Text-book of forensic medicine and toxicology

by R. J. M. Buchanan

If, however, it becomes accepted as a reality and the person becomes obsessed thereby, it becomes a delusion.

Delusions.—A delusion is a chimerical thought, an affection of the mind. It implies a disordered intellect. Delusions generally concern the insane person, his power, soul, &c. A delusion is a perverted idea of the mind in which there is belief in non-existent things or occurrences. Delusions may be based upon previous hallucinations, or arise out of erroneous conceptions.

MANIA

Mania is the result of a morbid condition of the brain, and to express which “the term raving madness may be used with propriety, as an English synonym for mania. All maniacs display this symptom occasionally, if not constantly, and in greater or less degree.” Like other diseases, mania observes the same pathological laws. There is a period of incubation, during which the true state of the patient is in most cases misunderstood, or not appreciated. Mental exaltation may exist from the first onset of the disease, or the attack may be ushered in by a stage of gloom or despondency. The general health shows signs of impairment, the liver becoming sluggish, and the bowels confined or relaxed. In some cases a febrile condition of the system is among the premonitory symptoms of an attack of mania. The physical health is not usually much affected during the paroxysm.

Dr. Conolly remarks that “even acute mania is not always accompanied by the ordinary external signs of excitement. It would seem as if we had yet to learn the real symptoms of cerebral irritation. Certainly, in recent cases of mania—cases which have lasted more than six weeks, and in young persons in whom I have seen the maniacal attack pass into dementia—I have known the most acute paroxysms of mania exist, rapid and violent talking, continual motion, inability to recognise surrounding persons and objects, a disposition to tear and destroy clothes and bedding, without any heat of the scalp or of the surface, without either flushing or paleness of the face, with a clean and natural appearance of the tongue, and a pulse no more than eighty or eighty-five.”

This may occur in some cases, but in the majority there is always some amount of physical derangement; the system, however, gradually becoming tolerant of the undue excitement to which it is subjected.

Following the classification adopted, Intellectual Mania will now be briefly considered under its two divisions—General and Partial.

General Intellectual Mania.—By many medical writers general intellectual mania is divided into mania and melancholia. The mind in the former type of the disease is involved in the most chaotic confusion possible, and there is also considerable bodily derangement. The moral faculties become more or less affected, and the patient‘s social and domestic relations are greatly altered. At one time he is subject to violent fits of immoderate laughter, at another he is gloomy and taciturn; sometimes quiet and tractable, at others wild and excited, necessitating close confinement. He is haunted by wild delusions, which at times take entire possession of him, and under the influence of which he acts in the most extraordinary manner. In the latter—melancholia, or mania with depression—delusion may be absent, or, rather, for a time undetectable. The sufferer is gloomy, and troubled with unhappy thoughts, which sometimes lead him to self-destruction. He is sleepless, and rejects his food as unnecessary. He may be aroused for a short time by questions addressed to him, his replies to which are usually given correctly, most frequently in monosyllables; but the moment his questioner leaves him he relapses into his former gloomy state.

Partial Intellectual Mania.—The term monomania, first suggested by Esquirol, is now generally given to this variety of insanity. The patient, in the simplest form of this disorder, becomes possessed of some single notion, which is alike contradictory to common sense and to his own experience. Thus, he may fancy himself made of glass; and influenced by this idea, he walks with care, and in dread of being broken by contact with other bodies. In the case of an inmate at the City of London Asylum, the presence of a weasel in the stomach was stated by one woman. Esquirol mentions the case of a woman with hydatids in her womb, who believed that she was pregnant with the devil. Most of these strange fancies appear to be dependent on errors of sensation.

Monomaniacs are ready enough to declare their predominant idea; yet at times, and that without the occurrence of a lucid interval, they will as carefully conceal it. “In the simplest form of monomania, the understanding appears to be, and probably is, perfectly sound on all subjects but those connected with the hallucination. When, however, the disorder is more complicated, involving a longer train of morbid ideas, we have the high authority of Georget for believing that, though the patient may reason on many subjects unconnected with the particular illusion on which the insanity turns, the understanding is more extensively deranged than is generally suspected.”