Part 11

Again, in confirmation of the same argument, we may here remark, that the greatest number of those who become insane, become so between the ages of thirty and forty,—a period when establishments are formed, and habits have been strengthened by time, while the feelings yet retain all their energy and susceptibility of action. Thus we can conceive why reverses and disappointments should then have the most fatal and overwhelming influence.—Still less need we wonder that this should happen to those whose animal propensities and sentimental feelings have been exclusively cultivated, as they then find that if understanding and principle are insufficient to restrain them, the claims of society forbid their gratification. Hence the conflict becomes dreadful and dangerous, confounding and overturning the balance of the mind. Even without this, bad passions, disjointed and exclusive habits of feeling and thinking can hardly go on progressively increasing to this age, without becoming so irresistible as to threaten to destroy and swallow up in their vortex all that remains of the man within them. Such is a true and beautiful description that Johnson has given of Imlac’s insanity in his Rasselas. Any passion or propensity of our souls, when improperly indulged and carried to excess, is an abnegation of reason; and in saying this, we give a true definition of insanity, however startling this wide application may appear.

What is the most obvious history of most cases?—Thoughts and feelings are indulged on any given point, to the detriment or suppression of others which might draw us from this dangerous and exclusive habit of the mind; till at last we become incapable of resisting any other train of thought, and feeling, and action; “they are at first imperious, and at last despotic.”

When and how are all these evils to be best prevented? We answer, in the preliminary stage of our existence. We shall revert to this important subject in an essay on the primary principles of education; and shall only now remark, that where we perceive a soil full of the seeds of all these evils, we can expect only corresponding fruits? We shall conclude these remarks by directing the reader to look to the soil where these evils exist: we do this, because it exhibits the truth of the principle for which we are contending.

We see, in the history of families, that the extremes of heartless tyranny on the one hand, and the foolish fondness of blind affection on the other, engender soils equally favourable to the production of these terrible fruits to which we allude: still more so is this the case where these extremes exist in the same family.

Many are the married persons who waste their lives in inordinately and alternately hating and loving each other. From small beginnings, breezes arise and gather into storms; at last, exhausted by their violence, they subside, and for a while love returns, and all its ardent affection. Such is the brief but sad history of many a matrimonial union,—but who can describe its baneful influence?—how much evil and misery are propagated! how much reason and principle, health and happiness, reputation and prosperity, are sacrificed in those families, whose parents thus suffer reason and understanding to be the victims of these opposite and alternate mental states!

Of which states, such as become insane, are but the caricature samples of the hereditary family infirmities, and the actual habits of their lives; and perhaps this may happen to one less a hypocrite than the rest, because in such a one, the external and internal become more easily and readily in fixed and permanent correspondence. It is natural, therefore, to expect that this same character will be exhibited still more conspicuously after the understanding has altogether ceased to perform its godlike attribute of rightly using the light of pure reason so as to enthrone and support that one grand ruling principle to which the whole mind should be obedient and subordinate.

I have been the more particular in making these observations, because I conceive they may be useful in a medical point of view. They may prevent us from mistaking the simple, though modified, changes of the natural ebb and flow of our animal spirits, for an exacerbation or new accession of insanity,—and thus warn us from treating the patient with unnecessary restraint, as though he were suffering from a new attack, and from blindly endeavouring to cure a hopeless case by the wanton administration of strong and deleterious drugs, which in most instances would destroy health, as well as the remnant of the faculties: “In the diseases of the mind, as well as in all other ailments, it is an art of no little importance, to administer medicines properly; but it is an art of much greater and more difficult acquisition, to know when to suspend, or altogether omit them.” {151}

_No._ 8.—_Admitted_ 1783.

No statement on record. He was a respectable country Clergyman: his friends say he was a hard student, neglecting exercise, and all attention to himself or his health, and which had, for some time previous to the attack of derangement, been in a very precarious state—the attack was very sudden and violent.

He has a leprous eruption, which has continued since the time of his admission until now, without any very perceptibly abatement. He was formerly the most furious maniac amongst the old incurable cases, though less strikingly peculiar in his appearance and manners than the one last described. During the paroxysms of his greatest fury, he appeared like one whose mind, from excruciating pain and dreadful mental provocation, was wrought up to the highest pitch of passion and revenge; so that he would, as though he had the object of his malignity before him, be incessantly repeating, through whole nights and days, some single phrase, such as, “damn’d dog,” with a sort of suppressed barking, roaring furiousness, even until he foamed at the mouth, and his face was black with passion.

He was most violent when the eruption appeared least on the external surface. When his mind was more at ease, he would play like a little child for whole days together, with the merest trifle, such as a piece of string or paper. At these times, when given any thing he likes, he has something singularly fascinating in his smile.

For this eruption, many things had been administered, without any permanent advantage. Solution of nitric acid, about three years ago, {152} appeared to have, for a time, a good effect; the eruption became somewhat less, and the mind less violent: but this might arise from the debilitating effects, rather than the radical removal of the cause of his disease. After this, the solution of nitrate of potash, had a good effect both on his mind and the disease of his skin, without reducing or debilitating his system. He has lived, for this last twelve months, on vegetable diet, and he is apparently better; but this may be a fallacious appearance, since his vital energies appear to be sinking.

OBSERVATION VI.

It has been said, by the late Dr. Jenner, and some others, that cutaneous disorders are common to the insane. I should think they are not very common. {153} This is the only case that I have seen, where the two have continued to exist together. Whether it was the original cause of his mental malady, I have not been able to ascertain, but it is certain, it aggravated it. That mania, in some instances, follows the disappearance of eruptions, ulcers, and other local diseases, particularly with females, is satisfactorily established; but in many instances, other causes co-operate.

In cases of dementia, arising apparently from continued pressure on the brain, the surface, from the general bad habit of the system, is liable to sores, boils, and ulcerations. This cannot be called a cutaneous disease; it is rather a symptom of the diseased state of the brain, than itself the cause of insanity. Glandular swellings, however, seem to have a more direct connection; but still they appear rather before, than after the alienation has taken place. In a few cases, I have noticed slight eruptions during recent paroxysms, and in two or three, immediately previous to their convalescent state. Had such appearances occurred more frequently, I should gladly have regarded them as favourable prognostics; but they might arise from strong medicines, their state of confinement, or they might be mere accidental coincidences. There are many instances of cures by accidental injuries, {154a} as well as by the accession of consumption and other physical diseases.

Here I leave the question for the present, till I come to some cases, where, according to the theory of such a connection subsisting, (which I believe is the case in a few instances,) the tartarized antimonial ointment has been applied; {154b} but I confess, that there is no part of my experience in which my sanguine expectations of cure, after a certain duration of the disease, on this principle of counteraction, have been more disappointed. In the early stages of insanity, it is decidedly the most valuable principle in our practice.

_No._ 9.—_Admitted_ 1793.

No statement on record, that gives any satisfactory information. She was a respectable farmer’s wife, and her insanity was occasioned by her husband’s heavy losses of cattle. Her first symptom was throwing her little infant at the feet of the parish officers, saying, “there, take it.” {155} She often repeats, with a very moaning sound, and tears, “God rest thy soul, poor old mare.” She will be easily known, when I say, she is a poor, moaning, miserable looking imbecile, constantly sitting cowering in a corner, always crying for tobacco. She was one of those who were kept naked in loose straw, and hence her inclination to undress herself, her dirty habits, and her peculiar mode of sitting: indeed, formerly, throughout the house, the lowest and worst patients had no seats allowed them.

_No._ 10.—_Admitted_ 1793.

Nothing recorded of this case. It is said, that when young, he was severely kicked by a horse. There is now a considerable indentation just above his left ear.

His mind, though extremely childish, is altogether in a torpid state, for the most part quiet and good-natured; but sometimes, when more excited, he exhibits a love of mischief, generally very childishly, but sometimes more seriously so. {156a} His temperament is phlegmatic, and he has a heavy, dull look. He has been for years employed in the garden.

_No._ 11.—_Admitted_ 1793.

Nothing on record. I have been informed, that he was a well-sinker, and that his insanity was the consequence of a rheumatic fever. No one, except a complete idiot, can be in a more stupidly stagnant state of mind; he scarcely notices any thing, and never speaks unless spoken to, and then his answers are merely monosyllables. About once in twelve months, a slight exhibition of excitement shows itself in a sort of ill-tempered obstinate fit, {156b} but which soon subsides, especially with the aid of sulphate of magnesia. He is, together with No. 10, constantly employed in the garden.

OBSERVATION VII.

The observation which suggests itself on No. 10 and 11, is, that from such facts as these, it is very evident, there can scarcely be an old pauper patient in such a state as wholly incapacitates him from being brought, with a little trouble, into habits of useful employment.

As stupid men are generally less diverted from an object which once engages their attention, than men of greater capacity; so it is with these poor automata; if the first difficulty be but once overcome, that of acquiring the habit of working, there is no fear; but they will proceed in it more steadily than those who feel that they have a right to consult their own choice. They cannot be tempted, nor do they possess the power of giving their energies a new direction; and hence, as habit gathers strength, we may depend on them as on our time-pieces. If amusements and employment are good for these, how much better for those who are not past the hope of recovery; it may change the object of their thoughts, and gradually turn them to one of a less dangerous nature. I shall have some very interesting cures, partly attributable to this principle, to state in due course; in the mean time we perceive, that if even they are past the hope of recovery, they are kept in a better and more healthful state; and what is more, it diffuses a satisfactory feeling through the whole system, and they are made happier than they would be by a life of idleness.

_No._ 12.—_Admitted_ 1797.

Nothing on record; and I have failed in my efforts to obtain any information of her previous history. It is said, that her relations are respectable; yet her residence here is paid for by a parish in London. She has long been, together with No. 7, the most useful and hardworking person in the house. In the midst of her work, she will often scold and swear with vehemence, but no one knows about what, or against whom; and though her voice is loud and shrill, no one regards it, saying, “Oh! it is only poor M. W.” Yet she is very kind-hearted and friendly, giving away her own meat, especially to those who are ill; and when prevented from doing so, will throw it away with indignation. She would gladly starve herself to feed others; and always asserts, when a patient dies, “that they died for want of something to eat.” She used to practice this singular fancy, that of frightening the devil away, by taking a sweeping brush with her to bed; but now, a tin pint serves the same purpose. She is a tall, meagre-looking woman.

_No._ 13.—_Admitted_ 1798.

No statement of this case; but it is said that, in the first instance, he was very violent. His mind is now in a fixed imbecile state, and exhibits no alteration, except the slight changes which mere alterations of our spirits produce; when he is more easily provoked—talks, laughs, and sings more, or holds conversations with persons dead or absent; sometimes scolds them, fancying they tease him in some strange manner, which he calls “triangling;” but it is impossible to ascertain what ideas he affixes to the word; he is a very quiet, good-natured man, a general favourite, and is usefully employed by the attendants in the house. {159}

_No._ 14.—_Admitted_ 1799.

No statement of her case; and I have failed in obtaining any very satisfactory information about her.

[Picture: No. 14 page 159]

It is said, that she gradually became insane, after the death of her only boy, named “Charles,” (who was the natural son of Sir —:) this is probably true, as she now imagines that Charles is constantly with her—sleeps with her—that she feeds him at her meals—carries him about in a corner of her apron—nurses him—and talks to him with delight and maternal fondness. She often fancies, too, that she has been confined, and has got more children. {160}

Her appearance and manners are exceedingly polite, pleasing, and affectionate; she is attentive to others, in all those little nameless etiquettes of life, which, when regulated by truth, constitute the innocent fascination of a kind-hearted and well-bred character; and it is so with her: every one doats upon her as upon a favourite child. She never fails to tell me, if I have been out during dinner-time, when she next meets me, “you have not got your dinner, go and get it immediately;” and yet left to herself, she is wholly taken up with scolding some imaginary beings who annoy her, get into her throat, head, back, &c., run her through with swords, and do a thousand other strange and cruel things to her. Every evening she has a long scolding, with a tone three-fourths of anger and one-fourth affection, with some men who plague her in her bed and in her bed-room, and continue to do so till her attendant comes, sometimes at her call, to drive them away. Is this the lingering last impression made on her mind by her seducer? In the midst of her scolding she will often swear in a strange under tone of voice; and when accused, she says it is some other person, frequently Jack Swales. Her conversation is so exceedingly extravagant and varied, that it is impossible, except by the most lengthened description, to convey to others any adequate conception of it. Names of dukes, kings, queens, pipes of wine, sums of money, estates, &c., are as common to her as household words; yet strange as all this is, it seems to have some connexion with her past life, having formerly held a situation in a family of consequence. Her former situation and disposition are hinted at by these reminiscences, which are delightful traits of what she has been.

_No._ 15.—_Admitted_ 1799.—_Aged_ 50.

No statement on record; it is certain, however, from his own account, that he was formerly steward and butler in a gentleman’s family, and had been what some call a “hearty good fellow” all his life. His manner continued that of a blustering, passionate, half-inebriated man; {162} his skin was covered with a scorbutic eruption, and his face a bloated livid red. He died of dropsy in the chest, March 6th, 1821.

OBSERVATION VIII.

The observation, or rather the moral, in this case is so obvious, that it is almost superfluous to add, that from the nature of his case, and his own account of himself, his system both of body and mind had been brought into the extreme state of morbid irritability by the conjoined excitement of the dissipated companions, particularly of his early life,—unchecked in their effects by the exercise of any moral restraint over himself; and hence his mental powers and passions were not so much shattered and decayed, as they were like a vessel without its pilot, the sport of every wind and wave that assails it: bad habits had become too inveterate to allow the will to be taught obedience to reason; all measures of coercion, instead of inducing self-control, could only irritate and exasperate, as he was perhaps still less accessible by religion than by reason. I believe, however, that by gentle, and indirect means, he gradually became less boisterous in his manners; but it is proper also to add, that from age and disease, the sinking of his physical powers and animal spirits might imperceptibly, but more effectually, tame him.

_No._ 16.—_Admitted_ 1799.

Nothing on record.—It is said she was a belle: she is thin and tall, and is remarkable for a demure, prim, affected, stiff manner of sitting, like vanity turned to stone. She will spend hours in dressing, undressing, washing, &c. I have never heard her say more than “pretty well, thank you.” Her mind seems rather empty and motionless than diseased or deranged.

[Picture: No. 16 page 163]

_No._ 17.—_Admitted_ 1799.

Nothing on record.—She is a neat, clean, but rather crabbed-looking, middle-aged woman; and who, unless she is provoked, is scarcely to be distinguished from the sane; but when provoked, she is exceedingly abusive, and exhibits the deranged state of her mind. She is very useful as a laundress, and is known only by that name. The great objects of her affections are cats and kittens. {164}

_No._ 18.—_Admitted_ 1800.

Nothing on record.—He was an Italian, of a swarthy complexion, dark eyes, black hair; and to look on his countenance reminded one of an assassin, “the mark was upon him.” He was subject to violent fits of excitement when he was suspicious and thought himself insulted by a look or a word; and from his ignorance of the English language, he might perhaps have greater scope for suspicion. When offended, he gnashed his teeth; striking one hand violently against the other; appearing from these, and various other indications, to be preparing for action, and lashing himself into a state of the most determined revenge, he watched his opportunity, and seizing his victim with his teeth, was quite delighted if he drew blood. He bit several, some seriously; and in one instance, he bit a piece completely out of the lip of another. They all agree in the house that they never saw a patient so ferocious, or one where harsh measures _seemed_ more justifiable; yet nothing could conquer him—his attendant believes “he would have died first.” It was no accidental result of passion, but the settled object of his mind. {165a} He would chuckle and triumph over the injury he had done; and this was the more remarkable, as his mind in other respects was so much gone, that he continued to the time of his leaving the asylum, occasionally a dirty patient. Still it ought to be stated, that this ferocious disposition and these dirty habits, if they had not been absolutely grafted on his natural disposition, must have at any rate been made much worse by his brutalizing treatment; for he was one of those who were formerly kept naked in loose straw,—besides having during this time lost his toes, supposed to be from his exposure to the cold, he could not so well defend himself, and so might have been taught by necessity to have recourse to his teeth. That he was made worse by his treatment, is evident, as latterly he became sensible of kindness, and improved in personal cleanliness; and his general manners indicated much less malignity of feeling; indeed something like affection {165b} and gratitude to his attendants, began to excite in them, without effort, kindly feelings towards him. At first, (after the new state of things) it was with the utmost difficulty that he was made to keep his clothes on, or to be kept clean; but latterly, for many weeks together, he went on without any restraint whatever. He was removed in May, 1822.

OBSERVATION IX.

The observations that naturally suggest themselves on this case on the efficiency of mild treatment, are so obvious, that it would be obtrusive particularly to state them. I cannot, however, omit adverting to the fact of the probability of his having lost his toes by exposure to cold, because it illustrates the remark made in observation V. Patients, in former times, were kept naked in loose straw; and from their exposure to cold, mortifications in the extreme parts were common; and then writers on insanity say, that mortification of the extreme parts and insensibility to cold, are symptoms of mental derangement!!—See also observation 12th.

_No._ 19.—_Admitted_ 1800.

Nothing on record. He was a respectable tradesman.

He is constantly muttering and talking to himself, apparently busy in making calculations, holding in his hand something he calls an almanack, made by himself, as well as some pieces of money he has polished. He repeats something, seemingly as a duty imposed upon him, perhaps meant as a prayer. Though the shrivelled and decayed scraps of mind that remain, look only like the apparitions of his previous habits of life; yet they so wholly engross his attention, that he never notices passing and external objects around him. Sometimes, however, he can with great difficulty be for a moment diverted from his object, and while roused, will answer questions with considerable point and shrewdness, but returns as quickly into the same uniform abstracted state.

He is evidently of a contented and happy disposition. There is something in his appearance and countenance which seems to say, “I have been a respectable and good-natured fellow.”

OBSERVATION X.

The only observation here is one which I shall notice more particularly when I come to treat on the efficacy of moral management—viz. that, notwithstanding the deranged state of his mind, and the imaginary objects which occupy his attention, still he can be roused for a moment to something like a proper use of his faculties.

_No._ 20.—_Admitted_ 1801.