Part 3

In many cases, an entirely separate house is required. I have known cases, the cure of which would have been apparently blighted and blasted for ever, if they could not have been wholly removed from, not merely the real, but the apparent, association of former scenes and circumstances, and this without any change in their servants and medical treatment and attendance, which is also essential. Yet it is perfectly true, that in other cases this association is not so injurious as most people would imagine; the dawnings of the light of the understanding are, for the most part, so gradual, and the mists of delusion so gently steal away, that there would be a greater shock given by a sudden transfer to rational scenes and real life, than by their continuance in the place where they might be at the time.

I have often, with feelings of wonder and admiration, had occasion to observe these occurrences. I have seen a convalescent patient very much attracted by, and perfectly delighted with, the strange remarks, speeches, and conduct of another inmate, sometimes fancying it was meant purposely for his amusement and diversion; and on whom, refined wit would have been lost, while the incongruous combinations of unguided thought, which no wit or ingenuity can equal, appears, and is the very essence of wit to him. Notwithstanding the truth of all this, there are other cases,—cases of more sudden convalescence, where all this would shock and horrify, and produce a revulsion of feeling, most dangerous to them in their delicate and fragile state, and perhaps permanently fatal to their recovery. This is more particularly the danger in the incipient stage of convalescence in some violent cases of mania, {5} and where I am quite certain delicate and judicious attention have been essential; and where first, perhaps, removal to the family part of the house, then removal altogether to our own house, was apparently their salvation.

_No._ 106, _admitted April_ 11_th_, 1820, _aged_ 65.

This was one of the cases apparently saved by such timely attention, and which I intend hereafter to describe more particularly, for the purpose of illustrating both the medical and moral treatment of many similar cases of insanity. I shall, however, state so much of the case now, as will be sufficient to show, that there is not only a critical period of the disease, when judicious medical and intellectual attention arrests and prevents its transition into another and equally dangerous form of over-excitation, so dangerous, that if allowed to take its course, it not unfrequently ends in dementia, but also, and more especially to show, that in all cases our moral treatment must have in view the nature of the existing causes, in order that we may be able to adopt the most suitable methods of counteracting their effects,—a part of treatment which has hitherto been either wholly overlooked, or else exercised without much knowledge and discretion; although I am certain it is of great importance in the treatment of all curable cases of insanity, and in many cases so important, that by such methods we may ultimately succeed in removing these causes altogether; and removing them, remove also the fear of their again (at any future time) being allowed to have any baneful operation.

This person, who was a dissenting minister, had always been reckoned by all parties, one who entertained gloomy views in religion, and pushed these into extremes; his zeal was equally violent and vindictive, and he besides possessed a mind with every opposite quality in excess, and which had always, as far as I could ascertain, been in a state of irregular and discordant excitation; it is quite certain that during many years past, it had been habitually kept in a very painful and irritable state, by several causes, and one more especially deserving notice. He lived unhappily with his wife and her friends,—instead of union and harmony, all was dislike and contradiction, perpetual storms and altercations, which had just before terminated in a separation between himself and them.

Thus, from the condition of his own unsettled and ill-constituted mind, his gloomy and vindictive views in religion, his variable and irritable temper, and from the nature of the domestic excitement under which he had suffered most severely, it was easy to trace the distressing and awful form of his derangement to the causes which had produced it.

He was in a state of the most furious mania;—his was one of the most violent and distressing cases I had ever seen. It is impossible to convey any adequate conception of its appalling nature. His language was obscene and vulgar, and his horrible oaths and blasphemous speeches were poured forth for some weeks without ceasing, and without sleep, with a volubility, rapidity, and a voice so loud, and so foaming with passion, and with such a frightful expression of countenance, that even those most accustomed to such scenes, and of the strongest nerves, trembled before him. He had a demoniac energy and eloquence, which was, indeed, of the most harrowing and awful kind. It was truly terrific! for even at a distance, his voice sounded like a river escaping from some narrowed part, and rushing with impetuosity over every thing that would impede its course.

Had a short-hand writer taken down his ravings, it would have proved that this picture is far from being an overcharged one. One principle subject of his furious raving, was his favourite doctrine of Election; or rather, perhaps, I ought to say, his blasphemous doctrine of Reprobation. He was constantly denouncing every one (and against myself he was peculiarly severe) as lost, whose belief on this point was not, even in phraseology, the same as his own;—calling on God to execute vengeance upon them;—then blaspheming God, that his prayers and commands were neither heard nor obeyed;—taunting and cursing Him with a contempt which no language can describe;—calling his clemency weakness, and his not executing his decrees a proof he did not possess the power he pretended to have. In fact no one could hear and see him without feeling shocked, and without having a conviction forced upon him that there must be something wrong—some perversion of truth in those doctrines, as well as in his own mental system, out of which all this dreadful spirit, and all these terrific extremes originated, and of which this case appeared a Satanic caricature. It is a truth, that there is no error or perversion of truth that we may not perceive in reviewing the history of mind caricatured, and perhaps in a still more striking manner among those who are in confinement from being _directly_ denounced insane.

On the subsidence of his excitement, he was overwhelmed with the perfect recollection of all he had uttered during the utmost fury of his dreadful ravings, and his state was truly miserable and deplorable. In this state I took great pains with him, treated him with every possible kindness, and endeavoured to show him every possible mark of my confidence: one instance of which may be mentioned.—I gave him, at a very early period of his convalescence, a set of manuscript sermons, all in loose slips, and which he read with great pleasure, and preserved with great care. They were affectionate moral discourses, strictly, I believe, in agreement with the spirit of Christianity, though not on any peculiar doctrines; for in these I had purposely avoided all doctrinal points, although doctrinal views may, when properly presented, be the best preventives, and in some cases the best medicines, in the cure of insanity; but the circumstances in which I was at that time placed, appeared to forbid even their most cautious introduction, and were scarcely admissible to an audience consisting of some of almost all denominations. However, he said, the spirit of these discourses just suited his altered state of mind, for he himself felt horror-struck at the views which had led to such awful consequences.

Though no one can feel more than I do, the necessity of not busily trying to proselyte or unhinge unnecessarily any one’s settled opinions, yet this was an extreme case, and in such cases, where cure seems to depend on the proper administration of counteractive views, every other feeling should give way to this conviction; but at the same time, every thing depends on the judicious mode of stating these sounder views. This case was a remarkable instance of the necessity of such management; and where such views were apparently of the utmost importance to his comfort and peace. But it would require a separate Essay to defend what I conceive those sounder views; and even were I to give this striking case as a specimen of their happy influence, I still might lay myself open to cavils and objections. I shall, therefore, in a separate Essay, bring forth all the arguments, and exert all the power I possess in their defence.

Though his furious state was so unusually violent, yet it was of long duration, and after it had left him, it was some time before he was able to overcome the painful reflections which came over him; he however recovered, and returned home in the September following, since which period I have received many, and almost constant proofs of his great gratitude and attachment to me, one of which is worthy of being stated.

In the autumn of 1824, he walked about a hundred miles to see me, and not finding my place of residence, he called on a medical acquaintance, to whom his description of my kindness and attention, and their happy influence upon himself, were so powerful and eloquent, that this new and accidental medical acquaintance, became from that time to the present, my first and warmest medical friend in encouraging me to establish myself in my present residence, and to whom I have to attribute the origin of all my success; so that this recovered patient’s gratitude, who followed me unexpectedly, was the first step in my progress, and was the _sole_ foundation of every thing which I have done or exists in this place. It was my only introduction. I may be permitted, therefore, to acknowledge my great obligations to the warm-heart friendship of the person, of whose melancholy state I have just given a general description, as well as, the medical friend to whom I have alluded.

_No._ 195, _admitted October_ 27_th_, 1821.

This case, I shall hereafter show, was apparently saved by this separation from former associates, at this critical period of convalescence, and he was one who required very superior and intellectual attention.

He was a young man of some talents, and of various pursuits and acquirements, by far too many to be perfect in any one. Born with a large proportion of the family failing, his vanity had been fed by flattery and example, so much so, that it might be said he was bred in vanity’s hot-house; and ultimately, from over excitation, and too little collision with the world, he fancied himself a second Crichton. Of course with such an estimate of himself, it could not be otherwise but that he was constantly meeting with disappointments and mortifications, on his entrance into his profession, and the real business of life. From these causes, as well as from an increase at this time, of parental embarrassments and mortifications, (and home had always been an atmosphere of perpetual storms), from an hereditary scrofulous habit, and from his self-made morbid state, his mind was at last overwhelmed. But it is not my intention to enter into all the details of his history, further than to prove that the causes which produced his disease, and the form his insanity assumed, perfectly corresponded with each other.

On his arrival he was in a very exalted state of over-excitation; he was the greatest of men in every mental capacity and acquirement; all Philosophers, Poets, Painters, and Linguists, that had been, or were in existence, were nothing in comparison with himself, nor were their works to be compared with those he intended to execute, and the basis of which he had already formed in his own conception. Nothing could exceed the vain and pompous displays of his talents and acquirements; and it is impossible to conceive, from the difficulty he had to support his pretensions, with the defects under which he then laboured, what a very painful and ridiculous exhibition it produced. Still his vanity and exaggerated estimate of himself, combined with his ineffable contempt for others, remained unchecked. One feature was very striking; he possessed considerable powers of imitation, in the exercise of which he took great delight, and in pouring forth his contempt against others, he did it with the attitude and voice of Kemble; it was almost impossible not to feel the force of his manner, and against myself he was particularly severe, and his poignant expressions of contempt and indignity were most provoking and overwhelming. When, however, a change of state occurred, I felt so interested for his trembling and doubtful situation, that I had even a bed put up for him in my own room. I had always some case of this kind about me, and no one can conceive the sacrifice of health and comfort it cost me.

This case, as well as the last described, may perhaps be detailed more particularly in their proper place, to illustrate a general principle, of far more importance than even moral treatment. And even in moral treatment it will appear how important this general principle is, to enable us to perceive how we may best counteract the effects which may have arisen from the operation of baneful causes: for by it we shall be able to trace errors to their source, and without this, we can never counteract and cure them. And this we can only do with certainty, by possessing correct views of the origin, nature, and constitution of the human mind, and of the correspondence which exists between physical effects, and mental or spiritual causes: out of which views this general principle will be educed, and it will be found to be of universal application.

In this case it is evident, a system of moral and intellectual treatment was required, in order to counteract and cure the effects which had arisen out of the soil in which he had existed, very different from that which was necessary for the previous case; and it is equally evident, without such knowledge, it is more than probable that neither of these minds would ever have been restored to their balance, or right state.

He recovered, and his character appeared much improved by his severe visitation. He became very much attached to me, and wrote a great deal for me, as my amanuensis. It is worthy of remark, that he remained of choice for a considerable time after his health was re-established, on account of the dread he felt at returning to the place and circumstances where his disease had arisen.

It is remarkable also, that after he had been some weeks in private lodgings, assisting his father, in his profession at the Assizes, he, the very night previous to their intended return home, made his escape to America.

It is singular, that the first case I had, as an insane patient, after I left York, was his sister.

I might select a great number of cases, where I conceive such attention was apparently one principal cause of their recovery, and which I took under my more immediate care on this account, and to whom I devoted much of my time, and made many sacrifices of my comfort and convenience.

In order to show the importance of such attention, it will be necessary briefly to explain the description and character of the cases to which I more particularly allude, and that it may appear that these opinions are not new, I shall quote from the first part of this volume already published. I there say, “What is called mania and melancholia, are for the most part effects of the same power being overactive, but overactive in different directions.” If the distressing passions are overactive, we have melancholia,—if the animal propensities, we have furious mania,—and if the exhilirating passions, we have an exuberance of joyous activity.

“This is a view not before taken, and will account for much of the difference in the effect from the same cause. This melancholy, or state of depression, caused by the activity of the depressing passions, is to be distinguished from the state of exhaustion and debility, which succeeds some violent paroxysms, or which follows an exhausted state of body and mind from overexertion, and assumes either an apparent melancholy character, from torpor or partial suspension of mind, or is in reality a case of melancholia of the most miserable description, from the exclusive activity of these depressing passions, which are then more likely to become the sole masters of the field of action.” {16}

In the former mentioned cases, it appears, that the exciting and depressing passions alternately take on habitudes of action, so that it is still over excitement, but the effects, from its direction being different, are diametrically opposed to each other: in the one case, as I have already said, this nervous energy is employed in exciting into activity the passions which exhilirate: in the other, those which depress us.

This excitement of the depressing and exhilarating passions alternately, is the most striking characteristic of the insane. It is true, that both these states or stages of the disease, if long continued and not well managed, are necessarily followed by a third state of exhaustion. The systems of body and mind are wholly worn out by exertion, and require rest to recruit and manifest their renewed power, but changes from one state to another is only a partial exhaustion; another class of feelings become active, while the former are suspended, so that the melancholy and “high state” are for the most part, states of mind or changes in the direction of its energies, and not that the melancholy have less than the furiously malignant or joyous maniac, of that power which is equally necessary to mental activity of every description.

For instance, I have known the same person sent at one time as patient under the influence of religious melancholy, originating in erroneous extreme Calvinistic views; and at another period in the most joyous state of religious excitement, from having come under the influence of extreme Arminian views. On the same principle, I have by the most laborious process of argumentation and the statement of what I conceive right views, produced a counter-impression, given another character and form to the disease, and in some cases, on this principle, effected a cure. {18}

As these cases are much more common, and these views of much more importance than mankind, or even medical men imagine; and as many who possess a susceptible constitution of mind, similar to those whose cases I have described, are living in the world in this fearful and continual state of mental excitation, and of course, may be on the verge of the same precipice, it is right they should be warned of the danger to which they expose themselves.

It need scarcely be mentioned, that the present constitution of society is not in a healthy state. It is not bound together by that order and sympathy which should exist, but on the contrary, discord and disseverment prevail to an extent which seem to threaten its decomposition and destruction. But too many individuals are intoxicated with the fury of their various passions and inordinate desires, and mad with the endless anxieties and reverses they produce. One part of society, as well as one part of the mind, is at war with another. I wish it, however, to be particularly observed, because I shall have to revert to the fact hereafter, that it is not so much these exciting causes, or even the sad effects of these feverish and wasting passions, that are in themselves so dreadful and fatal, as they are when accompanied or followed by the conflicts and condemnations of conscience. Wherever there is the endeavour to overturn and sacrifice some confirmed and good principle, that which is lowest is encouraged to struggle for pre-eminence, and the mind suffers extreme misery and distraction.

It is in this way that we often find minds that have much that is amiable about them, are soonest overthrown; but in all cases when (as in this and what is in fatality next to this, perpetual domestic discord) _the fire of our spirits_, which should give life, health, and support to our exertions, is not united and clothed with that wisdom which ought to diffuse itself in every useful direction; it is in an altered and dangerous state, producing, according to this alteration of state, disordered function, _acrid secretions_, and if long continued, disease; and when disease is established, its state is further altered, so as literally to “eat up the flesh,” and in one form or another burns, scathes, withers, and consumes us, {20} but I need not now enter into all the various evils, miseries, and conflicts in which the mind is involved, and the dangers to which it is exposed, nor the corresponding physical effects, nor show that even were these extremes exclusive and improper, activity does not exist, but where the understanding seems most completely called forth; still we have reason to fear that we pursue the important duties of civil life, whether it be the weighty matters of legislation, or the scarcely less responsible exercise of the learned professions, or what ought to be the binding and sweet influence of faithful dealings in trade, and our common intercourse with each other, in an improper spirit, and from improper motives, and not with that singleness and simplicity of heart for each other’s good, which alone is useful and safe; which we could not fail to do, were we sufficiently aware, that in as far as we depart from this purity of spirit, our views of truth must be perverted, _and our __healthy vital energies changed_, _causing fever_, _paralysis_, _or some morbid state_, and all our sympathies poisoned and deranged. But I might find enough of matter for illustration without detailing the effects of over-excitation, arising from our mad desires after wealth, fame, and distinction, or even the consequent distracting and overwhelming miseries of misfortune, poverty, and starvation, in the modes and amusements of fashionable life, to which sensitive persons, and especially those who have made themselves morbidly sensitive, become, as in the case last stated, the victims.

Excitable and cheerful persons often fall into states of depression, purely because they have drawn too largely and exclusively on their exhilirating passions; whereas, had they drawn equally on the depressing passions, they would have tempered and balanced each other, and kept the mind in its right state; and such is the constitution of the world we live in, that our duties require that both should have their relative and appropriate share of exercise.

Persons, often, in company, think it necessary exclusively to exercise the exhilirating passions, and they return home not only with these feelings exhausted, but with the depression passions assuming in their turn an over-active state, and in this state they perhaps encourage a spirit of discontent, and peevishness, making sad havoc of domestic peace, and producing an unhealthy state of mind, _an alteration in the state of the nervous energy_, _generating an acrid and morbific matter in the system_, _and ultimately disease_, both in themselves and others. {22}