Insanity
a more or less impaired condition of any or all of the mental functions involving the intellect, emotion, or will. There can be no absolute test of insanity-or of sanity for that matter. Sanity is proved by normal selfcontrol, and insanity by the loss of it from disease.
The most common mental symptoms are morbid emotional depression and mental pain. In many cases of insanity to energize mentally is to suffer pain.
Another symptom in other cases is an undue emotional exaltation; this is commonly associated with a loss of the great controlling or inhibitory functions of the brain, and occurs in mania. There is morbid brain excitement, commonly exhibited in restless motions or shouting. Such cases may go on to complete loss of any consciousness of all the former brain impressions and mental life. The patient remembers nothing and does not know his nearest friends. Another common symptom is a diminution or loss in the power of attention. This is common to nearly all forms of insanity. Then we have perversion of the reasoning power, as seen more frequently in insane delusions, which are common in most cases and varieties of insanity. They are divided into fixed delusions and changing delusions, the former being the more serious and incurable. Hallucination is sensation without an object. The hearing of voices, when none exist, is a good illustration. Hallucinations usually subjective and psychical in their origin, though unquestionably both psychical and a sensorial element may enter into their genesis. Hallucinations may be of hearing, which are the most common and the most serious, as a symptom of incurability if long continued; of sight, the next most common and more likely to be recovered from; of smell and taste, which are rare, and not favorable.
Another mental symptom of insanity very common is impulsiveness of action in an automatic, unreasoning way sometimes without any conscious intention on the patient's part, and without power are a INSANITY of control by the will. A man sees a large plate glass window and he impulsively hurls a stone through it. Another cannot resist the impulse to tear his clothes, a third cannot resist the impulse to set a haystack on fire. Uncontrollable impulse naturally goes with diminished volition in insanity.
One of the most common and most painful symptoms of insanity is a change of natural affection toward relatives.
This is not universal, but in nearly half the cases of insanity the affective condition is thus perverted or reversed. The memory is not necessarily affected in insanity. In many patients it is exaggerated; things come back with unnatural vividness.
One of the chief bodily symptoms in insanity is sleeplessness. Almost every kind of insanity is sleeplessness in its early stages. Another is morbidness of speech; it may be incoherent or partially coherent; it may be over-rapid, slow, or entirely absent. Often the conventionalities of speech are lost or dropped in insanity. The articulation of words may be changed. Next in importance to speech is the expression of the face and eyes. This is given by the most delicate combined muscular and nervous apparatus that exists in nature, being in the most intimate connection with the mental part of the brain, and acting as its chief expositor and interpreter. In the depressed and demented cases the eye loses its luster and brilliancy; in maniacal cases it has abnormal feverish brilliancy; the pupil enlarging and the eye-lids being drawn too far apart produce staring, by exposing not only the cornea, but much of the sclerotic as well. Irregularity of the pupil is suggestive of organic brain disturbance. The natural expression of the face is greatly changed, and little beauty of feature survives during acute attacks. The conventional control over the outward expression of the emotions is lost, and the face accurately shows the state of the melancholic, the maniacal, or the demented patient. Clouston has thus classified the forms and varieties of insanity:
Melancholia, comprising all states of depression, and having emotional depression or mental pain and sense of ill-being as its leading and dominant symptom. There may in addition be loss of self-control, insane delusions, which are usually suggested by the depression or impulses toward suicide, as well as incapacity to follow ordinary avocations in melancholia. These distinguish it from sane melancholy. Suicide is the great risk in such cases; four-fifths of melan- INSANITY cholic cases being suicidal. The recoveries from melancholia are the most complete of all forms of insanity. It would seem to be caused by a more entirely functional and dynamical brain disturbance than any other form of insanity that may leave no trace whatever behind it after recovery.
Mania, comprising all states of mental exaltation, such as joyousness and rage, and commonly accompanied by muscular excitement, restlessness, sleeplessness, the speech tending to become incoherent, the conduct violent or uncontrolled. The symptoms range from a joyous elevation with talkativeness and merely want of common sense and foolish conduct up to complete incoherence, delirium, and raving madness, or "acute mania." Folie circulaire, or states of regular alternation between melancholia and mania, forms a small but distinct variety of insanity.
Monomania, or delusional insanity, is that form where insane delusions are the chief signs of the mental aberration. In such cases the intellect is chiefly affected rather than the affective nature. The delusions are morbid in a particular direction, the chief forms being monomania of grandeur or pride, of unseen agencies, and of unfounded suspicions. Electricity, mesmerism, telephones, gases, noises made by imaginary persecutors are the common subjects of the second form; while utterly perverse interpretations of the conduct of friends or strangers is the common form of the latter. The two together are sometimes classed as monomania of persecution. Hallucinations of the senses-i. e., imaginary sights, sounds, smells, and tastes are very common in this form of insanity. It is not very curable when the delusions get fixed.
Dementia, or conditions of general mental enfeeblement, is the state of mind where the memory is impaired, the reasoning weakened, the feelings diminished, the will especially lacking, the attention and curiosity far below normal, these changes having occurred in a person who had at one time been normally constituted. It is in fact silliness, want of mental force, imbecility not congenital, but acquired.
Stupor, embraces those cases where there is mental torpor, in which_impressions on the senses produce no effect, the patient neither speaking nor taking notice of anything, and having no volition except to resist, but being able to stand, walk, and to eat. Trance and catalepsy are forms of stupor, the heart's action is low and the body is cold, and the muscles are flabby. Stupor commonly occurs in INSANITY young people of both sexes, and is very curable, 50 per cent. recovering. disturbances have a close relationship to morals, law, social life, and conduct.
The children of insane or drunken parents are lacking in the normal power of control, and in their perception of the sense of right and wrong, their conduct lessened control, but there are persons by reasonable motives. All forms of insanity are more or less distinguished by lessened control, but there are persons without general depression or excitement, insane delusions, mind, who will suddenly smash furniture, tear clothing, steal, set things on fire, obey INSANITY the reproductive functions. Uterine, control, and in their perception of the ents are lacking in the normal power of The children of insane or drunken par- to morals, law, social life, and conduct. disturbances have a close relationship of all the mental faculties, and volitional fective control, is the most interesting nancy, childbirth, and nursing are the of all the divisions of the mental classi- causes of the insanity of pregnancy, pufications, inasmuch as will is the highest erperal insanity, and lactational insanof all the mental faculties, and volitional ity. These form 10 per cent. of mental disease in the female sex. amenorrhœal, most curable of all forms, recovering in eal , ovarian, hysterical, and peral insanity occurs commonly within a fortnight of childbirth, and is the most acute and one of the most dangerous to a fortnight of childbirth, and is the most life of all insanities, while the most curable, and is attended by the highest temperatures, sometimes reaching 105°. over 80 per cent. of the cases. Puer- The different periods of life have each They are the their own form of insanity. Pubescent tary, commonly acute and maniacal, cases, those not recovering commonly and recovers in over 60 per cent. of the able, and is attended by the highest passing into the most typical form of merous diseases to which the period of development is subject. Climacteric inusually has remissions and exacerbations secondary dementia. It is one of nucovers in 53 per cent. of the cases under sanity occurs at the period of the meno- Senile insanity is typically seen in the senile dementia of extreme old age, when the memory and all the faculties have pause or the "change of life." It is faded away. proper treatment and conditions of life. usually melancholic in character and reor afeeblement of themselves or others. The function of bey gross animal impulses, or kill have lost their power. portions or "centers of mental inhibition" supposed that the inhibitory controlling volutions. In this form of insanity it is tion in other portions of the brain con- regions of the brain, controls mental action in other portions of the brain convolutions. In this form of insanity it is supposed that the inhibitory specific disease of those portions of the have lost their power. ry controlling Clinical Varieties. - Chief among these eral paralysis, a types of insanity is general specific disease of those portions of the brain ain that subserve mind and motion. life itself. In this form of insanity pasively worse, gradually impairing and at ng speech, motion, ion, mind, length destroying s and, usually in about three years' time, life itself. In this form of insanity pasions of wealth and power. Paralytic sions of wealth and power. Paralytic tic clinical varieties of insanity have been described. Traumatic insanity, from injuries to the head; anæmic insanity, from A number of rarer and less important thinness of blood; diabetic insanity; ininsanity is that connected with apoplex- sanity from Bright's disease; post-febrile psy. ies, es , softenings and tumors of the brain, which cause ordinary paralysis first, and one form of dementia afterward. Epiirritability, and by danger to those It is often attended by great violence and irritability, and by danger to those around the patient. Many murders are sanity. litic insanity is the result of brain poisoning by this terrible scourge manity. Alcoholic insanity is a very frequent form. It may be very short in duration or very long continued, or incurable. Rheumatic and gouty insanities are very rare. of hu- Phthisical insanity, or that connected with consumption, is a very interesting curable. Rheumatic and gouty insani- duration or very long continued, or in- Phthisical insanity, or that connected variety. The patients are suspicious and unsocial, and often have no cough or spit or outward sign of consumption, which may not be discovered till the curable. There are various forms of insanity connected with derangement of insanity, following all kinds of fevers, especially scarlatina; the insanity of sanity from Bright's disease; post-febrile sanity. insanity, following all kinds of fevers, thinness of blood; diabetic insanity; in- juries to the head; anæmic insanity, from insanity. All sorts of disturbing influences to the brain bring out this predisposition into actual disease. No doubt Causes of Insanity. - Hereditary tendenness, all nervous diseases, consumption, too exciting or depressing or exhausting employment, or unfavorable conditions 70 per cent. of all cases have an insane the offspring. Marriage of near relatives causes it if the stock is bad; not if especially scarlatina; the insanity of it is good. The physical causes of insanity affecting the body, such as alcohol in excess, produce insanity times the proporti 70 per cent. of all cases have an insane position into actual disease. No doubt ences to the brain bring out this predismoral causes, such as affliction, losses, love-affairs, and religious excitement, do. proportion which mental and Nature of Insanity. No y in four one INSCRIPTIONS doubts that it is due to disorder of function of a certain portion of the brainviz., that part of the cortex which is the vehicle of all mental function. The exact pathology of many forms of insanity has not as yet been ascertained; but in 80 or 90 per cent. of the cases that die some abnormality can be found in the brain.
Treatment of Insanity. The general principles of modern treatment may be divided into bodily and mental or moral.
The bodily treatment may be generally said to be to put all the organs and functions right if wrong; to get up the strength and fat of the body; to restore the tone and right working of the nerv ous system; to restore the sleep; to invigorate and soothe by life in the open air; and to let off undue and morbid nervous energy by much exercise, gymnastics, and massage in some cases, and to secure complete brain and body rest for others. The mental treatment consists chiefly in careful observation, companionship, control, distraction of the mind from morbid thought and feeling, by suitable occupations and amusements, and guarding against the dangers of suicide, homicide, and self-neglect. All the States and many of the larger cities in the United States are equipped with hospital facilities for the insane.
In 1918 there were reported in the entire United States 239,820 insane per- Of these 125,919 were males and sons. 113,901 females. In the State hospitals were 109,994 insane males and 97,711 insane females. pyrus, parch-