founded on symptomatology must be abandoned; and to proceed on the etiology of this malady when the causes are so obscure, is quite impracticable. To him who wishes to define and arrange more accurately the phenomena of insanity, I would offer this advice. Let him first divest his mind of all predilections for systems, definitions, and nice distinctions. If he have not an opportunity of obtaining practical experience, he should read attentively, and impress on his memory the physical phenomena described, and their affinities to other diseases of the nervous and vascular systems. He must attentively study, and then contrast the characters of the human countenance as well as those of the mind; and he will then be able by degrees to detect even those slight shades by which only the limits of sanity and insanity are frequently to be distinguished. The best rule, however, for every body to observe, when attempting to form a judgment on any particular case of insanity, is to take care and preserve his own faculties clear, and as free from the mysticism of speculative philosophy as from the trammels of nosology. Entertaining these opinions, I have no system to prefer; but for the convenience of discussion, as well as for practical purposes, some arrangement must be followed. I think Esquirol's the least objectionable, because the most unpretending and simple. But it is defective; since it omits delirium and hypochondriasis, which, in my judgment, have better claims to be considered as distinct species than mania and melancholia. It is true, if delirium be received only in its ordinary acceptation as symbolical of intellectual disorder, it does not merit the rank of a distinct malady. But I think that there is ground to consider it as a frequent idiopathic affection, though certainly much more generally as sympathetic, and often as symptomatic. This point, however, I shall discuss more at length when treating on delirium. COMMENTARY II. CHARACTER OF INSANITY. THE ancient Stoics conceived that a wise man might become furious, but could not be insane; and that every foolish or vicious person was morally mad, and not to be distinguished from those actually or physically so, except by the degree of the disorder. We certainly sometimes meet with those who are not only considered sane, but who possess superior minds, nevertheless entertaining projects so preposterous, and committing themselves so unreasonably, that none can coincide with them. Some yield to first impressions and their immediate gratification. Others cherish prejudices uncorrected by reason, and thus voluntarily shut out the light of truth. Many good and otherwise sensible people are in these senses morally mad. Others, again, indulge in reveries, talking to themselves, regardless of all around, till they become insane. The danger of insanity, it has been truly said, is perhaps in a ratio with the habit of abstraction. The one is not a necessary consequence of the other, else Newton could not have escaped; yet this malady certainly more frequently attends on those who devote an exclusive and intense application to a solitary object. These moral madmen constitute, doubtless, a very large class of mankind; but they have not arrived exactly at that point to be considered physically or legally mad. Yet whenever these conditions of the moral faculties concur, as they sometimes do, very little more is required to convert them into a state of real insanity. In the common acceptation, that person is insane or mad, or in a delirium, when any single or several faculties, which synthetically constitute the mind, exhibit signs of disordered function. Whether one or more of the intellectual faculties be deranged, the pathognomonic of every species of insanity is delirium, continued or intermittent, general or partial. To describe insanity in all its varieties, would not only be difficult, but it would also be a work of supererogation. In every language of the civilised world, and in every system of medicine, descriptions, sufficiently accurate, of all the forms of mental derangement, are to be found. I shall confine myself, therefore, to a very general description of the characters of insanity. Madness, says Sauvages, is the dream of him who is awake; and really I know nothing that can be compared to the ideas of an insane person but the delusive images of sleeping visions. This waking dream may consist in an unnatural rapidity of thoughts, or in a morbid association of them with some known or recollected object, or in the substitution of illusions for realities. Sometimes perception is correct, but memory and judgment are defective, or the reverse may obtain. Sometimes sensation and volition are equally affected: one, or several, of the external senses shall be perfect, and the others changed; and sometimes all are implicated, or the mind and the will may be at variance. Every sensation, thought, or idea, may have place; but have neither order, object, connexion, nor stability. Neither, though they perceive and think, can the insane always connect, compare, or abstract. These must be received as general propositions, but with exceptions. For instance, the faculty of associating their ideas with words and things, and of applying them to their own situations, so as to combine and execute plans, is sometimes exhibited in a manner most correct and wonderful. Often, the most trivial thing will induce certain ideas, which at their birth are correct; but the judgment being lesed or perverted, the catenation is broken, their application mistaken, and the most wild and incoherent thoughts, expressions, and actions follow. Hence, impressions may be either strong or weak; the mind in the one case pertinaciously adhering to one illusion, to the exclusion of every other idea; in the other, the delusive impression is so evanescent as to induce us to presume that the memory is impaired; and yet, hereafter the last idea may revive, and recur with vivid force. Sometimes the attention to internal feelings supersedes that to all external objects, or the reverse; or one faculty may acquire such an excessive acuteness, while the others retain their natural condition, that such a preponderance of the trains of thought and actions connected with the objects of that sense ensues, as constitutes insanity.* The will, unconnected with sensation, is often solely occupied in voluntary exertion, and is under no control: hence there is no sense of shame or apprehension of consequences, and the muscular powers are intensely exalted, and every action is an irresistible impulse. Such are equally regardless of natural appetites, or of surrounding objects, except those which administer to their designs. To extremes of temperature, hunger, and other privations, they are insensible; and they display immense strength, and exercise it with great perseverance, with little apparent injury to their general health. On the * Parry, p. 277. |