1. We know that the physiological characteristics of normal sadness are reducible to a single formula: lowering of the vital functions. The same is the case with melancholia, where, however, the organic depression is much more accentuated. Constriction of the vaso-motor nerves, resulting in a diminished calibre of the arteries, anæmia, and lowered temperature of the extremities; lowering of the cardiac pressure, which may descend from an average of 800 grammes to 650 and even 600 grammes; a progressive slackening of nutrition, with various resultant manifestations, such as digestive troubles, checked secretions, etc.; slow and rare movements; a dislike of all muscular effort, all work, all physical exercise, unless there are (as sometimes happens in cases of agitated melancholia) moments of disordered reflex movements and attacks of fury. Such is the general condition. It is obvious that this represents pain carried to an extreme degree, and that we find, here too, as well as in normal melancholy, passive and active pains.
2. The psychic characteristics consist, in the first place, of an emotional state varying from apathetic resignation to despair; some patients are so crushed as to think themselves dead. It has been noted that, in general, persons of a gloomy disposition are inclined to melancholia, while those of a cheerful one rather tend towards mania. In both cases there is an exaggeration of the normal condition. The intellectual disposition consists in the slackening of the association of ideas, in indolence of the mind. Ordinarily, a fixed idea predominates, excluding from the consciousness all that has no relation to it; thus the hypochondriac thinks only of his health; the nostalgic, of his country; the religious melancholiac, of his salvation. Voluntary activity is almost nil; aboulia, “the consciousness of not willing, is the very essence of this disease” (Schüle). Sometimes there are violent and unexpected reflex impulses, which are a new proof of the annihilation of the will. To sum up: while normal sadness has its moments of intermission, the melancholiac is shut up in his grief as if by an impenetrable wall, without the slightest fissure through which a ray of joy might reach him.
Here arises a question we cannot neglect, because it is connected with one of the principal theses of this work, the fundamental part played by the feelings. Passive melancholia, being taken as the type of the painful state under its extreme and permanent form, what is its origin? There are two possible answers. We may admit that a physical pain, or a certain representation, engenders a melancholic disposition, and poisons the affective life. Or we may admit that a vague and general state of depression and disorganisation becomes concrete and fixes itself in an idea. On the first supposition the intellectual state is primary, and the affective state resultant. On the second the affective state is the first moment, and the intellectual state results from it.
This problem, rather psychical than practical, has only occupied a very small number of alienists. Schüle admits the twofold origin.[[50]] Sometimes the patient, suffering from a painful and causeless depression, which he cannot shake off, inquires no further; but, most frequently, he connects the painful feeling with some incident in his previous or present life. Sometimes, much more rarely, the haunting idea is the first to appear, and forms the pivot of the melancholic state and its consequences. Dr. Dumas,[[51]] who has devoted a special work to this question, founded on his own observation, comes to the same conclusions as Schüle. One of his patients attributed her incurable sadness, in turn, and without sufficient reason, to her husband, to her son, to expected loss of work. In others, the melancholy is of intellectual origin: the loss of fortune, the idea of irrevocable damnation, etc. He is thus led to admit that a melancholia of organic origin is the most frequent, one of intellectual origin the rarest.
Can we trace back these two modes of manifestation to a common and deeper cause? This is Krafft-Ebing’s[[52]] solution: “We must consider psychic pain and the arrest of ideas as co-ordinate phenomena; and there is reason to think of a common cause, of a nutritive trouble of the brain (anæmia?), leading to a diminished expenditure of nervous activity. Taken comprehensively, melancholia may be considered as a morbid condition of the psychic organism founded on nutritive troubles, and characterised on the one hand by the feeling of pain and a particular mode of reaction on the part of the whole consciousness (psychic neuralgia), on the other by the difficulty of psychic movements (instinct, ideas), and finally, by their arrest.”
I am unwilling to incur the reproach of inferring more from facts than they contain, and of insisting on unity at any price; but it follows from the preceding that if the element of feeling is not everywhere and always primary, at least it is so in the majority of cases. Besides, it is closely connected with fundamental trophic troubles, so that we arrive at the same conclusion by another road. Dumas (op. cit., pp. 133 et seq.) has insisted on the depressing influences of marshy soil, on the stagnation, the physical and moral apathy of the inhabitants of Sologne, the Dombes, the Maremma, and other regions infested by malaria, a condition which may be summed up in two words, sadness and resignation. These facts are quite in favour of the organic origin of melancholia.
The special study of the anomalies of pleasure and pain is not important for itself alone. The formula generally admitted since Aristotle, which couples pleasure with utility, pain with what is injurious, admits of many exceptions in practice. Perhaps the constitution of a pathological group in the study of pleasure and pain may permit us to solve some difficulties, to prevent the rule and the exceptions being placed on the same plane, and unduly assimilated to one another. We shall see that this is so in one of the following chapters.
CHAPTER V.
THE NEUTRAL STATES.
Two methods of study—Affirmative thesis founded on observation, deduction, and psycho-physics—Negative thesis: the psychological trinity; confusion between consciousness and introspection—Diversity of temperaments.
Up to the present, pleasure and pain have been studied first separately, as two perfectly distinct states, pure, by hypothesis, from every admixture. We then examined those singular cases where pain becomes the material or occasion of pleasure, and vice versâ. We have still to speak of those cases where the agreeable and the painful coexist in varying proportions in the consciousness—e.g., in the mountain-climber who feels at the same time fatigue, the fear of the precipices, the beauty of the landscape, and the pleasure of difficulty vanquished. Nothing is more frequent than these mixed forms; they would even be the rule if one could admit, with certain authors, that there are no unmixed pleasures or pains; but by their complex and composite nature they are, in fact, emotions, and we shall come to them again later on.