Popular Science Monthly/Volume 23/September 1883/Insanity
PERHAPS, if some of our most celebrated experts, in cases of insanity, had been, for a while at least, insane themselves, it would have been to the advantage of science. Of some diseases, like malarial fever, or small-pox, a physician can doubtless give a better idea than the patient who has suffered from them; because, these diseases being distinctly physical, the symptoms furnished by the body are generally sufficient data for an accurate diagnosis. But insanity may be said to possess more of a psychological than a physiological character. The brain, being the organ through which the mind communicates with the outside world, can not, if it becomes disordered or diseased, give or receive any trustworthy intelligence. Only the patient himself can know his condition, and he only so far as he can subsequently recall his experiences. Sometimes his recollections are confused and worthless, and at other times they are remarkably vivid. I have been undoubtedly insane twice, the delusions on each occasion continuing for the space of three or four weeks. These attacks occurred several years ago, and were about six or seven months apart. I propose, in this article, to allude to so much of my experience, during the two periods, as may throw some little light upon a subject that has always been as interesting as it is obscure, and that has occupied the attention of some of the ablest intellects in this country and in Europe.
In consequence of overwork, excitement, and mental anxiety, my nervous system had become almost totally prostrated, and I suddenly and without warning lost my reason. Neither my friends nor myself had received any such intimations as led us to apprehend a calamity of that kind. So far as we knew, there had never been any insanity among my ancestors or relatives. During the trial of Guiteau, it may be remembered, the question was raised, to what extent insanity could be regarded as hereditary. A distinction without a difference was drawn between inheriting insanity and inheriting a tendency to become insane. Few persons, perhaps, are born insane; and few are born with consumption. A man whose ancestors have been drunkards is not born an inebriate. But nobody believes it would be safe for him to tamper with intoxicating liquors, because, in all probability, he has inherited a predisposition to inebriety. And, if one's ancestors have been consumptives, the disease that affected their lungs would, under favorable circumstances, be more apt to affect his than those of one whose ancestors had never had consumption. If a man had an uncle, or an aunt, or a brother, who had suffered from that disease, it would seem to indicate that it was "in the blood." And so, in the same way, as regards insanity. It would not be correct, of course, to say that a person inherited insanity from an uncle or a brother. But the fact that the uncle or the brother had been insane would show that the disease was in the family—in the blood—and one, in such a case, would have good reason to be apprehensive lest he himself might have inherited a predisposition to become insane from the same source whence his relatives had derived their tendency.
The first that I remember of my attack was while I was riding in a railroad-car. It seemed to me that the passengers in the forward part were getting up amateur theatricals. The fact that this did not surprise me, nor appear at all out of place, illustrates one curious feature of insanity, and that is, its close similarity in many respects to dreaming. It is well known that the strange phantasmagoria attendant upon most of our dreams never strikes us at the time as at all astonishing, illogical, or contradictory, because the critical faculty in sleep is partially and perhaps wholly dormant. And so also is it in insanity. And as a sound or a touch will suggest or give direction to an ordinary dream, so everything that occurs within the sight or hearing of an insane man affects him in like manner. Also, he has no more control over his words and actions, when the insanity is complete, than a somnambulist. And, when a patient comes to himself, after having been insane, he feels as though he had been having a long and, sometimes, a very unpleasant dream. Some of my delusions were of a frightful character, and resembled a nightmare more than anything else; but more often they were by no means disagreeable. Of course, it seemed strange to me afterward that I could have been carried away by such absurdities. At one time I thought that the end of the world had come, and that the day of judgment was at hand. This was somewhat remarkable, because I had not for years been a believer in the scriptural prophecies relating to those two events. Nor had I any faith in the doctrine that there is a hell of fire; yet, in imagination, I visited that place of torment, and witnessed the tortures of the damned—without, however, getting scorched myself. Some strange conceits, that I had come across in books, occasionally suggested material for my mind to work on. I saw men whose souls I believed had been taken from their bodies, leaving behind the intelligent personal identity—an idea suggested by a character described in Bulwer's "Strange Story." Again, I thought that demons occasionally reanimated human bodies after death; and this fancy I must have got from a dramatic work by Bishop Coxe, entitled "Saul," in which the evil spirit sent to trouble that unfortunate monarch reanimated and took possession of the body of a priest whom Saul had slain. I mention these instances as serving to show the dream-like character of insanity.
I was confined in an asylum, and during the first part of the time I thought I was unjustly imprisoned, I knew not why, and that my friends were not far off, doing all they could to liberate me. I could hear them, as I thought, talking to me from some place not far distant. Many insane patients, with whom I have conversed, while they and I were convalescing, have told me that they also had heard similar voices, and been deceived much in the same way. This is called "false-hearing." Since my recovery I have had several attacks of it, but not to such an extent as to create any delusion. Sometimes after a day's hard work, or after reading or writing too long, I have heard voices that sounded as though they were out-doors, or in an adjoining room, or in the air. I have experimented with them for the purpose of finding out, if possible, how the brain is affected to produce them. They have led me to believe that there is a great deal more "unconscious cerebration" going on in every man's brain than any one is aware of. While listening to these voices, and conscious all the while of the fact that they were purely imaginary, I have heard remarks that astonished me! What was this but the mind surprising itself by its own communications? I have heard long conversations at such times, and when, for the sake of experiment, I have for the moment treated them as realities, I have received replies that staggered me for the time being, and almost led me to believe some intelligent being was talking to me. There can be no doubt that there have been many people who, without knowing it, have been victims of false hearing, and have honestly thought they were hearing the voices of their disembodied friends, while in fact they were being deceived by an unconscious mental action going on in a disordered brain.
The question, "What is insanity?" will probably never be fully and satisfactorily answered; and one reason for this may be because there are so many different kinds. One kind makes the patient lively and hopeful: he believes himself a king, or immensely wealthy; and he is full of the wildest projects. Another kind of insanity is directly the reverse in its characteristics; it is called melancholia, and often sinks the patient in the depths of despair. Then there is softening of the brain, that ends in dementia, or total absence of intelligence, so that the patient does not know enough to eat or drink, although his body may be apparently in a healthy condition. But, generally speaking, insanity may be said to be a state of delusion in which the mental faculties, to which it would be necessary to appeal in order to dispel the delusion, are so paralyzed or diseased that they can not be exercised. A few years ago, during the trial of an insane man in Chicago, it was asked whether there could be, strictly speaking, such a condition as partial insanity—that is, whether a man could be perfectly sane and responsible as regards all subjects except one or two. A very celebrated physician endeavored to maintain that it was impossible, because, he said, if one part of the brain was diseased, the whole organ, being in sympathy with that part, would be diseased also. It seems to me that, practically, this physician was mistaken. If the brain is the organ of the mind, there seems no reason why, notwithstanding one portion of that organ may be in an abnormal state, the other parts may not perform their functions well enough. I have certainly seen insane men whose opinions in reference to certain subjects it would be safer to trust than those of some men that have never been suspected of insanity. The question of responsibility is, of course, what gives insanity, from a legal view-point, its chief interest. It is certainly a mistaken idea that no insane person is responsible. It does not obtain in the asylums, at any rate; for discipline is very often maintained there by a system of rewards and punishments. If a patient misbehaves, he is informed that a repetition of his offense will put him back in some ward where his surroundings will not be so pleasant. This threat is seldom without avail, especially if the patient has once already had an experience of the penalty. This would seem to show that he knows good from evil, and has self-control enough to restrain himself from wrong-doing. There are some insane patients, though, of course, that have passed beyond the possibility of all self-control. It is plainly impossible to furnish any general rule by which to decide when a man is responsible and when not.
Insanity does not change a person's character so much as is usually believed. A distinguished English physician has said that, if there be anything in this world that is immutable, it is character. We meet with illustrations of the truth of this assertion almost every day. "Conversion" is believed, by many excellent church-people, to work a complete change for the better in a man's moral nature. But has any one ever seen a mean, close-fisted, narrow-minded man become, in consequence of conversion, liberal and generous? I trow not; and so even insanity seldom alters a man's nature much. For instance, the insane man may imagine people are plotting to kill him; he fancies he hears threats, and thinks he sees motions to carry them into execution. Now, if he be naturally a timid man, and a non-combatant, he will run, and try to escape; but if he is courageous by nature, and inclined to fight, he will act just as he would were all the circumstances really just as his disordered imagination pictures them. Compare the number of murders committed by insane men with those committed by men under the influence of alcohol, and the latter, in proportion, will be found to be greatly in excess. For my own part, I would sooner trust my life with an insane man than with one whose brain has been inflamed by over-indulgence in the liquors sold in the saloons and grog-shops. Before a person becomes insane there are two symptoms that almost invariably manifest themselves, insomnia and constipation. All the testimony I have been able to collect upon the subject goes to show this; and I have made very extensive inquiries. There has never been a single case brought to my notice, where the patient's mind was much drawn to any one subject, that it did not, to a greater or less extent, prevent his sleeping, and always enough to excite the attention of those about him. For my own part, although I believed Guiteau to be a "cranky" individual, of very peculiar mental characteristics, I never thought him in a sufficiently abnormal condition to be called insane, and principally for this reason, that with all the intensity of his purpose to shoot President Garfield, and notwithstanding the "pressure" he alleged that he felt upon his mind, he was never known to lose a night's rest. He himself said that he always slept well. Now, an insane man, in the condition which Guiteau wished to make the world believe he was, would not have slept well. He would have been up and down in his room all night, and would have been a nuisance to any one trying to sleep in an adjoining apartment. Nor did Guiteau suffer from constipation. The absence of either of these symptoms would have been sufficient to occasion distrust as-to his insanity; but the lack of both, to my mind at least, furnished conclusive evidence that he was a responsible man.
Before concluding this article, I wish to say a few words in behalf of a certain class of insane patients that, perhaps more than any others, deserve the sympathies of the public.
When I was convalescent, in the asylum, I attended an evening card-party, given in one of the pleasantest wards, for the amusement of those patients that were well enough to appreciate and enjoy such an occasion. I met a lady, a patient, who had been in the asylum three years. Although I could see that she was somewhat flighty, yet in all other respects she was quite an intelligent person. She told me that she had left at Home her daughter, an only child, about fourteen years old, whom she had not seen in all that time. This lady's husband had virtually put her in prison, and had never taken the pains to call on her himself oftener than once a year, and had never allowed her daughter to visit her. Tears stood in the poor woman's eyes as she told me these things, and I had no reason to believe that she was deceiving either herself or me. And upon inquiry I found that her case was not an exceptional one. There are mothers confined in all our asylums, as there were in the institution where I was, who, while they are insane enough to warrant their being put under restraint, are yet sufficiently intelligent to be sensible of their condition, and, like the lady I have alluded to, be overwhelmed by the thought that they are in a hopelessly helpless condition, and may be kept imprisoned thus for years, or even for life, away from their kindred and friends, and from the little ones for whom their hearts yearn with an intensity that no human being can appreciate, except some mother that has lost a child. This lady said she had known such patients, when talking about the little children from whom they had been separated, to sob and moan for hours at a time. But the law is inexorable. It says that a husband may confine his wife in an asylum if he can prove that she is insane—and that is a very comprehensive word. In some States the certificates of two physicians will accomplish this purpose; and, when once a patient is shut up in a ward, there is no deliverance that can be depended upon, as I shall presently proceed to show. But not only do the women suffer in this way, for there are men whose affections are as keen and as strong as those of any woman, who long to be with their boys and girls, to see them growing to manhood and womanhood, but who know neither the day nor the hour when that longing shall be gratified.
In some of our asylums, if not in all, there is a disinclination on the part of the superintendent to take the responsibility of discharging a patient, even when cured. One superintendent explained it to me in this way: "There is," he said, "no certain way of knowing whether a patient is thoroughly cured. Now, if I discharge one such, while his friends do not wish him to be sent away, and he subsequently becomes insane again, I am held responsible, and it tells against my reputation, and, in some cases, I may be obliged to pay the expense of getting the patient back again into the asylum. For that reason," he continued, "I never like to discharge any one until his friends call for him. I keep them informed of his condition, and leave it to them to decide when they will take him away."
But some one will say, there is a Board of Charities or some such arrangement by which the asylums are visited and such patients liberated. In most cases such visitors do not visit in the way the public imagines or the law requires. I have yet to learn of a case of deliverance effected by any such board. They go to the asylum, glance through the "crack wards," and then partake of a sumptuous dinner got up for their benefit by the superintendent, and that is all. But as to any careful search and investigation, to see whether there are not patients whose conditions might not be improved, or whose sufferings alleviated, I never heard of anything of the sort, nor have I ever talked with any one that had. Now, I am not saying that superintendents are cruel, nor that they do not do their duty. I am simply pointing out a system that affords every facility for the perpetration of the grossest and most outrageous injustice; and I leave it to the public to say whether any such system ever existed long anywhere without suffering the perversions which it seemed to invite. Some way should be devised—and a legal enactment would be the best remedy—by which those who confine, or are instrumental in confining, persons that have children, should be compelled to see that the children are brought, a certain number of times every year, to visit the parent thus confined. Again, patients should have greater freedom in communicating with the outside world. As it is, every letter written by a patient is carefully read by the superintendent or some officer; now, suppose a man is unjustly confined, and that the superintendent is an accessory to this false imprisonment. What opportunity would such an unfortunate prisoner have to obtain his freedom? The superintendent can prevent any letter going out that contains any reflections upon himself or the institution in his care. Should friends wish to see such a patient, all the superintendent need do is to say that he can not permit an interview, because the patient is excitable or sick—any such excuse will do. It is always against rules for a patient to address visitors unless they come to see him particularly. But suppose a patient was successful in laying before a stranger a case of injustice—what then? Why, the superintendent can say that the patient did not know what he was talking about, and that would end the matter with ninety-nine people out of a hundred, for every one knows how humiliating it is to appear to be deceived by an insane person!
Let the reader remember that I am not publishing this to bring a railing accusation against asylums or superintendents. While I was confined I was treated like a gentleman, and was shown every consideration by the superintendent and all the officers. I do not believe that in the institution where I was a case of unjust imprisonment could possibly occur while the present superintendent is in charge. What I wish to demonstrate is that the system invites abuses by making it so easy for an unprincipled superintendent to act in collusion with an unprincipled outside party, where there are financial or other temptations to deprive some innocent man or woman of his or her personal liberty. It is enough to say there is the writ of habeas corpus; but how is an unfortunate person in such a case to inform a lawyer that he wants such a writ issued in his behalf? And does any one believe that, if the Board of Visitors in New York could have been relied upon to do their duty thoroughly, any such outrage as that upon Mr. Silkman could ever have been perpetrated, or that it would have ever been attempted?
The "cottage system" has been spoken of as one means of rendering asylum-life pleasanter. But, although that system is better for the patients, it is not nearly so convenient for the officers; and, as these latter have always more to say on the subject than the patients, it is not likely that the cottage plan will ever be very extensively adopted. It is much easier to manage an institution where everybody and everything are in one large building than where they are scattered in different houses. Nevertheless if patients could have more of out-door life, could move about in a flower-garden and breathe the fresh air and bask in the sunshine, more than they possibly can while they are penned up in wards, they would improve mentally and physically more rapidly than they do. I do not not know of any more depressing influence within the range of the possibilities than that which settles upon one who has recovered his senses in an asylum, and is retained there until he recovers his health! The possibility of recovering one's health, surrounded by insane people, is what I have always doubted, and why I insisted upon leaving the asylum as soon as I did; and I never look upon such an institution without a heart-felt pang for the many sad and wretched beings I know it must contain; and with this comes the still more horrible thought that there may possibly be among them some who, in all justice and right, should be as free as I myself.