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Delirium and intoxication may be considered transient effects, from temporary causes, of that condition of sensorium which, more deeply fixed and longer continued, obtains the name and produces all the aspects of mental derangement. It is obvious that there are circumstances in common here, not sufficient indeed to identify these various states for how difficult to identify the several conditions of one only! but enough to show that certain analogous changes occur as the cause and foundation of all.
Insanity, from having the characters of a malady, and this often of hereditary nature; - from its deep import as such to all the relations of human life; and from the strange and painful forms it assumes, has ever been viewed with more profound interest than any of the states thus allied to it. The feeling has led physicians and medical writers of every age to seek earnestly for some formal definition of madness;
a vain and unprofitable research! Its shapes and aspects are as various as those of the human mind in a sound state, and as little to be defined by any single phrases, however laboriously devised. Where such definitions are attempted, especially in courts of law, they fitly become matter of ridicule, or causes of contradiction and perplexity. Mental derangement, however the name be used, is not one thing, nor can it be treated as such. It differs in kind not less than in degree; and in each of its varieties we may trace through different cases all the gradations between a sound and unsound understanding, on the points where reason is thus disordered.*
* As far as I can see, one of the most assured practical tests of insanity, particularly in cases of difficult legal discrimination, is the sudden change of habitual judgments, feelings, or actions, without obvious cause. Many are the instances, indeed, where, from the less perceptible gradation of change, and its limitation to certain subjects, this criterion
On this latter view we are entitled chiefly to rest in every inquiry as to the nature and causes of insanity. We shall find here a wider and more secure basis on which to found observation, than in any other mode of regarding the subject: and if such a phrase was permitted as "a just theory of madness," I know no principle so capable of affording it as that which views all the forms of insanity, including delirium, in their relation to corresponding healthy states of mind; tracing this connexion through those intermediate grades, which are so numerously exposed to us in the various conditions of human existence. The diversities of the mind in what is accounted its healthy state; the effect of passions in suddenly altering its whole condition, of slighter emotions in gradually changing it, and of other incidents of life in affecting one or more particular faculties; its subjection periodically to sleep, and casually to the states of intoxication, somnambulism, and reverie; - its gradual transition in fever from a state where there is consciousness of vague and wandering ideas to that of perfect delirium;—all these furnish so many passages through which we may follow sanity into insanity, and connect the different forms of disordered intellect, as well with each other, as with the more natural functions of the mind.
Even looking to the broad distinction between congenital idiocy (amentia), where there is simple deficiency of natural faculties; and active insanity (dementia) in its more various and formidable shapes-we find various connexions between them, best illustrated in those cases where a more active form of madness subsides by degrees into fatuity. The
cannot be admitted alone. But it is manifestly more secure in general than the appeal to an imaginary common standard of reason, which scarcely two persons would describe alike.
complexities of the mind in its healthy state are such, its natural changes so great, its relations to the body so various, and the causes of disordered action so obscure, that we must be satisfied by classing the facts generally, without drawing those arbitrary lines which nature does not recognize, and which observation perpetually belies. Still, however, certain general distinctions are required on this subject, not merely for the sake of formal classification, but yet more to provide for the needful communication and common understanding upon cases, the right view and treatment of which is so important to human welfare. Many ingenious and learned physicians have devoted their attention to this object. Its difficulty is attested by the various methods of classification proposed; each having its peculiar value, but none perhaps comprising all the various forms and relations that occur in actual life.*
If it were an object to obtain a description of insanity, which might apply to the greatest number of cases of such disorder, I believe this would be found in the conditions which most associate it with dreaming; viz. the loss, partial or complete, of power to distinguish between unreal images created within the sensorium, and the actual perceptions drawn from the external senses, thereby giving to the former the semblance and influence of realities:- and, secondly, the alteration or suspension of that faculty of mind by which we arrange and combine the perceptions and thoughts successively coming before us.t
* The classification of mental disorders adopted by Dr. Prichard may be considered one of the simplest and most precise. That of Esquirol, though founded on the long experience of a most able physician, is scarcely perhaps so precise.
All the varieties which Dr. Arnold has brought under the general terms of ideal and notional insanity, would seem more or less distinctly referable to the above heads.
Though this general description will by no means apply to to all that is termed mental derangement, particularly to the various cases of moral insanity, yet, from the extensive influence of the causes denoted in it, there is reason for considering them more minutely; and particularly as they illustrate strikingly those gradations from the sound to the unsound mind, which I have mentioned as affording the best basis for every part of this inquiry.
A principal modifying cause, when tracing these relations between insanity and dreaming, will be found in the varying degree of exclusion of sensations from without. This exclusion is not marked by any single and definite limit, even in what may be deemed the soundest sleep. It varies presumably at every moment of time; and not only as to the degree in which the power of general perception is present, but even as to the ratio of sensation from different organs. One sense, in the plainest meaning of the expression, may be more asleep than another. In dreams this exclusion. of external sensations is generally more complete than in madness, or the ordinary state of intoxication; and here, accordingly, the excursus of aberration appears to be widest. Cicero says, and justly, that if it had been so ordered by nature that we should actually do in sleep all we dream, every man would have to be bound down before going to bed:-"majores enim, quam ulli insani, efficerent motus somniantes." *
Much has been written on the subject of spectral illusions, and not without reason, from their strange and almost mysterious nature; from the seeming warrant they give to the wildest tales of credulity; and yet further, from the link they form in the chain betwixt sound reason and madness. †
* De Divinatione, 59.
In the Zauber Bibliothek, a curious work, by G. C. Horst (1825),
Without repeating instances which have become familiar, I may remark that these singular phenomena, while connected on the one side with dreaming, delirium, and insanity, are related on the other, by a series of gradations, with the most natural and healthy functions of the mind. From the recollected images of objects of sense, which the volition, rationally exercised, places before our consciousness for the purposes of thought, and which the reason duly separates from realities—we have a gradual transition, under different states of the sensorium, to those spectral images or illusions which come unbidden into the mind; dominate alike over the senses and reason; and either by their intensity or duration produce disorder in the intellectual functions, and in all the actions founded thereon.
In the gradations between these two states the most remarkable is that in which the images of sensible objects, having no present reality, do nevertheless intrude themselves so forcibly that they cannot be put aside, although the person is fully awake, and conscious of the presence of illusion. Numerous instances of this fact are related. I have myself met with many singular examples of it; and more than one attesting that recorded by Dr. Abercrombie, in which the patient, though creating the illusion by an effort of will, had no equal power of removing it by voluntary effort. I recollect another remarkable case, where the patient, a robust young man, a native of Germany, suffering under various symptoms of cerebral disorder, was so severely affected by the continuance of these images of very painful kind, and the associations attending them, that his hair, in the course of
will be found two or three striking narratives to which this interpretation manifestly belongs, though presented here under a more indefinite and mysterious aspect.