Psychology in its Relation to Medicine
ART. IV.? :Author: MAJOR GREENWOOD, M.R.C.S.E., L.R.C.P. Lond.
Of all the sciences none have made more progress during the last few years than Psychology, the subject of this paper. Deep into the mists of time must we go back if our endeavour be to discover the earliest epoch when the problems of mind first began to perplex humanity. The ignorant savage who in the earlier eras of the world pondered with awe over the various phenomena of nature, fabricating for himself rude theories of natural theology, was in his way as much a student of Psychology as the savant of the present who eagerly seeks to read in the ever-growing resources of cerebral pathology the wide and varied world of mental phenomena. The latter possesses the basis that the former lacked, and already the Archi- median lever has been applied to a universe of false doctrines and ideas, with what result a few more years will show.
None can consider of small import this, from the one point of view, most modern, from the other, most ancient of sciences, dealing as it does with the highest emanation of life without which Biology would be poor indeed. To the student of medi- cine the history of all the phenomena of life must be of the greatest importance; and although it is to the objective aspect his studies are usually applied, and not unjustly?for here the ground is much more open and clear, many facts have been ascer- tained and upon it the lamp of science throws its strongest light? still he must not altogether disregard the subjective ; this side of life will reveal a field equally spacious, and its study, though more complex, yield scarcely inferior rewards. To many the interest of the pursuit will be enhanced by the mystery envelop- ing it, and by the thought that perchance through its paths they may approach more nearly to the secret of life than by any other.
Psychology is not by any means a new study; in all ages it has had its votaries, and many of the old philosophers who stand high in the history of the world for pre-eminence in other branches of learning have left enduring records of having thought long and deeply over the wonderful problem of mind.
No science has suffered more than this from ignorance and superstition ; and as a perfect freedom of thought was essential for its development, it is only comparatively recently it can be said to have been established on a scientific basis. It is not here attempted to deal with Psychology in a strictly scientific manner, nor to discuss the more modern views and theories relating to its phenomena, interesting as it would be to trace its history from the time of Aristotle, more than 2,000 years ago, when the first great theory was evolved, through the many modifications that have sprung from this as the thoughts of the great Greek were acted on and remoulded by the minds of many and diverse ages. This would be far beyond the scope of a single paper, and I shall only briefly allude to it. The definition also of Psychology cannot claim to be exhaustive, but only to serve as an introduction to a few remarks on its study; when attention will be almost exclusively given to that branch which is more intimately connected with medicine, viz. mental pathology, if so fine a term may be applied to a few crude remarks on certain aspects of insanity.
Psychology, as the term implies Xoyo?) is the science of mental physiology, that is, the study and examination of those phenomena which from the earliest times have been regarded as depending on some entity distinct from the animal organism to which the Greeks applied the term Psyche, and whose nearest equivalent in our language is the soul.
This has always been regarded as the impassable line between humanity and the lower animals; for although it is recognised that man in certain conditions of disease may lose these special attributes of the Psyche and differ in scarcely any respects from the beasts of the field, no instance has ever been on record of any animal other than man possessing these pre- eminently distinguishing characteristics. No doubt the careful observer has for many years been cognisant of the fact that as we ascend in the scale of life we meet with a more and more highly developed type of nervous system, and we see the animals in these latter classes endowed with qualities resembling more and more those relegated to the Psyche, and, in fact, it is generally considered that the difference between the meanest creeping thing and the most highly organised animal is simply one of degree; only is it when we come to compare this latter with man that the real difficulty commences, and that dispute and division wax strong in the army of scientific thinkers, and the Psyche comes forward with its apparently insurmountable difficulties.
With the Psyche too are linked all the beliefs and theories of the past and present as to a future existence after the decay of our animal organism. It was this entity that Pythagoras believed was continually passing from body to body; nor was tlie transmigration confined to men, for not a few believed that in some cases the Psyche at death passed into the bodies of the lower animals, and strangely enough this belief has found a place in the mythology of most nations. Plato first taught its essential immortality, and its perfect entity and existence apart from tlie body, together with its limitation to man, form one of the fundamental doctrines of Christianity.
Science, however, has little to do with the past theories of the ancients on the nature of psychical philosophy : they were the emanations of the ages that produced them, and often help to throw light on the history of those times, but as scientific deductions are now dismissed to the region of poetry and imagination.
Tlie first difficulty that presents itself on entering into any discussion on the subject of Psychology is to define its boundaries and limits. Here, as in nearly all natural sciences, we find it by no means an easy matter, and the maxim, ” Natura non habet lineas,” was never better exemplified than in this instance. At the commencement of our study we find ourselves mentally drawing a sharp and rigidly defined line between the physiology of the human mind and every other science in nature ; we think of it as the ancients did, as something quite distinct from everything we can possibly be acquainted with ; we assume almost at once that the laws which hold sway and cannot be disregarded in other natural sciences in this avail nothing.
Acting thus we should progress but little, and were the laws and conditions of Psychology of such a kind they might justly be dismissed to the unknowable; and with that science can have little to do : it deals with the unknown, not the unknow- able.
The fact, however, that the physiology of mind is now allowed by most to be fitly placed in the ranks of natural science ; that is to say, to belong to a philosophy that claims as its only right of existence a basis of undisputed facts, many of which have taken ages to discover and elaborate, but when once discovered are for all time. This, I think, is great progress on the time when mental philosophy was supposed to be governed by no laws, but was placed on an arbitrary pedestal by itself. As in our study of the animal organism we distinguish two branches of physiology, viz. that of health and that of disease, so in our study of mental phenomena we may with great utility make for ourselves a similar distinction ; and as our facts increase in number and our theories arise where one branch fails us, the other will often supply what is wanting to complete the chain; and, moreover, with regard to the body, it is often impossible to say when we reach the limits of health and disease begins, still more difficult is it to tell among all the diversities of psychical phenomena the exact period when the healthy mind becomes invaded by disease. Often, indeed, when it is advanced the character of the phenomena becomes less complex and more intelligible ; they appear less anomalous, and we find ourselves grouping their causes in separate classes with almost as much certainty as if we were dealing with the better known diseases affecting the organs of animal life. This, however, is not the case in the earlier stage, as the physiology of the mind in health is still in its infancy, its early pathology is still less understood; in an advanced stage it may afford no trouble to the physician to recognise it, and he may diagnose widespread devastation going on in many of those intricate centres of which so little is known, but on the healthy condition of which so much of the greatness of life depends.
As in the case of organic disease, it is not difficult to trace its symptoms when the functions of some important organ have become almost annihilated, and the labour and skill consist in observing at the earliest possible stage when these functions become altered and vitiated; so must our endeavour ever be to discern if possible when the first small cell becomes altered in character, and to read in the psychical symptoms it presents, and which are to be discovered, the indication thereof, as it will often be then, and then only, that our remedies will be of any avail
Not that I mean to say among all the Protean aspects in which the human mind appears in different individuals it would ever be possible to draw a hard and fast line between what is pathological and what physiological, as it is extremely probable that what is physiological in some may in others be incipient disease, and many of the qualities ranked as virtues among mankind when carried to excess become disease. At all ages men of great imagination and creative genius, such as poets, and in early times soothsayers, prophets, and the various ministers of the old superstitions, have been regarded with some degree of suspicion as to their soundness of mind by many of the outside world who have been unable to comprehend them. True it is that at first this scepticism did not exist, and then in the fullest sense imagination, healthy and morbid, bore the utmost sway, a grossly ignorant world putting down as heaven-inspired whatever they did not understand, and too often hearing the oracles of Grod in the ravings of madmen. Hence the respect of the ancients for those of unsound mind ; and these, at a period when medicine could scarcely be said to exist as a science, not unfrequently were the physicians of the community. This relic of the past still exists among oar aboriginal savages, where we often find the fetish, or medicine-man, in the ranks of the insane.
All, however, changed, as the world’s education advanced, and the above-mentioned scepticism took the place of the old superstition.
John Dryden has said : Great wits are sure to madness near allied, But thin partitions do their bounds divide ; and when he wrote these lines he was expressing a belief that is as common and widespread now as it was two centuries ago. Of course, among unimaginative people it is only natural to have doubts as to the mental soundness of the writers of senti- ments they cannot understand. They read the words, but the thoughts that the words are intended to convey strike no responsive chord in the minds of the readers; the language in which they are put is their own mother tongue, and they think if the sentiments were not irrational they must comprehend them. Hence, they are often put down as ” poetical nonsense,” ” mere imagination,” and in their own minds they consider them the outcome of a species of mental unsoundness, not that they would tell you the writers, perhaps men of worldwide fame and reputation, were in the least degree insane. No, the opinion of society has too great an influence upon them, and impresses them unknowingly, so that they take in faith that such a senti- ment or thought is sublime when to their own minds it is simply unintelligible.
But, apart from this, it is also a question whether ” great wits are ‘ not’ to madness near allied;” and as evidence in favour of this may be brought forward the tendency to insanity shown by many of those in whom the imaginative genius has been most pre-eminent. It will here be naturally urged that these in their pursuit of fame threw much more strain on their mental faculties than others, and as is a well-recognised fact in every animal organ overwork is too frequently followed by some form of degeneration, hence that the overworked mind was naturally prone to disease. In some cases this is undoubtedly a true explanation, but it does not afford a reason why the same deterioration of mental faculties does not follow the mental labour of great thinkers, mathematicians, and others, in whom brain-work is probably still more excessive, with anything like the same proportional frequency.
Is it that through the imaginative faculties we approach more easily to the boundary where mental health ceases and disease begins than by any other way ? Is it possible that the wonderful imagery often seen in the creations of the poet may be somewhat allied to the delusions of a madman ?
Perhaps Psychology might show that they depended on not altogether different changes of brain matter. It may be said that the former controls, while the latter is ruled by his imagination, and this in a certain sense is true ; but an old saying that one may be carried away by the imagination is often more literally correct than is supposed, and very few could be really said to control it, although extremely probably is it that every thought or image formed by the mind depends on cerebral changes, as definite as are now considered to accompany every voluntary movement of the limbs so readily under control. Whatever may be the changes upon which the faculty of imagination depends, in all forms of insanity they must be greatly multiplied, and the psychical phenomena resulting from this are among the first symptoms of mental disease. Thought and imagination during sleep are normally absent or present in a very modified degree ; very suspicious therefore is it of commencing disease when dreams?that is to say, morbid imaginations?appear more and more vividly at night, and force themselves more and more on the attention of the patient; and in proportion as his attention is fixed by them, and they appear to him real and natural, we recognise the near approach of mental unsoundness, for we have direct evidence of his imagination getting more and more out of his own control, the servant becoming master. As a consequence of this, sleep cannot take place, for it is essentially an abeyance of the imaginative faculties, a time during which changes that have occurred in the brain cells, due to their dis- charge of function, undergo a reparative process, and are reno- vated for fresh exercise. This reparation in a great degree can only occur during sleep, and if sleep be withheld morbid mental changes may arise de novo, or if present make rapid progression : hence the importance of procuring sleep in the early treatment of these diseases. Another important symptom of mental disease, and one which is often present many years before disease is marked, is what is familiarly known as eccen- tricity ; not that every eccentric individual is to be regarded as insane, or necessarily will ever become so, but it is very probable that among this class their eccentricity is too often a psychical symptom of some deviation from health having taken place in their higher centres. These morbid changes may be of the most trifling character, destined never to become greater, but they may also be early symptoms of advancing disease. General pathology teaches that morbid change in all organic tissues has a tendency to increase, and hence eccentricity may be said to bear the same relation to insanity as a slight amount of arterial degeneration to apoplexy; they are both probably among the earliest symptoms of their respective diseases, but the relationship of the latter is more readily understood because far more is known of the physiology of body than of mind. Mental disease, in which eccentricity is a prominent symp- tom, not unfrequently culminates in suicide, and although juries may invariably pronounce in their verdicts, ” Death during temporary insanity,” there is great question as to its temporary nature. Mental disease must, indeed, be somewhat advanced when delusions or morbid imagination have gained such control over the individual that the first law of nature, self- preservation, under their influence is disregarded.
It is an .interesting fact that many forms of eccentricity are hereditary ; that insanity is so likewise is unquestionable, and with regard to its hereditary nature and the subtle and latent forms it may assume through several generations, it may be with intermissions but often with ineradicable obstinacy, much has been said and written. I would specially instance suicide as one of these forms of hereditary taint, and I might further add, suicide without any apparent reason for the mental condition from which it springs; for men under the influence of violent passions, or stimulated and goaded by the spur of misfortune, tend to lose much of the self-control on which a healthy condi- tion of the mental faculties depends. Hence in those constantly subject to such depressing influences, a natural weakening of the higher centres of the brain, results from frequent over stimula- tion, as is the case in all the organs of animal life, and in this way self-control becomes permanently weaker as the centres on which it depends undergo degeneration.
In these cases disease is more marked and intelligible; it progresses much more slowly, and suicide is only one out of numerous symptoms that are the usual manifestations of deficient self-control and growing weakness of mind. Our patient will often take to drink, and by slow or rapid strides become a confirmed drunkard ; or he will be noted for abnormal shortness of temper, with often more or less change in his moral cha- racter ; his memory becomes faulty, and there is often a notice- able falling off in his intellectual vigour. But, as I before said, I would draw more especial attention to a form of insanity, probably more or less hereditary, in which suicide, apparently uninfluenced by any of the above causes and perpetrated with appalling completeness and design, is the first observable symp- tom. What could be more instructive than the case of Prevost Paradol, that occurred two years ago, and which excited so much wonder at the time, as was evinced by the lengthy notices in the daily press ? A young man in the best society of Paris, whose life was only just beginning, talented, possessed of a large circle of friends, and as far as was known, unburdened by a trouble, is found one morning to have destroyed himself, and evidently by design. True, it may be said, none can know what motive he might have had ; a cheerful face and disposition have been known to mask the most bitter mental anguish; but when the rest of the story is told, and we also learn, as a coincidence, that at almost the same age and under similar cir- cumstances his father, a rising statesman and then French Ambassador at Washington, died by his own hand. Surely this is more than coincidental! Here was a symptom that existed in the father and was transmitted to the son. Had this disease, so insidious, no other symptoms ? None were observed .or reported ; but granting that the suicide was a symptom, is it in accordance with the analogy of organic disease for one so gross to be the first indication of aberration from health ? Had the Psyche been more closely questioned it is by no means improbable that much more might have been ascertained as to the mental con- dition of these men : eccentricities that none had dreamed of, or if noticed, put down as nothing, might have been the first physical signs of the final catastrophe. In such cases as these, it is not too much to say that treatment might be everything, and what cases are there in which this is more urgently needed ? the very essence of their fatality lies in our ignorance as to their history. The mental unsoundness, as a whole, of these individuals cannot be so hopeless, or how explain the accuracy with which the ordinary duties of life have been conducted by them up to the time of their suicide ? Surely if disease were very rampant symptoms would be noted by some of the many who must have had business relations with them, and met them frequently in the everyday affairs of life; for the men I speak of have not always been noted for their retiring and seclusive habits; many have been most active, and in the case of some it would seem that they might have rushed into body and mind engrossing pursuits with the object of guarding against some special form of mental activity that they felt was fated to be pernicious to them. If we take this view we have at least a plausible hypothesis to work upon, and we are led to consider in our minds as to the nature of this ” special and probably vary- ing form of mental activity.” This is the” enemy we have to combat, doubly dangerous because so subtle and difficult to discover.
Now, as the tendency of these psychic forces is to pervert the healthy action of the organism we may consider them under the head of delusions, but it is of the utmost importance when we use this term to be aware that delusions may be of the most varied character. We are all familiar with the story of Lord Castlereagh and the little woman in the red cloak that used to appear to him exciting various impulses; but delusions are seldom so material as this, and when they are they occur in patients whose disease it is not difficult to recognise. Delusions, in a practical point of view, are only important as far as they originate impulses, and these latter may be divided into two classes according as they arise from healthy or morbid mental action. Now it is obvious that it would be impossible to draw an exact line between these two classes, although none can over-estimate its advantage practically if such could be done ; and as the science of Psychology progresses and its laws become more understood, such a division will be more accurate and valuable.
Who among us can claim a mind that has never acted morbidly, or, in other words, has never given rise to impulses at the bidding of delusions ? What difference is there in kind between a delusion that makes us do some trivial, purposeless action and one that, perhaps by a much more complicated series of impulses, instigates self-destruction. Here, it may be said, we have the two ends of the chain, and the intermediate points represent a huge field open to the researches of the physician, and varying considerably in extent and intricacy according to the character of the mental calibre of the patient.
In all cases of mental disease statistics from our asylums tend to show that in proportion as they are treated early the prognosis is favourable, and becomes rapidly bad and hopeless with their chronicity in this point as in nearly every other according with the pathology of animal life. Insanity is said to be on the increase, and hence it behoves still more the practitioners of the future to be cognisant with the chief facts of Psychology, as they are quite certain to meet with and have to treat many cases of this kind. Macbeth asked Avith bitter irony of his physician, Canst tliou not minister to a mind diseased ?
The physician of the nineteenth century can answer such a question with far more confidence than was possible in the sixteenth ; and a time will certainly come when mental patho- logy though more complicated, will be no less material and intelligible than that of the organic system. Who can reasonably doubt now that the brain which we can see and feel, and whose weight not unfrequently corresponds in some measure with the intellect of the individual, is an organ in all respects comparable with the liver and kidney, differing only from them in respect to our relative ignorance of its function ? If our patient suffer from jaundice or uraemia we invariably see in our mind’s eye clearly which is the offending organ and, much as we may differ in our way of doing, know well what must be done before health can again be established. Let us thus regard the maladies of the mind. Instead of liver and kidney disease we are now dealing with brain disease, and when we have a patient brought who tells us he is constantly hearing voices at night prompting him to various acts, or that a mysterious stranger is ever dogging his footsteps, let us as surely conclude that certain cerebral elements, we know not what or how many, have become functionally or organically deranged, as from the yellow skin and black urine of the jaundiced patient we know the functions of the liver are diseased.
Of one thing we may be quite certain : we cannot study organic disease in all its aspects, disregarding the mental condition of our patient. Probably there is no disease but has its reaction on the mind, and would afford psychical symptoms if they could be observed. It is in the experience of all how deeply at times the bodily condition will affect and give colouring to the mental; many are the diseases in which this has been recognised for generations, and as we should expect the nearer they are, and the more they attack the great nervous centres, the more prominent’become the psychical phenomena. It is the same throughout the physiology of life, the mind grows and develops with the body as it likewise decays and degenerates with it. The external world acts equally on both, and although their reactions may appear different, they are bound together indissolubly ; we may separate them artificially, but neither in health nor disease can mind or body be properly studied alone.
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