, either to introduce or confirm its truth. There is then a certain periodicity in the excitement and depression of our spirits, as well as in all our diseases, mental or corporeal, so absolutely certain, that it must be the conjoined effect of some order in the operations of nature, and cannot be explained on the principle of accidental or apparent coincidence, by which credulous and superstitious minds are often deceived.

Though the artificial habits and constitutions of men must modify these influences, we still, notwithstanding, often perceive the effects are simultaneous in time, and sometimes that they preserve the same type, and as such artificial modifications do not exist in the same degree in the animal creation, especially in those undomesticated, on the contrary, these influences are so uniform on them, that the signs and symptoms of their presence are the barometers of rural life, it follows that these very modifications in men, when rightly perceived, are additional proofs of their being the effects of one cause.

Even in man the influence of seasons, climate, and all violent atmospherical changes, are so striking as to be admitted by all, because they are so powerful as to overwhelm all artificial counteracting modifications; but, as it regards all common and minor influences, even when the effect on the mass are coincident in time, they are in individuals so modified by the specific habits, the state of the health, and the peculiar state of mind, that they become so much disguised, and of course so much less obvious to common observation, that even some medical men will deny atmospherical influences altogether when held forth as objects of scientific investigation, and ridicule as fanciful the man who maintains a firm and well-grounded philosophical faith in them; this is most inconsistent, and is like admitting a clock may mark hours, but cannot mark minutes as they pass.—It is the child who has just discovered the use of the hour, but not of the minute hand, of a time-piece.

The philosopher knows that the unobserved and silent influence is the most important, and that the striking results are the mere indexes of its secret movements.

Let ignorance pretend to admire these striking results, and laugh at him who is anxious to discover the cause which produces them; he has incomparably more interest and pleasure, his eyes more open, and his understanding more exercised in these common facts, than other men, while yet he deems them as nothing compared to the end they serve; they are indeed interesting in themselves, but to him they are most interesting, because he considers them the means, but still only as the means, by which he obtains the noblest object which the light of his reason can discover—the discovery of those principles, or of that order of operation of the cause which produces them.

Medical libraries are full of books on the influence of seasons and climate, miasmata, malaria, and other local causes of disease: and they admit also that the influences of all these are such, that almost all diseases common to man will exhibit altered and corresponding symptoms under these varying circumstances, proving they participate in, and are conjoined (or “tinged as it were,” as it is said by some,) with them.

All this, however, I leave for the Essay on the Atmosphere, but I mention these facts and observations in the mean time for the sake of this argument, that if all these modifications are admitted to exist among the sane, how much more strikingly must the peculiar circumstances, the singular habits, and the altered state of mind of the insane, modify the effects of this influence:—so strikingly, that I have no doubt, from these causes, may be explained the very singular exhibitions in this last-mentioned case. Where the particular state of mind, and the peculiar circumstances connected with his confinement, have superinduced in the system the irregular accumulation and expenditure of the nervous energy, so that, though the increase of the animal spirits was, in the first instance, the common effect of a cause operating in and through all, every where,—yet, operating through, and modified by, the peculiarities connected with his case, has in time produced in him, as well as in a less striking degree in others, and in fact, in many, though certainly not in all cases of insanity, effects so very singular and striking.

Again, these changes of the atmosphere, which produce these effects on the sane, seem, on the insane, in many cases, to be wholly expended in producing fluctuations on the animal spirits (not in bodily effects,) so expended, as if this increase of the vital energies were neither subject to the usual laws of corporeal nor intellectual distribution. These insane, consequently, are less subject to disease from these causes, as if they, no longer responsible, paid not, therefore, the price of the use and abuse of the energies continually imparted to all. It is true, that the life they lead, not only removes them from many causes of disease, but the very nature of their diseased state, also, renders the mind more susceptible of impressions, for, beside their excited state, by being shut out from the world, they necessarily give to trifles all the importance of weightier matters, and thus it is, that by their being the victims of mental excitement, [133a] which is every where a protection against prevailing diseases, they are not so liable to be attacked by the prevailing epidemics. [133b]

Whatever influences prevail externally, they must in all cases, sane and insane, be counteracted and modified by internal influences.

But to enter upon this investigation is not at present my intention, therefore I shall not now examine the question, whether the epidemics of different times, and the character of all diseases, which always partake, more or less, of the prevailing epidemic, can be wholly [134] explained as being caused by some difference in the prevailing state of the weather. I shall only remark that it is certain such seasons and states of the weather are equally fruitful in the production of insanity and in the excitement of those already insane. Yet, from these internal mental or moral influences, it is evident that neither insanity nor epidemic diseases can prevail exactly in proportion to the state of the weather, unless it could be proved there always existed a correspondence between the state of the weather and the moral and physical susceptibilities or predisposition of the persons exposed to its influence.

At the same time I assert that our moral state has more to do with disease, either directly or indirectly, than is generally credited, yet these moral causes are necessarily every where physical in their operation, so that the assertion that our physical corresponds with our moral state, and what we call physical causes are the effects of this state, need not alarm us, in fact, the interesting truth is now demonstrated, [135] that health and longevity correspond with our moral state, (though this is true as a general principle, there are many real and apparent exceptions,) in fact, natural and moral effects co-operate, just as the circulation depends on the nervous energy, so the nervous energy depends greatly on our mental condition.

Whether, however, the causes of diseases are more of a mental or corporeal character, is not now the question to decide.

For though in the Essay I propose to give on atmospheric influence, I shall endeavour to point out the various causes which may give rise to an irregular display of the spirits of the insane, I am far, however, from denying, that there are alternate states of excitement and depression, of better and worse days, which we may not be able to trace to these causes, but which may depend on principles similar to other physical intermittents, just as we have periodical head-aches, having their accession and intermission most frequently every alternate day, and yet, even in these cases, I have been able to discover the origin of these head-aches, as was my own case, to alternate sleepless and distressing nights. Looking at these periodical exacerbations of insanity, without tracing them up to their first causes, they seem like the operation of some disturbing cause, requiring a given time to arrive at their crisis, or to produce the effect, and when produced, to subside again, and this cause, thus viewed in its less remote operation, seems altogether of a physical nature. But this periodicity, which I also advocate, will be more fully examined in the third section of the Essay on Atmospheric Influence, in which some observations will be ventured on lunar influence.

Let the reader in the mean time take it for granted that such an influence exists; we shall then be able to examine the modifying influence which the peculiar state of the mind, in each, among the insane, must have over their manner of exhibiting these alterations in their animal spirits, especially among the old incurable cases, labouring, as it has been said, under the chronic form of insanity.

Often, after the first attack, their minds are left in an imperfect state; yet, notwithstanding this inability to discharge the functions of mind properly, they generally retain their physical energies, enjoy vigorous health, and, of course, the flow of their animal spirits dependent thereon, is more likely to be improved than otherwise; with respect to mind, however, they not merely want volition, and the common motives and principles of control over themselves, but there have been circumstances connected with their confinement, which, co-operating with the excitement, (the cause of which I shall hereafter attempt to explain,) have formed in the system regular periodical returns of these states; so that, at these periods, they not only, more obviously, exhibit these changes in their spirits, and, of course, display without disguise, their peculiarities of mind, as children do, and sometimes as even men do, when warmed with friendship, or with wine; but they also do so in a higher degree, and, of course, with all their latent imperfections of mind, in a much more striking manner; they then “show themselves,” their peculiar character and defects; nor should this explanation of the periodical return of these states of excitement, from the above-mentioned co-operating causes, surprise us; we may every day witness the operation of the same principle, among men possessed of reason.

We all know, whoever gratifies any passion, or accustoms the system to any artificial stimulus, at stated periods, invariably finds the difficulty of resisting this passion, and his inclination for this stimulus greatest, at the usual period of gratification: and so it is with the expenditure of animation; in fact, nothing is more certain, than that both mind and body become the slave of those customs, which the manner of our living, and moral conduct, and the circumstances through which we have passed, have fastened around us. Now, as the circumstances and treatment of the insane, have hitherto been different from common life, (the object ought to be, in the treatment of the insane, to resemble common life as much as possible;) and as they are without control over themselves, their mode of displaying their more animated state, must be as different from the civilized man, as the civilized man is from the savage. If, then, habits of civilization may be called a second nature, here it may be said, that a third has been superinduced.

From these circumstances and states of mind, it appears, that, instead of their stock of animal spirits being expended, under the guidance of a moral agency, and regularly diffused over their existence, they are subject to mere physical influence, and become the sport of every eddying wind that blows; and therefore we find every possible variety and irregularity exhibited.—A perfect contrast to that of the good and wise man, if such a one can be found, whose balance of mind is preserved, whose spirits are tranquil and even, who enjoys perpetual sunshine within, and diffuses peace and serenity around him.

Thus, because when their spirits are buoyant, they strangely exhibit their inherent defects of mind, it has in many instances been mistaken for an exacerbation or a returning accession of the disease, and called the chronic type of old incurable cases.

It further appears, that this view is correct, from the fact, that if their manner of talking and acting, in expending their increased flow of spirits, is improperly encouraged or exasperated, then we find their individual and latent defects become more obvious; but with proper treatment, they gradually die away: in fact, these appearances are more or less perceptible, in a great measure, according to the spirit and conduct of the superintendant; and even, under him, to that of their respective attendants. Of this, I could give some striking illustrations. It is astonishing how much the increased flow of the spirits will be dark, gloomy, and vindictive; or light, cheerful, and full of kindliness; just as we by our treatment excite and keep alive one part of the mind or another. The same principle might be illustrated also, on a larger scale, by surveying the conduct of different parties and governments in the world; and on a smaller scale we see every one in authority, a magistrate, a gentleman, a minister, a pastor, the captain of a ship, and a parent, stamp their character on the sphere in which they move.

Were it the place, nothing could be more instructive than examples to demonstrate the correctness of these observations.

The preceding case, I consider, is one of these examples. I have said, that for the most part, these states of excitement and depression, are merely an irregular exhibition in the accumulation and expenditure of the animal spirits, and not always to be considered, according to Dr. Halloran’s view, as the remains of the disease in the state of a returning paroxysm, and that which characterises the permanently insane; but that this originated in, and depended on, causes which equally affect the animal spirits of the sane and insane, with this difference, that in the insane, as in this case, they are modified by the peculiar state of mind, and the sort of treatment they have received.

Grant that, from the state of his mind, any little increase of animation would resemble, in a slight degree, that which he now exhibits, then I am, by the help of facts, in this and some other cases of a similar nature, justified in saying, that I have been able to trace the process and progress of these changes, from small beginnings to their present state. I know, from the best information, that his manner and appearance were, when excited, so laughable and striking, that the attendants and their friends, from want of proper feeling, or perhaps mere thoughtlessness, actually made him a source of private sport and amusement, and thus increased his excited state, which, in the course of time, assumed its present peculiar and amusing form. [141]

A minute detail of all these things, together with unnecessary and injudicious confinement, I am certain, would prove all this.

In many cases, and especially in the last, I have been able to trace, as I have already said, the process and progress of these changes, from small beginnings to their present state. In some cases, any little increase of animation gave rise to manners and conversation, which were extremely amusing, and such as tempted silly and unthinking people, as well as the other patients, to encourage by listening or assenting too much to them, or to exasperate by wantonly making them a source of sport and amusement; conduct which cannot be too strongly deprecated, especially during the critical period of their convalescence.

In most instances, however, it must be allowed, that among these old incurable cases, [142] the most powerful exciting causes are within them. When their minds are at all irradiated, striking ideas, and scenes of the past, cross their imaginations; they are further excited by them; and in proportion as the system is excited, these ideas are themselves more powerfully awakened; they have no clear consciousness nor control over themselves; and this dreaming state of their minds, to them all reality, is sometimes as cheering as the dreams of hope can make it, and at other times as horrible as the night-mare! and thus they are wrought up into the most excited or exasperated state. In some cases, especially the foregoing, this goes on until they are worn out, when they require a corresponding portion of time to renew their vital energies; and thus cause and effect mutually produce each other. These alternate states of excitement and depression, being often repeated, they gradually increase in strength and duration; and thus it is in some few cases, and especially those similar to the last, we find, that their spirits are not expended and renewed, as ours are, once in twenty-four hours, because these changes have become the habitudes of their nature, so that their system becomes governed by new laws of action. It is very singular that those most liable to extremes, are most predisposed to insanity, and in its more confirmed stage to this periodicity of excitement and depression.

I have already noticed, [143] that the excitement of the depressing and exhilarating passions alternately, is the most striking characteristic of the old insane,—so striking that the general division of insanity is intomania and melancholia; a division, however, which is altogether unphilosophical, as the mania and melancholia are not any abstract difference in the cause of the disease itself, but merely the results of the over-active nervous energy operating in different directions—at one time on the depressing, another on the exhilarating passions; this indeed is the case, more or less, with all those who preserve not this mental equilibrium, but who act more from the impulse of their feelings and passions than the cold calculations of reason, and the rigid restraints of principle. To what extremes are the passions of the human mind liable, when neither the true light of the understanding nor any right sense of justice guide them! We see this in ignorant and unprincipled individuals, who suddenly rush out of their thraldom and pupilage into liberty and licensciousness; we see the same thing exhibited by agitated and wicked masses, as in the French Revolution, when the moral, like the physical ocean, is let loose from its order and control, and heaves its tumultuous waves of passion, as if by an earthquake, from one overwhelming extreme to another.

When then, as in the insane, all the restraining powers of the mind are lost, can we wonder that the mental energies should be subject to accidental and baneful influences? that they should impetuously rush with fearful, because with unguided force, into the most opposite and direful extremes? These extremes, however, always correspond to the individual peculiarity of mind, and the nature of the exciting causes, which exciting causes often exist internally long before they become externally evident; thus gradually forming ruts in those weak or soft parts of the mind, as it were, in which their feelings are naturally more apt to run; and thus they acquire the increasing facility and strength of habit, in operating in one direction rather than another, until they become irresistible: or in other words, until the understanding has no longer the power to extricate the mind from their influence.—Body and mind have been allowed conjointly and reciprocally to produce and increase these effects. The effects are first, disordered action; next, inflamed and diseased organization of the brain, as well as this disordered action being continually strengthened by a daily increase in the power of mental association, “calling forth an increased susceptibility to the action of certain exciting causes;” and so far I agree with Dr. Halloran, that a something like the original “accession of the disease,” more readily takes place. [145a]

I have said, [145b] that in cases of permanent insanity, the alternations into these opposite mental states occur most frequently among persons whose previous character was marked by extremes,—who were easily excited, and as easily depressed, either by their hopes, their fears, their anger, or their affections. And I have often had occasion to hear these remarks on their admission; and further, that they could not bear stimulants, especially ardent spirits; and that there was insanity decidedly developed during their worst paroxysms of intoxication.

In fact, the history of their lives, at least of some of them, was that of comedy and tragedy, perpetually prophesying and exhibiting a threatening prelude of their present more awful state; more awful in appearance, because it has now become bereft of its former lucid interludes; which lucid interludes had, possibly for some time, been externally maintained only by the mere power of external moral influences, long after the internal control had ceased to preside over the mental operations.

We call it insanity when external restraints are broken down and disregarded; we cannot decide how long absurd and delusive feelings and notions have monopolized all the operations of the little world within. I shall have occasion hereafter to adduce the history of many cases which will serve to illustrate the truth of these views. I may briefly mention, that they occur most frequently in those families where such a constant April atmosphere exists: and, as a further argument it may be stated, that a greater proportion of victims to these causes occur among the women than among the men; and in the male sex we find they are those of a more feminine character, or those whose feelings naturally predominate over their understandings.

Thus children who resemble their parents, through the spirit in which they were conceived and brought forth, become still more like them by example and education; and hence the very important fact, that the greater number of those who lose the power over their own minds, are from among those who have been unaccustomed at an early stage of their existence to exercise a salutary control over their feelings and habits; and of those especially such as naturally possess strong animal and sentimental feelings. Hence it is said, “that of all the causes of mental derangement termed moral causes, perhaps the greatest number may be traced to the error of early education.” [147] Thus, as I have already remarked, an only child, or the youngest, (who has often as much exclusive attachment as an only child, because he is the son of old age, or is young when the rest cease to be children; or may be the only one left at home,) are numerous amongst the insane.

Again, in confirmation of the same argument, we may here remark, that the greatest number of those who become insane, become so between the ages of thirty and forty,—a period when establishments are formed, and habits have been strengthened by time, while the feelings yet retain all their energy and susceptibility of action. Thus we can conceive why reverses and disappointments should then have the most fatal and overwhelming influence.—Still less need we wonder that this should happen to those whose animal propensities and sentimental feelings have been exclusively cultivated, as they then find that if understanding and principle are insufficient to restrain them, the claims of society forbid their gratification. Hence the conflict becomes dreadful and dangerous, confounding and overturning the balance of the mind. Even without this, bad passions, disjointed and exclusive habits of feeling and thinking can hardly go on progressively increasing to this age, without becoming so irresistible as to threaten to destroy and swallow up in their vortex all that remains of the man within them. Such is a true and beautiful description that Johnson has given of Imlac’s insanity in his Rasselas. Any passion or propensity of our souls, when improperly indulged and carried to excess, is an abnegation of reason; and in saying this, we give a true definition of insanity, however startling this wide application may appear.

What is the most obvious history of most cases?—Thoughts and feelings are indulged on any given point, to the detriment or suppression of others which might draw us from this dangerous and exclusive habit of the mind; till at last we become incapable of resisting any other train of thought, and feeling, and action; “they are at first imperious, and at last despotic.”

When and how are all these evils to be best prevented? We answer, in the preliminary stage of our existence. We shall revert to this important subject in an essay on the primary principles of education; and shall only now remark, that where we perceive a soil full of the seeds of all these evils, we can expect only corresponding fruits? We shall conclude these remarks by directing the reader to look to the soil where these evils exist: we do this, because it exhibits the truth of the principle for which we are contending.

We see, in the history of families, that the extremes of heartless tyranny on the one hand, and the foolish fondness of blind affection on the other, engender soils equally favourable to the production of these terrible fruits to which we allude: still more so is this the case where these extremes exist in the same family.

Many are the married persons who waste their lives in inordinately and alternately hating and loving each other. From small beginnings, breezes arise and gather into storms; at last, exhausted by their violence, they subside, and for a while love returns, and all its ardent affection. Such is the brief but sad history of many a matrimonial union,—but who can describe its baneful influence?—how much evil and misery are propagated! how much reason and principle, health and happiness, reputation and prosperity, are sacrificed in those families, whose parents thus suffer reason and understanding to be the victims of these opposite and alternate mental states!

Of which states, such as become insane, are but the caricature samples of the hereditary family infirmities, and the actual habits of their lives; and perhaps this may happen to one less a hypocrite than the rest, because in such a one, the external and internal become more easily and readily in fixed and permanent correspondence. It is natural, therefore, to expect that this same character will be exhibited still more conspicuously after the understanding has altogether ceased to perform its godlike attribute of rightly using the light of pure reason so as to enthrone and support that one grand ruling principle to which the whole mind should be obedient and subordinate.

I have been the more particular in making these observations, because I conceive they may be useful in a medical point of view. They may prevent us from mistaking the simple, though modified, changes of the natural ebb and flow of our animal spirits, for an exacerbation or new accession of insanity,—and thus warn us from treating the patient with unnecessary restraint, as though he were suffering from a new attack, and from blindly endeavouring to cure a hopeless case by the wanton administration of strong and deleterious drugs, which in most instances would destroy health, as well as the remnant of the faculties: “In the diseases of the mind, as well as in all other ailments, it is an art of no little importance, to administer medicines properly; but it is an art of much greater and more difficult acquisition, to know when to suspend, or altogether omit them.” [151]

No. 8.—Admitted 1783.

No statement on record. He was a respectable country Clergyman: his friends say he was a hard student, neglecting exercise, and all attention to himself or his health, and which had, for some time previous to the attack of derangement, been in a very precarious state—the attack was very sudden and violent.

He has a leprous eruption, which has continued since the time of his admission until now, without any very perceptibly abatement. He was formerly the most furious maniac amongst the old incurable cases, though less strikingly peculiar in his appearance and manners than the one last described. During the paroxysms of his greatest fury, he appeared like one whose mind, from excruciating pain and dreadful mental provocation, was wrought up to the highest pitch of passion and revenge; so that he would, as though he had the object of his malignity before him, be incessantly repeating, through whole nights and days, some single phrase, such as, “damn’d dog,” with a sort of suppressed barking, roaring furiousness, even until he foamed at the mouth, and his face was black with passion.

He was most violent when the eruption appeared least on the external surface. When his mind was more at ease, he would play like a little child for whole days together, with the merest trifle, such as a piece of string or paper. At these times, when given any thing he likes, he has something singularly fascinating in his smile.

For this eruption, many things had been administered, without any permanent advantage. Solution of nitric acid, about three years ago, [152] appeared to have, for a time, a good effect; the eruption became somewhat less, and the mind less violent: but this might arise from the debilitating effects, rather than the radical removal of the cause of his disease. After this, the solution of nitrate of potash, had a good effect both on his mind and the disease of his skin, without reducing or debilitating his system. He has lived, for this last twelve months, on vegetable diet, and he is apparently better; but this may be a fallacious appearance, since his vital energies appear to be sinking.

OBSERVATION VI.

It has been said, by the late Dr. Jenner, and some others, that cutaneous disorders are common to the insane. I should think they are not very common. [153] This is the only case that I have seen, where the two have continued to exist together. Whether it was the original cause of his mental malady, I have not been able to ascertain, but it is certain, it aggravated it. That mania, in some instances, follows the disappearance of eruptions, ulcers, and other local diseases, particularly with females, is satisfactorily established; but in many instances, other causes co-operate.

In cases of dementia, arising apparently from continued pressure on the brain, the surface, from the general bad habit of the system, is liable to sores, boils, and ulcerations. This cannot be called a cutaneous disease; it is rather a symptom of the diseased state of the brain, than itself the cause of insanity. Glandular swellings, however, seem to have a more direct connection; but still they appear rather before, than after the alienation has taken place. In a few cases, I have noticed slight eruptions during recent paroxysms, and in two or three, immediately previous to their convalescent state. Had such appearances occurred more frequently, I should gladly have regarded them as favourable prognostics; but they might arise from strong medicines, their state of confinement, or they might be mere accidental coincidences. There are many instances of cures by accidental injuries, [154a] as well as by the accession of consumption and other physical diseases.

Here I leave the question for the present, till I come to some cases, where, according to the theory of such a connection subsisting, (which I believe is the case in a few instances,) the tartarized antimonial ointment has been applied; [154b] but I confess, that there is no part of my experience in which my sanguine expectations of cure, after a certain duration of the disease, on this principle of counteraction, have been more disappointed. In the early stages of insanity, it is decidedly the most valuable principle in our practice.

No. 9.—Admitted 1793.

No statement on record, that gives any satisfactory information. She was a respectable farmer’s wife, and her insanity was occasioned by her husband’s heavy losses of cattle. Her first symptom was throwing her little infant at the feet of the parish officers, saying, “there, take it.” [155] She often repeats, with a very moaning sound, and tears, “God rest thy soul, poor old mare.” She will be easily known, when I say, she is a poor, moaning, miserable looking imbecile, constantly sitting cowering in a corner, always crying for tobacco. She was one of those who were kept naked in loose straw, and hence her inclination to undress herself, her dirty habits, and her peculiar mode of sitting: indeed, formerly, throughout the house, the lowest and worst patients had no seats allowed them.

No. 10.—Admitted 1793.

Nothing recorded of this case. It is said, that when young, he was severely kicked by a horse. There is now a considerable indentation just above his left ear.

His mind, though extremely childish, is altogether in a torpid state, for the most part quiet and good-natured; but sometimes, when more excited, he exhibits a love of mischief, generally very childishly, but sometimes more seriously so. [156a] His temperament is phlegmatic, and he has a heavy, dull look. He has been for years employed in the garden.

No. 11.—Admitted 1793.

Nothing on record. I have been informed, that he was a well-sinker, and that his insanity was the consequence of a rheumatic fever. No one, except a complete idiot, can be in a more stupidly stagnant state of mind; he scarcely notices any thing, and never speaks unless spoken to, and then his answers are merely monosyllables. About once in twelve months, a slight exhibition of excitement shows itself in a sort of ill-tempered obstinate fit, [156b] but which soon subsides, especially with the aid of sulphate of magnesia. He is, together with No. 10, constantly employed in the garden.

OBSERVATION VII.

The observation which suggests itself on No. 10 and 11, is, that from such facts as these, it is very evident, there can scarcely be an old pauper patient in such a state as wholly incapacitates him from being brought, with a little trouble, into habits of useful employment.

As stupid men are generally less diverted from an object which once engages their attention, than men of greater capacity; so it is with these poor automata; if the first difficulty be but once overcome, that of acquiring the habit of working, there is no fear; but they will proceed in it more steadily than those who feel that they have a right to consult their own choice. They cannot be tempted, nor do they possess the power of giving their energies a new direction; and hence, as habit gathers strength, we may depend on them as on our time-pieces. If amusements and employment are good for these, how much better for those who are not past the hope of recovery; it may change the object of their thoughts, and gradually turn them to one of a less dangerous nature. I shall have some very interesting cures, partly attributable to this principle, to state in due course; in the mean time we perceive, that if even they are past the hope of recovery, they are kept in a better and more healthful state; and what is more, it diffuses a satisfactory feeling through the whole system, and they are made happier than they would be by a life of idleness.

No. 12.—Admitted 1797.

Nothing on record; and I have failed in my efforts to obtain any information of her previous history. It is said, that her relations are respectable; yet her residence here is paid for by a parish in London. She has long been, together with No. 7, the most useful and hardworking person in the house. In the midst of her work, she will often scold and swear with vehemence, but no one knows about what, or against whom; and though her voice is loud and shrill, no one regards it, saying, “Oh! it is only poor M. W.” Yet she is very kind-hearted and friendly, giving away her own meat, especially to those who are ill; and when prevented from doing so, will throw it away with indignation. She would gladly starve herself to feed others; and always asserts, when a patient dies, “that they died for want of something to eat.” She used to practice this singular fancy, that of frightening the devil away, by taking a sweeping brush with her to bed; but now, a tin pint serves the same purpose. She is a tall, meagre-looking woman.

No. 13.—Admitted 1798.

No statement of this case; but it is said that, in the first instance, he was very violent. His mind is now in a fixed imbecile state, and exhibits no alteration, except the slight changes which mere alterations of our spirits produce; when he is more easily provoked—talks, laughs, and sings more, or holds conversations with persons dead or absent; sometimes scolds them, fancying they tease him in some strange manner, which he calls “triangling;” but it is impossible to ascertain what ideas he affixes to the word; he is a very quiet, good-natured man, a general favourite, and is usefully employed by the attendants in the house. [159]

No. 14.—Admitted 1799.

No statement of her case; and I have failed in obtaining any very satisfactory information about her.

It is said, that she gradually became insane, after the death of her only boy, named “Charles,” (who was the natural son of Sir —:) this is probably true, as she now imagines that Charles is constantly with her—sleeps with her—that she feeds him at her meals—carries him about in a corner of her apron—nurses him—and talks to him with delight and maternal fondness. She often fancies, too, that she has been confined, and has got more children. [160]

Her appearance and manners are exceedingly polite, pleasing, and affectionate; she is attentive to others, in all those little nameless etiquettes of life, which, when regulated by truth, constitute the innocent fascination of a kind-hearted and well-bred character; and it is so with her: every one doats upon her as upon a favourite child. She never fails to tell me, if I have been out during dinner-time, when she next meets me, “you have not got your dinner, go and get it immediately;” and yet left to herself, she is wholly taken up with scolding some imaginary beings who annoy her, get into her throat, head, back, &c., run her through with swords, and do a thousand other strange and cruel things to her. Every evening she has a long scolding, with a tone three-fourths of anger and one-fourth affection, with some men who plague her in her bed and in her bed-room, and continue to do so till her attendant comes, sometimes at her call, to drive them away. Is this the lingering last impression made on her mind by her seducer? In the midst of her scolding she will often swear in a strange under tone of voice; and when accused, she says it is some other person, frequently Jack Swales. Her conversation is so exceedingly extravagant and varied, that it is impossible, except by the most lengthened description, to convey to others any adequate conception of it. Names of dukes, kings, queens, pipes of wine, sums of money, estates, &c., are as common to her as household words; yet strange as all this is, it seems to have some connexion with her past life, having formerly held a situation in a family of consequence. Her former situation and disposition are hinted at by these reminiscences, which are delightful traits of what she has been.

No. 15.—Admitted 1799.—Aged 50.

No statement on record; it is certain, however, from his own account, that he was formerly steward and butler in a gentleman’s family, and had been what some call a “hearty good fellow” all his life. His manner continued that of a blustering, passionate, half-inebriated man; [162] his skin was covered with a scorbutic eruption, and his face a bloated livid red. He died of dropsy in the chest, March 6th, 1821.

OBSERVATION VIII.

The observation, or rather the moral, in this case is so obvious, that it is almost superfluous to add, that from the nature of his case, and his own account of himself, his system both of body and mind had been brought into the extreme state of morbid irritability by the conjoined excitement of the dissipated companions, particularly of his early life,—unchecked in their effects by the exercise of any moral restraint over himself; and hence his mental powers and passions were not so much shattered and decayed, as they were like a vessel without its pilot, the sport of every wind and wave that assails it: bad habits had become too inveterate to allow the will to be taught obedience to reason; all measures of coercion, instead of inducing self-control, could only irritate and exasperate, as he was perhaps still less accessible by religion than by reason. I believe, however, that by gentle, and indirect means, he gradually became less boisterous in his manners; but it is proper also to add, that from age and disease, the sinking of his physical powers and animal spirits might imperceptibly, but more effectually, tame him.

No. 16.—Admitted 1799.

Nothing on record.—It is said she was a belle: she is thin and tall, and is remarkable for a demure, prim, affected, stiff manner of sitting, like vanity turned to stone. She will spend hours in dressing, undressing, washing, &c. I have never heard her say more than “pretty well, thank you.” Her mind seems rather empty and motionless than diseased or deranged.

No. 17.—Admitted 1799.

Nothing on record.—She is a neat, clean, but rather crabbed-looking, middle-aged woman; and who, unless she is provoked, is scarcely to be distinguished from the sane; but when provoked, she is exceedingly abusive, and exhibits the deranged state of her mind. She is very useful as a laundress, and is known only by that name. The great objects of her affections are cats and kittens. [164]

No. 18.—Admitted 1800.

Nothing on record.—He was an Italian, of a swarthy complexion, dark eyes, black hair; and to look on his countenance reminded one of an assassin, “the mark was upon him.” He was subject to violent fits of excitement when he was suspicious and thought himself insulted by a look or a word; and from his ignorance of the English language, he might perhaps have greater scope for suspicion. When offended, he gnashed his teeth; striking one hand violently against the other; appearing from these, and various other indications, to be preparing for action, and lashing himself into a state of the most determined revenge, he watched his opportunity, and seizing his victim with his teeth, was quite delighted if he drew blood. He bit several, some seriously; and in one instance, he bit a piece completely out of the lip of another. They all agree in the house that they never saw a patient so ferocious, or one where harsh measures seemed more justifiable; yet nothing could conquer him—his attendant believes “he would have died first.” It was no accidental result of passion, but the settled object of his mind. [165a] He would chuckle and triumph over the injury he had done; and this was the more remarkable, as his mind in other respects was so much gone, that he continued to the time of his leaving the asylum, occasionally a dirty patient. Still it ought to be stated, that this ferocious disposition and these dirty habits, if they had not been absolutely grafted on his natural disposition, must have at any rate been made much worse by his brutalizing treatment; for he was one of those who were formerly kept naked in loose straw,—besides having during this time lost his toes, supposed to be from his exposure to the cold, he could not so well defend himself, and so might have been taught by necessity to have recourse to his teeth. That he was made worse by his treatment, is evident, as latterly he became sensible of kindness, and improved in personal cleanliness; and his general manners indicated much less malignity of feeling; indeed something like affection [165b] and gratitude to his attendants, began to excite in them, without effort, kindly feelings towards him. At first, (after the new state of things) it was with the utmost difficulty that he was made to keep his clothes on, or to be kept clean; but latterly, for many weeks together, he went on without any restraint whatever. He was removed in May, 1822.

OBSERVATION IX.

The observations that naturally suggest themselves on this case on the efficiency of mild treatment, are so obvious, that it would be obtrusive particularly to state them. I cannot, however, omit adverting to the fact of the probability of his having lost his toes by exposure to cold, because it illustrates the remark made in observation V. Patients, in former times, were kept naked in loose straw; and from their exposure to cold, mortifications in the extreme parts were common; and then writers on insanity say, that mortification of the extreme parts and insensibility to cold, are symptoms of mental derangement!!—See also observation 12th.

No. 19.—Admitted 1800.

Nothing on record. He was a respectable tradesman.

He is constantly muttering and talking to himself, apparently busy in making calculations, holding in his hand something he calls an almanack, made by himself, as well as some pieces of money he has polished. He repeats something, seemingly as a duty imposed upon him, perhaps meant as a prayer. Though the shrivelled and decayed scraps of mind that remain, look only like the apparitions of his previous habits of life; yet they so wholly engross his attention, that he never notices passing and external objects around him. Sometimes, however, he can with great difficulty be for a moment diverted from his object, and while roused, will answer questions with considerable point and shrewdness, but returns as quickly into the same uniform abstracted state.

He is evidently of a contented and happy disposition. There is something in his appearance and countenance which seems to say, “I have been a respectable and good-natured fellow.”

OBSERVATION X.

The only observation here is one which I shall notice more particularly when I come to treat on the efficacy of moral management—viz. that, notwithstanding the deranged state of his mind, and the imaginary objects which occupy his attention, still he can be roused for a moment to something like a proper use of his faculties.

No. 20.—Admitted 1801.

Nothing satisfactory on record. Said to have been a violent maniac. He was kept naked on loose straw. Since that time it is said he was improved by a seton; but still he was to the last a stupid, heavy, idiotical looking man, and in reality was so. [168] That he was less dirty, and kept himself dressed, was owing to better habits, into which proper management had gradually moulded him. But his mind was irrecoverably gone; he was motionless and silent, unless spoken to, or urged to some action. His replies were merely monosyllabic, and these only correct when they referred to something he had formerly best known; he was, however, drilled into some degree of usefulness, in helping about the wash-house. He was removed by his friends in April, 1821.

No. 21.—Admitted 1801.

Nothing on record.—He was one of those who was formerly kept naked on loose straw. He has been for years, for the most part, in a moping, poring, and solitary looking state; yet he has had occasional seasons of excitement, when the disposition towards furious revenge seemed to possess him, so much so, that he would, unprovoked, place his back against a corner of the wall in the attitude of self-defence, shaking his doubled fists in a daring and threatening manner. Though these effervescences of his spirits occur as frequently as ever, yet the malicious disposition seems dying away, and instead of which he will, at these periods, sing a little comic air, and give other indications of his mind being happy and full of good-nature, as much so as the little mind he possesses will enable him to be, if, indeed, beings in such a state can be said to have minds at all; for what an appalling difference between them and minds enriched with laborious habits of reading and reflection!

OBSERVATION XI.

In addition to the observations already made on former and present treatment, it is only justice further to say, that amongst recent patients, I have scarcely seen (if indeed I have seen) one instance of continued revenge. Their spirits exhibit themselves in good or ill-nature, according to the direction that is given them, and even in the old cases, as in the one above stated, it appears simply the remains of their former usage; so that if their minds are still agitated in some sort with feelings of revenge, it is only like the sea which will fluctuate awhile after the storm has ceased; but the winds are hushed, and every wave becomes less and less, until it subsides into a calm.

No. 22.—Admitted 1801.

Nothing on record.—I have been informed, that his mind was instantly wrecked by the female of his heart unexpectedly marrying another the very day previous to that on which she had promised to be made his own for ever. He was an idiot, who could barely answer in a low whisper, and to a few very simple questions, “yes” or “no.” He was old, and pale, and thin—had a long face—his head hanging forwards—his stare was ludicrously vacant and goggling—his lower jaw fallen, and saliva flowing over his large hanging lip—though he generally stood quietly in a corner with his face to the wall, yet sometimes he would for some hours together make a strange and disagreeable noise—what was still more disgusting about him, he had the sickening habit of bringing up his food and regorging it, yet, in other respects he was not a dirty patient—perhaps because having been with a better class, he had received more attention.—He had this singular fancy, that if he had one or fifty pieces of bread and butter, he would eat, or secrete, or pocket them all, except one. He gradually declined from old age, and died in December, 1821.

No. 23.—Admitted 1801.

No statement of his case. It is reported that he was a clever man, a hard student, fond of political subjects, and that speculations on the national debt were the cause of his insanity.—This report receives a colouring of probability from two large trunks full of books now in the Asylum belonging to him, almost wholly on subjects of political science, among which is a large collection of pamphlets on the national debt, and it is apparently confirmed by the nature of his hallucination; only I cannot trace the report to any certain source. It is certain he was Superintendant of the Police at Bombay.

His appearance and manners are very peculiar, and very difficult to describe. He holds his head forwards and obliquely upwards in a calculating position; moving his hands in different directions, and working with his fingers like unto one gathering something in the air.—At times he extends and stretches his hands higher than his head, moving and working them in the same manner: he will hold his face directly upwards—open and shut his mouth in a gaping and catching style, as if he were feeding on air; repeating these operations, and intermingling them with a strange gurgling noise in his throat—almost always muttering to himself as if he held busy converse with his own thoughts, with visible appearances of pleasure or anger on his countenance, occasioned by his imaginary operations being successful or otherwise.

Though he is sometimes as immoveable as a statue, yet he is for the most part moving about, and has a singular mode of treading with his feet like one who has been accustomed to a tread-mill, lifting them higher than necessary, and setting them down cautiously,—sometimes pulling off his shoes—sometimes, however, quickening all his motions, as if something required extraordinary haste and dispatch; and thus he marches about like some star-gazer treading on precious and frail materials; seldom more than a few moments in one place, and in all his movements in different rooms and parts and corners of his gallery, stairs, and airing court, and in all his operations and mutterings it is evident that he, in his imagination, is performing some essential part of his mighty task of paying the national debt, for when any of his operations or mutterings are interrupted, like one whose studies are suddenly broken in upon at some unlucky moment, he seems vexed and unhinged; sometimes bursting into a violent passion, when he is most eloquent in the use of scurrilous epithets (a proof that to use abusive epithets requires very little mind) calling the person who has impeded him in his great work, low-bred, mean, dirty scoundrel, rascal, villain, thief, vagabond, madman; accusing him of being the cause of the loss of many millions to the nation, threatening him with the direst punishment, particularly that he shall be whipped in the air. He is otherwise remarkably quiet and inoffensive, and uniformly intent upon this object, except that sometimes, as already stated, he appears unhinged and irritable by the unsuccessful issue of his calculations, and is then more liable to take offence, especially at any disrespectful deportment towards him, for it must be observed that he is still very fond of his title and of that deference due to a man of rank. Occasionally, like some alchemist of old, he fancies that some äerial being, which he calls the clown of the air, plagues him in various strange ways and interrupts his operations, for which mischievous interference he, in his way, severely scolds him.

The politeness which may be traced in his manners, is evidently the result or remains of his old habits, as he is so absorbed in abstract speculations that all attention to himself or external objects is utterly excluded; he is always solitary, but it is like the solitariness of one whose intense studies allow him no time for fellowship or the exercise of social feelings, so much so, that notwithstanding a consciousness of kind and respectful treatment towards him, he scarcely yet seems to know the name of his attendant.

Although his system is delicately susceptible of changes of temperature, he scarcely ever notices it himself; and when roused to pay attention to his feelings, he says that it is the clown in the air that has teased him with the iron ague.

He has been subject to occasional attacks of asthma, brought on, apparently, by exposure to cold in the night time, during these operations, (for he frequently jumps out of his bed to carry on this great patriotic duty.)

Though he can, if properly roused and managed, still answer questions much more correctly than all these appearances would indicate, yet it is evident that his mind is gradually declining, from age, exertion, and the nature of his case; he is an object of interest and sympathy, and nothing can exceed the way in which it is shewn towards him by his attendant.

OBSERVATION XII.

The correspondence between the insane state and the previous character and habits are in most cases, and certainly in this, very striking. On this subject I refer to the Essay on the Changes and Correspondence between the previous Natural Character, and that which they exhibit in their Insane State.

There is another fact in this last case, which may conveniently serve the purpose of introducing some observations ON THE EFFECTS OF HEAT AND COLD AND THE STATE AND CHANGES OF TEMPERATURE IN INSANE PERSONS, which may be considered as an Appendage to the remarks made in Observation V. and IX.

The fact to which I allude in this case is this, viz. that his system “is delicately susceptible of changes of temperature, but that he himself scarcely ever notices it.”

When the hallucinations of the insane are purely intellectual, and wholly and intensely occupy the attention, the generation of animal heat appears less than usual; and decidedly less than in those cases where the aberrations of the mind are connected with the stimulus of selfish and exciting passions,—hence the system is cold. But this arises rather from defective quantity of heat, than from any irregularity in its distribution; and thus, while the mind, from its state of abstraction, either disregards, or is wholly unconscious of exposure to the cold, the body is very sensibly and strongly affected by it.

In the last stages of gradual decay of mind, the changes and disturbances in the quantity, state, and diffusion of heat, resemble that observable in paralytics; there is great insensibility to heat and cold, and the infliction of pain; and, previous to the period of their dissolution, the slightest pressure, even so slight as to give no pain, produces ulcerations, which rapidly degenerate into gangrenous ulcers.—In old torpid cases of neglect—cases of suspension of mind; and in cases of pure mental abstraction, it is deficient in quantity, although equable in its diffusion.

In all these cases, as well as in cases of over activity of mind, especially during violent paroxysms, there is a general loss, or want, of consciousness to the usual impression of the corporeal system. Sometimes, however, this consciousness is on some points morbidly acute, indicated by strange sounds, and sights, desires, or aversions, &c., according to the parts or organs affected. In fact, it is this undue concentration of energy, which abstracts or confuses, rather than destroys the proper diffusion of consciousness.

Hence the insane, during violent paroxysms, bear the want of sleep and food, resist the action of severe cold, and the effects of large doses of strong medicines. In most cases their minds are so absorbed or suspended during their paroxysms that passing and external events are wholly excluded, and though some few, after their recovery, vividly remember their dreadful dreams; to others, all has been a blank, and they feel just as a person feels respecting that section of the country in which he happens to sleep as he travels; but all these things, (which I intend shall be noticed more particularly hereafter,) are not peculiar to the insane, as has been held by some; they are equally the case with patients during the paroxysms and delirium in the inflammatory stage of fevers. Indeed, the same principle is exemplified in the cases of men of spirit or energy, who, during the excitement produced by the achievement of some difficult enterprise, bear the want of food and sleep, and resist the effects of cold and exhaustion, to an extent which would seem to have exempted them from the common laws of humanity, and these are the incidents in life which are never forgotten; but then, as with the insane, this extraordinary expenditure of the cerebral energy leaves the system exhausted, and it requires all our art and care to recover the enfeebled powers. It is this critical period of convalescence which is so important, and so difficult in the management of the insane.

I further observe, that the variation of temperature of the system, observed during paroxysms of insanity, is more like that produced by the passions in a state of excitement than that which accompanies inflammatory fever. It appears to fluctuate in quantity, and to be tumultuous in its distribution, in proportion as the exciting and depressing passions are active and contending with each other. In proof of the truth of this, I need only mention that every thing which excites the malignant passions, or produces misery and distraction of mind, increases these appearances. I allude not merely to the expression of the countenance, but to the absolute heat of different parts of the system,—of different parts of the head in particular, of which they complain and to which they point distinctly, being often sensible to the external touch of another. It is to be remarked, that the changes and unequal diffusion of heat in other parts of the body correspond with the general and particular state of the mind: indeed the condition, (as it regards health or disease) of each part of the bodily system, directly or indirectly, corresponds with, and indicates states of the mind: but this truth requires more than an observation to do it justice; I make the remark, however, in the mean time, because there is no better guide to us in our treatment than this knowledge, and it explains this temperature as one of the corresponding effects. And though I shall not now enter on the medical nature of the treatment these indications afford us, neither is it necessary to say what kind of moral treatment they point out to us as our wisest course to pursue. In all such cases, and indeed in every case, we ought always to be anxious not only to keep our sympathies alive, but, in order that we may never fail rightly to direct them, we must also possess ourselves of a thorough knowledge of the mind, and its individual peculiarities.—To give settled calmness and tranquillity to the distracted mind, and bloom to the wild and faded countenance, ought not to be considered matters of trifling importance.

OBSERVATION XIII.
ON THE EFFECTS OF INTENSE STUDY, AND GENERAL INTEMPERANCE OF MIND.

Though the effect of intense study and general intemperance of mind, may be better illustrated by many cases than by the preceding, yet for the sake of the moral deducible from the combined view of this part of the subject, and the preceding observations on the distribution of animal heat, I am tempted briefly to glance at the important reflections included within it; intending to resume a more elaborate consideration of its merits when I come to the Essay on the Causes which produce Insanity.

In those cases where intense study has been considered as the exciting cause of insanity, I have almost always been able, on closer investigation, to trace it rather to the intemperate feelings and sentiments of the mind, combined with the injudicious mode of procedure and irregular habits attending it. In young students, these studies are blamed; but, alas! how often have I ascertained that much greater and more decided causes (secret and wicked causes) have long been exercising the most baneful influence. In cases of regular and well-balanced exertion, however severe, the effects were rather a general depression and weakness of the whole nervous system than absolute derangement, producing either debility or suspension of mind, but which for its restoration required only cessation from accustomed exertions. Calmness and tranquillity, combined with innocent diversions and general attention to hygeian rules, invariably effected a cure.

I am the more particular on this point, as some authors on the subject of insanity seem almost to discourage all mental exertion whatever; whereas, we should never lose an opportunity of repeating the common observation, that the judicious exercise of mind, as well as body, is equally conducive to health and strength, as it is to mental improvement and worth. Rightly to apportion and conjoin the exercise of the feelings and understanding, as well as of the corporeal frame, constitutes the whole of Physiology as applied to health. When the civil duties of life are performed from right motives, we then are obedient to the first law of nature, as well as of the Decalogue: then all is healthy co-operation—all portions of the system have their fair proportion of exercise—none are over-worked, neither in the individual nor in the mass—neither in body nor in mind, as we at present see to be the case, singly and collectively: everywhere the effect is similar, destructive alike of all healthy, mental, and corporeal energy, and of all the sweet ties and charities of life which bind families and societies together.

It is remarked by Dr. Arnold and Dr. Penel, that most mathematicians and philosophers have not only lived to an advanced age, but have enjoyed good health, and have been exempt from mental diseases. Perhaps the number of such men vouchsafed to the world, has been too inconsiderable to enable us to form any correct comparative estimate between them and the rest of mankind, yet reason proclaims it true; and as far as medical statistics furnish us with facts, they all tend to confirm the truth. Certain it is, that nothing conduces so much to health and long life as conduct, well regulated, and a mind habitually preserved in a state of intellectual calmness.

Such exercise of the reflective faculties not merely subjugates, but virtually diminishes the energy of the passions; for reflection convinces that every improper gratification must produce dangerous consequences. The very exertion of thought on subjects of exact enquiry, by appropriating the vital energies to its more exalted purposes, abstracts as much from the strength of the passions and propensities as it adds might to the powers of reason and conscience to subdue and control them. On the contrary, persons with vacant and ill-regulated minds, (instead of possessing the passport to the wise and good, whose habits create in the social circle cheerfulness and felicity, and from thence diffuse these blessings to others around them,) fly, when unoccupied, to those who expend the energies of their existence in senseless follies or sensual gratifications. The virtuous man has an ever-living zeal about him, which benevolence warmly inspires, and truth calmly regulates. There is no destructive warfare among the powers of his mind, as is the case with those whose zeal is generated by pride, and nourished by malignity, but his more noble faculties take the lead in activity, and superintend the whole; all are cheered and invigorated by the co-operation and harmony that reigns among them. It is wonderful how with this proper balance and use of the faculties they stimulate each other, and keep the mind alive;—“Peace is within these walls, prosperity within these palaces.” Such a one alone possesses his soul with the full use of its instruments of operation. Where the powers of body mind are well balanced—every thing is in its place—every part subservient to every other—all reduced to practice—then the mental and corporeal powers wear well—age brings few diseases, and no apprehensions—our peace of mind becomes more settled—our wisdom greater—our friendships more valuable, and we come to the grave in a full age, like a shock of corn in its season. To say, that knowledge is power, is only to assert half the truth: it is knowledge combined with moral worth, or as Solomon more beautifully expresses it, “Wisdom is Strength.”—Without virtue, knowledge is ruinous and destructive; with it, the progress of improvement and happiness is illimitable,—here providence smiles—there she frowns; this is equally applicable to individuals as well as nations. History is but one large commentary on this truth, and when men (indeed such a period appears now to dawn) have learned wisdom by the severe lessons of providence, then the Rise and Progress, not “the Decline and Fall, of Empires,” will be the title of the volumes of some future historian.

Were it not for the vast importance of the subject, this might seem the place to introduce some observations on that most grievous error so common among religious persons, of supposing that God requires, on sacred matters, the abnegation of reason—of that reason which distinguishes men, and without which there is no distinction between us and brutes;—it is not merely our will, or affections, or instincts, but this will combined with the superadded attribute of our own understanding which makes us men, and makes us even images and likenesses, (so far as the will and understanding are united, and exist in perfection,) of our Maker! These doctors teach their hearers to dethrone reason, in order, as they say, that the Gospel, the grace, the wisdom, the justice, and goodness of God, may be exalted thereon. They call all this a reasonable and acceptable service. Strange paradox! Wonderful perversion, that a view so contradictory and false can be enforced with a fiery zeal that proves it is believed, embraced, and retained under the influence of the fear, (and not the conviction in the understanding,) that it is essential to their salvation! yet I know this doctrine is the main branch, or the first fruits of that grand fundamental error which is called in the strong prophetic language of Scripture, “the abomination which maketh desolate.”—Some of the effects are, separating faith from charity, truth from goodness, the will from the understanding; and all that God hath, according to the laws of order in the Creation ordained to be joined together, it tears asunder, throwing the mind into a dislocated and distracted state, destructive alike of its peace, and of the bonds which preserve society together:—madness, wickedness, infidelity, and anarchy are the fruits which it produces.

If people are destroyed for lack of knowledge—if to hate the light is a proof of deeds being evil—if the fear of the Lord is the beginning of wisdom—if this knowledge is the continent in the mind for the reception of every other what shall we say of those who teach—that this—the first, the best, the godlike gift of the Creator, must be sacrificed in order to embrace the view of religion which they propose? I cannot use stronger language than I have used already, but repeat that mental alienation is one of the dreadful consequences of that doctrine which is emphatically called the ‘abomination which maketh desolate;’—of that doctrine, whose fruits are bitter, and which fills the mind with doubt, gloom, and misery.

When the only true basis of religious knowledge is removed, and insane notions occupy its place, what desolation follows!

At present, however, I will not enter into a clear and full explanation of this momentous subject; but I trust hereafter I shall be able show, that I am fully prepared to prove these assertions, and, moreover, to prove that, besides the extremes of pride and presumption, despair and misery, with endless indications that it is not according to the wisdom which cometh from above, it is the most common and frightful cause of the most incurable forms of insanity which I have found in lunatic asylums, I repeat, however, that so important and awfully true are these facts in my estimation, that I cannot remain contented with simply making these slight allusions to them, and I therefore intend hereafter to attack the error with all the force which my conception of its magnitude and baneful influence can inspire. Oh! that I could attack it with such effect that it would be rooted up for ever—so that it would no longer exist as the cause, (as it has hitherto been,) of gloom, misery, and desolation to minds of the most gentle, amiable, and acute construction. Such would not be the case did mankind behold the delightful harmony which exists between revealed truth and the constitution of the human mind. I see no lines and separations in knowledge, but behold in each part a portion of one grand whole. Science, intelligence, wisdom, and religion, are all One, and woe to the man who separates them!

O that mankind knew these glorious truths, which are everywhere most beautifully held forth to our view—not only knew these things, but knew also the happiness of making all this knowledge increase the well being and happiness of others around them! Then would the world possess the channels for the right influx of the inspiration of the heart; and then would that true and steady light be received into the understanding which would prevent it from falling into the mazes and darkness of error, or into actual evils and miseries of heart and of life.

Then, indeed, would the fire of Divine Love purify the earth of the human mind;—then would the oil of charity be the fuel on the altar of every heart;—then would the light of Divine Wisdom ascend into understanding, there to remain a sun without clouds for ever.

No. 24.—Admitted 1802.—Aged 25.

Nothing on record. She was brought up tenderly and respectably: her health was rendered delicate by close confinement at her needle-work, and her fondness for reading and writing. She was from home when her mind received a severe shock by the unexpected intelligence of her father having put an end to his own existence. Soon after this a grievous disappointment completed the overthrow of her mind. Before her father’s death, it was generally supposed he was wealthy: she was then engaged to one who had secured her affections; after her lover knew of her father’s death, and the involved state of his affairs, he still continued to profess his attachment, and held out the prospect of speedily fulfilling his promise of marriage;—she believed him, until she happened accidentally in company to cast her eye on the announcement of his marriage to another, when she shuddered and shrieked, and exclaimed “Wretch!” and from that moment she was insane, and has been so ever since. Her lucid intervals are considerable; yet she always retains so painful a recollection of this fact, that though fond of talking of all other occurrences of her former life, she studiously evades all conversation, or any question that at all alludes to this; so much so, that from this fact, as well as some others, I think it highly probable that even her present less violent, and less frequent paroxysms, are partly brought on by associations which awaken the same agony of mind and feelings of indignation as she then suffered. When highly excited, she will, like one who has received some extreme provocation, (her face red and swoln with rage) burst forth into the most violent passion, using the most scurrilous language; sometimes it is maniacal fury; at other times, only like one excessively angry, venting feelings by a hearty scolding; at others, she is only perverse and sulky, and frequently merely odd and flighty. All these symptoms for the most part occur, more or less, at certain periods, (see Observation V. and Essay on Atmospherical Influence,) but now they are something less violent at all times, and sometimes, for many months in succession, so slight that strangers could not perceive them, when she continues conversable and pleasant. She is very agreeable and useful in the house, which she considers her home. Perhaps this improvement may be attributed partly to the application of the medical swing—partly to the greater mildness of her present attendant: she is made happy by a little attention, and often visits her friends in York. Her natural talents are good, and improved by reading; her disposition is friendly and benevolent, but hasty, credulous, and incautious.

No. 25.—Admitted 1803.—Aged 28.

Nothing satisfactory on record. I have been informed by his family and friends, that he was a proud, passionate, spoiled child, and that the immediate exciting causes of his derangement were these. Through the interest of an elder brother, he expected to obtain a most lucrative and respectable situation in the East Indies, but it was discovered on his examination that he did not possess the requisite qualifications, consequently, he was not merely disappointed, but his pride was doubly mortified by being reduced to the necessity of undertaking the management of a common farm; there, with several other causes, these things operating on a spirit ill prepared for any adverse wind or the common storms of life, soured his temper; and at last produced so exasperated and violent a state of mind, that his mother, sisters, and friends, were compelled on account of various outrageous acts of passion to confine him.

It is said that he was so violent after this, that it was deemed necessary to punish him, by chaining him for years, at times, to another patient; and yet, notwithstanding this treatment, it is evident from the remark of an old journal he then wrote, that he possessed a considerable proportion of mind; there are many excellent reflections on general subjects, joined, it is true, with what must appear to others, trivial observations, on the conduct of the attendants in the house. About two years ago he was subject to maniacal fits of outrageous passion, when his manner was proud and stalking, his voice loud and blustering, and his language contemptuous and imperative; calling the house his own; commanding every one of us as his servants, in grand style. The mention of a single fact, out of an immense number, will be sufficient to characterise his spirit and manners. Often have I seen him look at the patients with ineffable arrogance and contempt, and say, in a style which no acting could imitate, “Take this dog out of my sight.”

This violence and noise was so exciting to others, and unhappy for himself, that after various attempts by methods of kindness and argumentation, he was, without any previous threat, taken to the medical swing, where I told him that I was sorry to be obliged to apply so severe a medicine, but that I was certain from his conduct lately he must be very unwell, and that this would cure him, and more to the same purpose. Since this time, I have never heard any noise, or seen any violence about him. The name of the swing, after this, was enough to check him; but now even this was not necessary, and his seasons of excitement have from self restraint disappeared; and he is now, though an old incurable case, much more social than he was. In fact, he appears affable to me, and in some measure, even is so to the patients around him. He is fond of whist, and has very much improved in the game; and when I add to this, that reading the newspapers, walking, taking large quantities of snuff, and laying leaning on his arm, fill up his time, and that he is a dark, cadaverous, sulky, proud, gaunt looking man, all the house will know him. [192]

No. 26.—Admitted 1806—Aged 45.

There was nothing on record; nor have I been able to obtain any information about her previous history, except that she was a charwoman. Her appearance was rather respectable, her manners and conversation were distinguished by sort of bravado air of pride, very often extremely wild and extravagant; she was particularly fond of boasting of and displaying herself as being or doing something great and wonderful,—a general, lord mayor, king, &c.—always a male, and had a full beard on the upper lip, and her voice was more like that of a man than a woman. When addressed as a female, she immediately said she was a man, or a woman turned into one. She was very fond of decorating herself in a fantastic style. When provoked, she swore and talked most brutishly and strangely. She was removed May 15th, 1822—much in the same state, except that latterly she was worse, and not so useful in the laundry as she had heretofore been.

No. 27.—Admitted 1806.—Aged 36.

Nothing on record about her, but report says, that others in the family are insane; and that the exciting cause, in her case, was the loss of some money she had saved in service as a cook.

She is at present in a state of imbecility of mind, and she looks a quiet, timid, silent, motionless, stupid creature, sitting continually in the same posture, like one almost shivering with cold. Although extremely peaceable and timid, yet her mind is irritable, wanting, however, courage for retaliation, so that when provoked, she looks angry, but walks away: she never speaks unless spoken to, and then her answers are short, but mostly correct, though it is evidently all force work. This has been for years her state, or rather debility, with scarcely any perceptible changes, except that her mind appears gradually sinking. She was formerly more conversable, and would have done something at her needle, but at present she is always idle, and has latterly, from inaction, become less cleanly in her person.

OBSERVATION XIV.

Her habits of saving (if the report be true) prove her love of money, the loss of which would of course, be felt in proportion as she valued it; and, with her exceedingly susceptible and delicate mind, it must have been overpowering; hence, as in all hereditary cases, there was something discoverable in the natural disposition which rendered the exciting cause more efficient, and we find benevolence, caution, and consciousness large, and self-esteem and combativeness defective.

No. 28.—Admitted 1806.—Aged 23.

There is nothing on record, but I have been informed that the cause was religious controversy, resulting from association with the followers of Johanna Southcote. [195] He was the son of a respectable country wright and joiner, and had a decent ordinary education.

His present state of mind presents a strange mass of confusion from which nothing can be drawn or collected, except that from his fondness for drawing houses, and different things connected with building, and from his muttering to himself (for he declines all conversation with others) something about measurement, the square being so much, &c. some traces of his former habits of life, may be remarked and determined: the strange and absurd material views of the coming new order of things, betray the view which did (and I am told, still,) belong to that sectarian delusion. He is chiefly distinguished by his unsocial habits, and by the singular practice of always cramming a part of his meat, and sometimes other things, into his ears, shoes, breeches, and different parts of his dress.

No. 29.—Admitted 1808.—Aged 47.

Once for all, I must say of these old cases, since there is no book or documents concerning them, that the origin, nature, and progress of the disease cannot now be known except from enquiries directly made, either by writing, or of such friends as may occasionally visit them; and with many of these lower class of patients, it cannot of course surprise us that they should not have any friends to visit them after such a lapse of time. This is more likely to be the fact when the character of the case is of a more revolting nature—as is very singularly so of the one I am about to describe. Yet she has had visitors, from whom, however, I was not able to gather any information upon which I could depend; her insanity was said to be hereditary, she having a sister who is insane.

She is one of those old cases which, in former times in this institution, were kept naked in loose straw and not allowed seats; and hence she now, from this deprivation, sits huddled up, resting on her calves, when worn out by her violence, curled up like an urchin in a corner in a sort of dog sleep, the slightest noise instantly rousing her, when she starts into her strangely agitated state,—shaking her head and gnashing her teeth, and uttering horrible curses with a sort of barking, hoarse, and hideous gutteral sound, apparently against some object present to her imagination; in this violence she formerly continued, sometimes for weeks, latterly only for days, with the most part only for hours, with scarcely any intermission. In fact, she was in appearance and manner the most brutal and blasphemous demon—no imagination can picture any thing at all equal to the awful reality; and yet it is a remarkable fact, that, some years since, her intellect was restored by a very decided physical cause, the breaking of her leg; when, during the process of the bone uniting, her reason returned: her manners were mild, grateful, and affable, and the tone of her voice was soft and sweet; and again, when her leg was healed, she relapsed into the same violent state. It has continued, excepting a short convalescence during an attack of dysentery: and this is now more than seven years ago; and after which, an artificial drain was kept open, but with no apparent benefit; the dysenteric attack was also imitated, but with no further benefit or effect than its mere physical depressing influence at the time. It is worthy of notice, that when taken to the swing [198] a second time, she talked more sensibly, refrained from swearing, promised to behave better, and in a sweet tone begged not to be swung: since this time, she has been less violent, has shaken her head and sworn less than before; indeed she has a more good-natured manner, and very often expends her excitement in mirthful dancing and singing, and generally seizes my hand, that I may dance with her.

OBSERVATION XVIII.

Though the doctrine of Demons, or being possessed, has been discarded; yet, in my opinion, it deserves a more serious consideration than medical men imagine:—it involves the true theory of mind and matter, their connection with each other, and the principles on which this connection depends, and by which it is regulated. I shall leave this question for the present, with the intention of returning to it at some future opportunity. However, one thing this case serves to prove and illustrate, which is, that whatever mysterious link the mind may constitute in the order of being, it is certain that this is according to or dependant on the physical condition of the material organs through which this connection operates, so that the physical reasoning on disordered and diseased organization remains precisely the same, whether we admit or deny that the visible, and invisible world subsist together and are in indissoluble connection.

No. 30.—Admitted 1808.—Aged 47.

I have not been able to obtain a very accurate or full history of this old and incurable case. He was a clergyman of the Church of England. He had been a hard reader and distinguished student at Cambridge, and he now gives proof of his having been an excellent classic. It is said, that after he had obtained a small vicarage, although not an immoral man, he was gay and expensive in his habits. After the age of thirty, he hastily married an exceedingly beautiful girl of about sixteen years of age, but who was uneducated and from a low station of life. Afterwards discovering her deficiencies as a companion, his love cooled into indifference, and his naturally proud, impatient, and uncontrollable temper was made worse; he treated her harshly, their quarrels became habitual, and they lived in hatred, misery, and distraction together.

In this state of his disappointed affections he was seduced into various intrigues. Shame, conscience, and loss of character, quarrels with his parishioners, aggravated at the same time by a fall from his horse on his head, increased his natural irratibility of temper, and so mortified his pride, that he became desperate and attempted suicide. After this he had a regular paroxysm of maniacal violence, which subsided, although it has returned with considerable increasing intervals up to this time.

During his lucid intervals, he will talk of the harshness with which he was used, when it was first considered necessary to remove him from home; and there is no doubt there is some truth in his statements: at the same time it seems right to observe that, if in any instance it can be excusable to allow our natural feelings for a moment to overcome us, this was one of such cases. The proud, malignant, and contemptuous manner displayed in his violence, was irritating in the extreme.

About eight years ago, he continued for some time in a perfect state of convalescence, and when the paroxysm returned, its violence and duration appeared in proportion to the length of intermission. These paroxysms and intervals of convalescence have since preserved the same ratio to each other. It is remarkable that the last interval of convalescence, commencing about five years ago, continued for more than three years, which I attribute to the absence of causes of irritation, more delicate and attentive treatment, and constant resources of various amusements. During the whole of this time, he could not be persuaded to leave the place; he said “It would not do;” that he “should soon be worse than ever.” The name of home and his wife seemed to make him shudder; and when asked if he should not like to go, he shook his head, turned away, and said nothing; but he evidently painfully felt the association of old exciting causes.

It ought, however, to be mentioned that during the whole of this time he would frequently exhibit signs of great uneasiness and irritability, would pace the gallery or airing court, in quick and hurried steps, and afterwards call his attendants to play a game at whist or backgammon: at these times he was in the habit of chewing orange-peel, which he constantly carried in his pocket for that purpose, and afterwards he would say his troubles were overcome. He has since had a return of his insanity, from which he never perfectly recovered; I have since understood that he is dead.

OBSERVATION XIX.

The most obvious remark suggested by this case is, that, like many old cases, when once an irritable habit is established in any part of the mind, how easily the mere association of old existing causes will overturn the balance and introduce a relapse into the same state: no exciting causes can have more power to do this, than the constant painful state of mind which ill-assorted and unhappy marriages produce; and therefore, the next most obvious remark suggested by this case, is the evil which arises from the whole mind being ultimately disagreeably affected by the contraction of hasty, mistaken, and ill-assorted matrimonial connexions. As the sublime principle of rightly-constituted and spiritual or mental marriage is involved in the consideration of such cases; and as, from the want of a proper understanding of this principle being duly impressed upon mankind, the evils and miseries which the parties bring upon themselves and entail upon their offspring in the world, are so numerous and so frightful, and so frequently the cause of the most terrible forms of insanity, I shall, in an after part of this work, endeavour to embody in an essay expressly on this subject, all the arguments which I can bring forth, for the purpose of enforcing this first, this inmost, this greatest, grandest principle involving the happiness and well-being of the world.

No. 31.—Admitted 1808.—Aged 30.

He is a surgeon, and was formerly in great repute as a successful practitioner, as well as a lecturer on anatomy, surgery, and the practice of physic.

He was very studious, and chiefly during the night, though his sleep was already sufficiently broken by his professional labour. As a young student he was ambitious to excel, as he would often say, “I employed my time well, that it might serve me in after life; and it did so.”

His mind is naturally one of much greater activity than power, hence his harassing day and night practice and preparation for lecturing induced a morbid state of mind, in which condition a fever in his family occurred. Rapidly and unexpectedly, four male children, a niece, and a maid-servant, were the victims, and this completed the wreck of his overworked, active, and feeling mind.

His present state is most interesting and singular, and very difficult to describe. His activity of mind, prodigious command of words, and most animated and graceful manner, excite the greatest surprise; and even in his present deranged and deluded condition, with his varied stores of information, these exhibitions are mistaken for the remnants of versatility of genius; yet, as I have already said, it is most true that his mind was not naturally one of so much power as it was of amazing ambition and activity.

He will suddenly rush into some of his anatomical, surgical, and medical lectures, going through different parts of the human body, operations, and practice. His lectures on the circulation of the blood, seem to have been most strongly impressed upon his memory. At other times, his eloquence is displayed in imitations of various celebrated characters. If they are ancients, and he be asked, how can this be? since they lived two thousand years ago, he says: “Yes, but I died and rose again in the world.” And thus, he imagines himself every character he personifies, and that at that time he was alive, and afterwards died, again reappearing in such another character. In this way having passed through numberless transmigrations, he was Adam, Abel, or Melchisadeck, Abraham, Isaac, and Jacob, Moses, Joshua, Samson, Goliah, David, and Solomon. Solomon had great attractions: frequently describing, with great animation, his state of grandeur and enjoyment. In the same way he was Aristotle, Pythagoras, Confucius, Plato, Zoroaster, Pliny, Ptolemy, Cicero, Demosthenes, and particularly Homer, Mahomet, and even our Saviour, &c. All these he will still personate, and make speeches differing in manner and matter, and suitable in some measure to each of them.

In medicine, all the list of celebrated men are claimed as the same transmigration of his soul. He lifted up the serpent. He was Hypocrates, Celsus, Galen, Paracelsus, Stahl, Van Helmont, Boerhave, Cullen. In anatomy, surgery, chemistry, and natural philosophy, it was the same. The whole list of celebrated medical men is monopolized by this mania of transmigration.

He always addressed strangers as contemporaries, saying, “Good God! you were alive at such a time: I knew you well; you were with me when I conquered at the plains of Marathon! or, you met me at such a place when I was singing the Iliad, as old Homer,” and so on. All this with such a fascination of look, manner, and address, that he arrests and amuses every one, especially strangers. He frequently talks with imaginary, and especially angelic beings, which he does with a manner and expression that prove he believes he beholds their actual presence.

He had a peculiarly bright and glistening eye, indicative of the secret and destructive habit so dreadfully fatal to the insane.

It appeared to me, since amidst all this strange confusion and delusion, his intellectual powers were still in existence, that if his understanding could be constantly occupied, this confused condition might in time be corrected, and his mind restored to a right state: for this purpose I undertook to make him translate a French work, while I wrote from his dictation, at the same time checking and controlling his wild starts into all these vagaries. In this manner we nearly finished an important medical work together, and he was evidently much improved by the exercise; the task was however so amazingly arduous, that in the midst of my other duties I was obliged to discontinue it, and he then relapsed into his former state.

The effect, however, was sufficiently decided to prove a fact of very great importance, and many such facts having since occurred, which further tend to confirm that many cases which are generally given over as incurable, may be cured by a well-directed exercise of the understanding, by which it is at once strengthened, and the mind drawn and excluded from the exercise of its insane feelings and hallucinations. In some cases I have made them translate a work on the nature and effects of their secret vice, and it has silently checked this habit, and at last restored them.

Here I close my description of these old cases, conceiving I have given a sufficient number for the purpose I had in view, that of exhibiting a fair average picture of the state and character of the old insane. After one general abstract observation on the whole essay, I shall afterwards, and following this last case, make my next essay on the origin and nature of disease in general, and of insanity in particular: and which I shall do as preliminary to the more intimate and direct investigation of the causes and nature of insanity; and especially the direct consideration of the cause to which I have alluded in this case, because it is one of the most general and most fatal causes of insanity, and a cause, which if not removed, inevitably renders them incurable. Such was the habit of the person whose case obliged me very reluctantly to assume a defensive attitude, and refute falsehood by a statement of the truth, or otherwise I should have continued silently to proceed in the path of duty, without obtruding our own secret exertions on the notice of the public, as it may appear that I have done in this essay, as well as in those which are to follow, written, as they will be, in some measure on the same principle, for the truth should not suffer from diffidence, any more than it ought to be brought into disrepute by vain ostentation; still, I am quite certain, that I am actuated by no feelings incompatible with charity and justice.

CONCLUDING OBSERVATIONS.

The concluding general observations on this Essay and its Appendix, are, that the one principal object I have had constantly in view, has been the removal of the erroneous impressions and prejudices which exist almost universally against the insane, as if they alone were all furious wild beasts or infernal demons, and which have hitherto excited and still continue to excite a spirit and conduct toward them, productive of a baneful and injurious influence.

So long as these prejudices exist in the mind, even the soothing treatment which is now so much the boast of the age, assumes a spirit and manner, perhaps as galling and injurious to the afflicted as was, undoubtedly, the heartless tyranny of former times.

I deprecate that altered tone of voice and manner which implies in every word and action, that they are considered either as children, or as beings wholly bereft of rationality.

In the system (which I have in some degree stated and explained) of receiving and treating them as visitors, even as though they were still rational, and of course observing towards them the same polite and delicate attentions as are practised in well-bred society, the same irresistible effects which precept and example always produce in every sphere, in proportion as they are exercised in sincerity and truth, will be found to be produced also on them; and hence we may easily perceive how it comes to pass that we have so much greater dependence on their attachment, good conduct, fidelity, and honour, than is generally imagined to be possible, and why, consequently, the greater liberty which is given them is seldom or never abused; and, as cause and effect increase each other, it is evident that this system, by exciting and exercising the higher feelings and moral principles of the mind, produces, (as will be seen from the tables I shall hereafter introduce) a much greater proportion of cures than has hitherto been the case. It is much more conducive to cure than the system of perfect separation and exclusion from any association. This truth is another important reason for being anxious, from the best of motives, to remove these baneful prejudices which have hitherto made a marked moral line of distinction between diseases of the brain, and other parts of the system, exclusively and absurdly making the former a proof of some shameful criminality. And though this greater degree of well-judged liberty (not indiscriminate) appears alarming to those who retain the usual worldly prejudices against the insane, it is in reality attended with much less of danger or of any thing to excite the fears of others, than most assuredly is a contrary system.

I am now enabled, from nearly twenty years’ experience, to say this with confidence; and I am the more anxious to impress this on the world, in order that I may not be obliged, from too great a deference to its fears and prejudices, to abridge the exercise of this influence, so far as to lessen the happy effects of a system which theory and feeling have suggested and compelled me to pursue, and which increased knowledge and experience have confirmed and justified.

Our fears and prejudices create and realize that which would otherwise have no existence. We often blame effects of which we ourselves are the cause. This is one principal, if not the only, source of all our complaints and all our troubles. Servants, children, families, sects, parties, nations, and even the insane, are more or less good or bad in their conduct and character, in proportion as our principles and conduct towards them are under the influence of a wrong spirit or a right one.

Such are our views, and I trust it will be seen (the experimental part at least,—the theory will be explained in due course) that we have endeavoured, however imperfectly, to reduce them to practice.

Wherever natural and spiritual good exist, there we shall behold those best fruits of charity, of which the vine and fig-tree are beautifully appropriate emblems.

I trust that what I have advanced will be considered less as a personal boast than as an explanatory statement, suggested by recognised evils, and enhanced by candour and conviction. Although past conduct is the best guarantee for the future, yet it is by no means an infallible security; and it altogether ceases to be the test of any security, the moment boasting, pride, or self-confidence exclude a higher and better dependence.

THE END.

DEAN AND MUNDAY, PRINTERS,
THREADNEEDLE-STREET.