By W. F. BECKER, M. D. As a fog about a ship removes it from exact relations to surroundings, so, from the standpoint of morbid psychology, we may fancy the mind peering through a more or less misty envelope to the true adjustment to things—the "glass" through which we see "darkly." Were all action and reaction of the mind to surroundings perfectly adapted, there could be such a thing as absolute sanity. So long, however, as evolution with continuous readaptation and the processes of dissolution with attempted adaptations continue, so long can there be but groping, imperfect relations to surroundings, so long must there be defective or morbid mental action, and sanity and insanity therefore but relative terms. Thus many symptoms of the insane appear to be but varying degrees of the morbid mental manifestations of health, and we may assume a priori that they have a common genesis and can be identified for study. If we take, for example, one of the commonest of these—viz., the idea of persecution among the insane—we may safely identify it with the "sense of injury" equally common among the sane. By this "sense of injury" is meant that vague sense which afflicts many of us at times of being the object of hostile feelings on the part of others. No doubt we often are, for, in the stress of necessary rivalry and conflict upon which progress depends, we It seems to find an easy entrance to the mind from a mere feeling of being ill used or stinted in sympathy to the entertainment of serious grievances or persecutory ideas. In certain temperaments it is marked. On so-called "blue" days we are constantly moved to a "sense of injury" from fancied aloofness of our friends. Madam Lofty slights us, and our jaundiced imagination has it that she has heard something detrimental and dislikes us. But lo! to-day, when the liver is released, madam smiles sweetly, and never heard a thing. So in suspicious people. They entertain a chronic state of mind, by which the acts of others are given an invidious construction. They anticipate ill will, carrying the chip on the shoulder. Of two constructions of a given situation, they leap to the more offending. Some take on the vindictive attitude as a result, approaching that type of insanity known as paranoia, of which Guiteau and Prendergast were conspicuous examples; others are humiliated, as a consequence approaching the melancholia type of insanity, each illustrating again how the sane and insane states are paralleled. Many come to bear the outward marks—the stigmata of this mental attitude, approaching sometimes the "asylum" face, like that of the insanely suspicious Rousseau. We all know such faces, with their hard, set expressions, as if forever sealed against any tender of good will. By a curious fact, those who invite ill will seem often to get it. Society, based on a reciprocity of faith, seems to have no smiles to bestow upon the misanthrope. It bids him, "Laugh, and the world laughs with you." It so comes to pass that many of them acquire some real ground for their "sense of injury," and in the long run that real quarrels are precipitated from this atmosphere of suspiciousness. Indeed, this is the psychology of most quarrels. The effect of imaginary grievances comes in turn to be the cause of real ones. Thus into an incident between two persons, one of them mistakenly reads an affront to himself. He retaliates, and the other person, unconscious of having done anything to evoke any hostility, finds himself affronted, and in his turn retaliates. By this time real grievances have come, and the quarrel is on. Balzac, that master analyst, in alluding to friendship, in one of his stories, says: "It died" (the friendship) "like other great passions—by a misunderstanding. Both sides imagine treachery, In irritable persons we find the morbid sense of injury coupled with resentment. Quickly interpreting anything disagreeable to them as an affront by another, their first impulse is to resent it, which they do more or less violently, according to circumstances, their second thought often recognizing the irrational nature of the outbreak. This suggests the feral instinct. Examples are common in the lower animals, while in pain attacking those about them as if they were the cause of it. No doubt this resentment is a survival from evolutionary ancestry. It has probably served a necessary purpose in the conservation of animal life by causing the animal to attack what may, in the jealousy of self-preservation and its feeble discrimination, even be suspected of being inimical to its welfare. Blind and unjust, perhaps, but Nature hesitates at no apparent injustice to accomplish this. When we go higher, to the tribal relation of man, we find the same blind resentment. The Australian aborigines have no conception of death, except as vaguely associated with homicidal causes, and when a member of a tribe dies a most natural death a member of a hostile tribe is killed to avenge the supposed murder. The Africans, too, read homicidal forces into natural deaths. In civilized social relations it appears again in the very popular and usually irrational demand for a scapegoat when matters go wrong. The idea of religious sacrifice, too, is a practice by which the anthropomorphic God is credited with being aggrieved by human conduct and of wishing to be appeased therefor. Though the exercise of this indiscriminate resentment was probably greater and more necessary in the pre-social stage of human evolution, there is still ground for its activity to-day in the struggle for existence which has but changed its arena. Under a veneer of amity, laudable enough, there are till the suspicion and resentment of the tribal relation, as we may often see unveiled in a posse of boys, and that this resentment is yet of the blind kind, we still have proof if we have seen an enlightened man deliberately kick a harmless chair because he stumbled on it in the dark. Phylogenetically, then, we see this morbid "sense of injury" When we look for the physical equivalent of the mental state which evokes the "sense of injury" we find it in dynamic and toxic states of the nervous system and their correlation. Certain conditions of the individual or environment bring these into special relief. Old age is one. The querulousness, the sense of abuse The primary and secondary effects of alcohol or other narcotic indulgence is another soil in which the "sense of injury" easily grows. The habituÉ is notoriously suspicious and irritable, and full of fictitious grievances and unwarranted persecutory ideas. His attitude toward them is that of the paranoiac, vindictive, rather than that of the melancholiac, humiliated. They swell the army of so-called "borderland" cases of insanity, fretting their friends and puzzling the doctor with conduct alternately interpreted as "cussed" or "crazy." Where there is bodily disease, acute or chronic, the morbid "sense of injury" is much in play. An intelligent patient, on recovery from a stomach disorder, admitted that whenever her stomach had ached she was taken with a violent hatred of her companion with whom she was in affectionate relation. An ignorant Southern colored woman, who had rheumatism in her ankle, believed that she had been "hoodooed," and explained the pain in her ankle by the presence of a snake, which she believed had been put there by a "hoodoo." She was not insane, the idea being consistent with her degree of intelligence, training, and early environment. Another patient, a sensible, cultivated woman, while suffering from a non-nervous illness, in which she had received all the consideration that love and money could furnish, believed herself to have been constantly and deliberately abused. After her recovery, now some years, she still maintains the belief. Instances could be multiplied, for doctors continually meet this atmosphere in the sick-room, from ugly little grievances to delusions of persecution. They are not surprised when a patient tells them in mingled confidence and complaint that he is hungry and neglected, that "they" will give him nothing to eat, etc., to find that his wife has been most attentive, has been pressing him to eat, and has stocked the pantry in anticipation. Dr. Johnson had plenty of ground for saying that a sick man is a rascal, though the modern doctor has reversed the formula. Persons who suffer from actual trouble or ill treatment easily develop a morbid sense of injury, just as under similar conditions they may become insane. Unable to estimate the precise amount of their real grievance, there is an easy mental overflow into the fictitious ones. It is for this reason that the narrative of a real trouble or quarrel is so fraught with calumnious arraignment of In the insane the sense of injury or its analogue—delusions of persecution—appears in numerous shapes. Thus patients are defrauded, or conspired against, or acted upon by witchcraft, magnetism, electricity, or poisoned, or preached against, or subjected to disagreeable odors. Sometimes the delusions are but ill-defined and vague. Often it is possible to trace them to their underlying disordered sense impression or the particular environment or to vestiges of outgrown beliefs. They appear in depressed states of melancholia as well as in the exalted states of mania and paranoia. In melancholia they accompany a feeling of worthlessness which is the patient's explanation of his persecution—i. e., he is unworthy of better treatment. In paranoia the patient believes the persecution to be prompted by fear or envy of him, and there is consequently a feeling of self-importance—a morbid egotism which is in direct proportion to the magnitude or complexity of the ideas of persecution. Indeed, it is probable that these ideas of persecution, acting on a potentially melancholic or a potentially paranoiac mind, whatever these may be, determine the type that these mental diseases take. The difference between the "injured" sense in the sane and insane states we must from our view point, without essaying to bridge all the terra incognita which lies between sanity and insanity, regard as largely but one of degree. And so with the underlying Thus the relativity of insanity which has all along been maintained is clear on the line here pursued. It would be equally so in following other lines of morbid psychology. It has, though, received but little general recognition, and writers still treat insanity as an entity apart from its bearings on the average mind and its evolutionary history. The word "insanity," or "lunatic," is no doubt largely responsible for this, suggesting popularly, as it does, a distinct class of persons—a type of being as unlike ourselves as a Martian might be fancied to be. Nature or science, however, has set no line between the morbid mental manifestations which constitute sanity and those which constitute insanity, that being an arbitrary, however practical, distinction which science has had rather to descend to meet. Nothing so stands in the way of the best welfare of the insane than this abysmal ignorance which still prevails in regard to them—an ignorance which still clings to the mediÆval idea of insanity, the classical portraiture, as in the pictures of Hogarth, or on the stage, or in fiction; an ignorance which is ever hearkening for the maniac's shriek or the clanking of his fetters, which recognizes nothing short of "furious madness" as sufficient ground for committing a brain-sick man to the tender therapy of the hospital ward. But those who know best tell us that the insane are very much like other people, that there is wonderfully little difference between them and ourselves; and sometimes but a slight circumstance, a mere accident of environment, determines which side of the hospital wall we shall be on. |