DEFINITION.

There is no word in the English language more deserving of a precise definition than madness: and if those who have treated on this subject have been so unfortunate as to disagree with each other, and consequently have left their readers to reconcile their discordant opinions; yet it must be confessed that considerable pains have been bestowed, to convey a clear and accurate explanation of this term. Although this contrariety of sentiment has prevailed concerning the precise meaning of the word madness, medical practitioners have been sufficiently reconciled as to the thing itself: so that when they have seen an insane person, however opposite their definitions, they have readily coincided that the patient was mad.

From this it would appear that the thing itself, is, generally speaking, sufficiently plain and intelligible; but that the term which represents the thing is obscure. Perhaps, we might be somewhat assisted, by tracing back this word, in order to discover its original meaning, and shewing from its import the cause of its imposition.

If the reader, as is now the custom, should turn to Johnson’s Dictionary for the meaning and etymology of this word, he will find that the Doctor has derived it both from the Anglo-Saxon ?emaa? and the Italian matto; but without giving any meaning as the cause of its employment. The word is originally Gothic, and meant anger, rage, mod. [Mod]. It is true that we have now converted the o, into a, and write the word mad: but mod was anciently employed.

“Yet sawe I MODNESSE laghyng in his rage.”
Chaucer. Knight’s Tale, fol. 1561, p. 6.

There is so great a resemblance between anger and violent madness, that there is nothing which could more probably have led to the adoption of the term. Dr. Beddoes, who appears to have examined the subject of insanity with the eye of an enlightened philosopher, is decidedly of this opinion, he says, Hygeia, No. 12, p. 40, “Mad, is one of those words which mean almost every thing and nothing. At first, it was, I imagine, applied to the transports of rage; and when men were civilized enough to be capable of insanity, their insanity, I presume, must have been of the frantic sort, because in the untutored, intense feelings seem regularly to carry a boisterous expression.”

Mad is therefore not a complex idea, as has been supposed, but a complex term for all the forms and varieties of this disease. Our language has been enriched with other terms expressive of this affection, all of which have a precise meaning. Delirium, which we have borrowed from the latin, merely means, out of the track, de lira, so that a delirious person, one who starts out of the track regularly pursued, becomes compared to the same deviation in the process of ploughing. Crazy, we have borrowed from the French ecrasÉ, crushed, broken: we still use the same meaning, and say that such a person is crack’d. Insane, deranged, or disarranged,[1] melancholic, out of one’s wits, lunatic, phrenetic, or as we have corrupted it, frantick, require no explanation. Beside one’s self most probably originated from the belief of possession by a devil, or evil spirit.

The importance of investigating the original meaning of words must be evident when it is considered that the law of this country impowers persons of the medical profession to confine and discipline those to whom the term mad or lunatic can fairly be applied. Instead of endeavouring to discover an infallible definition of madness, which I believe will be found impossible, as it is an attempt to comprise, in a few words, the wide range and mutable character of this Proteus disorder: much more advantage would be obtained if the circumstances could be precisely defined under which it is justifiable to deprive a human being of his liberty.

Another impediment to an accurate definition of madness, arises from the various hypotheses, which have been entertained concerning the powers and operations of the human mind: and likewise from the looseness and unsettled state of the terms by which it is to be defined.

Before treating of the intellect in a deranged state, it will perhaps be expected that some system of the human mind, in its perfect and healthy condition, should be laid down. It will be supposed necessary to establish in what sanity of intellect consists, and to mark distinctly some fixed point, the aberrations from which are to constitute disease.To have a thorough knowledge of the nature, extent, and rectitude of the human faculties, is particularly incumbent on him who undertakes to write of them in their distempered state; and, in a legal point of view, it is most important that the medical practitioner should be enabled to establish the state of the patient’s case, as a departure from that which is reason.

The difficulty of proposing a satisfactory theory of the human mind, must have been felt by every person, who has touched this delicate string since the days of Aristotle, and failure must be expected in him who attempts it: yet the endeavour is laudable, and miscarriage is not linked with disgrace. Every contribution, to illustrate what are the powers of mind we possess; how we are acted upon by external circumstances in the acquisition of knowledge; and concerning the manner in which we use this knowledge for the purposes of life; ought to be candidly received.

Enquiries of this nature have been usually conducted by commenting on the numerous and discordant authorities which have treated on metaphysical subjects; these persons, however they may differ on many points, appear to be pretty generally agreed, that the human mind possesses certain faculties and powers; as imagination, judgment, reason, and memory. They seem to consider these, as so many departments, or offices of the mind, and therefore class men according to the excellence or predominance of these powers. One man, is said to be distinguished by the brilliancy of his imagination; another, by the solidity of his judgment; a third, by the acuteness of his reason; and a fourth, by the promptitude and accuracy of his recollection.As far as I have observed respecting the human mind, (and I speak with great hesitation and diffidence,) it does not possess, all those powers and faculties with which the pride of man has thought proper to invest it. By our senses, we are enabled to become acquainted with objects, and we are capable of recollecting them in a greater or less degree; the rest, appears to be merely a contrivance of language.

If mind, were actually capable of the operations attributed to it, and possessed of these powers, it would necessarily have been able to create a language expressive of these powers and operations. But the fact is otherwise. The language, which characterizes mind and its operations, has been borrowed from external objects; for mind has no language peculiar to itself. A few instances will sufficiently illustrate this position. After having committed an offence it is natural to say that the mind feels contrition and sorrow.

Contrition is from cum and tero, to rub together, which cannot possibly have any thing to do with the operations of the mind, which is incapable of rubbing its ideas or notions together. Contrition is a figurative expression, and may possibly mean the act of rubbing out the stain of vice, or wearing down by friction the prominences of sin.

If we were to analyze the word Sorrow, which is held to be a mental feeling, we should find it to be transferred from bodily sufferance: for the mind, is incapable of creating a term correctly expressive of its state, and therefore, it became necessary to borrow it from soreness of body.—See Mr. Tooke’s Diversions of Purley, vol. ii. p. 207, where sore, sorry, and sorrow are clearly made out to be the same word.

It is customary to speak of a man, of accurate perceptions, and of another, who has grand and luminous conceptions of human nature. Perception, from per, and capio to take, seize, grasp, through the medium of the organs of sense, being implied. But to take, seize, and grasp are the operations of the hand, and can only, by extreme courtesy, be attributed to mind.

Mr. Dugald Stewart, the most thoughtful and intelligent of modern metaphysicians, has said, “By conception I mean that power of the mind which enables it to form a notion of an absent object of perception, or of a sensation which it has formerly felt.”—Elements of the Philosophy of the Human Mind, 8vo. p. 133.This definition means merely memory; and by perusing attentively the whole chapter the reader will be convinced of it. Conception, from cum and capio, has been applied to mind from the physical sense of embracing, comprehending, or probably from the notion of being impregnated with the subject. It may be remarked, that these three terms, by which conception has been explained, have been all applied to mental operation.

The words reason and reasoning, I believe, in most languages, strictly imply numeration, reckoning, proportion; the Latin ratio, ratiocinor, ratiocinator are sufficient examples. A curious coincidence between the Latin ratio and the Gothic rathjo, together with some pertinent and interesting observations, may be seen in Ihre’s Glossarium Svio-gothicum, p. 393, art. RÆkna. As we now acknowledge the science of number to be the purest system of reasoning, a system, on which all persons agree, and so unlike medicine, politics, and divinity, concerning which there is a constant, and hostile variety of sentiment, it adds some force to the argument. Indeed, Mr. Locke, who almost personifies reason, after having painfully sifted this matter, appears to be much of the same way of thinking: he says, “Reason, though it penetrates into the depth of the sea and earth, elevates our thoughts as high as the stars, and leads us through the vast spaces and large rooms of this mighty fabrick, yet it comes far short of the real extent of even corporeal being; and there are many instances wherein it fails us: as,

“First: it perfectly fails us where our ideas fail: it neither does, nor can extend itself farther than they do, and therefore, wherever we have no ideas our reasoning stops, and we are at an end of our reckoning: and if at any time we reason about words, which do not stand for any ideas, it is only about those sounds, and nothing else.

“Secondly: our reason is often puzzled, and at a loss, because of the obscurity, confusion or imperfection of the ideas it is employed about; and there we are involved in difficulties and contradictions. Thus, not having any perfect idea of the least extension of matter, nor of infinity, we are at a loss about the divisibility of matter; but having perfect, clear, and distinct ideas of number, our reason meets with none of those inextricable difficulties in numbers, nor finds itself involved in any contradictions about them.”—Works. 4to, vol. i, p. 431.

It can scarcely be necessary, longer to fatigue the patience of the reader, by reverting to the etymology of those terms, which have been considered as significant of mind and its operations. Every one will be able sufficiently to develope imagination, reflection, combination, [as applied to ideas, importing the amalgamation of two into one] abstraction, [vide Mr. Tooke, from p. 15 to 426, vol. ii.] and a variety of others; and to shew, that they have arisen from physical objects, and the circumstances which surround us, and are independant of any operation which mind has elaborated.

But as madness, by some, has been exclusively held to be a disease of the imagination, and by others, to be a defect of the judgment; considering these as separate and independant powers or faculties of the intellect; it is certainly worth the trouble to enquire, whether such states of mind did ever exist as original and unconnected disorders. With respect to imagination, there can be but little difficulty; yet this will so far involve the judgment and memory, that it will not be easy to institute a distinction. If a cobbler should suppose himself an emperor, this supposition, may be termed an elevated flight, or an extensive stretch of imagination, but it is likewise a great defect in his judgment, to deem himself that which he is not, and it is certainly an equal lapse of his recollection, to forget what he really is.

Having endeavoured to give some reasons for not according with the generally received opinions, concerning the different powers of the mind, it may be proper shortly to state, that, from the manner in which we acquire knowledge, the human mind appears to be composed of a sum of individual perceptions: that, in proportion as we dwell by the eye, the ear, or the touch on any object (which is called attention,) we are more likely to become acquainted with it, and to be able to remember it. For the most part, we remember these perceptions in the succession in which they were presented, although, they may afterwards, from circumstances, be differently sorted.

The minds of ordinary men are well contented to deal out their ideas, in the order in which they were received; and, not having found the necessity of bringing them to bear on general subjects, they are commonly minutely accurate in the detail of that which they have observed. By such persons, a story is told with all the relations of time and place; connected with the persons who were present, their situation, state of health, and a vast variety of associated particulars; and these persons, however tedious, generally afford the most correct account. On the other hand, those who are men of business, and have much to communicate in a given space, are obliged to subtract the more material circumstances from the gross narrative, and exhibit these as the sum total. It is in this way, that words, originally of considerable length, have been abbreviated for the conveniency of dispatch, and from this necessity short hand writing has been employed.

As the science of arithmetic consists in addition to, or subtraction from, a given number; so does the human mind appear to be capable solely of adding to, or separating from, its stock of ideas, as pleasure may prompt, or necessity enforce.

Language, the representative of thought, bears the same construction; and it is curious to remark in the investigation of its abbreviations, that those words, which serve to connect ideas together, (conjunctions) and which have been supposed to mark certain operations of intellect, postures of mind, and turns of thought, have merely the force and meaning of to add, or to subtract.

Insanity is now generally divided into Mania and Melancholia, but formerly its distributions were more numerous. Paracelsus, speaking of this disease, says, “VesaniÆ hujus genera quatuor existunt: primi Lunatici vocantur: secundi Insani: tertii Vesani: quarti Melancholici, Lunatici sunt qui omnem suum morbum ex Luna accipiunt, et juxta eam sese gerunt ac moventur. Insani sunt, qui malum id ab utero materno hauserunt, veluti hÆreditarium, uno subindÈ insaniam in alterum transferente. Vesani sunt, qui a cibis ac potibus ita inficiuntur ac taminantur, ut ratione sensuque priventur. Melancholici sunt, qui ex intimÆ naturÆ vitio a ratione deturbantur, et ad vesaniam precipitantur.” Paracelsus, however, thinks that a fifth genus may be added. “Ad quatuor hac genera genus insuper aliud quodammodo annumerari potest, videlicet obsessi, qui a diabolo variis modis occupari solent.”—Paracelsi Opera, folio, tom. i. fol. 572.

The idea of being besieged, beset, or possessed by the devil was formerly a very favourite notion, and is derived to us by an authority we are taught to reverence: indeed it is still the opinion of many harmless and believing persons, some of whom have bestowed considerable pains to convince me that the violent and mischievous maniacs in Bedlam were under the dominion of this insinuating spirit. They have employed one argument which would seem to have considerable weight, namely, that the most atrocious crimes are stated in our indictments (much to the credit of human nature) to have been committed by the instigation of the devil: and they have also endeavoured to explain, how a late and eminently successful practitioner, by an union of the holy office with consummate medical skill, was enabled to cure nine lunatics out of ten, which certainly has not hitherto been accounted for.

Paracelsus, who contemplated this subject with uncommon gravity and solicitude, is of opinion that the devil enters us much in the same manner as a maggot gets into a filbert.—Vide Fragmentum Libri PhilosophiÆ de DÆmoniacis et Obsessis, tom. ii. p. 460.

To conclude this part of the subject, and to exhibit the state of belief at that period, I shall take the liberty of extracting a portion from the 11th chapter of Dr. Andrewe Boord’s Extravagantes, which “doth shewe of a Demoniacke person, the which is possessed of or with the devyll or devylls.

“Demoniacus or Demoniaci be the Latin wordes. In Greke it is named Demonici. In Englyshe it is named he or they, the whiche be mad and possessed of the devyll or devils, and their propertie is to hurt and kyll them selfe, or els to hurt and kyll any other thynge, therfore let every man beware of them, and kepe them in a sure custody.

The cause of this Matter.

“This matter doth passe all maner sickenesses and diseases, and it is a fearefull and terryble thyng to se a devyll or devylles shoulde have so muche and so greate a power over man, as it is specified of such persons dyvers tymes in the gospell, specyally in the IX. Chapitre of St. Marke. Chryste sendynge his disciples to preache the worde of God, gevynge them power to make sicke men whole, lame men to go, blynde to se, &c. Some of them dyd go by a mans that was possessed of devils and they coud not make him whole. Shortly to conclude, Chryst dyd make hym whole. The dysciples of Chryste asked of him why that they coud not make the possessed man of the devylls whole. And Jesus Chryste said to them: this kynde of devylls can not be cast out without prayer and fastynge. Here it is to be noted, that nowe a dayes fewe or els none doth set by prayer or fastynge, regardyng not gods wordes; in this matter, I do feare that suche persons be possessed of the devil, although they be not starke madde, and to shew further of demoniacke persons the whiche be starke madde. The fyrste tyme that I dyd dwell in Rome, there was a gentilwoman of Germani, the whych was possessed of devyls, and she was brought to Rome to be made whole. For within the precynct of St. Peters church, without St. Peters chapel, standeth a pyller of whyte marble grated round about with iron, to the which our Lorde Jesus Chryste dyd lye in hymselfe unto the Pylates hal, as the Romaynes doth say, to the which pyller al those that be possessed of the devyl, out of dyvers countreys and nacions be brought thyther, and as they say of Rome, such persons be made there whole. Amonge al other this woman of Germany, which is CCCC myles and odde from Rome, was brought to the pyller, (I then there beyng presente,) with great strength and violently with a XX or mo men, this woman was put into that pyller within the yron grate, and after her dyd go in a preeste, and dyd examine the woman under this maner in the Italian tonge. Thou devyl or devyls, I do abjure thee by the potencial power of the father, and of the sonne our Lorde Jesus Christe, and by the vertue of the Holy Ghoste, that thou do shewe to me, for what cause that thou doeste possess this woman: what wordes was aunswered I will not write, for men will not beleve it, but wolde say it were a foule and great lye, but I dyd heare that I was afrayd to tarry any longer, lest that the devyls shulde have come out of her, and to have entred into me; remembrynge what is specified in the viii Chapitre of St. Matthewe, when that Jesus Christ had made two men whole, the whiche, was possessed with a legion of devils. A legion is IX M. IX C. nynety and nyne: the sayd devyls dyd desyre Jesus, that when they were expelled out of the aforesayde twoo men, that they might enter into a herde of hogges, and so they did, and the hogges did runne into the sea and were drowned. I consyderynge this, and weke of faith and afeard, crossed myselfe and durste not heare and se such matters, for it was to stupendious and above all reason yf I shulde wryte it; and in this matter I dyd marvell of an other thynge; if the efficacitie of such makynge one whole, dyd rest in the vertue that was in the pyller, or els in the wordes that the preest dyd speake. I do judge it shulde be in the holy wordes that the prest dyd speak, and not in the pyller; for and yf it were in the pyller, the Byshops, and the Cardinalles that hathe ben many yeres past, and those that were in my tyme, and they that hath bin sence, wolde have had it in more reverence, and not to suffre rayne, hayle, snowe, and such wether to fal on it, for it hath no coverynge, but at laste when that I did consyder that the vernacle, the phisnomy of Christ, and scarse the sacrament of the aulter was in maner uncovered and al St. Peters Churche downe in ruyne, and utterly decayed, and nothing set by, consideringe in olde chapels, beggers and baudes, hoores and theves dyd lye within them, asses and moyles dyd defyle within the precincte of the Churche, and byenge and sellynge there was used within the precinct of the sayde church that it dyd pytie my harte and mynde to come and se any tyme more the sayde place and churche.”—Andrewe Boorde,[2] the seconde Boke of the Brevyary of health, 1557, fol. 4th.

To return from this digression. Dr. Ferriar, whom to mention otherwise than as a man of genius, of learning, and of taste, would be unjust, has adopted the generally accepted division of insanity into mania and melancholia. In mania he conceives “false perception, and consequently confusion of ideas, to be a leading circumstance.” The latter, he supposes to consist “in intensity of idea, which is a contrary state to false perception.” From the observations I have been able to make respecting Mania, I have by no means been led to conclude, that false perception, is a leading circumstance in this disorder, and still less, that confusion of ideas must be the necessary consequence of false perception.

By perception I understand, with Mr. Locke, the apprehension[3] of sensations; and after a very diligent enquiry of patients who have recovered from the disease, and from an attentive observation of those labouring under it, I have not frequently found, that insane people perceive falsely the objects which have been presented to them.

We find madmen equally deranged upon those ideas, which they have been long in the possession of, and on which the perception has not been recently exercised, as respecting those, which they have lately received: and we frequently find those who become suddenly mad, talk incoherently upon every subject, and consequently, upon many, on which the perception has not been exercised for a considerable time.

It is well known, that maniacs often suppose they have seen and heard those things, which really did not exist at the time; but even this I should not explain by any disability, or error of the perception; since it is by no means the province of the perception to represent unreal existences to the mind. It must therefore be sought elsewhere; most probably in the senses.

We sometimes (more especially in the early stages of furious madness) find patients from very slight resemblances, and sometimes, where none whatever can be perceived by others of sound mind, confounding one person with another. Even in this case it does not seem necessary to recur to false perception for the explanation. It is equally probable that the organs of vision are affected in consequence of the disease of the brain, and therefore receive incorrect sensations: and still more likely, from the rapid succession in which objects are noticed, that a very slight trait of countenance would recal the idea [or name] of some particular person.

I have known many cases of patients who insisted that they had seen the devil. It might be urged, that in these instances, the perception was vitiated; but it must be observed there could be no perception of that, which was not present and existing at the time. Upon desiring these patients to describe what they had seen, they all represented him as a big, black man, with a long tail, and sharp talons, such as is seen pictured in books; a proof that the idea was revived in the mind from some former impressions. One of these patients however carried the matter a little further, as she solemnly declared, she heard him break the iron chain with which God had confined him, and saw him pass fleetly by her window, with a truss of straw upon his shoulder.That “confusion of ideas” should be the necessary consequence of false perception, is very difficult to admit. It has often been observed that madmen will reason correctly from false premises, and the observation is certainly true: we have indeed occasion to notice the same thing in those of the soundest minds. It is very possible for the perception to be deceived in the occurrence of a thing, which, although it did not actually happen, yet was likely to take place; and which had frequently occurred before.—The reception of this as a truth, if the person were capable of deducing from it the proper inferences, could neither create confusion nor irregularity of ideas.

Melancholia, the other form in which this disease is supposed to exist, is made by Dr. Ferriar to consist in “intensity of idea.” By intensity of idea, I presume is meant, that the mind is more strongly fixed on, or more frequently recurs to, a certain set of ideas, than when it is in a healthy state. But this definition applies equally to mania; for we every day see the most furious maniacs suddenly sink into a profound melancholia, and the most depressed and miserable objects become violent and raving. There are patients in Bethlem Hospital, whose lives are divided between furious and melancholic paroxysms, and who, under both forms, retain the same set of ideas. It must also have been observed, by those who are conversant with this disorder, that there is an intermediate state, which cannot be termed maniacal nor melancholic: a state of complete insanity, yet unaccompanied by furious or depressing passions.[4]In speaking of the two forms of this disease, mania and melancholia, there is a circumstance sufficiently obvious, which hitherto does not appear to have been noticed: I mean the rapid or slow succession of the patient’s ideas. Probably sound and vigorous mind consists as much in the moderate succession of our ideas, as in any other circumstance. It may be enquired, how we are to ascertain this increased, proportionate, and deficient activity of mind? From language, the medium by which thought is conveyed. The connexion between thought and utterance is so strongly cemented by habit, that the latter becomes the representative of the former.The physiology of mind, I humbly conceive to be at present in its infancy, but there seems good reason to imagine, that furious madness implies a rapid succession of ideas; and the circumstance of rage, from whence its origin has been deduced, points out the hurried consecution. In this state of mind the utterance succeeds

————————“sudden as the spark
From smitten steel; from nitrous grain the blaze.”

and it frequently happens, after the tumult has subsided, the person remembers but little of that which had escaped him.

“I then, all-smarting with my wounds, being cold,
(To be so pestered with a popingay)
Out of my greefe, and my Impatience,
Answered (neglectingly) I know not what—
He should, or should not: for he made me mad.”

From this connexion between thought and utterance, we find many persons (particularly those who are insane) talking to themselves; especially when their minds are intently occupied; and taking the converse, we frequently observe those who are desirous to acquire any subject by heart, repeating it aloud.

From the same cause we have often occasion to remark, that strong, and perhaps involuntary, propensity to repeat the emphatical words in a sentence, and which are commonly the last, before we endeavour to reply to, or confute them.

“King. No: on the barren Mountaine let him sterve:
For I shall never hold that man my friend
Whose tongue shall aske me for one peny cost
To ransome home revolted Mortimer.
“Hotsp. Revolted Mortimer?
He never did fall off, my Soveraigne Liege,
But by the chance of warre:”

As the terms Mania and Melancholia, are in general use, and serve to distinguish the forms under which insanity is exhibited, there can be no objection to retain them; but I would strongly oppose their being considered as opposite diseases. In both there is an equal derangement. On dissection, the state of the brain does not shew any appearances peculiar to melancholia; nor is the treatment, which I have observed most successful, different from that which is employed in mania.

As the practitioner’s own mind must be the criterion, by which he infers the insanity of any other person; and when we consider the various, and frequently opposite, opinions of these intellectual arbitrators; the reader will be aware that I have not abstained from giving a definition of madness without some reason. There is indeed a double difficulty: the definition ought to comprize the aberrations of the lunatic, and fix the standard for the practitioner.

But it may be assumed that sound mind and insanity stand in the same predicament, and are opposed to each other in the same manner, as right to wrong, and as truth to the lie. In a general view no mistake can arise, and where particular instances create embarrassment, those most conversant with such persons will be best able to determine.

The terms sound mind and insanity are sufficiently plain. If to an ordinary observer, a person were to talk in an incoherent manner, he would think him mad; if his conduct were regular, and his observations pertinent, he would pronounce him in his senses: the two opposite states, well marked, are well understood; but there are many different shades, which are not so likely to strike the common examiner.