Meninges

“ If we call organic diseases of the mind those in which the mental disturbance is the accompaniment of a brain disturbance, and functional those in which no brain disturbance exists, we [Pg 82] leave entirely the ground of modern psychology. As soon as we believe that the mind can be disturbed without a change in the functions of the brain, we give away all that which has brought scientific order into the study of psychological existence. ”

“ It would be easy to draw a demarcation line if the pathology of the mind introduced any mental features which are unknown in our normal existence, but the opposite is true. No mental disease introduces elements which do not occur in the sphere of health. A degenerated brain cell looks differently under the microscope from a normal one, but the ideas of a paranoiac, the emotion of a maniac, the volition of a hysteric, the memory idea of a paralytic is each in its own structure not different from such elements in any one of us. ”

“ It is true that there are some diseases which are only betrayed at all by something in the face, e.g., the eye or the tongue, as great irritability of brain by the appearance of the pupil of the eye. But we are talking of casual, not minute, observation. And few minute observers will hesitate to say that far more untruth than truth is conveyed by the oft repeated words, He looks well, or ill, or better or worse. ”

“ Not ours is the task of analyzing special methods of neurological and mental differential diagnosis such as are used in the psychiatric clinic and in the office of the nerve specialist. There the family history with reference to nervous and other diseases, the history of the patient himself, the infectious diseases which he has passed through, his habits and anomalies, his use of alcohol and of drugs, his experiences in social life, the demands of his profession, his recent troubles and their first origin are to be recorded carefully. ”

“ As a matter of fact, the most important group of mental diseases develop without presenting any alteration of the brain substance, so far as can be detected by our present-day methods of examination. The initial symptoms of these diseases, then, are of great importance, and not readily recognisable unless looked for especially. There is no physical change to attract attention, and the change of disposition and mental condition is often insidious and only to be recognised by some one who is in the confidence of the patient. ”

“ But what should we say of a man who directed his ill usage of his body to that part of our system which is most closely connected with the brain; who were purposely to impair his nervous system, and subject himself to those delusions and diseased views of things which are the well-known result of any disorder there? Yet this is precisely what they do who seek to mortify and lower their understanding. ”

“ In certain mental diseases the patient can perceive the various qualities, although he cannot represent them to himself. In other cases the patient can clearly and vividly represent objects in all their details, but he cannot perceive the objects, when directly confronted with them. Clinical cases, even if we exclude all facts from introspective study, clearly point to the qualitative difference of image and sensation, irrespective of the assumption of localization―they may be due to the function of different brain structures, or to different processes of the same brain structures. ”

“ Function has become the dependent accessory of its organs, the mind the dependent accessory of the brain. In modern mental therapy the mind has been the loser, whilst great progress has been made in cerebral anatomy; of the mind we know less than nothing. Current psychiatry behaves like a man who thinks he can unriddle the meaning and importance of a building by a mineralogical investigation of its stones. Let us attempt to realise which mental diseases show obvious changes in the brain, and what is their proportion. ”

“ The censor of the sick brain is stupefied by toxins, shock, or exhaustion, and the citadel he is supposed to guard is thronged with besiegers from every side. The strongest—i. e., those equipped with most associations pertinent to the emotional status at the time—win out, occupy the brain by force, and demand recognition and expression from all the senses, deluding them by their guise of the reality of external matter.
We find consciousness, then, determined by all past experience, by an external world, and by its organ of expression—the brain. ”

“ The story of telepathic mysteries which is often brought before the public is probably always the outcome of a diseased brain. It is indeed a frequent symptom in paranoia and other insanities that the patient who feels abnormal organic sensations and abnormal unaccountable impulses interprets them as influences of a distant enemy. Whole pamphlets have been written with elaboration of such insane misinterpretations and requests to legislatures have been made in that spirit, but the physician recognizes easily throughout the whole argumentation the well-known phenomena of the mental disease. ”

“ In a word, the brain has its pathological anatomy exactly as all the organs of the economy have, and the pathology of the brain has its special series of symptoms, just as the other organs have theirs. In mental alienation we observe the most remarkable disturbances of the reason, furnishing in their study a rich mine for the researches of the physiologist and the philosopher ”

“ One might cite the feeble-mindedness that results from meningitis, brain tumor, brain abscess, brain wounds, etc., as further evidence of the dependence of mind upon brain, of its status as a function of brain. No philosopher seriously doubts that equilibrium and movement are functions of the brain, and yet to prove this there is no evidence of any other kind than that cited to prove the relationship of mind to brain. [1] And what applies to the intelligence applies as forcibly to character, for purpose, emotion, mood, instinct and will are altered with these diseases. ”

“ Before beginning the study of the nerve-centres I shall remind the reader of a few very simple facts, which, doubtless, he already knows, but which, recalled, will render more apparent the part taken by the body in the functions of the mind.
In order to know how the brain works, it is sufficient to recall the pictures and visions which pass before us when we are absent-minded. How curious it is when the mind sets out on its fanciful wanderings! when, unconsciously, we leave the everyday world behind us and stand motionless, with open eyes, seeing and hearing nothing. ”

“ The senses themselves are the rudiments of mind, are the means by which stimuli alighting on sense organs enter consciousness; for the nerves of special sense immediately carry the impetus to the brain, where it is recognized as the “not me,” the something definitely affecting the me, and demanding reaction from the me.
The functions of the cerebrum we find grouping themselves in three classes: intellect, emotion, and volition, more simply, thinking, feeling, and willing; and we find no mental activity of the normal or abnormal mind which will not fall into one of these groupings. ”

“ Authorities do not agree in their opinions as to the pathological and psychological processes with which we are directly concerned; they are quite uncertain how to explain the human brain in all its more subtle functions, or the sympathetic nervous system and nervous states generally, in relation especially to human consciousness under various abnormal but not diseased conditions of the organism ”

“ Another proof of progress might have been given, had time allowed of a reference to what has been done in the study of the brains of idiots, both morphologically and histologically, by Mierzejewski, Luys, and others, these results being sufficient to prove, had we no other evidence, the fundamental truth of cerebro-mental pathology—the dependence of healthy mind on healthy brain.
We are surely justified in expecting that by a prolonged examination of every part of the brain structure, and the notation of the mental symptoms, we shall arrive in future at more definite results ”

“ All Mental Process Accompanied by Neural Process.—Whatever the ultimate decision of psychologists may be regarding the relation of mind to the sensory and nervous mechanism of man it is certain that there is so close an association between them that the least alteration in the mechanism means a parallel effect in the mind, or in the words of Huxley, “every psychosis is definitely correlated with a neurosis.” The rind or cortex of gray matter which constitutes the surface of the large cerebral hemispheres of the [Pg 196] human brain is regarded as the seat of consciousness. ”

“ Yet that alone would not exclude the possibility of considering some diseases, for instance, exclusively from the mental side, and we should be justified in doing so if those parts of the brain which are the seat of the mental processes could remain in the diseased state without influence on other parts of the nervous system and of the whole body. ”

“ Keeping the same principle in view, we shall not be surprised to find that want of exercise of the brain and nervous system, or, in other words, that inactivity of intellect and feeling, is a very frequent predisposing cause of every form of nervous disease, even with those who have not been deprived of any of their senses. ”

“ But which symptoms are real and which are simulated? Here the tough or toughened organisation is usually hopelessly at sea. Here no information will enlighten, no rules will guide. If we are by nature incapable of making simple observations correctly, we had better give the whole thing up and go into another line of business. Even the so-called simulated symptoms are in a sense real symptoms of a morbid condition of brain; so, however good observers we may be, if we have not the wisdom and the patience to deal with these wisely and gently, we are still disqualified. ”

“ To sum up: in round figures a quarter of our insane patients show more or less clearly extensive changes and destruction of the brain, while three-fourths have a brain which seems to be generally unimpaired or at most exhibit such changes as give no explanation of the psychological disturbance.
These figures offer the best possible proof that the purely morphological view-point of modern psychiatry leads only very indirectly, if at all, to the understanding of the mental disorder, which is our aim. ”

“ If we consider that, with sick as with well, every thought decomposes some nervous matter,—that decomposition as well as re-composition of nervous matter is always going on, and more quickly with the sick than with the well,—that, to obtrude abruptly another thought upon the brain while it is in the act of destroying nervous matter by thinking, is calling upon it to make a new exertion,—if we consider these things, which are facts, not fancies, we shall remember that we are doing positive injury by interrupting, by "startling a fanciful" person, as it is called. ”

“ The significance of this supplementing by ideas is illustrated also in pathological cases. It happens that some of the associative connections in the brain are destroyed by disease, reducing the mind to a condition like that of early childhood, when direct sense impressions alone determined action. Patients may see the shape and color of a thing correctly, may even be able to draw it or paint it, but are unable to tell the name of the object, although they are perfectly familiar with it. ”

“ The unusual course that the association of ideas sometimes takes, the flow of words and of thoughts at certain moments, the passing difficulty of speech, the recurrence of tormenting thoughts, the disappearance of expressions or ideas from the memory, even the increase of mental activity and of every kind of motor reaction as well as many other phenomena of intellection, can be satisfactorily explained on this hypothesis. It is only necessary to suppose that in certain parts of the brain the neuroglia cells are at rest, while at other parts they are in a condition of active contraction. ”

“ On the whole, there is a far-reaching independence between the apparent mental variations and the seriousness of the brain affection. Light hysteric states may produce a strong absenting of the mind while severe epileptic conditions of the brain may be accompanied by very slight mental changes. Every neurasthenic state may play havoc with mental life, while grave brain destructions may only shade slightly the character or the intellect. ”

“ Physicians generally undervalue the nervous functions, and overlook the importance of the brain as an indicator of the conditions of the physical system, because they are not sufficiently familiar with its influence over the bodily functions. Pathological conditions are faithfully represented by the thoughts, and words, when used to describe symptoms, become the symbols of feelings which arise from disease. ”

“ Melancholia is especially associated with injury or disease of the parietal lobe of the brain, more particularly with injury or disease of the convolutions underlying the parietal eminences of the skull, i.e. the supramarginal and angular convolutions. (ii) Mania furiosa is especially associated with injury or disease of the central portion of the temporal lobe. (iii) Mania with suspicion and delusions of persecution is especially associated with injury or disease of the posterior portion of the temporal lobe. ”