It further appears, that this view is correct, from the fact, that if their manner of talking and acting, in expending their increased flow of spirits, is improperly encouraged or exasperated, then we find their individual and latent defects become more obvious; but with proper treatment, they gradually die away: in fact, these appearances are more or less perceptible, in a great measure, according to the spirit and conduct of the superintendant; and even, under him, to that of their respective attendants. Of this, I could give some striking illustrations. It is astonishing how much the increased flow of the spirits will be dark, gloomy, and vindictive; or light, cheerful, and full of kindliness; just as we by our treatment excite and keep alive one part of the mind or another. The same principle might be illustrated also, on a larger scale, by surveying the conduct of different parties and governments in the world; and on a smaller scale we see every one in authority, a magistrate, a gentleman, a minister, a pastor, the captain of a ship, and a parent, stamp their character on the sphere in which they move.
Were it the place, nothing could be more instructive than examples to demonstrate the correctness of these observations.
The preceding case, I consider, is one of these examples. I have said, that for the most part, these states of excitement and depression, are merely an irregular exhibition in the accumulation and expenditure of the animal spirits, and not always to be considered, according to Dr. Halloran’s view, as the remains of the disease in the state of a returning paroxysm, and that which characterises the permanently insane; but that this originated in, and depended on, causes which equally affect the animal spirits of the sane and insane, with this difference, that in the insane, as in this case, they are modified by the peculiar state of mind, and the sort of treatment they have received.
Grant that, from the state of his mind, any little increase of animation would resemble, in a slight degree, that which he now exhibits, then I am, by the help of facts, in this and some other cases of a similar nature, justified in saying, that I have been able to trace the process and progress of these changes, from small beginnings to their present state. I know, from the best information, that his manner and appearance were, when excited, so laughable and striking, that the attendants and their friends, from want of proper feeling, or perhaps mere thoughtlessness, actually made him a source of private sport and amusement, and thus increased his excited state, which, in the course of time, assumed its present peculiar and amusing form. [141]
A minute detail of all these things, together with unnecessary and injudicious confinement, I am certain, would prove all this.
In many cases, and especially in the last, I have been able to trace, as I have already said, the process and progress of these changes, from small beginnings to their present state. In some cases, any little increase of animation gave rise to manners and conversation, which were extremely amusing, and such as tempted silly and unthinking people, as well as the other patients, to encourage by listening or assenting too much to them, or to exasperate by wantonly making them a source of sport and amusement; conduct which cannot be too strongly deprecated, especially during the critical period of their convalescence.
In most instances, however, it must be allowed, that among these old incurable cases, [142] the most powerful exciting causes are within them. When their minds are at all irradiated, striking ideas, and scenes of the past, cross their imaginations; they are further excited by them; and in proportion as the system is excited, these ideas are themselves more powerfully awakened; they have no clear consciousness nor control over themselves; and this dreaming state of their minds, to them all reality, is sometimes as cheering as the dreams of hope can make it, and at other times as horrible as the night-mare! and thus they are wrought up into the most excited or exasperated state. In some cases, especially the foregoing, this goes on until they are worn out, when they require a corresponding portion of time to renew their vital energies; and thus cause and effect mutually produce each other. These alternate states of excitement and depression, being often repeated, they gradually increase in strength and duration; and thus it is in some few cases, and especially those similar to the last, we find, that their spirits are not expended and renewed, as ours are, once in twenty-four hours, because these changes have become the habitudes of their nature, so that their system becomes governed by new laws of action. It is very singular that those most liable to extremes, are most predisposed to insanity, and in its more confirmed stage to this periodicity of excitement and depression.
I have already noticed, [143] that the excitement of the depressing and exhilarating passions alternately, is the most striking characteristic of the old insane,—so striking that the general division of insanity is intomania and melancholia; a division, however, which is altogether unphilosophical, as the mania and melancholia are not any abstract difference in the cause of the disease itself, but merely the results of the over-active nervous energy operating in different directions—at one time on the depressing, another on the exhilarating passions; this indeed is the case, more or less, with all those who preserve not this mental equilibrium, but who act more from the impulse of their feelings and passions than the cold calculations of reason, and the rigid restraints of principle. To what extremes are the passions of the human mind liable, when neither the true light of the understanding nor any right sense of justice guide them! We see this in ignorant and unprincipled individuals, who suddenly rush out of their thraldom and pupilage into liberty and licensciousness; we see the same thing exhibited by agitated and wicked masses, as in the French Revolution, when the moral, like the physical ocean, is let loose from its order and control, and heaves its tumultuous waves of passion, as if by an earthquake, from one overwhelming extreme to another.
When then, as in the insane, all the restraining powers of the mind are lost, can we wonder that the mental energies should be subject to accidental and baneful influences? that they should impetuously rush with fearful, because with unguided force, into the most opposite and direful extremes? These extremes, however, always correspond to the individual peculiarity of mind, and the nature of the exciting causes, which exciting causes often exist internally long before they become externally evident; thus gradually forming ruts in those weak or soft parts of the mind, as it were, in which their feelings are naturally more apt to run; and thus they acquire the increasing facility and strength of habit, in operating in one direction rather than another, until they become irresistible: or in other words, until the understanding has no longer the power to extricate the mind from their influence.—Body and mind have been allowed conjointly and reciprocally to produce and increase these effects. The effects are first, disordered action; next, inflamed and diseased organization of the brain, as well as this disordered action being continually strengthened by a daily increase in the power of mental association, “calling forth an increased susceptibility to the action of certain exciting causes;” and so far I agree with Dr. Halloran, that a something like the original “accession of the disease,” more readily takes place. [145a]
I have said, [145b] that in cases of permanent insanity, the alternations into these opposite mental states occur most frequently among persons whose previous character was marked by extremes,—who were easily excited, and as easily depressed, either by their hopes, their fears, their anger, or their affections. And I have often had occasion to hear these remarks on their admission; and further, that they could not bear stimulants, especially ardent spirits; and that there was insanity decidedly developed during their worst paroxysms of intoxication.