GEN. I.

Ecphronia. Insanity.

Craziness.

and been followed technically by Crich

ton.

Explanation of Pinel in

one point incorrect;

And hence the unison with this

tinued to be applied to the present day.
vulgar sense of the term, which is in
view, is at variance with the technical and pathological.
Yet the pathologists themselves have not been uniformly
true to their own import: for even Dr. Cullen, who has fol-
lowed the technical signification in his Synopsis, by defining
melancholy as "insania partialis sine dyspepsia," some-
times adopts the colloquial meaning in his Practice of
Physic, and hereby betrays a confusion which rarely be-
longs to him; while Dr. (now Sir Alexander Crichton)
has given himself over completely to the popular, or, as he
would perhaps call it, the antient interpretation of the
terms; distinguishing mania, not by the generalization of
the delirium, but by its raving fury or elevatea gaiety;
and melancholy, not by a limitation of the delirium to
single objects or trains of ideas, but by its concomitant
dejection and despondency.

There seems to be an equal incorrectness, though of a different kind, in M. Pinel, whose book is, nevertheless, of great merit. Delirium or wandering is made a pathonomic symptom in his definition of the genus; in other words, a want of correspondence between the judgement and the perception; and consequently this symptom should be found in every species which he has arranged under it. M. Pinel, however, has given us one species which has no such symptoms, and which is purposely intended to include cases of what he calls mania without any such discrepancy; on which account he has denominated it manie sans delire. All such cases, however, are reducible to modifications of rage or ungovernable passion, and ought ungovern- by no means to be confounded with mania; the judgement able passion. being, in these instances, not at variance with the perception, but overpowered by the predominant fury or passion that has been excited. They all belong properly to our next genus; under which they will be considered.

that of confounding delirium with

Difficulty of distinguishing insanity from habitu

Much difficulty has also been felt in defining ecphronia or insanity, so as to draw the line between real disease and habitual waywardness or oddity; and hence while al oddity of some definitions are so narrow as to set at liberty half the temper.

GEN. I. Ecphronia.

Insanity.

patients at Bethlem or the Bicêtre; others are so loose and capacious as to give a strait waistcoat to half the world. M. Dufour, undertook with great learning and inge- Craziness. nuity to prove that, as all our knowledge of an external essentially

Faculties

of the ex

world is derived from the action of the external senses, diseased. while mental sanity depends upon the soundness of these Dufour's hypothesis, senses, mental insanity is alone to be referred to a diseased or diseased condition of one or more of them. And in proof of condition this he gives the case of a person who lost his senses ternal because he could not be persuaded that the objects he saw senses. in consequence of an incipient cataract, arose entirely from that complaint. "When he found that he could not remove the dark web which appeared to him to be constantly floating before his eyes, he fell into such frequent fits of violent passion that he became quite insane. as soon as the disease was completed he became more tractable, and submitted to the operation like a reasonable man."

But this only shows us that

Ira furor brevis est,

But

or else that the insanity was caused, not by the cataract, but by the frequent fits of violent passion. Thousands of persons have had cataracts in every form, and other external senses than the eye diseased in every form, and have been born defective in several of these senses without the least mark of insanity; while other persons, apparently in the most perfect possession of all the five senses, have been stark mad. And hence the doctrine of M. Dufour, boasts of few advocates in the present day.

Hypothesis.

of Locke

and Con

dillac, or

In insanity or delirium without fever, it is far more obvious that there is a morbid condition of the judgement, or of the perception, or of both. Mr. Locke, and after him M. Condillac, refers it to the former alone, and characterizes madness, in the general sense of the term, by false judgement; by a disposition to associate ideas incor- false judgerectly, and to mistake them for truths; and hence, says Mr. Locke, "madmen err as men do that argue right

ment.

GEN. I. Ecphronia. Insanity. Craziness.

from wrong principles "*. Dr. Battie on the contrary, refers madness to the latter faculty alone, and characterises it by false perception; but the perceptions in madness seem, for any thing we know to the contrary, to be or false per- frequently as correct as in health, the judgement or reasoning being alone diseased or defective.

Battie's

hypothesis

ception.

Both hy

potheses imperfect, and in what

respect.

Cullen's hypothesis apparently borrowed

from

Locke's.

Crichton's

It is difficult to say which of these two explanations of madness is most imperfect. It is sufficient to observe that neither of them, taken alone, describes a condition of the faculties strictly morbid, and consequently neither of them defines madness. For we are daily meeting with thousands of mankind who are under the influence of false judgements, who unite incongruous or discrepant ideas, and draw from false associations right conclusions, yet whom we never think of regarding as out of their senses. While on the contrary if false perceptions be sufficient to constitute madness, every man is insane who mistakes at a distance a square for a round tower, the bending azure sky that terminates an extensive landscape for the sea, or the distant rumbling of a heavy waggon over the streets for a peal of thunder: and we should none of us be safe from such a charge for a single day of our lives.

Dr. Cullen seems to have embraced Mr. Locke's view of the subject: for his definition of insanity (vesaniæ) in the latter editions of his Synopsis is "injured functions of the mind in judging (mentis judicantis) without pyrexy or coma." Dr. Crichton, on the contrary seems rather to an improve- adhere to Dr. Battie's view, though he enlarges and ment upon improves upon it; and hence his definition is "General derangement of the mental faculties, in which diseased perceptions are mistaken for realities; with incoherent language and unruly conduct."

hypothesis:

Battie's;

Diseased is certainly a better term than false, which is that of Dr. Battie; but "unruly conduct" does not essentially belong to madness, even under this excellent writer's own explanation: for of the three species which

B. II. Ch. xi. § 13.

Craziness.

he comprehends under this disease as a genus, viz. mania GEN. I. Ecphronia. furibunda, mania mitis, and melancholia, while the last, Insanity. as he afterwards illustrates it*, evinces these symptoms only occasionally, he expressly tells us of the second, that the diseased are "all happy, gay, and cheerful; that "good humour characterizes this insanity, and hence the patients are in general very tractable”+.

But the chief objection to Sir A. Crichton's definition of insanity, is his limiting it, in respect to the mental faculties, to the power of perception while the judgment remains totally unaffected. "In regard to lunatics", says he, in another place," and men who are of a sound mind, the faculty of judging is the same in both, but they have different perceptions, and their judgements therefore, must be different"+.

Now if the faculties of perception, attention and memory be liable to derangement, as the same writer admits, and there be "a general derangement of mental faculties in insanity", there seems no sufficient ground for exempting the faculty of judgement. And a little attention to the history of an insane patient will, I think, sufficiently support the opinion of Mr. Locke and Dr. Cullen upon this point, and show that this, if not the faculty chiefly diseased, labours under at least as much disease as that of perception.

but his detrue to his own his

finition not

tory,

and not sufficiently compre

hensive in disease to the faculty of percep

limiting the

tion.

faculties of the mind, like all the

organs of

the body, capable of being diseased:

We have already observed in the proem to the present All the class, that all the powers of the mind are as liable to be affected with diseases, and diseases of various kinds, as those of the body; and that either the body or the mind may be enfeebled at the same time in the whole of its powers, in a few of its powers, or in a single power. A sound mind supposes an existence of all the mind's feelings and intellectual powers in a state of vigour and under the subordination of the judgement, which is designed by nature to be the governing or controlling principle. And thus constitut

GEN. I. Ecphronia. Insanity.

but slight derangements in

ed, the mind is said to be in a state of order or arrangement. It often happens that this order or arrangement is Craziness. slightly broken in upon by natural constitution, or some corporeal affection; but so long as the irregularity does not essentially interfere with the mental health, it is no more attended to than slight irregularities or disquietudes of the body. Yet whenever it becomes serious and complicated, it amounts to a disease, and the mind is said, and most correctly so, to be deranged or disordered.

either little attended to, as not essen

tially interfering with the mental or bodily health.

Upon this principle the ensuing

genera are founded.

The judge

ment and perception both dis

eased in insanity,

and sometimes, though not

other men

This derangement may proceed from a morbid state of any of the intellectual or any of the empassioned faculties of the mind, for the perception may not correctly convey the ideas we receive by the external senses, or the judgement may lose its power of discriminating them; or the memory may not retain them, or the imagination or the passions may be in a state of unruly excitement: all which will lay a foundation for different kinds or genera of diseases, and in fact form the foundation of those appertaining to the present order.

Now an attentive examination into the habits of an insane person will show first, that the judgement and the perception are BOTH injured during the existence of insanity; and next that though, from a violent or complicated state of the disease, the morbid condition often extends to some other, or even to all the other mental faculties, necessarily, yet it does not necessarily or essentially extend to them; for a madman may be furious or passionate, yet every tal powers: madman is not so; his memory may fail or his attention be incapable of fixing itself, or his imagination be wild nor are the and extravagant, but these do not always occur. The judgement faculties, however, of the judgement and the perception are affected in every case, though they are not always equally affected at one and the same time: for the morbid power seems, for the most part, unaccountably to shift in succession from the one to the other, so as alternately to leave the judgement and alternately the perception free or nearly free from all estrangement whatever, the disease being, however, always accompanied with irregular remissions; and often with such a diminution of sensibility

and perception always equally af

fected at the same time.