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brain, we may reasonably conclude that various forms of insanity, which we have seen to be so closely related to them, may exist, and even long continue, without permanent alterations of structure, or changes appreciable by the human eye. That organic differences do often exist as an original cause, must be presumed from the cases where the disorder is hereditary in the habit; and from the numerous instances where examination after death shows deviation from the natural structure. But even where there is proof that such organic changes have occurred, and that the derangement depends upon them, it is remarkable to what extent amelioration may for a time take place in the mental symptoms, though the original causes remain the same: giving further proof that the proximate cause resides in some parts of structure to which our present means give us no access, and that to this we must chiefly look for the modifications of the disease.*
Viewing the question more generally, and in reference to the total mass of the brain, it may be stated as probable that where the intellectual and moral functions are chiefly disturbed, any physical disorder therewith connected will be found to exist in the cerebral hemispheres; consisting either
* I recollect a case of mental derangement, where the post mortem examination showed great organic changes in the brain; many of them, from their nature, of long standing, and upon which it was next to certain the symptoms depended. Yet in this instance there occurred not long before death a lucid interval, so far complete as to afford hopes of recovery where none had before existed, and where the event proved that none could reasonably be entertained. Other similar cases I find in my notes. The instances, in fact, are frequent and familiar, where the memory, affected manifestly, and it may be said permanently, by organic changes in the brain, does nevertheless at intervals, and without obvious cause, recover itself for a moment with singular clearness-then pass under a cloud as before. An example of this, as it occurred in one of the most eminent men of this age, can never be lost to my own remembrance.
in imperfect original development; or in softening or induration of substance; or in some more especial and local disease of structure. Our actual knowledge scarcely carries us beyond this; though some eminent physiologists have held the opinion that the cineritious neurine of the brain is the particular part related to these functions, and the subject of the diseases which affect them. Every part, indeed, of this topic offers large scope to speculation. In another chapter I have ventured a suggestion as to the effect upon the mental functions of an unequal or incongruous action of the two hemispheres of the brain. As the variety of the disorder presumes a corresponding difference in its cause, another suggestion may arise, whether certain kinds of insanity be not the effect of simple excess or deficiency in quantity of that power (nervous, sensorial, or however denominated) by which the mutual relations of mind and body are carried on? It is certain that such variation as to quantity exists;- certain also that it produces much influence on both these parts of our existence. If we might suppose that some maniacal disorders depended on morbid excess of this power, we should have an example of the case alluded to above, viz. a derangement of mind proceeding from physical causes, but these such as to involve only alteration in a natural function, and not any changes of structure leaving permanent traces behind.
Throughout the whole of the foregoing remarks I have used the term insanity in its most comprehensive sense; seeking to define its varieties chiefly by their relation to the healthy functions of mind; or to other states of mental aberration, either natural like dreaming, or at least frequent and familiar to us. It is one of those subjects in which the facts are so complicated, that truth may expediently be sought
for simply by varying their arrangement. And this truth is likely to be best obtained when we can thus associate together the natural and morbid conditions by a series of intermediate steps, which bring no new element into our theory of mind, and at the same time render some explanation of the strange and seemingly anomalous variety of these cases. Such gradations are most easily followed in all that regards illusions of the senses. But though becoming much less obvious as we advance into the inward recesses of thought, and seek for explanation of those states in which false combinations of ideas, and perverted passions and feelings, are chiefly concerned, yet we may still obtain illustration from the healthy habitudes of mind, especially as pursued through the intermediate phenomena of dreaming and intoxication.
In the most complete degree of melancholia, for example, it is often but the exaggeration and persistence of that gloomy mood of mind, which, in one degree or another, occurs occasionally to every person, overshadowing for the time all the thoughts and feelings of life. This may be the delusion of an hour, readily removed by change of place, occupation, or events; but it may continue longer under the character of hypochondriasis; or become permanent as a form of insanity; still depending on some common cause, however different the intensity and manner of operation.
The most difficult part of the subject, undoubtedly, and that which we can least solve by any knowledge we possess, is what has been termed Moral, in contradistinction to Intellectual Insanity;- where no actual false perceptions exist, and the intellect in its ordinary sense is slightly affected; but where the feelings, temper, and habits are vitiated and variously perverted, sometimes assuming a character exactly opposite to that of the same mind in its healthy state, and seeming to alter the whole moral condition of the being.
It is needless to dwell upon the melancholy details of cases, which are so familiar to common experience. The attempt, moreover, is almost painful, of seeking explanation or analogy for them in the more natural conditions of human character. Yet such relations exist, and may be easily recognized in particular examples. In truth, we seldom meet with instances where this moral derangement is altogether of sudden occurrence, or wholly detached from the prior life and habits of the individual. It comes upon the mind gradually, though often very unequally; -sometimes shown at first in the excess or misdirection of certain accustomed feelings; these aberrations fostered often by the very circumstances they create, acquiring the force of habits, and in the same proportion losing the controul of the intellect and will. The understanding, indeed, though exempt perhaps from any common hallucinations, is really perverted or enfeebled in most of those cases, and no longer gives that direction and balance which is essential to the healthy state of the mind. Even where a particular feeling or affection seems changed into one utterly opposite, a closer view will often show some relation to the previous temperament. While a more general contemplation of human character will afford the proof that opposite extremes are not always so distinct or incongruous, as at first sight they may appear.
All wonted methods of delineating character are, indeed, in some degree covenanted and artificial, and scarcely according with the reality of facts. We describe it as a unity, distinctly marked for each individual; — and, in a common sense, this is just. But there are few in whom the feelings and sentiments which compose it do not undergo fluctuations; as well under the influence of age and the greater events of life, as also more variously and incessantly from changes that belong to the day or hour; the conditions of health the bodily
sensations or instincts society and the many events which crowd upon every part of existence. Amidst such momentary changes, particularly in persons of a certain temperament, we very often recognize the elements of those future and more fixed aberrations to which the name of mental derangement is needfully applied. The greater or less facility, indeed, of being thus affected, forms one of the most essential circumstances in character itself; and in few respects do individuals differ more widely than in their power of preserving habits, steady and unimpaired, under the circumstances ever pressing upon them. The highest exaltation of man lies in this direction; and the state of mind, moreover, which gives greatest security against every form of derangement.
The intellectual, as well as moral part of our nature, is subject to the same continued change; subordinate, it is true, to the individual faculties of each, but well marked to common consciousness and observation. Thinking is not a single or uniform act even in the most sober and regulated understanding. It varies continually in rapidity and intensity, according to the conditions of the body, or influence from without; and the amount of variation, great in the same person, becomes more obvious when the observation is directed to many. There are times and causes which raise the intensity of thought almost to the condition of a passion, despite every effort to suspend what is felt to be a morbid and painful state of mind.
These considerations, which might be pursued to much greater extent, obviously apply to the singular forms of madness which the French physicians have named Monomania; where we may generally discover connexion with some of the more ordinary states of mind; furnishing analogy, at least, in default of other solution. Most persons