Popular Science Monthly/Volume 2/December 1872/Humanity and Insanity
FROM THE FRENCH OF MAXIME DU CAMP.
IN studying the history of insanity, we are surprised to find that the same mild treatment now universally adopted was very clearly prescribed by the chief professors of medical science in the beginning of our era. Thus, Aretæus the Cappadocian recommends the use only of the supplest cords, to restrain violent maniacs, "for," says he, "to resort to any cruel measures of restraint will increase rather than allay the over-excitement." Galen was the first to maintain that all disorders of the mental faculties are produced by a lesion of the organs of thought, which are situate in the brain. Yet we are not to imagine that in Galen's day the art of healing was faultless; indeed, so far is this from being the case, that we find his contemporaries making large use of philters, charms, and magical formulae. In the seventh century Paulus of Ægina reasserted the principles maintained by Galen and by Aretæus; but with him the line of rational medical tradition comes to a close, and henceforth, for centuries, it would seem as if the doctors shared in the disorder which they assumed to cure. The madman was now no longer regarded as a sick patient, nor even as a human being. He was treated as a wild-beast—half brute, half demon; soon his disorder was called "satanic possession," and he himself burned at the stake.
The middle ages were a period of upheaval, when every thing was swallowed up in the bottomless abyss of scholasticism and demonology, and medicine became a routine of superstitious practices. Such and such a plant was considered beneficial, if gathered at the new moon; but deadly poison, if at the moon's wane. Science, art, and literature, went down in the storm, and wars, battles, pestilence, and famine, were the order of the day. As God was invoked in vain, men turned to Satan. The belief in the devil was universal, and the world became a hell. Now both science and experience show that the prevailing notions of a given period are very rapidly taken up by the insane, and by them distorted into grotesque shapes, with a uniformity resembling the symptoms of epidemic disorders. This phenomenon is of daily occurrence. Thus, accordingly as France is ruled by a king, an emperor, or a president, those insane persons who imagine themselves to be somebody, claim the rank of president, emperor, or king, as the case may be. Just now, respectable women patients at the Salpêtrière, Ste.-Anne, Vaucluse, and Ville-Évard asylums solemnly assure the physicians in charge that they are pétroleuses, while men of unquestionable patriotism will tell you that they guided the Prussians up the heights of Sedan. The phenomenon therefore of diabolic possession in the middle ages is perfectly natural. The calamities attendant on continual wars had so enervated the people, that they were fit subjects for all manner of mental disorder; and this, taking form from the prevailing ideas of the times, found expression in demoniacal possession.
During the middle ages the devil was everywhere—ubique dæmon. There was one religious sect whose adepts were ever spitting, hawking, and blowing the nose, with a view to expel the devils they had swallowed. A trace of this still remains in some localities, where one who sneezes is saluted with "God bless you!" Such beliefs were universal. Thus a certain prior of a convent had around him constantly a guard of two hundred men, who hewed the air with their swords, so as to cut to pieces the demons who were assailing him. Demons were even cited to appear before ecclesiastical tribunals.—A curious and a pitiful epoch, when the possessed and their exorcists were madmen alike!
This view of insanity was favored by the philosophical, or rather the theological ideas of the time. According to these, man was of a twofold nature. On the one hand was the flesh, mere matter; on the other, the soul, a direct emanation from Deity, passing through this vale of tears, on its way to the ineffable glory of heaven. The body is but the soul's dwelling-place—a temple or a den, accordingly as its invisible inhabitant is the servant of God or of Satan. Therefore, when the soul is diseased, the treatment must regard the soul alone, which is governed by laws of its own, and is merely in juxtaposition with the body for a moment. No doubt the ideal of purity thus held up was sublime; yet the result of it was the upsetting of the body's equilibrium; and this reacted on the mind. But this theory led to still more serious consequences; for it was admitted into science, and checked the progress of the medical art. When in 1828 Broussais attacked it, he was accused of blasphemy, and of "sapping the foundations" of society. Now, however, we know that the faculties of the mind are not independent of the conditions of the body. Take a slight dose of sulphate of quinine, and you lose, for the time being, the faculty of recollection; swallow a little hashish, and you are transiently insane.
In 1453 Edelin, a priest and doctor of the Sorbonne, preached against the cruelty of putting to death poor creatures who were the dupes of their own diseased imaginations. On being cited to defend himself before a tribunal, he became suddenly insane, and was immured for life, that is, shut up between four walls, without food, drink, or light. In the sixteenth century Europe literally blazed with the fires lighted to punish witches and sorcerers, who were simply mad-men. Luther had a visit from the devil. Pico della Mirandola tells of Savonarola's visions, and Melanchthon holds converse with spirits. Even Ambroise Paré, the Hippocrates of modern times, believed in possession, in compacts with the devil, and the like. The same is to be said of Fernel, famous for his calculation of the earth's dimensions, and of Bodin, the great jurisconsult. These great men, with all their sagacity, with all their learning, would seem never to have heard of the monk Bacon's dictum: "We cannot determine by speculation or by imagination what Nature will do, or what endure; all that must be made out by experiment." When illustrious savants like these were firm believers in demonism, it need not cause us any surprise to see eight hundred sorcerers burnt at the stake within sixteen years in Lorraine alone, or five hundred at Geneva in three months.
The first effective blow was aimed at this superstition by Wier, a physician of Cleves, who was the true founder of mental pathology. Knowing well the temper of his time, he moved with extreme caution. He classes demons in sundry categories, and reckons their number by millions. Having thus given an exhibition of his orthodoxy, he next throws all the blame on the devil. It is he, and not the witch or the sorcerer, that is to be punished. As possession is simply a form of disease, the possessed should rather be treated medically than burned at the stake. Wier brings facts to show that the phenomena of possession are all explainable without supposing any diabolic interference. His was the period of the invention of printing, of the discovery of America, of the Protestant Reformation—the age of Galileo and of Kepler. It might have been supposed that the sixteenth century would have seen the end of demonism in Europe. But no; the princesses of the house of Medici brought in their train to France a horde of astrologers, necromancers, disciples of Locusta, fortune-tellers, etc. Three famous cases of possession marked the beginning of the seventeenth century: that at Labourd in 1609; that of the Ursulines at Aix in 1611; and of the Ursulines at Loudun, from 1632 to 1639.
The phenomenon of insensibility to pain is one of not very rare occurrence. This insensibility may be confined to a single member, or some particular locality, or it may extend to the whole body. During the middle ages all sorcerers were supposed to bear the mark of the devil, viz., the spot touched by the fiend when taking possession of his subject. This spot was insensible to pain, and was discovered by prodding the unfortunate culprit with a long needle, here and there, all over the body until it was found.
So general was the prevalence, among the inmates of convents, of a peculiar form of hysteria, that it got the name of possession des nonnains (nonnain, nun). Its pathology is clear: melancholia attended by hallucinations, illusions of the sense of touch, and an irresistible desire of suicide. Take the remarkable case of the nuns of Saint-Louis de Louviers (1642), which engaged the attention of the Parliament of Rouen. The principal heroine of this sad history was Madeline Bavent, who, on being shut up in a dungeon, spent four hours in endeavoring to put an end to her life, by driving a large nail into her bowels, and turning it round and round. She was clearly the subject of hystero-melancholia, but her judges decided that she was possessed of a devil. But at length the belief in demonism was forced to give way before the gradual advance of science, and in 1672 Colbert induced Louis XIV. to sign the famous ordinance forbidding the Parliament any longer to prosecute sorcerers. But this was not until over twenty thousand individuals had perished at the stake simply for having been insane.
Thus ended what we may call the thaumaturgic era of insanity, and now follows the era of repression. There were as yet no hospitals to receive the insane, who were confined in convents or in prisons, according to the violence of their disorder. They were fettered, beaten, suffered to wallow in straw, exhibited to sight-seers, to gratify idle curiosity, or to afford amusement. This treatment was far from being such as medical science requires; but, still, it at least was a great improvement on the stake, and was less calculated than the exorcisms of the previous period to over-excite the patient. A last effort was made by the clergy and the Parliaments in 1713 to recover the powers of which they had been deprived by the ordinance of Louis XIV., but they were unsuccessful; and, consequently, when the Jansenist miracles and diableries became the talk of Paris, the government was content with simple measures of police repression. Finally, in 1768, the Parliaments declared that possession is a disease. Cagliostro was afforded every facility for summoning up the devil and putting him en rapport with the Cardinal Rohan; and Mesmer might now assemble at his famous banquet all the nervous subjects in Paris, without any hindrance on the part of king, clergy, or police.
Science meanwhile was not idle. While justice was growing more lenient toward the insane, the study of the principles to be applied in the treatment of insanity engaged the earnest attention of all the great physicians of Switzerland, England, Holland, Germany, Italy, and France, and the various phenomena of-mental pathology were carefully described by Plater, Willis, Boerhaave, Fleming, Fracassini, Morgagni, Boissier de Sauvages, Lieutard, Lorry, and others. As regards the question of treatment, however, these learned writers nearly all fell into error, because they started out with false premises. In their time the famous theory of humorism held undivided sway, and according to this all disease came from the humors, the blood, lymph, bile, etc.; and a person was diseased to a greater or less degree, according to the higher or lower degree of crudity or of coction in which his humors were found. Hence there were two universal remedies, which were expected to answer every malady: purging and blood-letting. Violent insanity had its seat in the blood; melancholy madness, in the bile; exalted mania, in the spleen. Baglivi, who died in 1707, introduced into medicine the doctrine of solidism, which attributes the cause of disease to the solid parts of the body. Baglivi's writings were translated into French by Pinel, who was himself a reformer in the best sense of that word, and who introduced the mild treatment of the insane in modern times. In 1791 he published his "Medico-philosophical Treatise on Insanity," and 1792 was appointed physician-in-chief of the Bicêtre Asylum.
We can imagine what Bicêtre must have been when Pinel took charge—a jail, house of correction, penitentiary, and hospital, all in one; and its inmates—assassins, debauchees, sick patients, paupers, idiots—lived in fearful promiscuousness; it was, in fact, a moral cess-pool. The insane, as being no better than wild-beasts, were kept separate, shut up in pens six feet square, to which light and air were admitted only through a small opening in the door. There was a bed of loose straw, renewed every month. The patient had a chain around the waist, besides being manacled and fettered. He received neither care nor medical treatment, but was left to exhaust himself in his paroxysms, affording amusement to curious visitors, who flocked to witness the strange antics of the madmen. Pinel had the invaluable assistance, in carrying out his reforms, of a humble hospital attendant, who had himself by practical experience arrived at Pinel's own conclusions years before. "When the insane patients become too violent, what do you do?" asked Pinel. "I take off their chains, they then become quiet." Pinel ordered the irons to be struck off all the patients. Among them was an old soldier of the guards, a man of herculean strength, and a violent lunatic. The physician had his irons taken off, and then bade him remove the chains off all the other patients. The old soldier's gratitude was such that he remained for the rest of his life attached to the personal service of Pinel. As Colbert, in persuading Louis XIV. to publish his famous ordinance, had brought. the thaumaturgic era to a close, so Pinel put an end to the era of repression. After a protracted contest, victory declared in favor of common-sense and humanity. Esquirol followed after Pinel, and showed that the physician who would treat mental disorders, must study the various symptoms; and this he can do only by daily contact with the insane. Ferrus discovered the importance of giving to the insane employment of some kind, as a means of restoring them to a healthy condition of mind. While thus, in France, science was engaged in establishing the moral bases of the disease, Roller was founding a model establishment in Germany, on the principle of surrounding the patient with all those influences which could bring his thoughts back into their normal courses. His long experience went to show the advantage of employing opium and its derivatives in the treatment of mental disorders. These are the founders of the science of Mental Alienation: others have developed their premises and added to their teachings, but to Pinel, Esquirol, Ferrus, and Roller, the human race owes a debt of everlasting gratitude for having first opened the way.—Abridged from the Revue des Deux Mondes.