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CHAPTER VI.

INTELLECTUAL MANIA.

§ 127. INTELLECTUAL MANIA is characterized by certain hallucinations or delusions,1 in which the patient is impressed with the reality of facts or events that have never occurred, and acts more or less in accordance with such belief; or having adopted some notion not altogether unfounded, carries it to an extravagant and absurd extent. It may be general, involving all or the most of the operations of the understanding; or partial, being confined to a particular idea, or train of ideas.

SECTION I.

General Intellectual Mania.

§ 128. The general description of mania is equally applicable to the acute state of this, and sometimes of other forms of the disease. It is not generally till after the excitement has somewhat subsided, that the distinctive features of each become very manifest. In this stage of general intellectual

1 These terms, though they have long held a place in medical language, have always been used with remarkable diversity and vagueness of meaning. Without troubling the reader with an array of nosological definitions, it will be sufficient to say, that in this treatise, the former is used as a general designation of all those notions which are indicative of derangement of the reflective, as the latter is of the perceptive powers.

mania, many glimpses of natural soundness may be discovered amid the intellectual disorder.1 Questions on indifferent subjects may be appropriately answered; many of the patient's relations to surrounding circumstances may still be perceived; and no little acuteness and ingenuity are often manifested in accommodating the real and true to the delusions under which he labors. The difficulty is to fix the attention on a particular point, the mind constantly running from one idea to another, or absorbed in the thoughts which happen, for the moment, to predominate over every other.

§ 129. In the present state of our knowledge of the mental constitution, it is not strange to find considerable diversity of opinion respecting the nature or cause of hallucinations of the senses; yet, in a medico-legal point of view, it is important that they should be correctly understood. Hoffbauer' says that they consist in a vicious relation between the imagination and the senses, in consequence of which the patient mistakes the creations of the one for objects really perceived by the others. Esquirol, not entirely satisfied with this explanation, divides them into two classes, termed by him, illusive sensations, and hallucinations. The first arise in the senses, as when a maniac mistakes a window for a door, passes through it and is precipitated to the ground; or takes the clouds which he sees in the sky for contending armies; or believes his legs are made of glass; or his head turned round. In all these instances, the error refers to the real impression which is ill-perceived; there is an error of sensation, a vicious relation between the sense which actually perceives and the intellect which judges falsely of the external object. In the second, on the contrary, the senses have no share; the imagination alone is exalted; the brain is exclusively the seat of the disturbance; the patient mistaking the creations of his imagination for objects actually present to his senses. He sees images and apparitions amid the thickest darkness; hears sounds and voices in the most

1 Pinel, Traité sur l'alienation mentale, 142, § 148.

2

Op. cit. sup. § 84.

3

3 Idem, § 82, note.

perfect silence; and smells odors in the absence of all odorous bodies. This distinction does not seem to be well supported. That the functions of the senses are sometimes greatly perverted, there can be no question; but it needs more evidence than we yet have, to prove that such perversions bear much if any part in producing these illusions; more especially as Esquirol admits, that, in what he terms hallucinations, an exalted imagination is sufficient of itself to produce a very similar effect. In old age, where, in consequence of the decay of the senses, wrong impressions are being constantly received, they nevertheless give rise to none of these delusions. When the hero of Cerventes did battle with the sheep and the windmills, it will not be contended that he was laboring under any special optical infirmity which conveyed false impressions of outward objects, because on most occasions, the action of his senses was unequivocally sound. Ready as he was to mistake a company of peaceable shepherds for the creations of his disordered intellect, he never imagined Sancho to be any other than his faithful squire, for the reason that his reflective faculties were not so far subverted as to be incapable of any healthy action. Besides, if erroneous sensation has any thing to do with producing these illusions, we must go the length of asserting, that at such times all the senses are disordered, or deny that the errors of one may be corrected by the others. It is not so strange that vision should sometimes be so affected as to deceive a person with the idea that his legs are made of glass or butter, but it certainly is very strange, that on such occasions, the other senses should all return equally false impressions; the touch being unable to distinguish the feel of flesh and blood, and the hearing the sound produced by striking them, while they retain this power in regard to every other part of the body. These illusions appear to result from a morbid excitement of the perceptive faculties, whereby they are stimulated by outward impressions to involuntary and irresistible activity, while a coexistent impairment of the reflective faculties prevents them from being considered as illusions and not actual realities. The physi

cause.

cian will not unfrequently hear a patient complaining of seeing colors of the utmost beauty and variety of combination passing and repassing before his eyes, or forms of objects of every possible description, whether his eyes be open or shut, the room dark or light. His understanding being sound, he is not deceived, but believes them to be what they actually are, merely illusions; but if, on the contrary, it were unsound, then these illusions would be taken for realities, and he would conduct accordingly. Ben Jonson would keep awake an entire night, gazing at armies of Turks and Tartars, Carthaginians and Romans contending around his great toe; in which amusement there is no evidence of mania, but merely of a morbid activity of the internal perceptive organs. The apparitions of Nicolai of Berlin, and others of a similar kind, arose, no doubt, from the same Indeed unnatural excitement of these organs in insanity is sometimes so obvious and well-marked, as to be immediately recognized and properly understood. Rush gives the case of a young woman who delighted her visitors with her efforts in singing and poetry, though previously she had never manifested any talent for either; and the author once attended an insane patient of feeble intellect and defective education, who occupied much of her time in making verses, though she had not shown the slightest trace of such a power before the invasion of her disease. The faculty of construction, too, is occasionally heightened to a wonderful degree. Pinel speaks of a maniac who believed he had discovered the perpetual motion; and in the course of his researches he constructed some very ingenious machines. The common and essential element, then, in the production of hallucinations and illusive sensations, is an impairment of the reflective faculties accompanied by morbid activity of the perceptive faculties. The only real difference between them is, that in the latter, the morbid activity of the perceptive faculties requires to be excited by outward impressions, while in the former, this effect is produced by the remembrance of past impressions, a distinction that can be of but little if any importance, in judicial investigations. We

have been thus particular in showing the true origin of hallucinations, that any mistake arising from wrong views of their nature might be avoided, an event not altogether beyond the limits of possibility, for one instance has come to our own knowledge, where it was attempted, in a court of justice in a neighboring State, to measure the extent of the insanity by the comparative number of the senses supposed to be deranged in the hallucination.

§ 130. Hallucinations of the senses occur in a large proportion of maniacs. In the early stage of acute mania they are generally numerous and changing, and somewhat masked by the more conspicuous symptoms. In chronic mania they are more simple, uniform, and obvious. Occasionally, however, this rule is reversed, the hallucinations being very distinct and vivid from the beginning of the disease. And it should be borne in mind, that when it is the predominant feature of the mental disorder, the patient is disposed to conceal it from others as long as he retains sufficient control over his thoughts. A little strangeness of demeanor may, for months, be the only perceptible deviation from the natural condition, the reason, in the mean while, struggling with the suggestions of the hallucinated sense, till it finally yields, and the patient, in obedience to some voice or vision, commits a sudden and fearful act of violence. In the stillness of night they are more common and often more vivid than during the day. For the most part their occurrence is irrespective of times and seasons, and whether in solitude, in the church, in the gay assembly, in the midst of animated ` conversation, in the pursuit of pleasure or of business, the attention may be arrested at once, and the whole soul engrossed by the powerful appeal to the senses. When the patient describes his hallucinations, there is a remarkable air of sincerity and frankness in his manner, which no art of simulation can successfully imitate.

§ 131. To determine exactly what mental impairment it is which is essential to insanity, metaphysicians and physiologists have long and anxiously labored with hardly the shadow of success. The various definitions and explana

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