Dr. T. Mayo observes, that “no intellectual delusion need be present when self-destruction is coveted. But there must be an extinction of that moral sense which revolts from it on grounds independent of fear. Owing, however, to the systematic neglect of moral symptoms, the suicide is seldom recognised as possessing this destructive tendency until he has made an attempt upon his life; often, therefore, until all measures must be too late.”
A very common feature of moral mania is a deep perversion of the social affections, whereby the feelings of kindness and attachment that flow from the relations of father, husband, and child, are replaced by a perpetual inclination to tease, worry, and embitter the existence of others. The ordinary scene of its manifestations is the patient’s own domestic circle, the peace and happiness of which are effectually destroyed by the outbreakings of his ungovernable temper, and even by acts of brutal ferocity. Frederic William of Prussia, father of Frederic the Great, undoubtedly laboured under this form of moral mania; and it furnishes a satisfactory explanation of his brutal treatment of his son, and his utter disregard of the feelings or comfort of any other member of his family. About a dozen years before his death, his health gave way under his constant debauches in drunkenness; he became hypochondriacal, and redoubled his usual religious austerities. He forbade his family to talk of any subject but religion, read them daily sermons, and compelled them to sing, punishing with the utmost severity any inattention to these exercises. The prince and his elder sister soon began to attract a proportionate share of his hostility. He obliged them to eat and drink unwholesome or nauseous articles, and would even spit in their dishes, addressing them only in the language of invective, and at times endeavouring to strike them with his crutch. About this time he attempted to strangle himself, and would have accomplished his design had not the queen come to his rescue. His brutality towards the prince arrived to such a pitch that he one morning seized him by the collar as he entered his bed-chamber, and began to beat him with a cane in the most cruel manner, till obliged to desist from pure exhaustion. On another occasion, shortly after, he seized his son by the hair, and threw him on the ground, beating him till he was tired, when he dragged him to a window, apparently for the purpose of throwing him out. A servant hearing the cries of the prince, came to his assistance, and delivered him from his hands. Not satisfied with treating him in this barbarous manner, he connived at the prince’s attempts to escape from his tyranny, in order that he might procure from a court-martial a sentence of death; and this even he was anxious to anticipate by endeavouring to run him through the body with his sword. Not succeeding in procuring his death by judicial proceedings, he kept him in confinement, and turned all his thoughts towards converting him to Christianity. At this time, we first find mention of any delusion connected with his son, though it probably existed before. In his correspondence with the chaplain to whom he had entrusted the charge of converting the prince, he speaks of him as one who had committed many and heinous sins against God and the king, as having a hardened heart, and being in the fangs of Satan. Even after he became satisfied with the repentance of the prince, he shewed no disposition to relax the severities of his confinement. He was kept in a miserable room, deprived of all the comforts and many of the necessaries of life, denied the use of pens, ink, and paper, and allowed scarcely food enough to prevent starvation. His treatment of the princess was no less barbarous. She was also confined, and every effort used to make her situation thoroughly wretched, and though, after a few years, he relaxed his persecution of his children, the general tenour of his conduct towards his family and others evinced little improvement in his disorder, till the day of his death.[65]
In considering this point it is important to remember that the attempt at self-destruction is OFTEN the FIRST distinct overt act of insanity. A young lady of delicate constitution, but previously in apparent health, started up one day from the tea-table, rushed to the window, and endeavoured to throw herself out. It required several persons to restrain her until a strait-waistcoat could be procured. She remained insane from that time until the day of her death, with very partial glimmerings of reason. “Fortunately,” says Mr. Chevalier, who relates the case, “her life was not long protracted.”
It has been inferred, that when an unsuccessful act of suicide has been committed, and the person expresses his regret for what he has been guilty of, that we are justified in concluding that the mind was sane when the suicide was attempted. The effort which Sir Samuel Romilly is said to have made to stop the hemorrhage after having cut his throat, has been cited by a celebrated living authority as an evidence of his previous sanity.[66] We must bear in mind that many cases of suicide result from derangement of mind dependent on cerebral congestion.
In such cases, we can imagine a person insane when the act of self-destruction is attempted, and sane immediately afterwards. The loss of blood which a person would sustain from an extensive wound of the throat, particularly when, as is often the case, some large vessel is wounded, would instantly relieve the brain of the superabundant blood which had been oppressing it, and deranging its manifestations, and thus producing a return of sanity. That this was the fact in Sir Samuel Romilly’s case is evident from its history. There cannot be a shadow of doubt that he was insane when he cut his throat; and his apparent desire to live after the act was committed, may be attributed to the relief which he had derived from the loss of blood.
Mr. T. Miller, of Spalding, in a fit of delirium, cut his throat so dreadfully that after languishing three days, he died. He manifested during this interval the utmost contrition for his offence, declaring he knew not what he had done until he found the blood streaming from his wound. He dictated his will, and talked rationally with his friends till his dissolution.[67]
A merchant in the city, not many months back, met with some losses in business. His mind became affected to a certain extent; he felt a strong desire to kill himself; but being a man of education and enlarged capacity, he fought most resolutely against this inclination. He had been exposed during one day to the influence of circumstances which caused great mental depression. He said to his head-clerk, previously to his leaving his counting-house, that his head felt heavy and oppressed, and he had a presentiment that something would happen before the morning. The clerk suggested the propriety of his having medical advice, but he did not think proper to do so. In this state he went to bed. In the middle of the night he awoke in a state of extreme agitation; no language could convey an adequate idea of his feelings, and suicide was the only act which held out the hope of relief. In this state he rose from his bed, called up the servants, and commanded them to run for the surgeon. A professional gentleman who lived close by was soon in attendance, and the moment he entered the room the patient exclaimed, “Bleed me, or I shall cut my throat!” The operation was instantly performed, and as the blood flowed from the vein the patient exclaimed, “Thank God! I have been saved from committing self-murder.” Every disposition to suicide was immediately removed.
The following is an extract of a letter found in the pocket of Captain Aitkins, of the Pembroke Fusileers, who committed suicide:—“As some inquiry may be instituted as to the cause of my death, I think it necessary to state that it was inflicted by my own hand, partly from pecuniary embarrassment, and partly from the effect of strong nervous malady, which has fixed itself on my spirits so as to render life insupportable.” In this case we have no hesitation in asserting, that if the brain could have been relieved of the unnatural weight which oppressed it, this poor man would not have stained his hand with his own blood.
In many cases the delusion of the intellect is so self-evident that no one questions the existence of insanity. A respectable Scotch merchant, near Pimlico, committed suicide by cutting his throat. He fancied the devil was in him; he asserted he could feel him in his throat. On examining his room after his death, two wills were discovered, in one of which he desires his executors to employ a surgeon to open his body, that the devil might be found, secured, and destroyed; and in this way, he says, he will be prevented from injuring any one else.
Many other cases could be cited in which the act of suicide was clearly traceable to mental derangement, were it considered necessary further to illustrate this point. Much evil has resulted from the opinions which the profession have entertained relative to the absence of insanity in cases of those who have exhibited a disposition to destroy themselves. In this matter, the principle which the great Edmund Burke applied to politics is equally applicable to medicine—“We had better be blamed for too anxious apprehension, than be ruined by too confident a security.”