As the terms Mania and Melancholia, are in general use, and serve to distinguish the forms under which insanity is exhibited, there can be no objection to retain them; but I would strongly oppose their being considered as opposite diseases. In both there is an equal derangement. On dissection, the state of the brain does not shew any appearances peculiar to melancholia; nor is the treatment, which I have observed most successful, different from that which is employed in mania.
As the practitioner’s own mind must be the criterion, by which he infers the insanity of any other person; and when we consider the various, and frequently opposite, opinions of these intellectual arbitrators; the reader will be aware that I have not abstained from giving a definition of madness without some reason. There is indeed a double difficulty: the definition ought to comprize the aberrations of the lunatic, and fix the standard for the practitioner.
But it may be assumed that sound mind and insanity stand in the same predicament, and are opposed to each other in the same manner, as right to wrong, and as truth to the lie. In a general view no mistake can arise, and where particular instances create embarrassment, those most conversant with such persons will be best able to determine.
The terms sound mind and insanity are sufficiently plain. If to an ordinary observer, a person were to talk in an incoherent manner, he would think him mad; if his conduct were regular, and his observations pertinent, he would pronounce him in his senses: the two opposite states, well marked, are well understood; but there are many different shades, which are not so likely to strike the common examiner.
CHAP. II.
SYMPTOMS OF THE DISEASE.
On this part of the subject, authors have commonly descended to minute particularities, and studied discriminations. Distinctions have been created, rather from the peculiar turn of the patient’s propensities and discourse, than from any marked difference in the varieties and species of the disorder. Every person of sound mind, possesses something peculiar to himself, which distinguishes him from others, and constitutes his idiosyncrasy of body and individuality of character: in the same manner, every lunatic discovers something singular in his aberrations from sanity of intellect. It is not my intention to record these splintered subdivisions, but to exhibit the prominent features, by which insanity may be detected, as far as such appearances seem worthy of remark, and have been the subject of my own observation.
In most public hospitals, the first attack of diseases is seldom to be observed; and it might naturally be supposed, that there existed in Bethlem, similar impediments to an accurate knowledge of incipient madness. It is true, that all who are admitted into it, have been a greater, or less time afflicted with the disorder; yet from the occasional relapses to which insane persons are subject, we have frequent and sufficient opportunities of observing the beginning, and tracing the progress of this disease.