One of these cases, illustrative of this necessity of more delicate and intellectual treatment in certain states of mental aberration, I am advocating, I may mention. It is that of a lady who had been, upwards of seventeen years, in alternate states of excitement and depression, and in confinement all this time, whose recovery I attribute, combined with medical means, principally to such attention.
No. 335 was first admitted of her own accord, March 5th, 1826, aged 56; discharged May the 4th, 1826; again returned of her own accord, June 30th, 1826 [36]
This case was a most striking sample of a great number of a similar description, who are the subjects and victims of this perverse and irregular mental excitation, which become, without proper management, more confirmed cases of mania and melancholia, which continuance in this state for a sufficient time, produces disease, and disorganization of the brain, and ultimately terminates in incurable dementia, either of a partial or more general character.
She was a person of a highly sanguine temperament, possessing by nature great capabilities, but her intellectual powers had not, by education or circumstances in life, been so much developed and increased as her energetic feelings, which were most excitable, strong, and active. If her education had equalled her natural endowments, her understanding would have assumed no common pre-eminence, and in which case her feelings would probably have been brought under due subordination. It was not, however, so much even the defects of her education, as the circumstances of her life, and especially those connected with her religious associations, which were incomparably more calculated to increase the strength and activity of her feelings, than to call forth and cultivate her intellectual powers; indeed, instead of any such cultivation in any proportionate degree, there is every reason to believe, these associations had a paralysing influence; nor perhaps were any habits of self-control, or any mental restraint whatever, formed or acquired in this connection, except that which operated too exclusively on her religious and conscientious fears; and hence, without entering into the details of her history, the result was the formation of a character, such as is most common under the present artificial systems and circumstances in modern times, ill formed to withstand the effects of adverse or prosperous fortune.
It was her lot to pass through these extremes, and after suffering many reverses, mortifications, disappointments, bereavements, and some matters of a private and most afflictive nature, she had a rheumatic fever, when the explosion took place; then the weak and over-exercised parts of her mind displayed themselves in an irregular and increased degree. Her state was an exaggeration of her former energetic and acute nervous sensibility, operating alternately on the depressing, and exhilirating passions.
When she came to me, for she had been in various places previous to this period, she was in a state of religious melancholia. Her conscientious fears were dreadful, and her misery extreme. She conceived herself condemned to eternal punishment—she was already in torture. When in this terrible state, she had more power to engage one’s commiseration, than any patient I ever had. Her descriptions of her own state were extremely eloquent and affecting, and her appeals for sympathy were overpowering and irresistible, and I was absolutely worn out and overcome by the fatigue and misery I endured in my efforts to console and restore her. I shall always continue to feel the painful effects of my anxious exertions in this and several similar cases of melancholia; but no case and perhaps no number of cases, shook and overwhelmed my nervous system as this did, (unless it be one through whom I had a nervous fever); not merely because of her extreme agony, but my own health and spirits were then in a very depressed state, having been for years a martyr to chronic enteritis and gastritis. I mention this to account for the obligation I felt myself under, to dissever my sympathies from this overwhelming influence, and to transfer her to the kind care of Mrs. Allen, to whose lively and cheerful disposition, uniform and judicious kindness, combined with great firmness and gentleness, soothed and softened her melancholy state, and, in time, tempered the extremes to which she had been subject, and kept her spirits in a better direction.
One great art in this management was that of Mrs. Allen’s making her useful as her deputy in every thing in the house, either in matters of a household nature, or in attending upon others. And notwithstanding her own miserable state, no one was ever more qualified for a nurse, or better understood every thing connected with the arrangements of the table; and her very perfection in all these matters, had, before Mrs. Allen came, been the cause of an increase rather than a relief to her misery, for she became the object of great jealousy and dislike to my housekeepers and matrons, on this score: but now it became a source of employment, amusement, and diversion. Though she long continued to possess, for the most part, this disposition to fall into the same miserable state, yet it never afterwards degenerated into that dreadful agony and distraction I have described. At times it ceased altogether, and her more happy state supervened, when she was full of hope and self-esteem, of life and activity, the very antipodes of her former state. But it is altogether astonishing how both these states were lessened and kept in check by Mrs. Allen’s manners, combining the most inflexible firmness with admirable tact and good nature. When all her almost exhaustless fund of sympathy failed, it was always found a sufficient check, and at once to call forth our patient’s powers of self-control, for Mrs. Allen to say that she really could not bear the association of her miserable state any longer, and that they must separate; and it was very seldom necessary to hold out the threat, that she must be removed into the gallery and back part of the house.
Perseverance in this system of unwearied and perhaps unequalled kindness, gradually mitigated and diminished these alternate states of excitement and depression; thus shewing to demonstration, that in this way, with the aid of medical treatment, the excitement of the depressing and the exhilirating passions may be checked and restrained, so that in time they may regain their due equilibrium;—that instead of these cases degenerating, as they have almost always done, into hopeless cases of mania or melancholia, and often terminating in complete dementia, they, by this system, might in process of time regain the due equipoise, or the relative and appropriate share of the exercise of the different functions of mind, and be brought, as in the case just described, to repossess the greatest of blessings, the healthy action of the feelings and faculties in the discharge of those duties which constitute alike the object, the usefulness, and the happiness of her present existence.
I mention such cases, because I shall hereafter do all I can to draw attention to similar mental states, as the common causes of insanity. That almost all cases begin in this way, but that they are disguised or kept from our view, with those who possess self control, until (unless the tendency be cured by such efforts to disguise it) they at last burst forth into some form of insanity; and indeed insanity itself may be defined generally, the uncontrolled over-excitement, imbecility, suspended or paralysed state of one or more of the mental functions, arising from some previous faulty state of action. I shall have to show hereafter how all these cases might in their incipient and curable stage have their specific modes of moral and medical treatment applied in order to counteract and cure them; and by this method incurable cases would be almost unknown.
At the same time let it be observed, that such treatment requires much more delicate and intellectual attention than is in the power of those who for the most part live amongst the insane, and, have the direct and important management of them; and that, in justice to ourselves, I have a right to assert, that where such treatment has existed, and does exist, it is not a matter which money can remunerate, and that in this case there was no pecuniary reward. It was no such inducement that had any influence in regulating the conduct which we pursued with such unwearied diligence; and not merely was there no pecuniary reward, but even gratitude was wanting for a time; for this attention was so delicate, that she was always made to feel she was the person conferring rather than receiving favours; so that when she was relieved from her depressed state, and it was superseded by the excitement of the exhilirating passions, her self esteem dwelt only on the favours she imagined she had been conferring. She was useful, but her usefulness was more for her own good than for ours. Indeed, we paid the price of patient endurance to a degree and extent which can never be conceived or known, still less was she in a state to perceive or appreciate our motives, therefore she conceived, and was confirmed in the impression that she was actually the person to whom obligation and gratitude were due. This impression was the last remains of her disease, or of that over-excitement of the exhilirating passions, which with the longer-continued paroxysms of the over-excitement of the depressing passions, constituted the character of her case; and she left us, not merely before the “high state” had solely subsided, but at the very time when we felt it to be our duty to restrain and subdue it, and of course when she felt most mortified, and was least able to perceive and appreciate our motives, but which she has since done to our entire satisfaction.