INSANE ASYLUM. 646 INSANITY. asylums or not, the scinblniice and much of tlio reality of coercion has been aboliahed; the inllu- enee of religion, oeeupalion, edueulion, recrea- tion, the juiJicioiis uppliealion of moral imprcs- sioud, ami the dominion of rational kindness and discriuiinatinK discipline, have btrn added to mere luedieal treatment, and siibstituteil fur brute force, terror, and cruelty. In fact, the word "asyhinr lias been supplanted by "liosiiilal :' "keepers' have fjiven place to nursi's" and "altenil- ants;' and the insane are treated, especially in institutions in the United Slates, as sick people. (See I.NSANITV.) Consult: Kscpiirol. Drs mala- dies mentaltm, etc. (I'aris, 1S38; Knglish trans, by Hunt, Philadelphia. 1845) ; tiuislain, Traiti sur I'aliciiation mentale ct sur Ivs hospices dss aJi<Jn<!s (.msterdam. 1820) ; t'onoUy, Vonstruc- tion and (jovcinimitt nf Lunnlir Asiiliims (Lon- don, 1847) ; V. KralTt-Kbing, Ivirn, Neumann, Fr. Fischer, Eickholl. Wilser, l.anderer and Diez, Festschrift ziir Fcicr dcs fuDlzifijiihriiien Juhi- Idiims dcr .install IlUnaii (lleidelW-rjl', 1892); Allison, "The Care and Custody of the Convict and Criminal Insane," in I'loiecdinijs of the .Va- tional Prison Association (Washington, I'JOl). See Insanity. INSANITY (Lnt. insanitns, from insanus, insane, unsound, from in-, not -f- sanus, sane, sound: connected with f!k. /riot, wins, crdt. sos. sound, safe), or l.rxACV. . manifestation of disease of the lira in characterized by a general or partial derangement of one or more of the mental processes, in which, wliilo consciousness is not abolished, nicn(;il activity is weakened or perverted. This deliiiitinn is iimdiHcd from that given by HamMioiid. and, like all attempted definitions of the term, is inndeqiuite. Insanity is not mental disorder, although disorder of mind is always present in insanity. . person who mistakes red for gray has disordered men- tality; but he is not insane, though color-blind. Defective reasoning, which leads a man. for in- stance, into a had investment, is a disordered mental process, yet not insanity. Thus it is a matter of extreme ditliiulty to define insanity so as not to include the eomlitions existing in sleep, or trance, or the common nuinifcstations of gen- eral neuroses like epilepsy, hysteria, and chorea, the delirium of fever, acute intoxicatioas, etc. There is no rigid line of demarcation between sanity and insanity. The conditions of each bear close resemblance. The processes of mental action in sanity and in insanity are of the same kind, although they differ in their origin and in the degre«i of their intensity. It is often said that everj' (me is more or less insane. Tliis is an ab- surdity, as insanity is a, manifestation of disease, not merely a name for mental disorder. The notion, also, that one ma.v be insane on one subject, and otherwise perfectly .sane, is erro- neous, for the same reason. .
insane person
may betray his mental condition when drawn out by one line of thoiglit. or when one topic is broached: but. if insane, he is diseased and in no respect sane, even if able to carry on hia business or perform complex acts properly. To understand insanity one must understand the normal action of the mind and have some knowledge of the physical basis of mental action: that is, of the cerebral cortex and its as.sociation fibres. (See Xbrvois System.) Tlie functions of the cerebral cortex are: (1) To receive im- pressions from the organs of sensation (conscious jicrccptions) ; (2) to group the.se impressions into a unit, known as a concept; (3) to store up these concepts, for future recognition and recollection (memory.), for gathering into novel combinations (imagination), and for use as a basis of thought; (4) to express thought in siK'Cch and action; (5) to experience emotion which accompanies mental activity; (0) to exert self-omtrid over all mental action. (Starr, t 'this statement is true enough for the practical study of insanity, and is made to avoid opening the subject of the connection iK'twcen nervous and mental iihcnoniena. -While many alienists accept the anatomical basis, and believe in a transference of the mental into the nuiterial. others claim that the activity of the highest nervous centres is attended by a mental state, but is not in itself a mental state. (See Mi.nd.I At all events, when areas of the corle.x are diseased, one or more of the cortical functions named ma.v be suspended, and mental disorder results. If changes in blood-supply or in nutrition occur, or 14 disease allects the entire cortex, insanity may result : and, as a lesult, thought becomes illogical, emotion becomes excessive, or arises witliout ex- ternal stimulus, action is irregular or purpose- less, and conduct is not properly adjusted to surrounding circumstances. In the insane person impressions from sense perceptions may be wrongly interpreted.
illusion is a falsely
interpreted sense perception. For example, a chair nuiy be mistaken for an animal ; the rumble of a w.igon may be mistaken for the angry voices of a pursuing mob. Ideas may arise without any sense perception. When quiet exists, th« insane person may hear voices; he may see faces in an empty space; he may smell burning flesh when no odor is .present. These false perceptions without external origin in sensory experiences are called hallucinations. . mistaken idea uuiy be harbored by any one; for cxami)le. one may believe that a st<me is much larger than it is. ■Measurement and examination convince hiip of his error, and. if he is sane, he corrects his judg- ment. The in.sane man is not alTected by logic:iI methods, and retains his erroneous idea in spile of demonstration and reasoning. A mistaken ide.a accepted without logical foundation is a delusicm; if retained in spite of demonstration of its falsity, it is an insane delusion. Insane peo|)le freipieutly, though not necessarily, ex- hil)it delusions, varying according to the bodily ills, the occupation or profession, the emotions experienced, or their surroundings. Certain forms of delusion are fairly constant in certain types of insanity. For example, in melanclioli;i patients often declare that they have coniniilted some great sin: in piiranoia. delusions of per- secution and of conspiracy are present: in mania, delusions of identity, or of being an important |)erson. are frequent: in alcoholic insanity. Ilia delusion of marital infidelity is common: in gen- eral paresis, a number of grandiose delusions — of power, of wealth, of strength, of beauty — are present in one stage: and in early stages of dementia delusions of grandeur are also noticed, with less frequenc.y. Oi-iturlmnces of emotional feelinq occur in insane [leople: depression, ex- altation, languor, and absurd joy are noticed in dilTerent cases. .Xeting under the impulse of delusion or hallucination the insane exhibit <its>- turbance in voluntary action and conduct. In-
