Essay on the Classification of the Insane

by M. Allen

Whatever influences prevail externally, they must in all cases, sane and insane, be counteracted and modified by internal influences.

But to enter upon this investigation is not at present my intention, therefore I shall not now examine the question, whether the epidemics of different times, and the character of all diseases, which always partake, more or less, of the prevailing epidemic, can be wholly [134] explained as being caused by some difference in the prevailing state of the weather. I shall only remark that it is certain such seasons and states of the weather are equally fruitful in the production of insanity and in the excitement of those already insane. Yet, from these internal mental or moral influences, it is evident that neither insanity nor epidemic diseases can prevail exactly in proportion to the state of the weather, unless it could be proved there always existed a correspondence between the state of the weather and the moral and physical susceptibilities or predisposition of the persons exposed to its influence.

At the same time I assert that our moral state has more to do with disease, either directly or indirectly, than is generally credited, yet these moral causes are necessarily every where physical in their operation, so that the assertion that our physical corresponds with our moral state, and what we call physical causes are the effects of this state, need not alarm us, in fact, the interesting truth is now demonstrated, [135] that health and longevity correspond with our moral state, (though this is true as a general principle, there are many real and apparent exceptions,) in fact, natural and moral effects co-operate, just as the circulation depends on the nervous energy, so the nervous energy depends greatly on our mental condition.

Whether, however, the causes of diseases are more of a mental or corporeal character, is not now the question to decide.

For though in the Essay I propose to give on atmospheric influence, I shall endeavour to point out the various causes which may give rise to an irregular display of the spirits of the insane, I am far, however, from denying, that there are alternate states of excitement and depression, of better and worse days, which we may not be able to trace to these causes, but which may depend on principles similar to other physical intermittents, just as we have periodical head-aches, having their accession and intermission most frequently every alternate day, and yet, even in these cases, I have been able to discover the origin of these head-aches, as was my own case, to alternate sleepless and distressing nights. Looking at these periodical exacerbations of insanity, without tracing them up to their first causes, they seem like the operation of some disturbing cause, requiring a given time to arrive at their crisis, or to produce the effect, and when produced, to subside again, and this cause, thus viewed in its less remote operation, seems altogether of a physical nature. But this periodicity, which I also advocate, will be more fully examined in the third section of the Essay on Atmospheric Influence, in which some observations will be ventured on lunar influence.

Let the reader in the mean time take it for granted that such an influence exists; we shall then be able to examine the modifying influence which the peculiar state of the mind, in each, among the insane, must have over their manner of exhibiting these alterations in their animal spirits, especially among the old incurable cases, labouring, as it has been said, under the chronic form of insanity.

Often, after the first attack, their minds are left in an imperfect state; yet, notwithstanding this inability to discharge the functions of mind properly, they generally retain their physical energies, enjoy vigorous health, and, of course, the flow of their animal spirits dependent thereon, is more likely to be improved than otherwise; with respect to mind, however, they not merely want volition, and the common motives and principles of control over themselves, but there have been circumstances connected with their confinement, which, co-operating with the excitement, (the cause of which I shall hereafter attempt to explain,) have formed in the system regular periodical returns of these states; so that, at these periods, they not only, more obviously, exhibit these changes in their spirits, and, of course, display without disguise, their peculiarities of mind, as children do, and sometimes as even men do, when warmed with friendship, or with wine; but they also do so in a higher degree, and, of course, with all their latent imperfections of mind, in a much more striking manner; they then “show themselves,” their peculiar character and defects; nor should this explanation of the periodical return of these states of excitement, from the above-mentioned co-operating causes, surprise us; we may every day witness the operation of the same principle, among men possessed of reason.

We all know, whoever gratifies any passion, or accustoms the system to any artificial stimulus, at stated periods, invariably finds the difficulty of resisting this passion, and his inclination for this stimulus greatest, at the usual period of gratification: and so it is with the expenditure of animation; in fact, nothing is more certain, than that both mind and body become the slave of those customs, which the manner of our living, and moral conduct, and the circumstances through which we have passed, have fastened around us. Now, as the circumstances and treatment of the insane, have hitherto been different from common life, (the object ought to be, in the treatment of the insane, to resemble common life as much as possible;) and as they are without control over themselves, their mode of displaying their more animated state, must be as different from the civilized man, as the civilized man is from the savage. If, then, habits of civilization may be called a second nature, here it may be said, that a third has been superinduced.

From these circumstances and states of mind, it appears, that, instead of their stock of animal spirits being expended, under the guidance of a moral agency, and regularly diffused over their existence, they are subject to mere physical influence, and become the sport of every eddying wind that blows; and therefore we find every possible variety and irregularity exhibited.—A perfect contrast to that of the good and wise man, if such a one can be found, whose balance of mind is preserved, whose spirits are tranquil and even, who enjoys perpetual sunshine within, and diffuses peace and serenity around him.

Thus, because when their spirits are buoyant, they strangely exhibit their inherent defects of mind, it has in many instances been mistaken for an exacerbation or a returning accession of the disease, and called the chronic type of old incurable cases.