Observations on Insanity / With Practical Remarks on the Disease and an Account of the Morbid Appearances on Dissection

by John Haslam

Insane people who have been good scholars, after a long confinement lose, in a wonderful degree, the correctness of orthography; when they write, above half the words are generally mis-spelt—they are written according to the pronunciation. It shews how treacherous the memory is without reinforcement. The same necessity of a constant recruit and frequent review of our ideas, satisfactorily explains, why a number of patients lapse nearly into a state of ideotism. These have, for some years, been the silent and gloomy inhabitants of the Hospital, who have avoided conversation, and sought solitude; consequently have acquired no new ideas, and time has effaced the impression of those formerly stamped upon the mind. Mr. Locke well observes, “that there seems to be a constant decay of all our ideas, even of those which are struck deepest, and in minds the most retentive; so that if they be not sometimes renewed, by repeated exercise of the senses, or reflection on those kind of objects, which at first occasioned them; the print wears out, and at last there remains nothing to be seen.”

As it has been attempted to explain, how an imbecility or loss of memory will obstruct the operation of the other powers of the mind: the next object is to shew, how necessarily our ideas must be disarranged where the determination on their comparison is wrong, or where the mind determines, or judges, with little previous examination or comparison. An example or two will illustrate this more satisfactorily than any length of reasoning. I remember a patient who conceived, that, although dead men told no tales, yet their feeling was very acute. This assumed principle he extended to inferior animals, and refused to eat meat, because he could not endure to be nourished at the expence of the cruel sufferings, which beef steaks necessarily underwent in their cookery. Another madman, who pretended to extraordinary skill in surgery, contrived to steal the wooden leg of an insane patient, and laid upon it for a considerable time, with a firm belief of hatching it into a limb of flesh and blood.

If a man shall form such ideas, and conceive them to be true, either from a defect in the power of his judgment, or without any comparison or examination shall infer them to be so, such defect will afford a sufficient source of derangement.

Some who have perfectly recovered from this disease, and who are persons of good understanding and liberal education, describe the state they were in as resembling a dream; and, when they have been told how long they were disordered, have been astonished that the time passed so rapidly away. Others speak of their disorder as accompanied with great hurry and confusion of mind, where the succession of ideas is so rapid and evanescent, that when they have endeavoured to arrest or contemplate any particular thoughts, they have been carried away by the tide, which was rolling after them.

All patients have not the same degree of memory of what has passed during the time they were disordered: but for the most part they recollect those ideas which were transmitted through the medium of the senses, better than the combinations of their own minds. I have frequently remarked that, when they were unable to give any account of the peculiar opinions which they had indulged during a raving paroxysm of long continuance, they well remembered any coercion which had been used, or any kindness which had been shewn them.

Insane people are said to be generally worse in the morning; in some cases they certainly are so, but perhaps not so frequently as has been supposed. In many instances (and, as far as I have observed) in the beginning of the disease they are more violent in the evening, and continue so the greatest part of the night. It is however a certain fact, that the majority of patients of this description have their symptoms aggravated, by being placed in a recumbent posture.

They seem themselves to avoid the horizontal position as much as possible when they are in a raving state: and when so confined that they cannot be erect, they will keep themselves seated upon the breech.

Many of those who are violently disordered will continue particular actions for a considerable time: some are heard to gingle the chain, with which they are confined, for hours without intermission; others, who are secured in an erect posture, will beat the ground with their feet the greatest part of the day. Upon enquiry of such patients, after they have recovered, they have assured me, that these actions afforded them considerable relief. We often surprize persons who are free from intellectual disease in many strange and ridiculous movements, particularly if their minds be intently occupied:—this does not appear to be the effect of habit, but of a particular state of mind.

Madmen do not always continue in the same furious or depressed states: the maniacal paroxysm abates of its violence, and some beams of hope occasionally cheer the despondency of the melancholick patients. We have some unfortunate persons who are obliged to be secured the greatest part of their time, but who now and then become calm, and to a certain degree rational: upon such occasions, they are allowed a greater range, and are permitted to associate with the others. In some instances, the degree of rationality is more considerable; they conduct themselves with propriety, and in a short conversation will appear sensible and coherent. Such remission, has been generally termed a lucid interval.

When medical men are called upon to attend a commission of lunacy, they are always asked, whether the patient has had a lucid interval? A term of such latitude as interval requires to be explained in the most perspicuous and accurate manner. In common language it is made to signify, both a moment and a number of years, consequently it does not comprize any stated time. The term lucid interval is therefore relative. I should define a lucid interval to be a complete recovery of the patient’s intellects, ascertained by repeated examinations of his conversation, and by constant observation of his conduct, for a time sufficient to enable the superintendant to form a correct judgment. Unthinking people are frequently led to conclude that, if during a conversation of a few minutes, a person under confinement shall betray nothing absurd or incorrect, he is well, and often remonstrate on the injustice of secluding him from the world. Even in common society, there are many persons whom we never suspect from a few trifling topics of discourse to be shallow minded; but, if we start a subject, and wish to discuss it through all it’s ramifications and dependances we find them incapable of pursuing a connected chain of reasoning. In the same manner, insane people will often, for a short time, conduct themselves, both in conversation and behaviour, with such propriety, that they appear to have the just exercise and direction of their faculties; but let the examiner protract the discourse, until the favourite subject shall have got afloat in the madman’s brain, and he will be convinced of the hastiness of his decision. To those unaccustomed to insane people, a few coherent sentences, or rational answers would indicate a lucid interval, because they discover no madness; but he who is in possession of the peculiar turn of the patient’s thoughts, might lead him to disclose them, or by a continuance of the conversation they would spontaneously break forth. A beautiful illustration of this is contained in the Rasselas of Dr. Johnson: where the astronomer is admired as a person of sound intellect and great acquirements by Imlac, who is himself a philosopher, and a man of the world. His intercourse with the astronomer is frequent; and he always finds in his society information and delight. At length he receives Imlac into the most unbounded confidence, and imparts to him the momentous secret. “Hear Imlac what thou wilt not without difficulty credit. I have possessed for five years the regulation of weather, and the distribution of the seasons. The sun has listened to my dictates, and passed from tropic to tropic by my direction. The clouds at my call have poured their waters, and the Nile has overflowed at my command. I have restrained the rage of the Dog-star, and mitigated the fervours of the Crab. The winds alone of all the elemental powers have hitherto refused my authority, and multitudes have perished by equinoctial tempests, which I found myself unable to prohibit or restrain. I have administered this great office with exact justice, and made to the different nations of the Earth an impartial dividend of rain and sunshine. What must have been the misery of half the globe, if I had limited the clouds to particular regions, or confined the sun to either side of the equator?”