The Factors of the Unsound Mind
126 REVIEWS AND BIBLIOGRAPHICAL NOTICES.
By William A. Guy, M.B.,
F.R.S. London: Thos. De La Rue & Co., 1881. Universal welcome will be accorded to Dr Gruy’s new volume, containing the substance of the Lumleian lectures delivered by him in 1868, amended to bring the work abreast of advances made since the date of their first appearance. The strong interest taken by their author in the criminal aspects of insanity, and his well-known insistance on a full and complete recognition of its bearing on the perpetration of acts committed under its influence, lends especial value to the opinions formed after what has probably been a fuller and more lengthened experience of the subject treated than has been enjoyed by any living observer.
The title of the work is a peculiarly happy one. It indicates exactly what is contained in it; and the exposition of principles which are at the root of every problem of incipient mental unsoundness to which we are treated in it, is a masterly performance, of incomparable excellence. On one point, occurring in the first chapter, we are bound to disagree with Dr Guy, and that is the confusion he imparts to the use of the terms ” imagination ” and ” fancy.” More than once he employs the terms with the evident intention of ascribing the same meaning to each, as e.g., on page 21, where he asks, ” Are spectral and other illusions, in any proper sense results of the workings of imagination or fancy?” And further on in the same page, as though to remove any doubt as. to his actual intention to assign equivalence to the two names, he continues : ” In these cases, which, as I have said, are very numerous, it seems obvious to attribute the illusions to that active, busy, creative faculty which we call Imagination or Fancy.” Now, from this passage, in which we have italicised the essential words, it is sufficiently evident that to the mind of Dr Gruy there is no distinction between that which is attributable to imaginative proceedings, and that which is the outcome of fanciful creations. And yet we are compelled to regard the two operations as specifically distinct, and as depending on utterly different antecedents. There is an important question involved in this bearing on the origin of the illusions to which Dr Gruy attaches, correctly, so high a value in the genesis of mental disease ; all the more reason, therefore, is there that an accurate conception of the two activities should be generally held. At one time the two terms were used in an identical sense, but there is an important distinction between them, which Leigh Hunt carefully explains, declaring Fancy to mean “nothing but a spiritual image or apparition (tyavTaafia, appearance, phantom),” and having no relation to real and existent objects, with which, on the other hand, imagination is wholly concerned. But the latter may alter, contort, rearrange, and rehabilitate the recollections of actual experiences, and in all this it will not ascend to the idealism that is pre-eminently characteristic of fancy. In connection with the illusory phenomena described by Dr Guy, the play of imagination is perfectly marked ; in all of the narrations he incorporates, the subjects of illusion have been under the spell of imagination simply; and it does not seem to us at all hypercritical to insist that those appearances should be ascribed to their real source, and that the name ” Fancy ” should be reserved to designate that which it legitimately belongs to, the spiritual creations, so to speak, of genius.
Dr Guy brings together a number of histories of persons who have been subject to illusions, and from them he proceeds to discuss the occurrence of illusions in animals, which fact he considers to prove that the intervention of such a faculty as the imagination is not necessary between the action of the brain and the illusion, and cites the following instance:?” Mr. W. J. Palmer, of Calcutta, gave to a puppy the liquid resulting from the chemical treatment of the stomachs of a man and his wife who had died poisoned by the young shoots of the dhatoora plant. The puppy vomited, performed a few antics, and fell on his side in a deep sleep; after ten minutes he got up, stared wildly about him, and appeared to see visions which he would scratch or snap at, but finding that they eluded him, he walked to his accustomed corner of the room and there lay down. A kitten treated to the contents of another stomach containing also the poison of dhatoora, when consciousness returned, is described as staring wildly, performing a series of grotesque actions, as being irritable and almost wild If Mr. Palmer is not wrong in his interpretation of the movements of these animals, and if other observers have not been similarly mistaken, then it follows that we may have illusions of the senses in creatures which we do not credit with any faculty resembling the human imagination.” It is quite possible of course, nay, more, probable, that Dr Guy’s assumption regarding the mental constitution of animals will not be generally accepted, and thus his deductions will not weigh with others as with himself. Few will disagree, however, with him as to the powerful influences illusions exert over their victims, who, impressed against their will and wish, with their reality, become for a time the unreasoning servants of an irresistible power. If asked concerning the phantoms they energetically declare they have no reality, and yet at each fresh occurrence of an illusion they are found to act for the time as if fully believing in it. ” A man who knows right from wrong, whatever the condition of his mind in other respects, and whatever the strength of the impulse which urges him to action, is held to be responsible for his act. Do not these cases help us to understand the surpassing reality of the brain’s own creations, and the tyranny they exercise over men’s actions, even in presence of the most perfect knowledge (experimental and theoretical) of their true nature and causation ? And if illusions of the sense of sight, which, if not corrected by real objects, are at least mixed up with them, are thus vivid and life-like, what shall we say of those illusions of the sense of hearing which, so to speak, have the mind all to themselves, and take the shape of definite commands to commit suicide or murder ? ” This passage sounds the key-note of the work, and it is followed by a luminous exposition of the data on which the final conclusions to which Dr Gruy gives expression are based. The second section is devoted to delusions, and concludes with the following passage :
?” I believe that there are illusions of the senses and delusions of the mind which are to the full as involuntary, and as certainly due to the direct action of the brain itself as the outward manifestations of emotion, the grotesque movements of chorea, or the aimless convulsions of epilepsy.” Succeeding comes a chapter on ” Dreams” and the analogy between these and the insane condition is dwelt on. Dr Guy refers to the strange and incomprehensible rapidity with which a lengthened series of events is sometimes gone through in imagination by the sleeper, between the occurrence of a noise which suffices to arouse him, and the actual awakening. Every physician has some time or other experienced this, and has striven in vain to afford a physiological explanation of it. Years may appear to elapse, and the actions and incidents crowded within them passed in detailed review, leading gradually up to some event connected with the sound which startles out of sleep, and yet we can be certain that an almost inappreciable period of time elapses between the two to full waking time; notwithstanding, sufficient for the mental review of a lifetime. In the lunatic this condition has not been recognised; but as Dr Gruy suggests, ” possibly some happy accident may supply us with a case in point.” It can hardly be that there is never anything equivalent to be noticed, and it were better to conclude that our means of observation are as yet inadequate to estimating the value and extent of the mental changes that make up the phases of insanity. The temptation to conclude that this latter condition, of necessity implies structural changes to disturb every normal process, is one that is found almost too strong to resist; and until there is a general willingness to regard the mentally alienated more in the light of a simply aberrant type, advance will be slow and gradual.
The exception we have ventured to take to a confusion of imagination and fancy is justified by the phenomena of dreaming. This has always reference to actual experiences; we never find a dream concerned with purely ideal creations of fancy ; even the most fantastic and impossible conceptions are based on some fact or occurrence of former time. There is no initiation or real origination of ideas, and we may perhaps be allowed to suggest that the recognition of this and its application to the phenomena of insanity may be found productive of good result. The two states, dreaming and insanity, agree in this, that each is concerned with that which is or has been. The lunatic may be wondrously imaginative, may be even poetical, but he is never a producer of new ideas, only always an adapter of old ones; and thus is he strangely and surely marked off from a class often unjustly put with him by hasty generalisers, viz. geniuses. Somnambulism, and delirium are treated by Dr Guy in separate chapters. Under each heading he has much to say that is interesting, and especially in the former section when dealing with double consciousness and spiritualism. As might be anticipated, the bearing of the somnambulistic condition on homicidal and suicidal tendencies is dilated on with the view of’bringing into relief the influence they have on the criminal aspects of such acts. “The word delirium,” says Dr Guy, ” was formerly in frequent use as the equivalent of insanity, and is even now occasionally employed in that sense. But its more common and appropriate use is to designate a state of mind which springs up during fevers, inflammations, (especially in the internal organs) severe wounds and injuries, the action of poisons, and especially of such poisons as opium and alcohol. Delirium tremens, the Nemesis of the drunkard, is one of its most instructive forms.” This definition of delirium satisfactorily includes the phenomena presented during those stages of illness of which it forms a characteristic feature, and separates it from the apparently similar states observed in actual insanity. We could wish that Dr Guy had somewhat extended this chapter to include a more complete differential diagnosis; but so far as it goes it is an admirable exposition of the subject it describes. Catalepsy is a condition so rarely met with, and, when seen, so excessively instructive, that it is much to be desired it could be more fully studied and explained. Dr Guy is unable to add much to what is already known concerning it; he states he has never seen a case since he was a boy. And the records of medicine contain so few descriptions of the disease, there can be but little learnt from them about it. It is possible to believe even of some of the few cases of which a history has been given, that their nature has been improperly understood, and they entitle to be ranked rather as instances of extraordinary hysteria. We believe Dr Drummond, physician to the Newcastle-on-Tyne Infirmary, has a woman now under his care, in the wards of that institution, of whom it would be rash to assert whether she can be correctly described as hysterical or cataleptic.
In non-professional circles every convulsive seizure is a “fit,” and, from occasional accounts received of ” fits ” occurring more or less frequently in persons who are not regularly under medical treatment, it is not unreasonable to assume that conditions allied to that of catalepsy are more frequent than we are in the habit of supposing. They are less fearful in appearance than the more terrifying epileptic attacks, and as in the case we refer to, it is only after long continuance, or increased severity of symptoms, that resort is had to skilled advice. Of epilepsy, fortunately, Dr Guy is enabled to speak definitely ; and he assents to the views propounded by Dr Cheyne that the strumous diathesis is a strong exciting cause of the complaint. Its relation to insanity is briefly but clearly described in the words of Dr Burrows, to the effect that ” Epilepsy is frequently complicated with, or ends in, mental derangement. It may be complicated with every form of aberration, alienation, or deficiency of intellect. Thus we find it combined with mania, melancholia, demency, and idiotism. The epileptic attack may be preceded by a furious paroxysm, or merely by elevated ideas, by great depression of spirits, or by mental imbecility, forgetfulness, &c.; or the reverse may obtain, and the sequel of the epileptic fits may exhibit these morbid conditions of the mental functions.”
Hysteria will probably never lose its interest for the practical physician ; and each year, in consequence of the attention that is given to it, we are becoming better and more truly acquainted with the meaning of its symptoms. The proneness of numbers of women when associated together, to imitate the hysterical condition when any one is attacked by it, is well known, and affords our author a theme for cogent and instructive comment. The subject of hysterical males also is carefully touched, and one case which came within Dr Guy’s own experience is so instructive in its details that we are unable to forbear quoting it in full. Dr Guy writes: “I was one of a party assembled one evening at the house of a friend. The conversation took the direction of mesmerism, and I was appealed to, as the person most likely to understand it, for an explanation of its method and effect. I disclaimed all knowREVIEWS AND BIBLIOGRAPHICAL NOTICES. J 31 ledge of the subject beyond the fact that the manipulations of the mesmeriser consisted of passes of the hand before the face 5 and the effect sleep, or a state allied to it. I illustrated the method by making a few passes, which were not directed towards anyone present, nor had I any particular person in my thoughts. But the master of the house, a healthy well-made gentleman, above the middle height, inclined to corpulence, of the temperament known as phlegmatic, and of an easy disposition, very ready to accept the views of others where most men prefer to help themselves?this gentleman, not being near me, or in the direction of my movements, suddenly sank on a sofa by which he was standing, and became convulsed, his features becoming so distorted that it was hard to say whether their expression, or the horror of his wife, or the surprise of the rest of the party, was most noteworthy. As the expression of his face, as well as the incoherent words he uttered, had reference to myself, I withdrew, and noiselessly, as I thought, made my way to an apartment above. But his eyes, gestures, and words followed me there, and I soon determined to leave the house. Next day I met him, and would have shaken hands with him, but he motioned me away,’ alleging that he could not bear it It is impossible to imagine a more complete illustration than this case affords of the existence of that exceptional condition of mind and nervous system which gives force to the passes of the mesmeriser and the fixed gaze of the biologist. In this strange case there was neither intention on the part of the operator nor imposition or possible imitation on the part of the ‘ subject.’ Attribute the phenomena if we will to the workings of the imagination, we do but assign a real cause; we do not, and we cannot, explain its mode of action. Some time after this event I was informed that the oldest son of this gentleman was found to be among the most susceptible persons at a meeting convened by a celebrated biologist.” Dr Gruy adds in reference to this question, ” the effects attributed to an external cause may be really due to the inner peculiarities of the ‘ subject’ himself; that convulsions and other abnormal states of the nervous system may originate, not in the strong will and confident actions of the mesmeriser or biologist, but in the hysteric weakness of the ‘ subject.’ ” These passages are among the most instructive in the book. They are exceptionally interesting in themselves, but as much, too, showing the conservative tendency of their author’s mind in rejecting the modern developments of physiological science in .respect to the subject he is discussing, and especially on account of his utterly ignoring the remarkable performances of Heidenhain.
The second part of Dr Guy’s volume is devoted to “The plea of Insanity.” We cannot now give space to any lengthened analysis of its chapters, but it will suffice almost to say of it that it is an able, eloquent, and irresistible argument in favour of removing the onus of responsibility from the insane criminal. Dr Guy recognises five classes of cases in whieh the plea of insanity can be admitted; they are (1) cases of acute instinctive or impulsive insanity, (2) cases of chronic instinctive or impulsive insanity, (3) cases of epilepsy with homicidal impulse, (4) cases of imbecility, (5) cases of mania. In demonstrating this part of his subject, our author will carry every educated physician with him. We have not always been able to agree with him in the earlier part of his work, but here we are heart and soul at one with his noble and generous desire to reform what is, perhaps, the greatest scandal of the criminal code. Indeed, it is high time that we dispense with all refinements in a matter so simple. A man kills another, and the plea of insanity is set up and maintained. Delusion is proved. If you can show that the madman knows right from wrong, and that murder is unlawful, do you also prove that he could act upon his knowledge as the sane criminal does ? Give what definition or description of madmen you please, you cannot exclude from it the weakening or destruction of the will. We cannot, in conclusion, say anything higher in praise of Dr Guy’s most admirable book, than that he succeeds in showing the perfect truth of a passage prefixed to his own volume, from Coke in ” Blackstone.” ” But if there be any doubt of sanity, surely the evidence of men of acknowledged science and reputation should, at least, be listened to, especially in capital offences, lest the execution of the maniac be a miserable spectacle both against law, and of extreme inhumanity and cruelty, and be no example to others.”
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