Popular Science Monthly/Volume 26/December 1884/Alcoholic Trance
I PROPOSE to describe in a general way a peculiar mental state following the toxic use of alcohol, which has only recently attracted attention, and which promises to be a very factor in the medical jurisprudence of the future. Morbid states of the nervous system, in which the mind seems to act automatically, and without consciousness of the surroundings, and with no registration by the memory of these acts, are not new to students of mental and nervous diseases; but the fact that they are more or less common in inebriety from alcohol, and may follow any excess, is a recent discovery. In 1879 I published a short paper "On Trance and Loss of Consciousness following Inebriety," which, as far as I can ascertain, was the earliest study of these cases ever made. The following are among the first cases which attracted my attention to this subject. In 1877 a patient was admitted to the asylum at Binghamton, with this incident in his history: A year before, while apparently sober, he purchased a trotting-horse, paying a fabulous price. Two days after, he denied all knowledge of the transaction, and became involved in a lawsuit. On the trial it appeared that the purchase of the horse had been discussed for many hours, and that the buyer had exhibited great sagacity and judgment to avoid deception; also that, although drinking large quantities of spirits, he gave no evidence of other than good judgment, and perfect knowledge of his acts and their consequences. In the defense it was shown that the purchase of the horse was a most unusual act; that he never showed any interest in fast horses, or racing, nor had he been on the race-course, and was in fact afraid of driving fast horses; and, lastly, he had many horses in his stables, and needed the money paid for this horse, for a distinct purpose, which had been determined on before. From his own testimony he had many blanks of memory while drinking, and at this time had lost all recollection of passing events from the hour of dinner, during which he drank freely, until next morning, when he drank again and fell into another blank which lasted thirty-six hours. Other testimony indicated a gradual increasing dullness and abstractedness of manner during this time; also apparent disinclination to fix his attention on any one thing long. The suit went against him, and he soon after was brought to the asylum. In another case the president of a bank, a man of wealth and irreproachable character, forged a large check, put the money in his pocket, and the day after was amazed to find the money and to account for it. In an investigation it was proved that he suffered from these blanks of memory after drinking wine freely; that he had before done many unaccountable acts, apparently fully conscious at the time, and yet afterward disclaimed all memory of them, a fact which was supported by their motiveless character. This mental condition may be described as a loss of memory and consciousness of present and passing events, that is concealed and not apparent from a general study of the conduct; or, in other words, a state of the brain similar to somnambulism in respect to the unconscious character of the acts, and all recollection of them. For the time being the sufferer is a literal automaton, giving little or no evidence of condition, and acting from impulses unknown, and motives that leave no trace.
The late Dr. Beard believed this state to be one of general lowered brain-function, in which the cerebral activity is concentrated in some limited region of the brain, and is largely suspended in the rest. He also urged that the plane of consciousness was below the point of remembering; hence these cases were conscious at the time, but the memory failed to record the impression. In confirmation of this, the late Dr. Forbes Winslow recorded a case of a somnambulist who, while walking about, set his night-dress on fire, and with excellent judgment and coolness threw himself on the bed and extinguished the flames, then resumed his walk, and awoke next morning with no memory of it, and was greatly alarmed at the charred appearance of his dress. Whatever the pathology may be, it is clear that this is a state of irresponsibility, and for the time being a form of dementia and insanity, about which there can be no question. Careful study of those cases for many years has indicated the startling fact that they are very common in inebriety; also that in every case where alcohol is used to excess there are histories of loss of memory and consciousness of acts committed while using spirits. These conditions are almost infinite in variety and complexity, and are considered mere freaks of memory by many persons. Probably in a majority of cases in the early stages these blanks of consciousness and memory are partial, and appear in the delirium or stupor which follows excess of spirits, or in mental states approaching it, and clear up after recovery, or remain like a cloud for weeks, then from some little circumstances break away and every act is recalled. In other cases only a dim, vague impression remains of what has transpired in the past, which may or may not become clear with time; or the blank may be total for the time being, and then break away. In many of these cases there is apparent realization of all his acts and words, in others a self-evident unconsciousness of them. This is only the beginning of another and more pronounced stage, in which the blank of memory and consciousness is total, and during this period the acts and appearance of the person differ but little from those of usual health. In many cases the brain function or action, as seen in his acts, is fully up to the best state of health, even showing more than usual strength in some directions. In a paper read before the Medico-Legal Society of New York, in 1881, I discussed this condition as a trance state following inebriety; since that time a number of different names have been suggested by authors, such as inebriate automatism, inebriate insanity, inebriate unconsciousness—all describing the same condition. The following may be mentioned as facts that are generally accepted as landmarks from which further study may be dated:
1. This trance state is a common condition in inebriety, where, from some peculiar neurotic state, either induced by alcohol, or existing before alcohol was used, or exploded by this drug, a profound suspension of memory and consciousness and literal paralysis of certain brain-functions follow.
2. This trance state may last from a few moments to several days, during which the person may appear and act rationally, and yet be actually a mere automaton, without consciousness or memory of his actual condition.
3. This trance state may be noted by criminal impulses and by unusual thoughts and acts foreign to all the man's past history. In all these cases there are no apparent disturbances of the nervous system, no convulsions, no premonitions to mark this state; at some unknown point, all unconscious, the eclipse begins, A comparison of the history of a number of cases will show three mental conditions quite prominent: 1. In which the mind in this state acts along certain accustomed lines of thought and action; 2. In which the mind displays unusual ranges of thought and action, which in some cases can be traced to certain mental states growing out of the surroundings; and, 3. Where criminal impulses are prominent, that have no apparent connection with the present or past. These conditions may be illustrated in the following cases: A railroad conductor, who drank to excess every night after the day's work was over, would frequently get up in the morning, go out on his train, perform all his duties correctly, and recover consciousness of himself suddenly on the road, and all the past be a blank to Lira from some point the night before. These blanks occasionally lasted twenty-four hours, and he could never recall anything which happened, and only knew by the money and tickets that he had made a trip on his train. After a time he would put down in a note-book events of importance in this state, which he never did otherwise. The train-hands knew that he was, as they termed it, "memory-drunk," when he used his note-book freely, and seemed dull and abstracted. A pilot on a Sound steamer, after seasons of hard work, and exhaustion from loss of sleep, would use brandy to keep up, and have blanks of hours from which he would recover, having no recollection of what had happened. He would act as usual, only be less talkative, and dull in his manner. A skilled mechanic, who used spirits to excess, suffered from blanks of many hours' duration, during which he attended a dangerous machine, performing all the duties, requiring both skill and judgment. A clergyman, who drinks wine, has frequently conducted service, and preached a sermon without any memory of the fact, having a blank of all surroundings for hours. A grocer, after a period of great excess in the use of spirits, will conduct his business for hours without any consciousness of events, and only know by the books and the statements of others what has taken place. These are only a few of the histories of a large number of cases which I have gathered to illustrate the fact that in this trance state the mind may work along accustomed lines of thought and action. In this condition, the evidence of a mental blank is more or less obscure. In the next division, the mind displays unusual ranges of thought and action, some of which can be traced to the surroundings. A physician, who drank constantly, and was a bitter skeptic, went into a revival meeting and professed change of heart, and took part in the exercises, and the next morning had no recollection of it. Later, while drinking, he heard the singing of the revival meeting, and, dropping all business, entered and took a very active part, and seemed fully conscious of all the surroundings, yet, after a night's sleep, had no recollection whatever of anything which had occurred. In this case the trance state was manifest in unusual deeds and acts, suggested from the surroundings. A similar case was that of an editor, who, after drinking to excess, could always be found in temperance-meetings, making eloquent appeals, and yet he gave no evidence of being under the influence of spirits, nor could he remember anything of what had occurred. Another case is that of a man of fortune, who drank wine freely, awoke and found that he had married his servant, and made an unusual disposition of his property, which was all a blank to him. To his friends and others he seemed fully conscious of the nature and consequences of these events at the time. I think it will be found that inebriates brought suddenly into conditions of excitement are moved by circumstances and surroundings to which they are often really oblivious. If the trance state is present, the influence of the surroundings can not be estimated. The last division, that of criminal impulse growing out of this trance state, illustrates the subject of our paper more closely. The following cases bring out the facts better than any description: An inebriate was repeatedly arrested for horse-stealing, and often punished. The crime was committed under similar circumstances, and no. attempt was made to conceal the property; on two occasions he assisted the owner to hunt up the horses. When it was apparent that he was guilty, great was his astonishment, and he denied all recollection of any circumstances or events. This was confirmed by all the circumstances of bis life, by his inebriety and blanks of memory, and absence of motive and object in the crime. He was fond of horses, and seemed at this time to be governed by an impulse to drive and ride behind a good horse. A farmer of quiet, good disposition suffered from blanks of memory after drinking to excess. One day, in what seemed full consciousness of the surroundings, he attacked a stranger and injured him so that he died. He had no recollection of the time, purpose, or any circumstances of the tragedy. A periodical drinker, of wealth, tired his buildings, and awaking when they had burned down, offered a large reward for the incendiary. To his great astonishment, the fire was readily traced to him; the circumstances and motive were all a perfect blank. A man of much talent and eminence, who drinks occasionally to excess, has on many occasions offered violence to his wife, whom he loves very dearly. On these occasions he is apparently sober, gives reasons for his conduct, and afterward has not the slightest recollection of it. In a murder-trial recently, it appeared that a drinking man drank early in the morning, then killed his wife, and went about his work in the vicinity, as if nothing had happened, all unconscious until arrested. He was sentenced for life, but has a firm conviction that he did not commit the crime, because he can not conceive of a motive, and has no recollection of it. A clergyman committed a rape under the most extraordinary circumstances, and denied all recollection of it; his drinking habits and all the incidents of the case sustained his statement. A lawyer of reputation planned the abduction of a lady he was going to marry. A man of a large family and happy domestic relations married a notorious woman. A physician stole a large sum of money from a patient. A college graduate enlisted in the army. In each of these cases there was a history of drinking to excess, and each had no memory of the event, and all the circumstances were so unusual and at variance with previous conduct that undoubtedly a trance state was present. These cases might be multiplied almost indefinitely from the records of criminal courts everywhere. Every day the papers record cases of crime, without motive or purpose, by inebriates who, in defense, claim to have no recollection of it; but, as they were not wildly delirious or stupid at the time of committing the act, they are punished as fully responsible, When the crime is of magnitude, and the defense is insanity, the explanation and theory are so far from the accepted views of experts as to confuse courts and juries, and be criticised and ridiculed by others. This defense occurs most frequently in two forms of cases: One, of a chronic inebriate, who is all the time more or less under the influence of spirits, and who lives in a low moral atmosphere, in bad physical surroundings. Suddenly he commits a crime, which is without motive, and seems a mere accident and result of unforeseen conditions. The second case is of a man who may be a periodical inebriate, and of good character and reputation in everything except excess of use of spirits; whose surroundings and general standing are good, and who commits a homicide or some strange crime under circumstances that are inadequate to explain or account for it. In both of these cases there is no recollection of any of the circumstances, and the defense is based on some specious reasoning and theories. There are evidently disorganized brain-power, mental and physical incoordination, with defect and unsoundness of the reasoning powers, which can not be made clear to the court and jury. The prevalence of the theological theory, that all these strange, unaccountable acts of inebriates, who are not stupid at the time, or wildly delirious, come from vice and sin, is fatal to all scientific study and progress. This condition of trance, noted by absence of memory and consciousness, has been discussed by Dr. Carpenter, of England, under the title of "Automatic Cerebration," from which I quote the following sentence: "I have noticed some cases of drunkenness, in which a suspension of memory and consciousness was noted, coming on unexpectedly, and then the patient was a victim to morbid impulses which he never realized or had any recollection of after." Dr. Hughlings Jackson writes at some length on mental automatism, following transient epileptic paroxysms, in which this same condition is described at length as a form of sudden paralysis of the cerebral functions, or conditions of hyperæmia and suspension of some controlling centers. The late Dr. Forbes Winslow describes a similar condition of trance and automatism where the person seemingly acted as fully recognizing right and wrong, although consciousness was obliterated. Dr. Hammond mentioned the case of a man who, after an attack of epilepsy, went about for eight days in a trance state, doing business, and having no memory of it. Dr. Hughes has also mentioned similar cases. Abroad many eminent specialists, including such names as Drs. Bucknill, Clouston, Mercer, and Motet, of Paris, and others, have described this state associated with epilepsy, and following mental shocks in persons who are drunkards. These references are presented to show that the trance state has been observed by eminent men, although not yet studied from the side of crime and responsibility. A large number of cases are constantly before the courts on trial for crime committed after and during excess in the use of alcohol—crime that is purposeless, without motive or object, and differing in the manner of execution, and effort to conceal afterward, from other crime of similar nature—in some cases noted for apparent coolness, without excitement, and cold-heartedness or indifference to the nature of the act. In the defense, all recollection or consciousness of the event is denied, and many circumstances, seen both before and after the crime was committed, bear out this statement. These cases receive no study, and are punished, the result of which precipitates the victim into worse and more degenerate stages. Undoubtedly these cases are suffering from alcoholic trance, and have crossed the border-line of sanity and responsibility, and are as truly insane as the wildest maniac. In this trance state the person is a mere automaton in motion, either moving along certain fixed lines of conduct, or acting in obedience to unknown forces which may change or vary any moment. Some governing center has suspended, and all rememberable consciousness of time and the relation of events has stopped. Changing thoughts and impulses, the suggestion of a disturbed organ, or the impression of a thought or desire felt in the past, may suddenly concentrate into action irrespective of consequences. Both subjective and objective states, influenced by conditions of health and brain-power, may develop into acts that will be unknown and unrecorded by the higher brain-centers. Clinical facts within the observation of any one will indicate, without any kind of doubt, that in all cases of inebriety there are a defective brain-power and ability to recognize the natural relations of life in all particulars. The sufferer is more or less incapable of healthy normal thought and action; he has opened the door for many complex nervous disorders, and the natural process of tearing down the structure is greatly accelerated. If the trance state is found to be present, he has passed into the realm of practical irresponsibility and unconsciousness of the nature and character of his actions. I believe the following summary will be found to outline the future recognition and treatment of these cases:
1. Inebriety in all cases must be regarded as a disease, and the patient forced to use the means for recovery. Like the victim of infectious disease, his personal responsibility is increased, and the community with him are bound to insist on the treatment as a necessity.
2. Inebriety must be recognized as a condition of legal irresponsibility to a certain extent, depending on the circumstances of each individual case.
3. All unusual acts or crimes committed by inebriates, either in a state of partial stupor or alleged amnesia (or loss of memory), which come under legal recognition, should receive thorough study by competent physicians, before the legal responsibility can be determined.
4. When the trance state is established beyond doubt, the person is both physiologically and legally irresponsible for his acts during this period. But each case should always be determined from the facts of its individual history.
In the light of science the present legal treatment of inebriety is but little else than barbarism. The object of the law, in punishment, benefits no one, and makes the patient more incurable—destroying all possibility of recovery and return to health again. Inebriety in any form may be no excuse for crime in a legal sense, but it is still less an excuse for punishment, which destroys the victim, or makes him more helpless and hopeless. A vast army of inebriates, hovering along these border-lands of disease and crime, who are unknown and unrecognized, except "as vicious and desperately wicked," are a perpetual menace to all progress and civilization, unless they can be reached and checked by rational, effective methods. A revolution of sentiment and practice is demanded, in which the inebriate and the conditions which developed his malady shall be understood; then the means for prevention, restoration, and recovery can be applied along the line of nature's laws.