In every species of madness there is a peculiar idea either of desire or aversion, which is perpetually excited in the mind with all its connections. In some const.i.tutions this is connected with pleasurable ideas without the exertion of much muscular action, in others it produces violent muscular action to gain or avoid the object of it, in others it is attended with despair and inaction. Mania is the general word for the two former of these, and melancholia for the latter; but the species of them are as numerous as the desires and aversions of mankind.

In the present age the pleasurable insanities are most frequently induced by superst.i.tious hopes of heaven, by sentimental love, and by personal vanity. The furious insanities by pride, anger, revenge, suspicion. And the melancholy ones by fear of poverty, fear of death, and fear of h.e.l.l; with innumerable others.

Quicquid agunt homines, votum, timor, ira, voluptas, Gaudia, discursus, nostri est farrago libelli.

JUVEN. I. 85.

This idea, however, which induces madness or melancholy, is generally untrue; that is, the object is a mistaken fact. As when a patient is persuaded he has the itch, or venereal disease, of which he has no symptom, and becomes mad from the pain this idea occasions. So that the object of madness is generally a delirious idea, and thence cannot be conquered by reason; because it continues to be excited by painful sensation, which is a stronger stimulus than volition. Most frequently pain of body is the cause of convulsion, which is often however exchanged for madness; and a painful delirious idea is most frequently the cause of madness originally, but sometimes of convulsion. Thus I have seen a young lady become convulsed from a fright, and die in a few days; and a temporary madness frequently terminates the paroxysms of the epilepsia dolorifica, and an insanity of greater permanence is frequently induced by the pains or bruises of parturition.

Where the patient is debilitated a quick pulse sometimes attends insane people, which is nevertheless generally only a symptom of the debility, owing to the too great expenditure of sensorial power; or of the paucity of its production, as in inirritative, or in sensitive inirritated fever. See III. 1. 1.

But nevertheless where the quick pulse is permanent, it shews the presence of fever; and as the madness then generally arises from the disagreeable sensations attending the fever, it is so far a good symptom; because when the fever is cured, or ceases spontaneously, the insanity most frequently vanishes at the same time.

The stimulus of so much volition supports insane people under variety of hardships, and contributes to the cure of diseases from debility, as sometimes occurs towards the end of fevers. See Sect. x.x.xIV. 2. 5. And, on the same account, they bear large doses of medicines to procure any operation on them; as emetics, and cathartics, which, before they produce their effect in inverting the motions of the stomach in vomiting, or of the absorbents of the bowels in purging, must first weaken the natural actions of those organs, as shewn in Sect. x.x.xV. 1. 3.

From these considerations it appears, that the indications of cure must consist in removing the cause of the pain, whether it arises from a delirious idea, or from a real fact, or from bodily disease; or secondly, if this cannot be done, by relieving the pain in consequence of such idea or disease. The first is sometimes effected by presenting frequently in a day contrary ideas to shew the fallacy, or the too great estimation, of the painful ideas. 2dly. By change of place, and thus presenting the stimulus of new objects, as a long journey. 3dly. By producing forgetfulness of the idea or object, which causes their pain; by removing all things which recal it to their minds; and avoiding all conversation on similar subjects. For I suppose no disease of the mind is so perfectly cured by other means as by forgetfulness.

Secondly, the pain in consequence of the ideas or bodily diseases above described is to be removed, first, by evacuations, as venesection, emetics, and cathartics; and then by large doses of opium, or by the vertigo occasioned by a circulating swing, or by a sea-voyage, which, as they affect the organs of sense as well as evacuate the stomach, may contribute to answer both indications of cure.

Where maniacs are outrageous, there can be no doubt but coercion is necessary; which may be done by means of a straight waistcoat; which disarms them without hurting them; and by tying a handkerchief round their ankles to prevent their escape. In others there can be no doubt, but that confinement r.e.t.a.r.ds rather than promotes their cure; which is forwarded by change of ideas in consequence of change of place and of objects, as by travelling or sailing.

The circ.u.mstances which render confinement necessary, are first, if the lunatic is liable to injure others, which must be judged of by the outrage he has already committed. 2dly. If he is likely to injure himself; this also must be judged of by the despondency of his mind, if such exists.

3dly. If he cannot take care of his affairs. Where none of these circ.u.mstances exist, there should be no confinement. For though the mistaken idea continues to exist, yet if no actions are produced in consequence of it, the patient cannot be called insane, he can only be termed delirious. If every one, who possesses mistaken ideas, or who puts false estimates on things, was liable to confinement, I know not who of my readers might not tremble at the sight of a madhouse!

The most convenient distribution of insanities will be into general, as mania mutabilis, studium inane, and vigilia; and into partial insanities.

These last again may be subdivided into desires and aversions, many of which are succeeded by pleasurable or painful ideas, by fury or dejection, according to the degree or violence of their exertions. Hence the a.n.a.logy between the insanities of the mind, and the convulsions of the muscles described in the preceding genus, is curiously exact. The convulsions without stupor, are either just sufficient to obliterate the pain, which occasions them; or are succeeded by greater pain, as in the convulsio dolorifica. So the exertions in the mania mutabilis are either just sufficient to allay the pain which occasions them, and the patient dwells comparatively in a quiet state; or those exertions excite painful ideas, which are succeeded by furious discourses, or outrageous actions. The studium inane, or reverie, resembles epilepsy, in which there is no sensibility to the stimuli of external objects. Vigilia, or watchfulness, may be compared to the general writhing of the body; which is just a sufficient exertion to relieve the pain which occasions it. Erotomania may be compared to trismus, or other muscular fixed spasm, without much subsequent pain; and maeror to cramp of the muscles of the leg, or other fixed spasm with subsequent pain. All these coincidences contribute to shew, as explained in Sect. III. 5, that our ideas are motions of the immediate organs of sense obeying the same laws as our muscular motions.

The violence of action accompanying insanity depends much on the education of the person; those who have been proudly educated with unrestrained pa.s.sions, are liable to greater fury; and those, whose education has been humble, to greater despondency. Where the delirious idea, above described, produces pleasurable sensations, as in personal vanity or religious enthusiasm; it is almost a pity to s.n.a.t.c.h them from their fool's paradise, and reduce them again to the common lot of humanity; lest they should complain of their cure, like the patient described in Horace,

--------Pol! me occidistis, amici, Non servastis, ait, cui sic extorta voluptas, Et demptus per vim mentis gratissimus error!

The disposition to insanity, as well as to convulsion, is believed to be hereditary; and in consequence to be induced in those families from slighter causes than in others. Convulsions have been shewn to have been most frequently induced by pains owing to defect of stimulus, as the shuddering from cold, and not from pains from excess of stimulus, which are generally succeeded by inflammation. But insanities are on the contrary generally induced by pains from excess of stimulus, as from the too violent actions of our ideas, as in common anger, which is an insanity of short duration; for insanities generally, though not always, arise from pains of the organs of sense; but convulsions generally, though not always, from pains of the membranes or glands. And it has been previously explained, that though the membrane and glands, as the stomach and skin, receive great pain from want of stimulus; yet that the organs of sense, as the eye and ear, receive no pain from defect of stimulus.

Hence it follows, that the const.i.tutions most liable to convulsion, are those which most readily become torpid in some part of the system, that is, which possess less irritability; and that those most liable to insanity, are such as have excess of sensibility; and lastly, that these two circ.u.mstances generally exist in the same const.i.tution; as explained in Sect. x.x.xI. 2. on Temperaments. These observations explain why epilepsy and insanity frequently succeed or reciprocate with each other, and why inirritable habits, as scrophulous ones, are liable to insanity, of which I have known some instances.

In many cases however there is no appearance of the disposition to epilepsy or insanity of the parent being transmitted to the progeny. First, where the insanity has arisen from some violent disappointment, and not from intemperance in the use of spirituous liquors. Secondly, where the parent has acquired the insanity or epilepsy by habits of intoxication after the procreation of his children. Which habits I suppose to be the general cause of the disposition to insanity in this country. See Cla.s.s III. 1. 1. 7.

As the disposition to gout, dropsy, epilepsy, and insanity, appears to be produced by the intemperate use of spirituous potation, and is in all of them hereditary; it seems probable, that this disposition gradually increases from generation to generation, in those families which continue for many generations to be intemperate in this respect; till at length these diseases are produced; that is, the irritability of the system gradually is decreased by this powerful stimulus, and the sensibility at the same time increased, as explained in Sect. x.x.xI. 1. and 2. This disposition is communicated to the progeny, and becomes still increased, if the same stimulus be continued, and so on by a third and fourth generation; which accounts for the appearance of epilepsy in the children of some families, where it was never known before to have existed, and could not be ascribed to their own intemperance. A parity of reasoning shews, that a few sober generations may gradually in the same manner restore a due degree of irritability to the family, and decrease the excess of sensibility.

From hence it would appear probable, that scrophula and dropsy are diseases from inirritability; but that in epilepsy and insanity an excess of sensibility is added, and the two faulty temperaments are thus conjoined.

SPECIES.

1. _Mania mutabilis._ Mutable madness. Where the patients are liable to mistake ideas of sensation for those from irritation, that is, imaginations for realities, if cured of one source of insanity, they are liable in a few months to find another source in some new mistaken or imaginary idea, and to act from this new idea. The idea belongs to delirium, when it is an imaginary or mistaken one; but it is the voluntary actions exerted in consequence of this mistaken idea, which const.i.tute insanity.

In this disease the patient is liable carefully to conceal the object of his desire or aversion. But a constant inordinate suspicion of all people, and a carelessness of cleanliness, and of decency, are generally concomitants of madness. Their designs cannot be counteracted, till you can investigate the delirious idea or object of their insanity; but as they are generally timid, they are therefore less to be dreaded.

Z. Z. called a young girl, one of his maid-servants, into the parlour, and, with c.o.c.ked pistols in his hands, ordered her to strip herself naked; he then inspected her with some attention, and dismissed her untouched. Then he stripped two of his male servants in the same manner, to the great terror of the neighbourhood. After he was secured, with much difficulty he was persuaded to tell me, that he had got the itch, and had examined some of his servants to find out from whom he had received it; though at the same time there was not a spot to be seen on his hands, or other parts. The outrages in consequence of this false idea were in some measure to be ascribed to the pride occasioned by unrestrained education, affluent wealth, and dignified family.

Madness is sometimes produced by bodily pain, particularly I believe of a diseased liver, like convulsion and epilepsy; at other times it is caused by very painful ideas occasioned by external circ.u.mstances, as of grief or disappointment; but the most frequent cause of insanity arises from the pain of some imaginary or mistaken idea; which may be termed hallucinatio maniacalis. This hallucination of one of the senses is often produced in an instant, and generally becomes gradually weakened in process of time, by the perpetual stimulus of external objects, or by the successions of other catenations of ideas, or by the operations of medicines; and when the maniacal hallucination ceases, or is forgotten, the violent exertions cease, which were in consequence of it, and the disease is cured.

Mr. ----, a clergyman, about forty years of age, who was rather a weak man, happened to be drinking wine in jocular company, and by accident swallowed a part of the seal of a letter, which he had just then received; one of his companions seeing him alarmed, cried out in humour, "It will seal your bowels up." He became melancholy from that instant, and in a day or two refused to swallow any kind of nourishment. On being pressed to give a reason for this refusal, he answered, he knew nothing would pa.s.s through him. A cathartic was given, which produced a great many evacuations, but he still persisted, that nothing pa.s.sed through him; and though he was frightened into taking a little broth once or twice by threats, yet he soon ceased intirely to swallow any thing, and died in consequence of this insane idea.

Miss ----, a sensible and ingenious lady, about thirty, said she had seen an angel; who told her, that she need not eat, though all others were under the necessity of supporting their earthly existence by food. After fruitless persuasions to take food, she starved herself to death.--It was proposed to send an angel of an higher order to tell her, that now she must begin to eat and drink again; but it was not put into execution.

Mrs. ----, a lady between forty and fifty years of age, imagined that she heard a voice say to her one day, as she was at her toilet, "Repent, or you will be d.a.m.ned." From that moment she became melancholy, and this hallucination affected her in greater or less degree for about two years; she then recovered perfectly, and is now a cheerful old woman.

Mrs. ----, a farmer's wife, going up stairs to dress, found the curtains of her bed drawn, and on undrawing them, she believed that she saw the corpse of her sister, who was then ill at the distance of twenty miles, and became from that time insane; and as her sister died about the time, she could not be produced to counteract the insane hallucination, but she perfectly recovered in a few months.

Mrs. ----, a most elegant, beautiful, and accomplished lady, about twenty-two years of age, had been married about two months to an elegant, polished, and affluent young man, and it was well known to be a love-match on both sides. She suddenly became melancholy, and yet not to so great a degree, but that she could command herself to do the honours of her table with grace and apparent ease. After many days intreaty, she at length told me, that she thought her marrying her husband had made him unhappy; and that this idea she could not efface from her mind day or night. I withstood her being confined, as some had advised, and proposed a sea-voyage to her, with expectation that the sickness, as well as change of objects, might remove the insane hallucination, by introducing other energetic ideas; this was not complied with, but she travelled about England with her friends and her husband for many months, and at length perfectly recovered, and is now I am informed in health and spirits.

These cases are related to shew the utility of endeavouring to investigate the maniacal idea, or hallucination; as it may not only acquaint us with the probable designs of the patient, from whence may be deduced the necessity of confinement; but also may some time lead to the most effectual plan of cure.

I received good information of the truth of the following case, which was published a few years ago in the newspapers. A young farmer in Warwickshire, finding his hedges broke, and the sticks carried away during a frosty season, determined to watch for the thief. He lay many cold hours under a hay-stack, and at length an old woman, like a witch in a play, approached, and began to pull up the hedge; he waited till she had tied up her bottle of sticks, and was carrying them off, that he might convict her of the theft, and then springing from his concealment, he seized his prey with violent threats. After some altercation, in which her load was left upon the ground, she kneeled upon her bottle of sticks, and raising her arms to heaven beneath the bright moon then at the full, spoke to the farmer already shivering with cold, "Heaven grant, that thou never mayest know again the blessing to be warm." He complained of cold all the next day, and wore an upper coat, and in a few days another, and in a fortnight took to his bed, always saying nothing made him warm, he covered himself with very many blankets, and had a sieve over his face, as he lay; and from this one insane idea he kept his bed above twenty years for fear of the cold air, till at length he died.

M. M. As mania arises from pain either of our muscles or organs of sense, the arts of relieving pain must const.i.tute the method of cure. See Sect.

x.x.xIV. 3. 4. Venesection. Vomits of from five grains to ten of emetic tartar, repeated every third morning for three or four times; with solution of gum-ammoniac, and soluble tartar, so as to purge gently every day.

Afterwards warm bath for two or three hours a day. Opium in large doses.

Bark. Steel.

Dr. Binns gave two scruples (40 grains) of solid opium at a dose, and twenty grains four hours afterwards; which restored the patient. Dr.

Brandreth gave 400 drops of laudanum to a maniac in the greatest possible furor, and in a few hours he became calm and rational. Med. Comment for 1791, p. 384.

_Prognostic._

The temporary quick pulse attending some maniacal cases is simply a symptom of debility, and is the consequence of too great exertions; but a permanent quick pulse shews the presence of fever, and is frequently a salutary sign; because, if the life of the patient be safe, when the fever ceases, the insanity generally vanishes along with it, as mentioned above. In this case the kind of fever must direct the method of curing the insanity; which must consist of moderate evacuations and diluents, if the pulse be strong; or by nutrientia, bark, and small doses of opium, if the pulse be weak.

Where the cause is of a temporary nature, as in puerperal insanity, there is reason to hope, that the disease will cease, when the bruises, or other painful sensations attending this state, are removed. In these cases the child should be brought frequently to the mother, and applied to her breast, if she will suffer it, and this whether she at first attends to it or not; as by a few trials it frequently excites the storge, or maternal affection, and removes the insanity, as I have witnessed.

When the madness is occasioned by pain of the teeth, which I believe is no uncommon case, these must be extracted; and the cure follows the extinction of the pain. There is however some difficulty in detecting the delinquent tooth in this case, as in hemicrania, unless by its apparent decay, or by some previous information of its pain having been complained of; because the pain of the tooth ceases, as soon as the exertions of insanity commence.

When a person becomes insane, who has a family of small children to solicit his attention, the prognostic is very unfavourable; as it shews the maniacal hallucination to be more powerful than those ideas which generally interest us the most.

2. _Studium inane._ Reverie consists of violent voluntary exertions of ideas to relieve pain, with all the trains or tribes connected with them by sensations or a.s.sociations. It frequently alternates with epileptic convulsions; with which it corresponds, in respect to the insensibility of the mind to the stimuli of external objects, in the same manner as madness corresponds with common convulsion, in the patient's possessing at the same time a sensibility of the stimuli of external objects.

Some have been reported to have been involved in reverie so perfectly, as not to have been disturbed by the discharge of a cannon; and others to have been insensible to torture, as the martyrs for religious opinions; but these seem more properly to belong to particular insanities than to reverie, like nostalgia and erotomania.

Reverie is distinguished from madness as described above; and from delirium, because the trains of ideas are kept consistent by the power of volition, as the person reasons and deliberates in it. Somnambulismus is a part of reverie, the latter consisting in the exertions of the locomotive muscles, and the former of the exertions of the organs of sense; see Cla.s.s III. 1. 1. 9. and Sect. XIX. both which are mixed, or alternate with each other, for the purpose of relieving pain.

When the patients in reverie exert their volition on their organs of sense, they can occasionally perceive the stimuli of external objects, as explained in Sect. XIX. And in this case it resembles sometimes an hallucination of the senses, as there is a mixture of fact and imagination in their discourse; but may be thus distinguished: hallucinations of the lenses are allied to delirium, and are attended generally with quick pulse, and other symptoms of great debility; but reverie is without fever, and generally alternates with convulsions; and so much intuitive a.n.a.logy (see Sect. XVII. 3. 7.) is retained in its paroxysms, as to preserve a consistency in the trains of ideas.

Miss G----, whose case is related in Sect. III. 5. 8. said, as I once sat by her, "My head is fallen off, see it is rolled to that corner of the room, and the little black dog is nibbling the nose off." On my walking to the place which she looked at, and returning, and a.s.suring her that her nose was unhurt, she became pacified, though I was doubtful whether she attended to me. See Cla.s.s III. 1. 1. 9. and Cla.s.s III. 1. 2. 2.

M. M. Large doses of opium given before the expected paroxysm, as in epilepsia dolorifica, Cla.s.s III. 1. 1. 8.

The hallucinatio studiosa, or false ideas in reverie, differ from maniacal hallucinations above described, as no insane exertions succeed, and in the patients whom I have seen they have always been totally forgotten, when the paroxysm was over.

Master ----, a school-boy about twelve years old, after he came out of a convulsion fit and sat up in bed, said to me, "Don't you see my father standing at the feet of the bed, he is come a long way on foot to see me."

I answered, no: "What colour is his coat!" He replied, "A drab colour."

"And what b.u.t.tons?" "Metal ones," he answered, and added, "how sadly his legs are swelled." In a few minutes he said, with apparent surprise, "He is gone," and returned to his perfect mind. Other cases are related in Sect.