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IMPOSSIBILITY OI" DEFINING INSANITY.
Anomalous and Masked Afictions of the Mind. _
Barons proceeding to the discussion of the various stages of incipient insanity, previously referred to, I propose to consider briefly, certain anomalous, generally unobserved, because mas/cea' conditions of brain and mind. I would, however, premise, that in the majority of cases of insanity, it is difficult to trace back to its origin, the first inroads and dawnings of morbid and insane perception, to demonstrate when the boundary-line between healthy and disordered idea has been traversed, at what precise period certain normal states of eccentricity of Molly/rt, singularity and oddity of conduct, have passed into actual insanity. Unfortunately, there is no psychical test to which we can with safety and satisfaction, judicially and psychologically appeal when difficult, doubtful, obscure, and subtle conditions of suspected mental disorder are submitted to us for medical, metaphysical, and legal analysis. Each case must be examined by, and in relation to, itself, and not in reference to any preconceived definition, or d prion' hypothesis of insanity? The vain attempt to frame a definition of this disease, will, in a measure, account for the great difl‘erence _ . When speaking of the degrees of departure from presupposed conditions of health, either of body or mind, perhaps the term latitude would be a. more philosophically correct expression than the phrase standard, now commonly adopted. How imperceptible and shadowy are the gradual transitions from a state of health to one of disease! Who can accurater define their characteristics? We are able, however, to appreciate when there is any positive
deviation on either side of the line. In the case of colours, it has been well remarked, “ that we know blue and red perfectly well, but they may be
of opinion, as well as unhappy conflict of testimony exhibited in courts of law by medical men supposed to be conversant with the phenomena of disordered mind. Before enumerating the symptoms characteristic of the commencement of insanity, I would premise that mental disorder often first manifests itself in a marked and significant manner at a very early period of life. Decided paroxysms of insanity have occurred in young children when at school, and in persons more advanced in age whilst at college, all traces of the transient attack of mental disorder having passed, like a dark cloud, entirely away, there being no recurrence of the disorder for many years. Several remarkable cases of this kind have come under my observation. In one singular instance, a young gentleman whilst studying for university honours had an attack of insanity. He was sitting up late at night, busily occupied in reading, when he was suddenly seized with an impulse to destroy everything within his reach. He first broke the lamp on the table, then a pierglass. He subsequently tore up and destroyed a number of books, and did great injury to several articles of value in the room. He left home about three o'clock in the morning, and came back at eight, covered with filth, apparently in full possession of his senses! He refused to give any explanation of his conduct, or to say where he had been. When pressed upon the subject, he became irritable, sullen, and morose. This gentleman continued mentally well for twelve years, when insanity again developed itself, and he has remained
blended together, in an infinite variety, in forming a purple colour, and it may be impossible to say where the red and where the blue prevails. Yet this does not deprive us of the power of forming a very distinct conception of both colours, apart from each other.” The experienced physician is able to appreciate when the boundary-line between reason and insanity has been traversed, although he is not competent to frame a definition thatcan be used as an unerring test in all doubtful cases of mental disorder.
msamrr AMONG CHILDREN. 161
from that period in a. deranged state of mind. A patient, now insane, manifested, at the age of ten, decided symptoms of mental aberration, and to such an extent, that, occasionally, for days it was deemed necessary to confine mechanically the hands, so mischievous were the child’s tendencies. At the age of fifteen, he, appearing like other boys, was sent to a public school, and it was not until he was t/n'rty that his insanity again manifested itself, and then it was considered necessary to place him under restraint.
When referring to this class of case, and of the possibility of insanity commencing at a very early age, then becoming arrested, and even remaining dormant for five, ten, twelve, and twenty years, Esquirol remarks, “I am more than ever convinced that the existing causes of insanity do not act abruptly, except when the patients are strongly predisposed. Almost all the insane exhibit, before their disease, some alterations in their functions, alterations which commenced many years previously, and even in infancy. The greater part had had convulsions, cephalalgia, colics, or cramps, constipation, and menstrual irregularities. Several had been endowed with great activity in the mental faculties, and had been the sport of vehement, impetuous, and angry passions. Others had been fantastical in their ideas, their affections, and passions ; some had had an extravagant imagination, and been incapable of continuous study; others, excessively obstinate, could not live, except in a very narrow circle of ideas and affections, whilst many, void of moral energy, had been timid, fearful, irresolute, indifferent to everything. W'ith these dispositions, a mere accidental cause is sufficient to make the insanity break out.“
M. Pinel was acquainted with a case of insanity that had been going on unnoticed for a period of fifleen ' “ Dictionnaire dcs Sciences Medicales." T. 16, p. 195.
years! In several other cases, the maniacal and melancholy state had begun four, 8112*, ten, fifteen, and twenég/ years previously. It is often easy to go back months or years in this way, and we finish by discovering that circumstances taken for causes by the friends, are frequently only the consequences of unobserved disease. In fact, it often happens at that period of the malady, that a. slight contradiction, or fit of anger, or some cause equally insignificant to a. person in good health, provokes the immediate and complete subversion of their reason, and gives rise to mistakes as to its true cause and duration. It does not, however, necessarily follow that when these symptoms of insanity appear in early life, that the disease will recur at a subsequent period. Children, as well as adults, are subject to sudden, transient, and paroxysmal attacks of temporary mental disorder, which pass entirely away, the mind retaining its healthy state for the remainder of life.
Dr. Brierre du Boismont has recently published some remarks upon the insanity of early life, in noticing the dissertation of Dr. Paulmier. This able and accom— plished physician (Dr. Boismont) accounts for the comparative exemption of childhood from mental aberration, by the absence of many of the causes so potent in its production in adult life ; not that children do not feel acutely, but their sensations are of a fleeting nature, and in this lies their protection. Nevertheless, children who inherit a disposition to mental disease, or who possess a highly nervous temperament, and who are exposed to favouring circumstances, occasionally manifest undoubted symptoms of the malady. Haslam, Perfect, Franck, Burrows, and Spurzheim, have recorded cases of insanity occurring in children under eleven years of age. Greding gives an account of a child of eighteen months, who died of marasmus. She was brought into the asylum at
INSANITY OF EARLY LIFE.
Wuldham with her mother (who was insane). The child was then scarcely nine months old. She was subject to paroxysmal nervous attacks, which ended either in an indescribable laugh, or in a fit of mania, during which the little creature tore everything she could lay hands upon. Jacobi refers to several cases of insanity in children, then in the asylum at Siegburg. Esquirol treated two children, one of eight and another of nine years, and a girl of fourteen, all labouring under mania; he was also consulted about a child of eleven, in which the disease assumed the form of melancholia.
Marc gives an account of a little girl of eight, who freely admitted that she wished to kill her own mother, her grandmother, and her father. Her object was, to be possessed of their property, and to have an opportunity of indulging her passions. The child was morose, pale, and silent ; when spoken to, her answers were very abrupt. Her health was improved by a residence in the country, but on being brought back to town, she became again pale and melancholy. For a long time the cause remained undiscovered; at length it was found that she was addicted to bad habits, which she openly avowed, regretting at the same time that she had not the opportunity of indulging her animal passions. Dr. Brierre du Boismont noted four cases, of children of six, seven, and ten years of- age, in whom the symptoms of mental disease were manifest; and at present he has under his care a female child of three and ahan years old, born of a paralytic father, which shows the strangest caprices; at one time sad and melancholy ; again in the most violent fits of rage, without any cause, and not to be appeased. The intelligence of the child is far beyond its years. The cases of insanity brought under notice by Dr. Paulmier cannot be said to belong to childhood; his children are young people ; for of thirteen