152 



INSANITY. 



Mini*, production of madness is disguised by the great plausi- 

 *-' bility of the hyperbolical spirit ; but it ought to be re- 

 collected that this plausibility throws a lustre on trie 



i i l *11 . I 



We confine ourselvea under the present article, to the Mania. 

 moral treatment, or genera) management. It is well ' S ^~Y~" > 

 known that, even after the* diseased state has. been cor- Mo * al 



manners and expressions of many individuals till the reeled, and the symptoms alleviated bj the judicious 



. i l_ .1 :....,..!;,,,.. n Knt.*.nf innc flicnlnco lisp nf mpHlpmp 51 slifrKt iir'cn vroiif'/' Icii/tum t<i iffi_ 



treatment. 



very instant in which their startling aberrations disclose 

 the matured existence of the malady which has been 

 all along in a train of preparation. 



Involuntary The last mental cause of madness which we shall 

 imitation, mention is the principle of involuntary imitation, 

 operating by the frequent sight of persons in similar 

 circumstances. That this has some influence we may 

 infer from the dread which many individuals have 

 of entering a madhouse. That principle which leads 

 us, even against our inclination, to adopt feelings, 

 and repeat motions which make a strong impres- 

 sion on our senses, is very strong in all men. The same 

 principle which makes a panic, (when once begun,) to 

 spread rapidly through an army, which gives the pa- 

 thos of the orator, and the performances of the trage- 

 dian, a simultaneous power over the whole of their 

 respective audiences, and which has sometimes spread 

 convulsions and enthusiastic visions among large con- 

 gregations, exerts a similar influence in the produc- 

 tion of nervous diseases. In hysteria and epilepsy, the 

 effect is well known. It is not, indeed, so frequently 

 nor so quickly produced in cases of insanity, because 

 this disease, in its decided forms, is more distant from 

 the ordinary state of any sane mind than these casual 

 motions. 



On this principle assisting the hereditar)' disposition, 

 the repetition of mania in the same family may be partly 

 accounted for. People think with particular frequency 

 and seriousness of any glaring mental aberrations that 

 affect their near connections. It has sometimes hap- 

 pened that the parent of a person who has become de- 

 ranged has acknowledged that he felt an apprehen- 

 sion of falling immediately into a similar state. When 

 the mind is weakened by sorrow, it is more easily ope- 

 rated on by sympathetic imitation; and the influence of 

 this principle would be more frequently seen than it is, 

 were it not counterbalanced by those efforts to maintain 

 fortitude, which are dictated by a sense of the neces- 

 sity of exertion for diminishing the evils with which a 

 family is afflicted. Even those who have had relations 

 whom they had never seen, who were subject to ma- 

 nia, especially if they died under the disease, must, if 

 they know the fact, be led to think at times of that 

 part of their family history, and certain expressions of 

 countenance and manner, arising from such circum- 

 stances, may be communicated from one relation to 

 another, and may thus contribute to cherish a diseased 

 train of feeling tending to mania. We often find two 

 or more individuals in a family becoming deranged at 

 the same time. This we can Attribute only to the in- 



use of medicine, a slight occurrence tending to irri- 

 tate the mind is sufficient to destroy in one moment all 

 the benefit produced, ami to give rise to an immediate 

 increase of violence in the symptoms. Moral circum- 

 stances must be attended to from the very begin- 

 ing. The first and most important step is, to remove the Change of 

 patient from his own home, and from all the objects habit*, 

 which he has been accustomed to see. His false no- 

 tions and harassing impressions are associated in his 

 mind with the objects exposed to his senses during the 

 approach of the disease. His relations have x become to 

 him, in the first place, stale and uninteresting, and af- 

 terwards causes of angry irritation. The places where 

 he has been accustomed to feel perplexity of thought 

 cannot be seen without in some measure reviving it. 

 It can seldom be expected, that in a private family in- 

 dividuals are to be found qualified for so difficult a charge 

 as the care of a maniac. The most favourable situation 

 is a retirement, where the patient will be surrounded 

 by objects which have a composing influence. It is 

 seldom, and only in the most violent form of the 

 disease, that confinement in a dark room is advis- 

 able. In ordinary cases, the darkness of night brings 

 with it an increase in the symptoms. The patient 

 should, even for some time after he is apparently well, 

 l>e kept at a distance from his friends. His importu- 

 nities, and those of his connections, for a premature 

 restoration to his family, ought to be firmly resisted till 

 his recovery is well established. From the too fre- 

 quent neglect of this precaution, many violent relapses 

 take place. Dr. Cullen judiciously recommends that, 

 where the patient cannot be removed, the furniture of 

 his room should be changed. In the Bicetre at Paris, 

 religious mania was often increased by the presence of 

 the emblems of the Catholic worship, and it was made 

 a serious question whether or not all such emblems 

 ought to be removed from the hospital. The propriety 

 of removing all such objects ought not to be doubted. 

 A patient might be hurt by an insult offered to his opi- 

 nions, but not by a step purely negative in its nature. 



Disputes have often been agitated on the utility of Comparison 

 harsh measures, compared with those of a milder kind, ot liarsh 

 Tyrannical principles, aided by the same passion for ""d mild 

 the extraordinary which in former ages led to a harsh treatulent - 

 treatment of almost all diseases, have been in .some 

 measure the causes of the cruel severities often prac- 

 tised with this description of patients. They have, for 

 the most part, had the effect of inflaming and irritating 

 the disease. In more enlightened times, iron fetters, 

 tight ropes, cruel floggings, and blows, have given 



fluence which the progress of the morbid feelings of place to the use of the strait waistcoat, which is at once 



each has produced upon the othei 1 

 Treatment Physicians sometimes differ in their treatment of ma- 

 of madness, n ia, according to their opinions regarding the compara- 

 tive influence f b <*% and of mental causes. Those 

 who hfve supposed that some sort of organic fault is 

 always the cause of mania, and _that the apparent causes 

 of it *>>. merely occurrences Slightly contributing to 

 develope the disease, place their chief dependence on 

 the resources of the Materia Medica; they trust to blood- 

 letting, blistering, purging, antispasmodics. and the ap- 

 plication of cold. This branch of the subject must be 

 allowed to be of great importance; but for the details we 

 refer to our article 



milder and more efficacious. There is no doubt, how- 

 ever, that a mild treatment has sometimes failed, or even 

 appeared to be hurtful. Some writers, on comparing 

 these facts, have contented themselves with observing, 

 that harsh or mild measures ought to be employed ac- 

 cording to the state of the patient, and our experience 

 of the effect of each method upon him. We must, 

 however, beware of suffering a mixed practice of this 

 sort to degenerate into an ambiguous and unmethodical 

 empiricism. The principle which we should follow is, 

 to practise uniform decision without harshness or in- 

 dignity, and to allow the patient, within a certain 

 range, a liberal degree of freedom without trifling. IN 



