Part 13

At the same time I assert that our moral state has more to do with disease, either directly or indirectly, than is generally credited, yet these moral causes are necessarily every where physical in their operation, so that the assertion that our physical corresponds with our moral state, and what we call physical causes are the effects of this state, need not alarm us, in fact, the interesting truth is now demonstrated, {135} that health and longevity correspond with our moral state, (though this is true as a general principle, there are many real and apparent exceptions,) in fact, natural and moral effects co-operate, just as the circulation depends on the nervous energy, so the nervous energy depends greatly on our mental condition.

Whether, however, the causes of diseases are more of a mental or corporeal character, is not now the question to decide.

For though in the Essay I propose to give on atmospheric influence, I shall endeavour to point out the various causes which may give rise to an irregular display of the spirits of the insane, I am far, however, from denying, that there are alternate states of excitement and depression, of better and worse days, which we may not be able to trace to these causes, but which may depend on principles similar to other physical intermittents, just as we have periodical head-aches, having their accession and intermission most frequently every alternate day, and yet, even in these cases, I have been able to discover the origin of these head-aches, as was my own case, to alternate sleepless and distressing nights. Looking at these periodical exacerbations of insanity, without tracing them up to their first causes, they seem like the operation of some disturbing cause, requiring a given time to arrive at their crisis, or to produce the effect, and when produced, to subside again, and this cause, thus viewed in its less remote operation, seems altogether of a physical nature. But this periodicity, which I also advocate, will be more fully examined in the third section of the Essay on Atmospheric Influence, in which some observations will be ventured on lunar influence.

Let the reader in the mean time take it for granted that such an influence exists; we shall then be able to examine the modifying influence which the peculiar state of the mind, in each, among the insane, must have over their manner of exhibiting these alterations in their animal spirits, especially among the old incurable cases, labouring, as it has been said, under the chronic form of insanity.

Often, after the first attack, their minds are left in an imperfect state; yet, notwithstanding this inability to discharge the functions of mind properly, they generally retain their physical energies, enjoy vigorous health, and, of course, the flow of their animal spirits dependent thereon, is more likely to be improved than otherwise; with respect to mind, however, they not merely want volition, and the common motives and principles of control over themselves, but there have been circumstances connected with their confinement, which, co-operating with the excitement, (the cause of which I shall hereafter attempt to explain,) have formed in the system regular periodical returns of these states; so that, at these periods, they not only, more obviously, exhibit these changes in their spirits, and, of course, display without disguise, their peculiarities of mind, as children do, and sometimes as even men do, when warmed with friendship, or with wine; but they also do so in a higher degree, and, of course, with all their latent imperfections of mind, in a much more striking manner; they then “show themselves,” their peculiar character and defects; nor should this explanation of the periodical return of these states of excitement, from the above-mentioned co-operating causes, surprise us; we may every day witness the operation of the same principle, among men possessed of reason.

We all know, whoever gratifies any passion, or accustoms the system to any artificial stimulus, at stated periods, invariably finds the difficulty of resisting this passion, and his inclination for this stimulus greatest, at the usual period of gratification: and so it is with the expenditure of animation; in fact, nothing is more certain, than that both mind and body become the slave of those customs, which the manner of our living, and moral conduct, and the circumstances through which we have passed, have fastened around us. Now, as the circumstances and treatment of the insane, have hitherto been different from common life, (the object ought to be, in the treatment of the insane, to resemble common life as much as possible;) and as they are without control over themselves, their mode of displaying their more animated state, must be as different from the civilized man, as the civilized man is from the savage. If, then, habits of civilization may be called a second nature, here it may be said, that a third has been superinduced.

From these circumstances and states of mind, it appears, that, instead of their stock of animal spirits being expended, under the guidance of a moral agency, and regularly diffused over their existence, they are subject to mere physical influence, and become the sport of every eddying wind that blows; and therefore we find every possible variety and irregularity exhibited.—A perfect contrast to that of the good and wise man, if such a one can be found, whose balance of mind is preserved, whose spirits are tranquil and even, who enjoys perpetual sunshine within, and diffuses peace and serenity around him.

Thus, because when their spirits are buoyant, they strangely exhibit their inherent defects of mind, it has in many instances been mistaken for an exacerbation or a returning accession of the disease, and called the chronic type of old incurable cases.

It further appears, that this view is correct, from the fact, that if their manner of talking and acting, in expending their increased flow of spirits, is improperly encouraged or exasperated, then we find their individual and latent defects become more obvious; but with proper treatment, they gradually die away: in fact, these appearances are more or less perceptible, in a great measure, according to the spirit and conduct of the superintendant; and even, under him, to that of their respective attendants. Of this, I could give some striking illustrations. It is astonishing how much the increased flow of the spirits will be dark, gloomy, and vindictive; or light, cheerful, and full of kindliness; just as we by our treatment excite and keep alive one part of the mind or another. The same principle might be illustrated also, on a larger scale, by surveying the conduct of different parties and governments in the world; and on a smaller scale we see every one in authority, a magistrate, a gentleman, a minister, a pastor, the captain of a ship, and a parent, stamp their character on the sphere in which they move.

Were it the place, nothing could be more instructive than examples to demonstrate the correctness of these observations.

The preceding case, I consider, is one of these examples. I have said, that for the most part, these states of excitement and depression, are merely an irregular exhibition in the accumulation and expenditure of the animal spirits, and not always to be considered, according to Dr. Halloran’s view, as the remains of the disease in the state of a returning paroxysm, and that which characterises the permanently insane; but that this originated in, and depended on, causes which equally affect the animal spirits of the sane and insane, with this difference, that in the insane, as in this case, they are modified by the peculiar state of mind, and the sort of treatment they have received.

Grant that, from the state of his mind, any little increase of animation would resemble, in a slight degree, that which he now exhibits, then I am, by the help of facts, in this and some other cases of a similar nature, justified in saying, that I have been able to trace the process and progress of these changes, from small beginnings to their present state. I know, from the best information, that his manner and appearance were, when excited, so laughable and striking, that the attendants and their friends, from want of proper feeling, or perhaps mere thoughtlessness, actually made him a source of private sport and amusement, and thus increased his excited state, which, in the course of time, assumed its present peculiar and amusing form. {141}

A minute detail of all these things, together with unnecessary and injudicious confinement, I am certain, would prove all this.

In many cases, and especially in the last, I have been able to trace, as I have already said, the process and progress of these changes, from small beginnings to their present state. In some cases, any little increase of animation gave rise to manners and conversation, which were extremely amusing, and such as tempted silly and unthinking people, as well as the other patients, to encourage by listening or assenting too much to them, or to exasperate by wantonly making them a source of sport and amusement; conduct which cannot be too strongly deprecated, especially during the critical period of their convalescence.

In most instances, however, it must be allowed, that among these old incurable cases, {142} the most powerful exciting causes are within them. When their minds are at all irradiated, striking ideas, and scenes of the past, cross their imaginations; they are further excited by them; and in proportion as the system is excited, these ideas are themselves more powerfully awakened; they have no clear consciousness nor control over themselves; and this dreaming state of their minds, to them all reality, is sometimes as cheering as the dreams of hope can make it, and at other times as horrible as the night-mare! and thus they are wrought up into the most excited or exasperated state. In some cases, especially the foregoing, this goes on until they are worn out, when they require a corresponding portion of time to renew their vital energies; and thus cause and effect mutually produce each other. These alternate states of excitement and depression, being often repeated, they gradually increase in strength and duration; and thus it is in some few cases, and especially those similar to the last, we find, that their spirits are not expended and renewed, as ours are, once in twenty-four hours, because these changes have become the habitudes of their nature, so that their system becomes governed by new laws of action. It is very singular that those most liable to extremes, are most predisposed to insanity, and in its more confirmed stage to this periodicity of excitement and depression.

I have already noticed, {143} that the excitement of the depressing and exhilarating passions alternately, is the most striking characteristic of the old insane,—so striking that the general division of insanity is intomania and melancholia; a division, however, which is altogether unphilosophical, as the mania and melancholia are not any abstract difference in the cause of the disease itself, but merely the results of the over-active nervous energy operating in different directions—at one time on the depressing, another on the exhilarating passions; this indeed is the case, more or less, with all those who preserve not this mental equilibrium, but who act more from the impulse of their feelings and passions than the cold calculations of reason, and the rigid restraints of principle. To what extremes are the passions of the human mind liable, when neither the true light of the understanding nor any right sense of justice guide them! We see this in ignorant and unprincipled individuals, who suddenly rush out of their thraldom and pupilage into liberty and licensciousness; we see the same thing exhibited by agitated and wicked masses, as in the French Revolution, when the moral, like the physical ocean, is let loose from its order and control, and heaves its tumultuous waves of passion, as if by an earthquake, from one overwhelming extreme to another.

When then, as in the insane, all the restraining powers of the mind are lost, can we wonder that the mental energies should be subject to accidental and baneful influences? that they should impetuously rush with fearful, because with unguided force, into the most opposite and direful extremes? These extremes, however, always correspond to the individual peculiarity of mind, and the nature of the exciting causes, which exciting causes often exist internally long before they become externally evident; thus gradually forming ruts in those weak or soft parts of the mind, as it were, in which their feelings are naturally more apt to run; and thus they acquire the increasing facility and strength of habit, in operating in one direction rather than another, until they become irresistible: or in other words, until the understanding has no longer the power to extricate the mind from their influence.—Body and mind have been allowed conjointly and reciprocally to produce and increase these effects. The effects are first, disordered action; next, inflamed and diseased organization of the brain, as well as this disordered action being continually strengthened by a daily increase in the power of mental association, “calling forth an increased susceptibility to the action of certain exciting causes;” and so far I agree with Dr. Halloran, that a something like the original “accession of the disease,” more readily takes place. {145a}

I have said, {145b} that in cases of permanent insanity, the alternations into these opposite mental states occur most frequently among persons whose previous character was marked by extremes,—who were easily excited, and as easily depressed, either by their hopes, their fears, their anger, or their affections. And I have often had occasion to hear these remarks on their admission; and further, that they could not bear stimulants, especially ardent spirits; and that there was insanity decidedly developed during their worst paroxysms of intoxication.

In fact, the history of their lives, at least of some of them, was that of comedy and tragedy, perpetually prophesying and exhibiting a threatening prelude of their present more awful state; more awful in appearance, because it has now become bereft of its former lucid interludes; which lucid interludes had, possibly for some time, been externally maintained only by the mere power of external moral influences, long after the internal control had ceased to preside over the mental operations.

We call it insanity when external restraints are broken down and disregarded; we cannot decide how long absurd and delusive feelings and notions have monopolized all the operations of the little world within. I shall have occasion hereafter to adduce the history of many cases which will serve to illustrate the truth of these views. I may briefly mention, that they occur most frequently in those families where such a constant April atmosphere exists: and, as a further argument it may be stated, that a greater proportion of victims to these causes occur among the women than among the men; and in the male sex we find they are those of a more feminine character, or those whose feelings naturally predominate over their understandings.

Thus children who resemble their parents, through the spirit in which they were conceived and brought forth, become still more like them by example and education; and hence the very important fact, that the greater number of those who lose the power over their own minds, are from among those who have been unaccustomed at an early stage of their existence to exercise a salutary control over their feelings and habits; and of those especially such as naturally possess strong animal and sentimental feelings. Hence it is said, “that of all the causes of mental derangement termed moral causes, perhaps the greatest number may be traced to the error of early education.” {147} Thus, as I have already remarked, an only child, or the youngest, (who has often as much exclusive attachment as an only child, because he is the son of old age, or is young when the rest cease to be children; or may be the only one left at home,) are numerous amongst the insane.

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}