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Lest a general description might fail to convey an adequate conception of this class of cases, we will give the particulars of one, which we take from Moreau.
A., aged twenty-eight, was admitted to the hospital of Bicètre. His father was a man of the worst character, intemperate, given to every excess, and finally died insane. A paternal uncle was insane, a paternal aunt was completely blind, another was nearly so, and also suffered much from vertigo. A. has every appearance of being sane. When told that he was considered insane, he admitted that he had been guilty of some extravagances and that he could exercise no self-restraint; that he would stick at nothing to gratify the slightest desire ; that shame, dishonor, and death were nothing to him ; that he ought not to go at large, and that he was just where he ought to be. This man's whole life has been one continual revolt against society. Not an instinct, desire, or passion has found a counterpoise either in that simple common sense which restrains the most perverse from doing what is manifestly contrary to their own interests, or in that inward voice which, from the innermost recesses of the soul, raises its protest against wrong-doing. Wilful, angry, and vindictive, when a child, he wanted every forbidden thing, and would eat or drink whatever came in his way, at the risk of being poisoned. When only three years old, being unable to open a door that led to a neighbor's house where he was in the habit of going, he jumped out of the window and was taken up for dead. His parents, unable to manage him, placed him at a boardingschool, in the hope that strangers might have some control over him. Here he behaved worse than ever before, and was sent home. Once, when his grandmother visited him, he begged her to take him away, and on her refusal, he picked up a stone and hurled it at her head, wounding her severely. On being reprimanded for his conduct, he not only manifested no penitence, but regretted that he had not injured her more.
As he grew up the little wretch became more and more terrible. At school, he stole from his comrades, beat them, and made himself a perfect pest. Between his twelfth and eighteenth year, he was put to several trades, but every master drove him out of the house for theft or other miscon
duct. At eighteen he enlisted in the army, and while in active service behaved very creditably; but in time of peace he was often in trouble, going about, sword in hand, to revenge his fancied wrongs. He underwent many painful punishments, which, however, made him no better. Having assaulted an officer, he was condemned to death. On hearing the sentence, he said, “It is time for this to stop. Let them kill me; I shall thus get rid of myself.” The punishment was commuted for ten years' imprisonment. After serving out his sentence, he became unequivocally insane, and was sent to Bicètre.
To cases like this - which we have given, not because it is strange and extraordinary, but because it represents a form of mental disorder very common and very much misunderstood it is objected, chiefly by those whose notions of morbid psychology have not been derived from the wards of a hospital, that they indicate unruly passions, defective training, anything, in fact, rather than an abnormal condition of mind. In replying to such objections in the present case, Moreau points to the antecedents of the family, and his own fate, and takes occasion to remark upon the difficulty experienced by the observer, in this class of cases, in communicating his impressions to others in all their force and vividness. “It is only by incessant personal observation of such cases, by day and by night, by watching their most trifling acts and prying into their thoughts, by inquiring of those around them, especially of their companions, towards whom they act freely and naturally, by identifying one's self, so to speak, with them, that we can succeed in obtaining an exact idea of their mental state, and comprehending to what extent their thoughts, desires, will, and actions are controlled by an irresistible, fatal, automatic influence, in spite of the specious appearance which covers them with a false varnish of reason, moral liberty, and all the essential attributes of man truly worthy of the name.” This remark by one who has spent his life among the insane, and brought to the study of their disorders all the resources of a sagacious and comprehensive mind, deserves to be carefully pondered by all who imagine that insanity is a superficial thing, requiring only the smallest modicum of common sense to be understood well enough for any judicial purpose. We may add, as a sort
of corollary to the above remark, that, while many an insane person may betray his mental condition by no single extravagance of thought or action, and, as long as no special pains are taken to expose his defects, may pass for a model of shrewdness, yet the practised eye, familiar with the physiognomy of mental disorder, will often detect the morbid element in the turn of thought, in the mode of action, in the style of reasoning, and in the play of feeling; and the skilful observer might be as little able to give a reason for his belief satisfactory to others, as to give one for believing that a certain face was remarkably handsome, or that a person he had just passed on the street was fresh from Ireland or Germany.
The forms in which the transmitted tendency is displayed are as various as the characters of men and the conditions of morbid action. We have selected a few by way of illustration, and we pause for a moment to direct the reader's attention to the practical lesson which they teach, viz. that the mental condition cannot always be expressed by the simple term sanity or insanity. And yet this is what the common sentiment on the subject implicitly requires. It recognizes no intermediate state. It admits no obscure, no indefinable deviations from the line of perfect soundness. Unless the expert can say, unhesitatingly and without qualification, that the person is insane, he is supposed to be endowed with the full measure of moral and legal responsibility. No account is to be made of abnormal traits of character which, however quiet and unobtrusive, may determine the conduct by a force as irresistible as that exerted by overt disease. In the common apprehension, insanity is something that may be handled, measured, weighed ; and it is made an occasion of reproach to physicians, that they are unable to define it. The perpetual straining after an unexceptionable definition of insanity is as far from success as it was a thousand years ago ; and the ever-beginning, never-ending attempts of the courts to establish a test of responsibility only furnish an indication of the false conceptions of this disease that still hold almost undisputed sway over the opinions alike of the wise and the foolish. The able, untiring expert, after spending many years in close observation of the insane, under the circumstances best fitted to
reveal their inmost thoughts, is, after all, scarcely more impressed by what he has learned than by what remains to be learned; but the judge, destitute of all such experience, and, consequently, of all self-distrust, calls the person to his side, converses with him a few moments, pronounces him sane, and discharges him from restraint. The transaction has in it a touch of the ludicrous; but it fairly illustrates how completely even men of culture have failed to comprehend the true character of mental disease. No one who watches the administration of the law, either here or in England, can help seeing that insanity is almost universally supposed to be something loud, noisy, fearful, foolish, or, at the very least, a constant and obvious irregularity or aberration of the mental faculties. Vagaries short of actual raving are simply regarded as very like the freaks of a singular and original character; and it is true that even the grossest delusions may be paralleled by some bold and extravagant conceptions of men who pass for striking examples of mental integrity and power. Of course it could hardly be expected that the sudden transformation of the hereditary tendency into overt, unmistakable disease would be readily admitted as a scientific fact, or that any mental manifestations would be allowed to pass for insanity which were only an exaggeration of traits natural to the individual, or, at the worst, mere eccentricities.
In any question of hereditary tendency, it should not be forgotten that the organic change implied in it may proceed very far without producing any obvious mental disturbance. In this respect cerebral affections follow the law of other diseases. In post-mortem examinations, we not unfrequently find extensive lesions of structure which were scarcely suspected during life, or which manifested their legitimate effect only towards the
It is not so very strange, therefore, in view of such facts, that suicide, or homicide, or a grievous assault, should sometimes be the first positive indication of cerebral disorder. And yet it has been warmly contended that a criminal act committed under such circumstances cannot properly be admitted in proof of insanity. It is enough to say, on this point, that in every hospital for the insane may be found patients whose derangement was first manifested by acts of this
kind. The order in which the manifestations of insanity appear is governed by no invariable rule of succession. There is nothing in the nature of things to prevent suicide or murder from being the first symptom of insanity. It may as naturally take precedence of all other symptoms, as a fit of abstraction, a foolish bargain, a groundless suspicion, or a gross delusion.
Thus far we have only considered those results of the neuropathic element which are obviously of a pathological nature. In the further development of his doctrine, M. Moreau advances another step, and contends for the essential identity of the organic conditions that constitute the starting-point of insanity and other cerebral affections, and of those on which depend such considerable deviations from the ordinary line of thought as ecstasy, theosophy, mysticism, and all the various forms of religious and political fanaticism. Hitherto our philosophies have been disposed to assign the origin of some of these to high mental endowments, worthy, perhaps, of admiration and imitation, while the subjects of them have been held up on the historian's page among the shining lights in the pathway of the race. In such characters as Saint Theresa and Madame Guyon, the psychological observer, while rendering homage to their exalted aspirations, discerns beneath an abnormal excitation of the nerve-cells of the brain, very different from that kind and degree of excitation which attend unqualified health. Those raptures which absorb all the faculties of the soul and defy all control, that intimate communion with the great objects of human worship which spurns all the bonds of flesh and sense, that divine afflatus which breathes into every pore and fills every channel of their spiritual being, — all these are remarkably like the phenomena of insanity, and are undoubtedly derived from the same nervous condition. The fact signifies nothing derogatory to this class of endowments, beyond denying to them a supernatural origin. Like all other mental manifestations, they are connected with certain physical conditions, which present to our apprehension no grades of honor or dishonor. In the founders of religious systems that have swept whole communities into their embrace - the Mohammeds, Joe Smiths, and many whose names the world is not yet willing to see in such