Essay on the Classification of the Insane

by M. Allen

Dr. Halloran, in his practical observations on Insanity, says,—“Chronic insanity is that form of the disease, which, having passed through the acute and convalescent stages, has assumed the more permanent character, and is known by the frequent exacerbation of the original accession; also, finally, under circumstances of less violence, and with symptoms subacute in relation to the primary affection.” He adds,—“There are few Practioners of the most ordinary discernment, who will not feel themselves disposed to acknowledge that cases of insanity, precisely of this form, compose the greater majority of those committed to their care.” He further says,—“That these paroxysms are for the most part periodical in their approach; for though of shorter duration, they continue pertinaciously unyielding.”

From the observations which I have to suggest, it will be seen, that I conceive in some instances, in opposition to Dr. Halloran, and some others, that the chronic type, or the paroxysms of some of the permanently insane, are merely an exhibition of the irregular increase in the stock of their animal spirits, and not an exacerbation or new accession of the disease: and that even, in many cases, where the alternating changes of excitement and depression are most striking, I believe they first originated in those fluctuations of the animal spirits, common to all of us; in some instances, it is true, (and the case last described is one,) singularly modified, not merely by the state of mental alienation, but by circumstances connected with their confinement. Before, however, I endeavour to explain these singular modifications, it appears necessary to premise some observations on one of the causes which conspires to produce them, which cause is connected with the atmosphere.

But as I intend to devote an Essay on Atmospheric influence, I shall content myself with asserting, in the mean time, that there is some common cause, or causes, assigned either to atmospherical changes, or co-ordinate with these changes, affecting the animal spirits of the sane and the insane—of the healthy and diseased, (in all, the manifestation is according to individual state,) is generally, and indeed, I might perhaps say, universally admitted, that the fact will require no further proof, either to introduce or confirm its truth. There is then a certain periodicity in the excitement and depression of our spirits, as well as in all our diseases, mental or corporeal, so absolutely certain, that it must be the conjoined effect of some order in the operations of nature, and cannot be explained on the principle of accidental or apparent coincidence, by which credulous and superstitious minds are often deceived.

Though the artificial habits and constitutions of men must modify these influences, we still, notwithstanding, often perceive the effects are simultaneous in time, and sometimes that they preserve the same type, and as such artificial modifications do not exist in the same degree in the animal creation, especially in those undomesticated, on the contrary, these influences are so uniform on them, that the signs and symptoms of their presence are the barometers of rural life, it follows that these very modifications in men, when rightly perceived, are additional proofs of their being the effects of one cause.

Even in man the influence of seasons, climate, and all violent atmospherical changes, are so striking as to be admitted by all, because they are so powerful as to overwhelm all artificial counteracting modifications; but, as it regards all common and minor influences, even when the effect on the mass are coincident in time, they are in individuals so modified by the specific habits, the state of the health, and the peculiar state of mind, that they become so much disguised, and of course so much less obvious to common observation, that even some medical men will deny atmospherical influences altogether when held forth as objects of scientific investigation, and ridicule as fanciful the man who maintains a firm and well-grounded philosophical faith in them; this is most inconsistent, and is like admitting a clock may mark hours, but cannot mark minutes as they pass.—It is the child who has just discovered the use of the hour, but not of the minute hand, of a time-piece.

The philosopher knows that the unobserved and silent influence is the most important, and that the striking results are the mere indexes of its secret movements.

Let ignorance pretend to admire these striking results, and laugh at him who is anxious to discover the cause which produces them; he has incomparably more interest and pleasure, his eyes more open, and his understanding more exercised in these common facts, than other men, while yet he deems them as nothing compared to the end they serve; they are indeed interesting in themselves, but to him they are most interesting, because he considers them the means, but still only as the means, by which he obtains the noblest object which the light of his reason can discover—the discovery of those principles, or of that order of operation of the cause which produces them.

Medical libraries are full of books on the influence of seasons and climate, miasmata, malaria, and other local causes of disease: and they admit also that the influences of all these are such, that almost all diseases common to man will exhibit altered and corresponding symptoms under these varying circumstances, proving they participate in, and are conjoined (or “tinged as it were,” as it is said by some,) with them.

All this, however, I leave for the Essay on the Atmosphere, but I mention these facts and observations in the mean time for the sake of this argument, that if all these modifications are admitted to exist among the sane, how much more strikingly must the peculiar circumstances, the singular habits, and the altered state of mind of the insane, modify the effects of this influence:—so strikingly, that I have no doubt, from these causes, may be explained the very singular exhibitions in this last-mentioned case. Where the particular state of mind, and the peculiar circumstances connected with his confinement, have superinduced in the system the irregular accumulation and expenditure of the nervous energy, so that, though the increase of the animal spirits was, in the first instance, the common effect of a cause operating in and through all, every where,—yet, operating through, and modified by, the peculiarities connected with his case, has in time produced in him, as well as in a less striking degree in others, and in fact, in many, though certainly not in all cases of insanity, effects so very singular and striking.

Again, these changes of the atmosphere, which produce these effects on the sane, seem, on the insane, in many cases, to be wholly expended in producing fluctuations on the animal spirits (not in bodily effects,) so expended, as if this increase of the vital energies were neither subject to the usual laws of corporeal nor intellectual distribution. These insane, consequently, are less subject to disease from these causes, as if they, no longer responsible, paid not, therefore, the price of the use and abuse of the energies continually imparted to all. It is true, that the life they lead, not only removes them from many causes of disease, but the very nature of their diseased state, also, renders the mind more susceptible of impressions, for, beside their excited state, by being shut out from the world, they necessarily give to trifles all the importance of weightier matters, and thus it is, that by their being the victims of mental excitement, [133a] which is every where a protection against prevailing diseases, they are not so liable to be attacked by the prevailing epidemics. [133b]