Observations on Insanity - Observations on Madness and Melancholy

It is well known, that maniacs often suppose they have seen, and heard those things, which really did not exist at the time; but even this I should not explain by any disability, or error of the perception, since it is by no means the province of the perception to represent unreal existences to the mind. It must therefore be sought elsewhere, probably in the senses, or in the imagination.

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I have known eight cases of patients, who insisted that they had seen the devil. It might be urged, that in these instances, the perception was vitiated; but it must be observed, that there could be no perception of that, which was not present and existing at the time. Upon desiring these patients to describe what they had seen, they all represented him as a big, black man, with a long tail, cloven feet, and sharp talons, such as is seen pictured in books. A proof that the idea was revived in the mind from some former impressions. One of these patients however carried the matter a little further, as she solemnly declared, she heard him break the iron chain with which God had confined him, and saw him pass fleetly by her window, with a truss of straw upon his shoulder.

It must be acknowledged, that in the soundest state of our faculties we sometimes perceive things which do not exist. If the middle finger be crossed over the forefinger, and a single pea be rolled under their extremities, we have the perception of two. By immersing one hand into warm, the other into cold water, and afterwards suddenly plunging them both into the same fluid, of a medium temperature, we shall derive the sensations of heat, and cold from the same water, at the same time. The power, by which the mind perceives its own creations and combinations is perhaps the same, as that by which it perceives the impressions on the senses from external objects.

We possess the faculty of raising up of objects in the mind which we had seen before, and of prospects, on which we had formerly dwelt, with admiration and delight; and in the coolest state of our understanding we can even conceive that they lie before us. If the power which awakens these remembrances in a healthy state of intellect, should stir up distorted combinations in disease, they must necessarily be perceived; but their apprehension, by no means appears to imply a vitiated state of the faculty by which they are perceived. In fact, that which is represented to the mind, either by a defect or deception of the senses, or by the imagination, if it be sufficiently forcible and enduring, must necessarily be perceived.

That "confusion of ideas" should be the necessary consequence of false perception, is very difficult to admit. Perhaps much may depend, in the discussion of this point, on the various acceptations in which confusion of ideas may be understood.

It has often been observed that madmen, will frequently reason correctly from false premises, and the observation is certainly true: we have indeed occasion to notice the same thing in those of the soundest minds. It is very possible for the perception to be deceived in the occurrence of a thing, which, although it did not actually happen, yet was likely to take place; and which had frequently occurred before. The reception of this as a truth in the mind, if the power of deducing from it the proper inferences existed, could neither create confusion, nor irregularity of ideas.

Melancholy, the other form in which this disease is supposed to exist, is made by Dr. Ferriar to consist in "intensity of idea." I shall shortly have an opportunity, in the definition I propose to give, of attempting to prove, that this division of Insanity, is neither natural nor just, upon the ground that the derangement is equally complete in both forms of the disease. We ought to attend more to the state of the intellect, than to the passions which accompany the disorder.

By intensity of idea, I presume is meant, that the mind is more strongly fixed on, or more frequently recurs to, a certain set of ideas, than when it is in a healthy state. But this definition applies equally to mania, for we every day see the most furious maniacs suddenly sink into a profound melancholy; and the most depressed, and miserable objects, become violent and raving. We have patients in Bethlem Hospital, whose lives are divided between furious, and melancholic paroxisms; and who, under both states, retain the same set of ideas.

Insanity may, in my opinion, be defined to be an incorrect association of familiar ideas, which is independent of the prejudices of education, and is always accompanied with implicit belief, and generally with either violent or depressing passions. It appears to me necessary, that the ideas incorrectly associated, should be familiar, because we can hardly be said to have our ideas deranged upon subjects, concerning which we have little or no information. A peasant, who had heard that superior comforts of life, with fewer exertions, were to be obtained by emigrating to America, might saddle his beast with an intention of riding thither on horse-back, without any other imputation than that of ignorance; but if an old and experienced navigator, were to propose a similar mode of conveyance, I should have little hesitation in concluding him insane.

Respecting the prejudices of education, it may be observed, that in our childhood, and before we are able to form a true, and accurate judgment of things, we have impressed upon our minds, a number of ideas which are ridiculous; but which were the received opinions of the place in which we then lived, and of the people who inculcated them; such is the belief in the powers of witchcraft, and in ghosts, and superstitions of every denomination, which grasp strongly upon the mind and seduce its credulity.

There are many honest men in this kingdom who would not sleep quietly, if a vessel filled with quicksilver were to be brought into their houses; they would perhaps feel alarmed for the chastity of their wives and daughters; and this, because they had been taught to consider that many strange and unaccountable properties are attached to that metal. If a lecturer on chemistry were to exhibit the same fears, there could be no doubt that he laboured under a disorder of intellect, because the properties of mercury would be known to him, and his alarms would arise from incorrectly associating ideas of danger, with a substance, which in that state is innoxious, and whose properties come within the sphere of his knowledge.

As the terms Mania, and Melancholy, are in general use, and serve to distinguish the forms under which insanity is exhibited, there can be no objection to retain them; but I would strongly oppose their being considered as opposite diseases. In both, the association of ideas is equally incorrect, and they appear to differ only, from the different passions which accompany them. On dissection, the state of the brain does not shew any appearances peculiar to melancholy; nor is the treatment which I have observed most successful, different from that which is employed in Mania.

In most public hospitals, the first attack of diseases is seldom to be observed; and it might naturally be supposed, that there existed in Bethlem, similar impediments to an accurate knowledge of madness. It is true, that all who are admitted into it have been a greater, or less time afflicted with the complaint; yet from the occasional relapses to which insane persons are subject, we have frequent and sufficient opportunities of observing the beginning, and tracing the progress of this disease.

Among the incurables, there are some who have intervals of perfect soundness of mind; but who are subject to relapses, which would render it improper, and even dangerous, to trust them at large in society: and with those who are upon the curable list, a recurrence of the malady very frequently takes place. Upon these occasions, there is ample scope for observing the first attack of the disease. To enumerate every symptom would be descending to useless minutiæ, I shall therefore content myself with describing the more general appearances.

They first become uneasy, are incapable of confining their attention, and neglect any employment to which they have been accustomed; they get but little sleep, they are loquacious, and disposed to harangue, and decide promptly, and positively upon every subject that may be started. Soon after, they are divested of all restraint in the declaration of their opinions of those, with whom they are acquainted. Their friendships are expressed with fervency and extravagance; their enmities with intolerance and disgust. They now become impatient of contradiction, and scorn reproof. For supposed injuries, they are inclined to quarrel, and fight with those about them. They have all the appearance of persons inebriated, and people unacquainted with the symptoms of approaching mania, generally suppose them to be in a state of intoxication. At length suspicion creeps in upon the mind, they are aware of plots which had never been contrived, and detect motives that were never entertained. At last, the succession of ideas is too rapid to be examined; the mind becomes crouded with thoughts, and indiscriminately jumbles them together.

Those under the influence of the depressing passions, will exhibit a different train of symptoms. The countenance, wears an anxious and gloomy aspect. They retire from the company of those with whom they had formerly associated, seclude themselves in obscure places, or lie in bed the greatest part of their time. They next become fearful, and, when irregular combinations of ideas have taken place, conceive a thousand fancies: often recur to some former immoral act which they have committed, or imagine themselves guilty of crimes which they never perpetrated; believe that God has abandoned them, and with trembling, await his punishment. Frequently they become desperate, and endeavour by their own hands to terminate an existence, which appears to be an afflicting and hateful incumbrance.

The sound mind seems to consist in a harmonized association of its different powers, and is so constituted, that a defect, in any one, produces irregularity, and, most commonly, derangement of the whole. The different forms therefore under which we see this disease, might not, perhaps, be improperly arranged according to the powers which are chiefly affected.