When laying down rules for the physical treatment of suicide, we have developed our view as to the influence of derangement of the primæ viæ, suppressed secretions, &c., on the healthy state of the mind; and we have only to refer the reader to that portion of the work for information on these points. In discussing the important question whether suicide invariably results from mental derangement, numerous instances have been brought forward that may be undoubtedly traced to that cause, therefore it will not be necessary to recapitulate in this chapter what has been there advanced.
CHAPTER IX.
MORAL TREATMENT OF SUICIDAL MANIA.
Diseases of the brain not dissimilar to affections of other organs—Early symptoms of insanity—The good effects of having plenty to do—Occupation—Dr. Johnson’s opinion on the subject—The pleasure derived from cultivating a taste for the beauties of nature—Effect of volition on diseases of the mind—Silent grief injurious to mental health—Treatment of ennui—The time of danger, not the time of disease—The Walcheren expedition—The retreat of the ten thousand Greeks under Xenophon—Influence of music on the mind in the cure of disease—Cure of epidemic suicide—Buonaparte’s remedy—How the women of Myletus were cured of the disposition to suicide, and other illustrations—Cases shewing how easily the disposition to suicide may be diverted—On the cure of insanity by stratagems—On the importance of removing the suicidal patient from his own home—On the regulation of the passions.
In treating this most important class of affections, we must dismiss from our minds all those pre-conceived notions which we have been led to form of what constitutes mental derangement. We must view the subject as medical philosophers in the most liberal acceptation of the term, and not as nisi prius barristers; we must consider ourselves at the bed-side of a suffering patient, demanding from our skill that relief which he is led to believe we have in our power to afford, and not as in a court of justice, undergoing an examination at the hands of a lawyer anxious to establish his case; and, above all, we must apply to the disease of the brain and its disordered manifestations those pathological principles which guide us in the elucidation of the affections of other organs. If we consider insanity not as a specific disease invariably exhibiting the same phenomena, but as it really is, the effect of a disordered condition of the sentient organ, having an incipient, as well as an advanced stage, we may, by a judicious application of the principles of therapeutics, succeed in many cases in crushing the disposition to suicide before it has taken a formidable hold of the constitution. In the great majority of cases the premonitory indications are well marked and unequivocal. The experienced physician and accurate observer will be able to detect, before the mental alienation becomes apparent to others, the early dawnings of derangement. He knows that it is frequently manifested by some change in the person’s usual healthy habits of thinking and acting,—by the exhibition of odd fancies and whims. Although surrounded by everything calculated to contribute to his happiness, he is the most miserable of human beings. Trifles annoy and irritate him; he sees in his dearest friends his deadliest enemies; talks of conspiracies, of plots, and stratagems; becomes suspicious of everything and everybody; his former objects of pleasure afford him no delight; he avoids society, and is occasionally heard muttering strange things to himself. In the majority of cases these are the early dawnings of cerebral disease leading to unequivocal insanity, and yet so tied down are we to definitions, arbitrary standards and poetical tests, that we will not admit derangement of mind to be present until the symptoms are so self evident and glaring that the condition of the mind becomes apparent to the most superficial observer. When this view of insanity is recognised as orthodox, and moral treatment adopted in the early stages of the disease, much good may be expected to result.
How often do we see in society, and during the intercourse of private friendship, individuals complaining of the severest mental sufferings, the effect of morbid alterations of feeling almost in every respect similar to insanity, dependent upon the same causes, manifesting the same symptoms, and removed by the same remedial agents. How are these mental ailments treated? The poor sufferer is perhaps smiled at; he is considered to be fanciful, and no regard is paid to the cerebral affection. The disease is allowed to advance until other faculties of the mind are implicated, and then the mental alienation exhibits itself so unequivocally that no one doubts its existence.
The success of the mental treatment of suicide will be mainly dependent on our paying strict attention to those apparently trifling alterations of temper and disposition, those deviations from the usual mode of thinking and acting, which so often predicate the presence of the incipient stage of insanity. An invincible love of solitude exhibited in a patient considered as labouring under an hypochondriacal affection, and who, when induced to converse, complains of being constantly pestered with one or two trains of ideas from which he cannot for a moment escape, although his efforts are great and unremitting, let his friends beware. These changes are, however, but rarely noticed, until some alarming event causes every friend to lament the want of timely attention.
Occupation is an infallible specific for many of the imaginary and real ills of life. In cases where the mind is sinking under the influence of its own weight, and the fancy is allowed to dwell uninterruptedly on the ideas of its own creation, until the individual believes himself to stand apart from all the world, the very personification of human misery and wretchedness, the physician can recommend no better remedy than constant and steady occupation for the mind and body. Burton concludes his able work on Melancholy with this valuable piece of advice:—“Be not solitary; be not idle.” Dr. Reid recommended a patient, labouring under great mental depression, to engage in the composition of a novel, which, during the time he was occupied in the task, effected much good. By interesting himself in the distresses of fictitious beings, he diverted his attention from sufferings which were no less the offspring of the imagination.