Part 2

"This matter doth passe all maner sickenesses and diseases, and it is a fearefull and terryble thyng to se a devyll or devylles shoulde have so muche and so greate a power over man, as it is specified of such persons dyvers tymes in the gospell, specyally in the IX. Chapitre of St. Marke. Chryste sendynge his disciples to preache the worde of God, gevynge them power to make sicke men whole, lame men to go, blynde to se, &c. Some of them dyd go by a mans that was possessed of devils and they coud not make him whole. Shortly to conclude, Chryst dyd make hym whole. The dysciples of Chryste asked of him why that they coud not make the possessed man of the devylls whole. And Jesus Chryste said to them: this kynde of devylls can not be cast out without prayer and fastynge. Here it is to be noted, that nowe a dayes fewe or els none doth set by prayer or fastynge, regardyng not gods wordes; in this matter, I do feare that suche persons be possessed of the devil, although they be not starke madde, and to shew further of demoniacke persons the whiche be starke madde. The fyrste tyme that I dyd dwell in Rome, there was a gentilwoman of Germani, the whych was possessed of devyls, and she was brought to Rome to be made whole. For within the precynct of St. Peters church, without St. Peters chapel, standeth a pyller of whyte marble grated round about with iron, to the which our Lorde Jesus Chryste dyd lye in hymselfe unto the Pylates hal, as the Romaynes doth say, to the which pyller al those that be possessed of the devyl, out of dyvers countreys and nacions be brought thyther, and as they say of Rome, such persons be made there whole. Amonge al other this woman of Germany, which is CCCC myles and odde from Rome, was brought to the pyller, (I then there beyng presente,) with great strength and violently with a XX or mo men, this woman was put into that pyller within the yron grate, and after her dyd go in a preeste, and dyd examine the woman under this maner in the Italian tonge. Thou devyl or devyls, I do abjure thee by the potencial power of the father, and of the sonne our Lorde Jesus Christe, and by the vertue of the Holy Ghoste, that thou do shewe to me, for what cause that thou doeste possess this woman: what wordes was aunswered I will not write, for men will not beleve it, but wolde say it were a foule and great lye, but I dyd heare that I was afrayd to tarry any longer, lest that the devyls shulde have come out of her, and to have entred into me; remembrynge what is specified in the viii Chapitre of St. Matthewe, when that Jesus Christ had made two men whole, the whiche, was possessed with a legion of devils. A legion is IX M. IX C. nynety and nyne: the sayd devyls dyd desyre Jesus, that when they were expelled out of the aforesayde twoo men, that they might enter into a herde of hogges, and so they did, and the hogges did runne into the sea and were drowned. I consyderynge this, and weke of faith and afeard, crossed myselfe and durste not heare and se such matters, for it was to stupendious and above all reason yf I shulde wryte it; and in this matter I dyd marvell of an other thynge; if the efficacitie of such makynge one whole, dyd rest in the vertue that was in the pyller, or els in the wordes that the preest dyd speake. I do judge it shulde be in the holy wordes that the prest dyd speak, and not in the pyller; for and yf it were in the pyller, the Byshops, and the Cardinalles that hathe ben many yeres past, and those that were in my tyme, and they that hath bin sence, wolde have had it in more reverence, and not to suffre rayne, hayle, snowe, and such wether to fal on it, for it hath no coverynge, but at laste when that I did consyder that the vernacle, the phisnomy of Christ, and scarse the sacrament of the aulter was in maner uncovered and al St. Peters Churche downe in ruyne, and utterly decayed, and nothing set by, consideringe in olde chapels, beggers and baudes, hoores and theves dyd lye within them, asses and moyles dyd defyle within the precincte of the Churche, and byenge and sellynge there was used within the precinct of the sayde church that it dyd pytie my harte and mynde to come and se any tyme more the sayde place and churche."--_Andrewe Boorde,[2] the seconde Boke of the Brevyary of health, 1557, fol. 4th._

To return from this digression. Dr. Ferriar, whom to mention otherwise than as a man of genius, of learning, and of taste, would be unjust, has adopted the generally accepted division of insanity into mania and melancholia. In mania he conceives "false perception, and consequently confusion of ideas, to be a leading circumstance." The latter, he supposes to consist "in intensity of idea, which is a contrary state to false perception." From the observations I have been able to make respecting Mania, I have by no means been led to conclude, that false perception, is a leading circumstance in this disorder, and still less, that confusion of ideas must be the necessary consequence of false perception.

By perception I understand, with Mr. Locke, the apprehension[3] of sensations; and after a very diligent enquiry of patients who have recovered from the disease, and from an attentive observation of those labouring under it, I have not frequently found, that insane people perceive falsely the objects which have been presented to them.

We find madmen equally deranged upon those ideas, which they have been long in the possession of, and on which the perception has not been recently exercised, as respecting those, which they have lately received: and we frequently find those who become suddenly mad, talk incoherently upon every subject, and consequently, upon many, on which the perception has not been exercised for a considerable time.

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; most probably in the senses.

We sometimes (more especially in the early stages of furious madness) find patients from very slight resemblances, and sometimes, where none whatever can be perceived by others of sound mind, confounding one person with another. Even in this case it does not seem necessary to recur to false perception for the explanation. It is equally probable that the organs of vision are affected in consequence of the disease of the brain, and therefore receive incorrect sensations: and still more likely, from the _rapid succession_ in which objects are noticed, that a very slight trait of countenance would recal the idea [or name] of some particular person.

I have known many 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 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, 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.

That "confusion of ideas" should be the necessary consequence of false perception, is very difficult to admit. It has often been observed that madmen will 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, if the person were capable of deducing from it the proper inferences, could neither create confusion nor irregularity of ideas.

Melancholia, the other form in which this disease is supposed to exist, is made by Dr. Ferriar to consist in "intensity of idea." 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 melancholia, and the most depressed and miserable objects become violent and raving. There are patients in Bethlem Hospital, whose lives are divided between furious and melancholic paroxysms, and who, under both forms, retain the same set of ideas. It must also have been observed, by those who are conversant with this disorder, that there is an intermediate state, which cannot be termed maniacal nor melancholic: a state of complete insanity, yet unaccompanied by furious or depressing passions.[4]

In speaking of the two forms of this disease, mania and melancholia, there is a circumstance sufficiently obvious, which hitherto does not appear to have been noticed: I mean the rapid or slow succession of the patient's ideas. Probably sound and vigorous mind consists as much in the moderate succession of our ideas, as in any other circumstance. It may be enquired, how we are to ascertain this increased, proportionate, and deficient activity of mind? From language, the medium by which thought is conveyed. The connexion between thought and utterance is so strongly cemented by habit, that the latter becomes the representative of the former.

The physiology of mind, I humbly conceive to be at present in its infancy, but there seems good reason to imagine, that furious madness implies a rapid succession of ideas; and the circumstance of rage, from whence its origin has been deduced, points out the hurried consecution. In this state of mind the utterance succeeds

"sudden as the spark From smitten steel; from nitrous grain the blaze."

and it frequently happens, after the tumult has subsided, the person remembers but little of that which had escaped him.

"I then, all-smarting with my wounds, being cold, (To be so pestered with a popingay) Out of my greefe, and my Impatience, Answered (neglectingly) _I know not what_-- _He should, or should not_: for he made me _mad_."

From this connexion between thought and utterance, we find many persons (particularly those who are insane) talking to themselves; especially when their minds are intently occupied; and taking the converse, we frequently observe those who are desirous to acquire any subject by heart, repeating it aloud.

From the same cause we have often occasion to remark, that strong, and perhaps involuntary, propensity to repeat the emphatical words in a sentence, and which are commonly the last, before we endeavour to reply to, or confute them.

"_King._ No: on the barren Mountaine let him sterve: For I shall never hold that man my friend Whose tongue shall aske me for one peny cost To ransome home revolted Mortimer.

"_Hotsp._ Revolted Mortimer? He never did fall off, my Soveraigne Liege, But by the chance of warre:"

As the terms Mania and Melancholia, 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 there is an equal derangement. On dissection, the state of the brain does not shew any appearances peculiar to melancholia; nor is the treatment, which I have observed most successful, different from that which is employed in mania.

As the practitioner's own mind must be the criterion, by which he infers the insanity of any other person; and when we consider the various, and frequently opposite, opinions of these intellectual arbitrators; the reader will be aware that I have not abstained from giving a definition of madness without some reason. There is indeed a double difficulty: the definition ought to comprize the aberrations of the lunatic, and fix the standard for the practitioner.

But it may be assumed that sound mind and insanity stand in the same predicament, and are opposed to each other in the same manner, as right to wrong, and as truth to the lie. In a general view no mistake can arise, and where particular instances create embarrassment, those most conversant with such persons will be best able to determine.

The terms sound mind and insanity are sufficiently plain. If to an ordinary observer, a person were to talk in an incoherent manner, he would think him mad; if his conduct were regular, and his observations pertinent, he would pronounce him in his senses: the two opposite states, well marked, are well understood; but there are many different shades, which are not so likely to strike the common examiner.

CHAP. II.

SYMPTOMS OF THE DISEASE.

On this part of the subject, authors have commonly descended to minute particularities, and studied discriminations. Distinctions have been created, rather from the peculiar turn of the patient's propensities and discourse, than from any marked difference in the varieties and species of the disorder. Every person of sound mind, possesses something peculiar to himself, which distinguishes him from others, and constitutes his idiosyncrasy of body and individuality of character: in the same manner, every lunatic discovers something singular in his aberrations from sanity of intellect. It is not my intention to record these splintered subdivisions, but to exhibit the prominent features, by which insanity may be detected, as far as such appearances seem worthy of remark, and have been the subject of my own observation.

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 incipient madness. It is true, that all who are admitted into it, have been a greater, or less time afflicted with the disorder; 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 establishment, a recurrence of the malady very frequently takes place. Upon these occasions, there is an ample scope for observing the first attack of the disease.

On the approach of mania, they first become uneasy,[5] 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 those who are 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;[6] the mind becomes crouded with thoughts, and confusion ensues.

Those under the influence of the depressing passions, will exhibit a different train of symptoms. The countenance wears an anxious and gloomy aspect, and they are little disposed to speak. 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. Frequently they will keep their eyes fixed to some object for hours together, or continue them an equal time "bent on vacuity." They next become fearful, and conceive a thousand fancies: often recur to some 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.

Madmen, do not always continue in the same furious or depressed states: the maniacal paroxysm abates of its violence, and some beams of hope, occasionally cheer the despondency of the melancholic patients. We have in the hospital some unfortunate persons, who are obliged to be secured the greater part of their time, but who now and then become calm, and to a certain degree rational: upon such occasions, they are allowed a greater range, and are admitted to associate with the others. In some instances the degree of rationality is more considerable; they conduct themselves with propriety, and in a short conversation will appear sensible and coherent. Such remission has been generally termed a _lucid interval_.

When medical persons are called upon to attend a commission of lunacy, they are always asked, whether the patient has had a _lucid interval_? A term of such latitude as interval, requires to be explained in the most perspicuous and accurate manner. [The circumstances which probably occasioned the employment of this term are pointed out in the chapter which enumerates the causes of insanity.] In common language, it is made to signify both a moment and a number of years, consequently it does not comprize any stated time. The term _lucid interval_ is therefore relative. As the law requires a precise developement of opinion, I should define a _lucid interval_ to be a complete recovery of the patient's intellects, ascertained by repeated examinations of his conversation, and by constant observation of his conduct, for a time sufficient to enable the superintendant to form a correct judgment. Unthinking people, are frequently led to conclude, that if, during a short conversation, a person under confinement shall bewray nothing absurd or incorrect, he is well, and often remonstrate on the injustice of secluding him from the world. Even in common society, there are many persons whom we never suspect, from a few trifling topics of discourse, to be shallow minded; but, if we start a subject, and wish to discuss it through all its ramifications and dependancies, we find them incapable of pursuing a connected chain of reasoning. In the same manner insane people will often, for a short time, conduct themselves, both in conversation and behaviour, with such propriety, that they appear to have the just exercise and direction of their faculties: but let the examiner protract the discourse until the favourite subject shall have got afloat in the mad man's brain, and he will be convinced of the hastiness of his decision. To those unaccustomed to insane people, a few coherent sentences, or rational answers, would indicate a lucid interval, because they discovered no madness; but he, who is in possession of the peculiar turn of the patient's thoughts, might lead him to disclose them, or by a continuance of the conversation, they would spontaneously break forth. A beautiful illustration of this is contained in the Rasselas of Dr. Johnson, where the astronomer is admired as a person of sound intellect and great acquirements by Imlac, who is himself a philosopher, and a man of the world. His intercourse with the astronomer is frequent; and he always finds in his society information and delight. At length he receives Imlac into the most unbounded confidence, and imparts to him the momentous secret. "Hear, Imlac, what thou wilt not, without difficulty, credit. I have possessed, for five years, the regulation of weather, and the distribution of the seasons. The Sun has listened to my dictates, and passed from tropic to tropic by my direction. The clouds, at my call, have poured their waters, and the Nile has overflowed at my command. I have restrained the rage of the Dog-star, and mitigated the fervours of the Crab. The winds alone, of all the elemental powers, have hitherto refused my authority; and multitudes have perished by equinoctial tempests, which I found myself unable to prohibit or restrain. I have administered this great office with exact justice, and made to the different nations of the earth an impartial dividend of rain and sunshine. What must have been the misery of half the globe, if I had limited the clouds to particular regions, or confined the Sun to either side of the Equator?"

A real case came under my observation some years ago, and which is equally apposite to the subject. A young man had become insane from habitual intoxication; and, during the violence of his disorder, had attempted to destroy himself. Under a supposed imputation of having unnatural propensities, he had amputated his penis, with a view of precluding any future insinuations of that nature. For many months, after he was admitted into the hospital, he continued in a state which obliged him to be strictly confined, as he constantly meditated his own destruction. On a sudden, he became apparently well, was highly sensible of the delusion under which he had laboured, and conversed, as any other person, upon the ordinary topics of discourse. There was, however, something in the reserve of his manner, and peculiarity of his look, which persuaded me he was not well, although no incoherence could be detected in his conversation. I had observed him for some days to walk rather lame, and once or twice had noticed him sitting with his shoes off, rubbing his feet. On enquiring into the motives of his doing so, he replied, that his feet were blistered, and wished that some remedy might be applied to remove the vesications. When I requested to look at his feet, he declined it, and prevaricated, saying, that they were only tender and uncomfortable. In a few days afterwards, he assured me they were perfectly well. The next evening I observed him, unperceived, still rubbing his feet, and then peremptorily insisted on examining them. They were quite free from any disorder. He now told me, with some embarrassment, that he wished much for a confidential friend, to whom he might impart a secret of importance; upon assuring him that he might trust me, he said, that the boards on which he walked, (the second story) were heated by subterraneous fires, under the direction of invisible and malicious agents, whose intentions, he was well convinced, were to consume him by degrees.