CHAPTER VII. MORAL MANIA. § 141. THUS far mania has been considered as affecting the intellectual faculties only; but a more serious error on this subject can scarcely be committed, than that of limiting its influence to them. It will not be denied that the propensities and sentiments are also integral portions of our mental constitution; and no enlightened physiologist can doubt that their manifestations are dependent on the cerebral organism. Here, then, we have the only essential conditions of insanity, a material structure connected with mental manifestations; and until it is satisfactorily proved that this structure enjoys a perfect immunity from morbid action, we are bound to believe that it is liable to disease, and, consequently, that the affective, as well as intellectual faculties are subject to derangement. In fact, it has always been observed, that insanity as often affects the moral, as it does the intellectual perceptions. In many cases there is evinced some moral obliquity quite unnatural to the individual, a loss of his ordinary interests in the relations of father, son, husband, or brother, long before a single word escapes from his lips, "sounding to folly." Through the course of the disease, the moral and intellectual impairments proceed pari passu, while the return of the affections to their natural channels, is one of the strongest indications of approaching recovery. Such being the fact, it ought not to be a matter of surprise, that in some cases the aberration should be confined to the moral impairment, the intellectual, if there be any, being too slight to be easily discerned. § 142. To moral mania, as a distinct form of the disease, the attention of the profession was first directed by the celebrated Pinel in the beginning of the present century. Previously to that time it was a matter of universal belief, that insanity is always accompanied by derangement of the reasoning powers, and a recognition of this fact entered into every definition of the disease. Participating in the common belief, he found, to his great surprise, on resuming his researches at the Bicetrè that there were many maniacs who betrayed no lesion whatever of the understanding, but were under the dominion of instinctive and abstract fury, as if the affective faculties alone had sustained injury. This form of mental disorder he designated as manie sans délire. The examples which he gives, being chiefly characterized by violent anger and unbounded fury, by no means furnished suitable illustrations of the affection now styled moral insanity, though they do illustrate a particular form of that disorder. This defect, however, has been amply supplied by the researches of others, which have made us acquainted with a great number and variety of cases, in which the affective faculties, either singly or collectively, were deranged, independently of any appreciable lesion of the intellect. The reality and importance of this distinction which thus establishes two classes of mania, is now generally acknowledged by practical observers, among whom it is sufficient to mention Esquirol, Georget, Gall, Marc, Rush, Reil, Hoff bauer, Andrew Combe, Conolly, and Prichard, though some of them are inclined to doubt whether the integrity of the understanding is so fully preserved in moral mania, as Pinel believed. Still, its apparent soundness, and the difficulty, at least, of establishing the existence of any intellectual derangement, while the moral powers are unequivocally and deeply deranged, render it no less important in its legal relations, than if the understanding were unequivocally affected. It is defined by Prichard, who has strongly insisted on the necessity of assigning it a more distinct and conspicuous place, than it has hitherto received, as "consisting in a morbid perversion of the natural feelings, affections, inclinations, temper, habits, and moral dispositions, 1 without any notable lesion of the intellect or knowing and reasoning faculties, and particularly without any maniacal hallucination." It will be convenient, even if not scientifically precise, to consider it under two divisions, according as it is general or partial. SECTION I. General Moral Mania. § 143. One form of this condition is thus vividly described by Prichard. "There are many individuals living at large, and not entirely separated from society, who are affected in a certain degree by this modification of insanity. They are reputed persons of singular, wayward, and eccentric character. An attentive observer may often recognize something remarkable in their manner of existence, which leads him to entertain doubts of their entire sanity, and circumstances are sometimes discovered on inquiry which assist in determining his opinion. In many instances it is found that there is an hereditary tendency to madness in the family, or that several relatives of the person affected have labored under diseases of the brain. The individual himself is discovered in a former period of life to have sustained an attack of madness of a decided character. His temper and dispositions are found on inquiry to have undergone a change; to be not what they were previously to a certain time; he has become an altered man; and this difference has perhaps been noted from the period when he sustained some reverse of fortune, which deeply affected him, or since the loss of some beloved relative. In other instances, the alteration in his character has ensued immediately on some severe shock which his bodily constitution has undergone. This has either been a disorder affecting the head, a slight attack of paralysis, a fit of epilepsy, or some fever or inflammatory disorder, which 1 Cyclop. Prac. Med. III. 826. has produced a perceptible change in the habitual state of the constitution. In some cases the alteration in temper and habits has been gradual and imperceptible, and it seems only to have consisted in an exaltation or increase of peculiarities which were always more or less natural or habitual.” “Individuals laboring under this disorder are capable of reasoning or supporting an argument on any subject within their sphere of knowledge that may be presented to them, and they often display great ingenuity in giving reasons for their eccentric conduct, and in accounting for and justifying the state of moral feeling under which they appear to exist. In one sense, indeed, their intellectual faculties may be termed unsound, but it is the same sense in which persons under the influence of strong passions may be generally said to have their judgment warped, and the sane or healthy exercise of their understandings impeded. They think and act under the influence of strongly excited feelings, and a person sane is under such circumstances proverbially liable to error both in judgment and conduct." It was this class of persons, undoubtedly, that suggested the following description in a work published in the beginning of the present century. "Among the varities of maniacs met with in medical practice, there is one, which, though by no means rare, has been little noticed by writers on this subject: I refer to those cases in which the individuals perform most of the common duties of life with propriety, and some of them, indeed, with scrupulous exactness, who exhibit no strongly marked features of either temperament, no traits of superior or defective mental endowment, but yet take violent antipathies, harbor unjust suspicions, indulge strong propensities, affect singularity in dress, gait, and phraseology; are proud, conceited, and ostentatious; easily excited and with difficulty appeased; dead to sensibility, delicacy, and refinement; obstinately riveted to the most absurd opinions; prone to controversy, and yet incapable of reasoning; always the hero of their own tale, using hyperbolic, high-flown language to express the most simple ideas, 1 Op. cit. sup. p. 826: accompanied by unnatural gesticulation, inordinate action, and frequently by the most alarming expression of countenance. On some occasions they suspect sinister intentions on the most trivial grounds; on others are a prey to fear and a dread from the most ridiculous and imaginary sources; now embracing every opportunity of exhibiting romantic courage and feats of hardihood, then indulging themselves in all manner of excesses. Persons of this description, to the casual observer, might appear actuated by a bad heart, but the experienced physician knows it is the head which is defective. They seem as if constantly affected by a greater or less degree of stimulation from intoxicating liquors, while the expression of countenance furnishes an infallible proof of mental disease. If subjected to moral restraint, or a medical regimen, they yield with reluctance to the means proposed, and generally refuse and resist, on the ground that such means are unnecessary where no disease exists; and when, by the system adopted, they are so far recovered, as to be enabled to suppress the exhibition of the former peculiarities, and are again fit to be restored to society, the physician, and those friends who put them under the physician's care, are generally ever after objects of enmity and frequently of revenge."1 § 144. Heinroth and Hoffbauer both recognize a form of mental alienation consisting exclusively of morbid excitement of the passions and feelings. "It is clear," says the latter, "that mania may exist uncomplicated with mental delusion; it is in fact only a kind of moral exaltation (tollheit), a state in which the reason has lost its empire over the passions and the actions by which they are manifested, to such a degree that the individual can neither repress the former, nor abstain from the latter. It does not follow that he may not be in possession of his senses and even his usual intelligence, since, in order to resist the impulses of the passions, it is not sufficient that the reason should impart its counsels; we must have the necessary power to obey them. The maniac may 1 Cox, J. M., Practical Observations on Insanity. London, 1804. |