Physician and patient

by Worthington Hooker

It is not the object of this chapter to treat at large of insanity. It is my intention to speak, as briefly as possible, of some points in regard to its causes and its treatment, which ought to be understood by the community.

The causes of insanity may be divided into two classes—those which act upon the mind, and those which act upon the body.

The mental causes of insanity do not produce the disease directly through their influence upon the mind. But this influence extends to the organization with which the mind is connected; and the insane manifestations or symptoms are entirely the result of the reaction of the affected organization upon the mind. As this point has been somewhat fully elucidated in the chapter on the Mutual Influence of Mind and Body in Disease, it is not necessary to dwell upon it here.

The physical causes of insanity may be subdivided into three classes; those which act upon the great central organ of the mind, the brain; those which produce disease in other organs, affecting the brain sympathetically; and those which have a more general influence upon the system as a whole, or as a congeries of organs. In an individual predisposed to insanity by the peculiar cast of his nervous system, this malady may be induced by some local disease of some of the organs, or by an impaired state of the general health.

There is commonly too much disposition to look to some one thing, as the cause of the insanity in each individual case. And this disposition is encouraged by the tables of causes, which appear in some of the reports which are issued from our Insane Hospitals. These tables cannot be made up with any degree of correctness. They are therefore of little, if any, use; and they are even calculated to lead to error, if any great reliance be placed upon them. In the great majority of cases of insanity, the disease is the result of a concurrence of causes, and not of one cause alone. Perhaps it will be said, that in constructing these tables the predominant cause is sought for in each case. If it be, it is by no means always easy to find it. In very many cases there must be much doubt in regard to it; and in no small proportion of them candor would lead to the confession, that we are entirely in the dark on this question. In the classification of causes, the class of doubtful or unknown should be much more numerous than it usually is in the annual reports of Institutions for the Insane.

One of the mistakes which are committed by the community, and sometimes even by physicians, in regard to the causes of insanity, deserves a passing notice. The form of the derangement is often considered as indicative of the nature of its cause. It is by no means necessarily so. For example, an individual, who in his derangement talks mostly on the subject of religion, cannot as a matter of course be considered as having become insane through religious excitement. It may have been so, but the bare fact, that religion furnishes the subjects of his insane ideas and feelings, is no absolute proof that it is so. As well might it be said, that a patient who thinks that he has no stomach, of course became insane through abuse of that organ. A very common cause of insanity of a religious character is an impaired state of the general health; and the insane ideas run in that particular channel very often from the influence of merely collateral, or adventitious circumstances.

Neither can the form of the derangement furnish any conclusive evidence as to the character of the patient. Persons of the purest minds, and of the deepest reverence for the Deity, are sometimes in their insanity exceedingly profane and obscene.

It is important that the public should be informed in relation to the causes of insanity, in order that these causes may as far as possible, be avoided. I will therefore notice some of them very briefly.

One of the causes of insanity is an indulgence of the passions. I take as an example the passion of pride. When this passion has obtained a monstrous growth from long indulgence, a severe mortification of it, especially if it be repeated or continued, will produce insanity in those who are predisposed to this disease, and sometimes in those who have no marked predisposition of this character. Many cases of this kind may be found in our Retreats.

In this connection I mention, as another source of insanity, the wrong views of life, the false principles, and the sickly sentimentalism, which are infused insensibly into the mind by a very large proportion of the fictitious literature of the world. This influence is a more prolific source of insanity than is commonly supposed. Not only is it exerted upon the reader as an individual, but it affects through the multitude of readers the general tone of thought and feeling, and thus acts widely, not merely as a particular, but as a general cause of insanity.