General paralysis of the insane

“ The medicinal virtues of the fruits of charity are best proved amongst them. Grant that the disease arises from some remote or proximate ill-directed mental states. Why should we have more horror of insanity, than many other consequences of ill-regulated minds? To me, the foul ward of some large public Hospital, is incomparably more horrible and loathsome. Such direct consequences of wickedness present the object before us in an aspect that makes it difficult for us to exercise any feelings of commiseration towards them. Not so the insane. ”

“ There is a universal insanity, which mistakes fable for fact throughout the entire round of the material senses; but this general craze cannot, in a spiritual diagnosis, shield the individual case from the special name of insanity. Those unfortunate people who are committed to insane asylums are only so many well-defined instances of the baneful effects of illusion on mortal minds and bodies. ”

“ Murderers have assigned as the only reason they themselves could give for their crime, that “the Devil got into them,” and urged the deed. But the insane have, perhaps, no attribute more in common than that of superweening self-esteem. The maniac who has been removed from a garret sticks straws in his hair and calls them a crown. So much does inordinate arrogance characterize mental aberration, that, in the course of my own practice, I have detected, in that infirmity, the certain symptom of insanity, long before the brain had made its disease manifest even to the most familiar kindred. ”

“ The possibility of insanity must always be a matter of the degree of the primary structural weakness and the energy and persistence of the operative forces; on these must depend the mere gentle, persistent illusion, or that fury of mania which transforms man, the "image of the Creator," into a wild beast. ”

“ Many persons, universally considered as insane, will however, at times, act, speak, converse, and reason acutely on various subjects, until{248} some particular mental string or chord is touched. With respect to general prognosticks in insanity, we have been already copious and diffuse; and shall only add, that in some degree of mania, more favourable hopes are entertained than in gloomy melancholy: indecency, no intermissions or remissions, epilepsy, palsy, tabes, frenzy, are all inauspicious. ”

“ The dense ignorance surrounding mental disease and the barbarous treatment of the insane within a century are facts familiar to everybody. Lunatics were supposed to be afflicted with demons or devils which took possession of them as retribution for their sins, and in addition to the hopelessly or maniacally insane, medical science recognized only a so-called "partial" or delusionary insanity. To-day it would be regarded about as comprehensive to relate all mental diseases to the old-fashioned "delusion" as to regard as insane only those who frothed at the mouth. ”

“ It was not the act of one mad person, because when the mind has become so far deranged that an insane person kills a human being, the disease has reached a climax, and the accompanying symptoms of homicidal frenzy cannot be concealed. ”

“ We know that insanity is often a sequel to infectious diseases, and that, moreover, it is possible to reproduce experimentally, by toxic drugs, all the phenomena of madness. [5] Is it not likely, therefore, that the loss of mental equilibrium in the insane is simply the result of a disturbance of the sensori-motor relations established in the organism? ”

“ If he cannot take care of his affairs. Where none of these circumstances 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 ”

“ In stir I could lie on my cot and read, and soothe my nerves. But in the mad-house I was not allowed to read, and lay awake continually at night listening to the idiots bleating and the maniacs raving about me. The din was horrible, and I am convinced that in the course of time even a sane man kept in an insane asylum will be mad; those who are a little delusional will go violently insane. My three years in an insane asylum convinced me that, beyond doubt, a man contracts a mental ailment just as he contracts a physical disease on the outside. ”

“ There are families in which insanity has existed where the disease has spared the mind in the posterity, but appeared in great strength and eccentricity of the memory and of the passions, or in great perversion of their moral faculties. Sometimes it passes by all the faculties of the mind, and appears only in the nervous system of persons descended from deranged parents; again, madness occurs in children whose parents were remarkable only for eccentricity of mind. Among the diseases that attack the children of the insane, but did not exist in their ancestors, are consumption and epilepsy. ”

“ Terror dominated my brain, pulsed like molten fire through my blood, until, as the desperation of my situation became more clearly defined, I tottered upon the very verge of insanity, feeling I should soon become a helpless, gibbering imbecile. ”

“ The concluding general observations on this Essay and its Appendix, are, that the one principal object I have had constantly in view, has been the removal of the erroneous impressions and prejudices which exist almost universally against the insane, as if they alone were all furious wild beasts or infernal demons, and which have hitherto excited and still continue to excite a spirit and conduct toward them, productive of a baneful and injurious influence. ”

“ It is this critical period of convalescence which is so important, and so difficult in the management of the insane.
I further observe, that the variation of temperature of the system, observed during paroxysms of insanity, is more like that produced by the passions in a state of excitement than that which accompanies inflammatory fever. It appears to fluctuate in quantity, and to be tumultuous in its distribution, in proportion as the exciting and depressing passions are active and contending with each other. ”

“ Writers have rather portrayed the sensations they would themselves, in the possession of full consciousness and of high sensibility, experience by a transfer to an institution as hopelessly mad, and have overlooked both the state of mental abasement and blunted sensibility which chronic insanity induces in so many of its victims, and still more the fact that no such absolute and universal separation of acute and chronic, as they picture to their minds, is intended. ”

“ Keep me in temper; I would not be mad : This self consciousness of gathering madness is common in various forms of the disease. It has recently been pointed to by an able French author as a frequent symptom in that form of insanity accompanied by general paralysis. Ac cording to my own observation, it is a far more common symptom in that form of mania which developes gra dually from exaggeration of the natural character. A most remarkable instance of this was presented in the case of a patient, whose passionate but generous tem per became morbidly exaggerated after a blow upon the head. ”

“ Those who were born with weakened or defective organizations, either physical or mental, would, under the exposed conditions and the rude experiences of uncivilized life, hardly attain to adult age, even if they were not intentionally left to perish, so [Pg 34] that the vast majority of those who did arrive at those periods of life during which insanity generally manifests itself, would probably possess such nervous organizations as would be little liable to become insane. ”

“ From a medical point of view the existence of a psychosis, if associated with a consequent judgment defect, emotional instability, disturbance of volition, intellectual deterioration, delusional and particularly persecutory control, hallucinatory trends, ideas of reference, etc., is of itself quite sufficient to explain criminal acts in the insane. ”

“ The second and more common form of insanity, and that which it is often difficult to discover and pronounce upon with certainty, is that which I have called delusional or illusional. Its characteristic trait, its very essence, lies in this, that the insane man mistakes what he imagines for what is real; and he cannot be made to distinguish between imagination and reality, though the difference is obvious to an intellect in its normal state. ”

“ Several of these offer no complete picture of insanity—even Case 25, although clearly aberrational, extremely defective in self-control, and markedly criminalistic, did not show to some psychiatrists who observed him a sufficiently clear correspondence to any form of insanity as laid down in the old-school text-books to be practically regarded as insane and in need of long segregation. In considering this whole matter we must never forget that there is no wall of demarcation between those whose conduct clearly betokens insanity and those who are not insane. ”

“ Every form of insanity, one may say, has a physiological prototype. Melancholia takes for its model the little depressive attacks of everyday life; mania has its prototype in the unrestrained enthusiasm of the baseball “fan”; and even the various forms of paranoia, the true insanity, have their typical representatives [Pg 92] among normal persons. To bring out this kinship we need no better example than that offered by the delusion of greatness. ”

“ Because in some cases insanity was supposed to be due to possession by the devil, to say that, therefore, in all cases no provision was made for the insane is nonsense. It is comparatively easy to find, from records of the hospitals of the fourteenth and fifteenth centuries, that there were what we now call psychopathic wards for the acutely insane in the cities, and some colonies for the chronic insane in country places. ”

“ When the hallucinations of the insane are purely intellectual, and wholly and intensely occupy the attention, the generation of animal heat appears less than usual; and decidedly less than in those cases where the aberrations of the mind are connected with the stimulus of selfish and exciting passions,—hence the system is cold. ”

“ Some of the peculiarities manifested in this case, aphasia, insensibility, and coprophagia, have been noticed in other simulators, and it is easy to see why morally insane persons, who are naturally insensible and filthy in their habits, should adopt these peculiarities as traits of their insanity. ”

“ The state produced furnishes a solution of the conflict which seems wholly satisfactory to the patient [p. 145] himself. In the case of paranoia the results of the rationalisation are so out of harmony with the ideals and traditions of the society to which the sufferer belongs that they are called delusions, and if the delusions led to conduct incompatible with social standards, their subject is called insane. ”

“ It would be impossible to draw the line rigidly between really insane persons and those suffering from temporary delirium, or ‘nervousness.’ No ready cut and dried definitions of insanity would serve the purpose, and the discrimination of cases in order to their return as ‘lunatic,’ or as ‘nervous,’ must within certain limits rest upon definitions imposed by law, and beyond these to common sense and professional experience. ”

“ There was, however, a very definite recognition of the fact during the later Middle Ages that the insane were just ailing persons who had to be taken care of, properly treated, kept from hurting themselves or others, just as delirious individuals {215} would have to be guarded, but who must be looked upon as sick in mind, just as a number of people were sick in body and with more than a hint that the bodily condition had more to do with the insanity than anything else. ”

“ Surely the giant, muttering, gesticulating, and slavering at the mouth, was on the road to madness. Would the monster find opportunity to rush at him, and, braving the blood-stained axe, kill him by main force? or would he sleep, and be himself a victim? Unhappy Vetch! It is the terrible privilege of insanity to be sleepless. ”

“ The brain is at fault and not the mind.”
“The old notion,” says Dr. Wynter, [758] “that derangement of mind may happen without any lesion of the instrument of thought being the cause or consequence, has long been exploded.”
The physical origin of insanity “became gradually accepted. Its mental phenomena were more carefully observed, and its relation was established to other mental conditions which had not hitherto been regarded as insane in the proper sense of the word.... Hitherto the criteria of insanity had been very rude, and the evidence was generally of a loose and popular character ”

“ In mania the strength is prodigiously increased. In general, insane persons endure hunger, cold, nakedness, want of sleep, with astonishing perseverance and impunity. During the exacerbation, most are restless; and most are costive. Some obstinately refuse all food and medicine, and are drenched by compulsion, as horses taking physick; which at length renders them more docile. Some, if indulged, are ravenous and insatiable as wolves. Some melancholick, on relapses, have only a periodical invasion of profound grief, want of sleep and appetite, restlessness and anxiety. ”

“ In proportion as insanity has assumed a systematic character, it become more difficult of cure. It ought to be noticed, that this state of methodical madness implies, that the disease has been of some continuance ”