He describes, in one of his letters, the horrors of his complaint:—“I have been for some time pining under secret wretchedness. The pang of disappointment, the sting of pride, and some wandering stabs of remorse, settle on my life like vultures, when my attention is not called away by the claims of society, or the vagaries of the muse. Even in the hour of social mirth my gaiety is the madness of an intoxicated criminal under the hands of an executioner. My constitution was blasted ab origine with a deep incurable taint of melancholy that poisoned my existence.”
Nothing can be more interesting to a physician who is endowed with only a moderate share of the spirit of observation than to watch the progress of hypochondriasis in a number of patients, especially in regard to its effect on the mind. They always struggle, more or less in the beginning, with the lowness and dejection which affect them; and it is not until many a severe contest has taken place between their natural good sense and the involuntary suggestions which arise from the obscure and painful feelings of the diseased nerves, that a firm belief in the reality of such thoughts gains a full conquest over their judgment. A firm belief in any one perception never takes place until it has acquired a certain degree of force; and as all impressions which arise from the viscera of the abdomen are naturally obscure, we see the reason why these must continue for a great length of time, or be often repeated, before they can withdraw a person’s attention from the ordinary impression of external objects, which are clear and distinct, and before they acquire such a degree of vividness as to destroy the operations of reason.
We meet every day with hypochondriacs in whom the disease is just beginning to be formed, and who, being possessed of a good understanding, seem unwilling to tell, even to their medical friends, the singular, and often melancholy, thoughts with which they are tormented. They acknowledge them to be unreasonable, and yet insist that they cannot help believing in them. A very curious display of this kind of struggle between the habitudes of reason and the approach of delirium is to be found in the diary of an hypochondriac, from which we make the following extract:—
“On the 14th of November, the idea that some person intended to kill me sprung up suddenly and involuntarily in my mind, and yet, I must confess, there was no reason why I should have harboured this thought, for I am convinced that no one ever formed such a cruel design against me. People who had a stick in their hands I looked on as murderers. As I was walking out of town, a countryman happened to follow me, and I was instantly filled with the greatest apprehension, and stood still to let him pass. I asked the fellow in a threatening voice, and with a view of intimidating him from his purpose, what was the name of the town before us. The man answered my question and walked on, and I found great relief, because he was no longer behind me.
“In the evening, I observed some water in the glass out of which I commonly drink, and I instantly believed it was poisoned. I therefore washed it carefully out, and yet I knew, at the same time, that I myself had left the water in it.
“18th November.—At particular periods I believe all mankind have conspired to murder me. I think I am deprived of my office; that I am doomed to die of hunger; and, to add to all this, I am tormented with horrid doubts concerning futurity, and these thoughts persecute me like furies. Those whom I used to love most, I now hate. I avoid my best friends, and my dear wife appears to me a much worse kind of woman than she really is.
“I cannot describe the exertion it requires to conquer in society the aversion I feel to my fellow-creatures, and to prevent my ill-humour from breaking out against the most innocent people. When it really does so, I spare no one. I am sorry for it afterwards, but then I am too proud to acknowledge my error.
“I find myself so enraged on seeing a stupid, vacant countenance, that I have almost an irresistible inclination to box the person’s ears to whom it belongs: the refraining from it is a severe effort.
“20th November.—A boy with a face like a satyr met me, and occasioned me the greatest uneasiness. Although he did nothing to displease me, I was forced to go to him, and tell him that I was sure he would die on the gallows.
“23rd November.—My sensibility is often extreme, and then my best friends become insupportable to me. To their expressions of regard I am either purposely cold or else I answer by rude and offensive speeches. I can seldom explain to myself the reason of this too great sensibility. If two people whisper to each other in my presence, I grow uneasy, and lose all command of mind, because I think they are speaking ill of me; and I often assume a satirical manner in company, in order to frighten them. Anxiety, dreadful anxiety, seizes me, if a person overlooks my hand at cards, or if a person sits down beside me when I am playing the harpsichord.”