How to Care for the Insane: A Manual for Nurses

by William D. Granger

Mania and melancholia are at first considered acute and curable, but, if recovery does not take place, they pass into either chronic mania or chronic melancholia, or, if the mind is much enfeebled, into a condition of dementia.

Mania.—In mania the mind is generally very active, though lacking in control, and is irregular and illogical in its action; the patient talks rapidly, and upon many subjects, and is often incoherent, or he laughs, sings, dances, or cries, perhaps in turn; he is often irritable and unreasonable, and perhaps threatening, and becomes more violent if interfered with.

Accompanying this mental excitement there is frequently persistent loss of sleep, constant restlessness, and great bodily activity, and indifference to or refusal of food. Sometimes the brain excitement is so great that all self-control is lost, and the patient becomes a raving maniac.

The delusions of mania are largely of grandeur and self-exaltation; the patient thinks himself in the best of health, and very strong, or of a superior mind, or, that he is a great singer, poet, actor, or preacher; perhaps, taking a higher flight, he thinks himself possessed of the wealth of Vanderbilt, or that he is the Pope, or the President, or even God himself.

Sometimes the excitement comes on in paroxysms, lasting a few days or weeks, with periods, more or less prolonged, of comparative mental quiet.

Melancholia.—In melancholia the expression of the face often tells the character of the disease; the eyes are downcast, the lines of the face are lengthened, and the whole appearance is that of unhappiness.

In this form of insanity the patient may refuse to speak or interest himself in any thing, or he may moan, groan and cry, and walk back and forth wringing his hands; when he is quiet, the mind, however, may be very active and full of delusions, which occupy it to the exclusion of every thing, driving away sleep, and making him indifferent to the taking of food or attending to his most necessary wants; sometimes the patient talks a great deal, but always about his delusions, which are generally connected with himself, his family, or his affairs.

Melancholiacs are often tortured by fears, and, therefore, become frenzied and as wild and violent as in mania; or they may be very suspicious, thinking that some one is persecuting them, or poisoning their food, or following to kill them. On account of their delusions they frequently refuse food, they generally sleep poorly, and are often very suicidal.

Dementia.—This form of insanity is most frequently the result of acute mania or melancholia, and comes after the force and intensity of the disease has spent itself, leaving the mind crippled and weakened. The perceptions are blunted and distorted, memory fails, the reasoning powers are weakened, the will has ceased to control, the emotions and appetites are dormant or changed, and the mind may become almost a blank, though in the narrow circle of thought there is left remains of delusions, illusions, and hallucinations. The patient is frequently careless of the ordinary necessities and decencies of life, and requires constant care.

There are degrees of dementia: it may be slight, partial, or nearly complete. During the first few months or years dementia often ends in recovery, but, as it continues, the case becomes more and more hopeless.