Responsibility in mental disease
I -^ J^ ""^fc ""^t. '*».l luiuiiirniigiip ."^ '^ mrn-^ '"■*■■*'■ "HiMW* » ^ V < LvUi/Z SCIENTIFIC SERIES A Cornell University Library The original of tliis book is in tine Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924031181310 Cornell University Library arV1846 Responsibility in mental disease. 3 1924 031 181 310 olin.anx THE INTERNATIONAL SCIENTIFIC SERIES. VOLUME IX. THE INTERNATIONAL SCIENTIFIC SERIES. U^in-is already Piiilhlud. EnglishConstitution." ivol. Cloth i'nce.^i.so. III. FOquS. By Edwakd Smith, M. D., LL. B., F. K. b. i vol. i-iow. T V mTnD and' body : the Theories of theib Relations. By Alex. ™ AiN, if D.TProLsor of Logic in the University of Aberdeen, ivol, V. THTsTuSy O^f" SOCIOLOGY. By Herbert Spencee. Price, VI THE NEW CHEMISTRY. By Prof. JpsiAH P. Cooke. Jr., of Harvard TIniversitv. 1 vol., i2mo. 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PAOB Insane persons iu asylums : how much they resemble and how much . they differ from sane persons — Erroneous popular and legal notions — Peeling of repulsion towards insanity — Cruel treat- ment of the insane : from what causes it originated — Effects of the theological and the metaphysical spirit— Mind a function of brain, and disordered mind a result of disordered brain- Influence of bodily organs on mental function — Physiological method of inquiry indispensable ; inadequacy of psychological method — Development of nervous system by education, and its necessary limits — The tyranny of organization — Hereditary influence— Moral responsibility — ^The criminal nature — Heredi- tary crime— The production of criminals : their defective physical and mental organization, and proneness to disease — Border-land between insanity and crime — Causes, course, and varieties of intellectual and moral degeneracy to be studied by the inductive method. ..... 1-37 CHAPTER II. THE BOBDERLAND. No distinct line of demarcation between sanity and insanity — Con- tinuity in nature — The borderland— The insane temperament — Transformation of nervous diseases — Kinship between insanity and epilepsy, neuralgia, chorea, dipsomania — Functional and organic diseases of the brain — Hereditary predisposition : its " pathological evolution through generations — Originalities of vi CONTENTS. PAGE idea, feeling and impulse in connection -with it — Insanity and the prophetic mania— The prophets of the Old Testament— The epileptic nature of Mahomet's visions and revelations— The madman and the reformer— Eccentricity and insanity — Deficiency or absence of moral sense a congenital fault of mental organization— Crime and insanity— Moral sense: its acquisition in the course of evolution ; and its dependence upon organization— Physical conditions of moral degeneracy — Con- clusiona. ....••• 38-65 CHAPTER in. DIFFERENT POEMS OF MENTAL DEEANGEMENT. Idiocy and imbecility — Kleptomania, pyromania, &c., often mark imbecility — Intellectual and Affective insanity — General and partial mania — Monomania and melancholia — Dementia — General paralysis of the insane — Objections to the received system of classification according to certain promineot mental symptoms only — ^The lines on which it is proposed to lay down a better system — The diagnosis of insanity a strictly medical question — Morels proposed classification — Skae's proposed classification — The path of future medical inquiry — The phy- sician's duty to declare the truth, however unpopular it may be. ...... . 66-87 CHAPTER IV. IiA"W AND INSANITY. Early legal notions of insanity— Lord Hale's dictum— Mr. Justice Tracey's wild beast theory of madness— The trial of Hadfield : Erskine's declaration that delusion was the true cha- racter of insanity— The trial of Bellingham : Chief Justice Mansfield's dictum that a knowledge of right and wrong gene- rally was the proper criterion of responsibility— The trial of MoNaughten : answers of the English judges to questions put CONTENTS. VU PAGF by tbe House of Lords — ^A knowledge of right and wrong in reference to the particular act at the time of committing it laid down as the true criterion of responsibility — One exception to this rule formulating the question to be left by the judge to the jury — ^Assumption by the judge of the function of the jury — Criticism of the answers of the English judges by American judges — Unqertainty of result in English trials where insanity is alleged — The dicta of American judges : cases of Boardman V. Woodman, State v. Jones, and State v. Piie— Articles of the French penal code and of the latest German penal code — Comment upon the right-and- wrong theory of responsibility. Formal legal views of testamentary capacity ; cases of Cart- wrighi v. Cartwriglit, Dew v. Clarice, and Waring v. Wai-ing — Kecent American decisions— Judgment of the Court of Queen's Bench in the Case of Banks v. Oood/ellow — Comparison of the ' law relating to testamentary capacity with the law relating to criminal responsibility ..... 88-120 CHAPTER V. PARTIAL INSANITT. I. — Affective Insanity. Insanity compris'es ' several forms of mental derangement — ^Varia- tions in the character of the symptoms of each form at different periods of its course — Early symptoms sometimes little marked, but of great significance : examples — Medical observation alone of the early stages of any value : misinterpretation ' of them by lawyers and others — Uselessneas of the capital punishment of insane persons as an example tq others.' Affective insanity : 1. Impulsive insanity. Insane suicidal impulse or suicidal monomania : examples — Pathological nature of the insane impulse : aninability to control it may be accompanied by a consciousness of its morbid nature — Suicidal insanity strongly hereditary: example — Homicidal monomania: examples — Discussion of its nature— Perverted desires and deranged 9111 CONTENTS. PAGE impulses common features in all forms of mental derangement — Symptoms of derangement before an outbreak of homicidal insanity — Latent tendencies may discover themselves for the first time on the occasion of a powerful exciting cause — Condi- tions precedent of an outbreak : a. the insane neurosis ; b. the epileptic neurosis— a. Insane neurosis : with some degree of imbecility — case of Burton : -without imbecility, but with manifestation of insane tendencies — case of Alton murderer — The homicidal impulse : was it irresistible or un- resisted ? — b. Epileptic neurosis : the homicidal mania may precede, take the place of, or follow an epileptic fit — 2. Moral insanity : its characteristic features and its causation — Moral alienation often precedes intellectual derangement, and remains after this has passed away ; attacks of it may alternate with attacks of regular mania and melancholia— Folie circulaire — Moral alienation in connection with epilepsy— Congenital moral imbecility— Conclusion. .... 121-184 CHAPTER VI. PAETIAL INSANITY. II. — Partial Intellectwil (or Ideational) Insanity. Simple melancholic depression preceding intellectual derangement : homicidal or suicidal outbreak : case of Charles Lamb's sister — Melancholia with hypochondriacal hallucinations and delusions ; homicide — Delusions of suspicion or persecution, and homicidal mania: case of Dr. Pownall — Concealment of their delusions by insane persons— Bodily symptoms preceding an outbreak of homicidal mania : the characters of the attack — Dangerous character of the insanity that is accompanied by delusions of persecution — An insane person does murder out of revenge : is he a, responsible agent?— Futility of argument against a, ' delusion ^ a limited delusion indicates deeper mental derange- ment : examples — Premeditation in planning and ingenuity in perpetrating homicide entirely consistent with insanity : ex- CONTENTS. rX PAOE . ample — Danger of recurrence of homicidal mania : examples — Conduct of insane persons after a homicidal act — Homi- cidal insanity in which, first, the act is the direct offspring of the delusion ; and. secondly,, in which it cannot be traced to its influence — Hofifbauer's metaphysical criterion of responsibility — The medical doctrine that partial insanity excludes the idea of criminality, whether or not the acts are the results of delusion : the reasons on which it is based — Discussion of the legal and medical views with regard to the working of an insane delusion in the mind : examples showing the impossibility of tracing its workings — Pathological meaning of the existence of an insane delusion, however limited — The right problem in homicidal insanity is to trace a connection, not between the delusion and the act, but between the disease and the act.. ...... 185-226 CHAPTER VII. EPILEPTIC INSAITETY. tiania following epilepsy : its furious character — Masked epilepsy — Mental disorder preceding the epileptic attack — Epileptiform neurosis manifesting itself in periodical attacks of mental derangement : examples— Description of the symptoms of epileptic insanity : of those that go before and foretell an attack ; of those that are exhibited in the milder and the more severe forms of the disease ; and of those that are met with after long-continued epilepsy — Peculiar states of epileptic con- sciousness — Epileptic visions — Transitory mania, of epileptic origin : examples— Features of epUeptio homicide — Transitory mania, without history of epilepsy— Somnambulism— The per- sistence of dream-haUucinations after waking from sleep. 227-253 CHAPTER VIII. SENILE DEMENTIA. Symptoms of senile dementia in the order of their occurrence : loss of memory, impairment of perception, incoherent talk, in- X CONTENTS. PAGB capacity of comprehension, complete mental decay — Com- parison of its symptoms with those marking the natural decay of mind in old age— The mental character of old age — Failure of mind in febrile and other diseases— Loss of consciousness of personal identity. . . . . • 254-267 CHAPTER IX, THE PRETENTION OF INSANITY Man's power over himself to prevent insanity — Outcomes of an insane temperament — The exercise of self-control in insanity — The gradual evolution of character— The development of will : its power over the thoughts and feelings — The propagation of insanity through generations— Unwise marriages — The tyranny of the passion of love— The degeneration and regeneration of families — The intensification of the neurotic type — Hereditary predisposition, intemperance, and mental anxieties as causes of insanity— Exposition of the evil efifects of intemperance — The prevention of insanity by education — The aim of a liberal education — Self-culture as an aim of life — Inconsistencies ol thought, feeling, and actions : the injury to character which they imply — The kind of mental activity involved in the conduct of business : how it fails to satisfy the requirements of true mental culture— Mistaken views of religious duties — The control of the emotions— Mental hard work not a cause of insanity — The full development of the mental faculties a pro- tection against insanity — Undeveloped mentality — The study of the natural sciences as a means of intellectual and moral training — The reign of law in human evolution— The moral duties consequent on the intellectual recognition of it 26S-308 EESPONSIBILITY IN MENTAL DISEASE. CHAPTER I. INTRODUCTORY. luaane persons in asylums : tow much they resemble and how much they differ from sane persons — Erroneous popular and legal notions — Feeling of repulsion towards insanity — Cruel treatment of the insane : from what causes it originated — Effects of the theological and the metaphysical spirit — Mind a function of brain, and dis- ordered mind a result of disordered brain — Influence of bodily organs on mental function — Physiological method of inquiry indis- pensable ; inadequacy of ijsychologioal method — Development of nervous system by education, and its necessary limits — The tyranny of organization — Hereditary influence— Moral responsibiUty — The criminal nature — Hereditary crime— The production of criminals : their defective physical and mental organization, and proneness to disease — Border-land between insanity and crime — Causes, course, and varieties of intellectual and moral degeneracy to be studied by the inductive method. Notwithstanding^ the great change which has ■ taken place in opiaiion and practice with regard to mental disease within the last century, there are still persons who, if invited to visit a lunatic asylum, would look on the pro- posal in much the same light an a proposal to visit the Zoological Gardens and inspect the wild beasts. They would certainly. expect to see something entirely unlike Z RESPONSIBILITY IN MENTAL DISEASE. what tliey were used to see in their daily experience, and would probably come away not a little disappointed with the result of the visit : like Mr. Burke, they might ask, at the end of it, where the insane persons were. It is related of that great philosopher, orator, and statesman that, after going through the wards of a large lunatic asylum, he turned to the gentleman who had accompanied him, and said that he had not seen one person whom he considered insane. Thereupon his conductor called one of the patients who had particularly interested Mr. Burke by his ingenious political theories, and touched the sub- ject of his delusions, when he began immediately to talk of the porcupine quills which he imagined to grow from his skin after each meal, and became so incoherent that Mr. Burke was convinced that madmen were not all like the pictures which Hogarth painted of them. For the most part, they are very unlike. Of the in- mates of an asylum, some few might present noticeable peculiarities of appearance, demeanour, and conversation ; more would strike the observer by their dull look and listless attitude, as if they had no interest in anything in the heavens above or in the earth beneath ; while others would not show, either by their looks or by what they said or did, that they were not as other men are. So much would the casual observer see. The skilled observer would see more, but even he would not find a new world and a new race of beings ; he would find man changed, indeed, but not transformed. He would meet, as Esquirol has remarked, with " the same ideas, the same errors, the same passions, the same misfortunes: it is the ERRONEOUS POPULAR AND LEGAL NOTIONS. 3 same world ; but in such a house the traits are stroDger, the colours more vivid, the shades more marked, the effects more startling, because man is then seen in all his nakedness, becaiise he does not dissimulate his thoughts, because he does not conceal his defects, because he lends not to his passions the charm which seduces, nor to his vices the appearances which deceive." Were the observer, whether casual or skilled, to reside for some length of time in an asylum, and thus to make himself practically acquainted with the ways, thoughts, and feelings of its inmates, he would certainly discover how great a mistake it is to suppose, as is often done, that they are always so alienated from themselves and from their kind as not to be influenced by the same motives as sane persons in what they do or forbear to do. When an insane person is on his trial for some criminal offence, it is commonly taken for granted by the lawyers that if an ordinary motive for the act, such as anger, revenge, jealousy, or any other passion, can be discovered, there is no ground to allege in- sanity, or, at any rate, no ground to allege exemption from responsibility by reason of . insanity. The ideal madman whom the law creates is supposed to act without motives, or from such motives as it enters not into the mind of a sane person to conceive ; and if some one, who is plainly mad to all the world, acts from an ordinary motive in the perpetration of an offence, he is presumed to have acted sanely and with full capacity of responsi- bility. No greater mistake could well be made. Much of the success of the modern humane treatment of insanity 4 RESPONSIBILITY IN MENTAL DISEASE. rests upon the recognition of two principles : first, that the insane have like passions with those who are not insane, and are restrained from doing wrong, and con- strained to do right, by the same motives which have the same effects in sane persons ; secondly; that these motives are only effective within limits, and that beyond these limits they become powerless, the hope of reward being of no avail, and the expectation or infliction of punish- ment actually priDvoking more unreason and violence. By the skilful combination of these principles in practice it has come to pass that asylums are now, for the most part, quiet and orderly institutions, instead of being, as in olden times, dens of disorder and violence, and that the curious sight-seer, who visits an asylum as he would visit a menagerie, sees nothing extraordinary; ajid comes away disappointed. And yet, although in much so like, how different is the madman essentially ! Be the change in him what it may, it is plain that he has fallen from man's high estate, that he is no longer one with his kind, that he has lo^t the highest human attributes — those by which man is what he is among animals. Learned men may dispute con- cerning the nature and extent of the change ; but the way- faring man, though a fool, cannot fail to perceive it. Nor does the change fail to influence him : deep in his heart there is generated an instinctive feeling of distrust, if not of actual repugnance ; he recoils in spite of himself from the distortion of humanity. Notwithstanding much bene- volence of sentiment towards those who are afflicted with insanity, and much rigliteous indignation against those CEUEL TREATMENT OF THE INSANE. 5 who ill-use them, it is still true that the public look upon the disease as a calamity of quite special kind, conceal it as a disgrace, and sometimes treat it as a crime. By the feeling evinced, so unlike that which any other disease elicits, one is reminded of the way in which the lower animals and some savages act when one of their number falls sick : they slacken not theii' speed to allow the sufferer to continue with them, but leave it by the way- side to perish alone ; so far from helpful sympathy, they evince actual antipathy and drive it from among them : it is the saddest sight, indeed, to see the way in which animals thus persecute sometimes the sick and helpless member of the herd. Happily it results from the moral development of civilized man that he does not so act towards one who has fallen sick of an ordinary bodily disease; on the contrary, the affliction elicits his warm sympathy and active help. But it is not in the same measure so when the sickness is a sickness of mind. There is a dim but deep instinct, that this is not a disease which is quite like other diseases, that a man by it " from himself is ta'en away," alienated from himself and from his kind, and that he is something of a reproach to the nature of humanity ; the result being a vague feeling of antipathy like that which the lower animals display to- wards one of their kind that has fallen ill. At bottom this might seem to be curious evidence of the operation of the law of natural selection, whereby a diseased member that is unfitted for the natural functions of its kind is instinctively extruded from companionship. Just 6 EESPONsrBHiixy in mental disease. as the lower animals, and the savages who have to wander long distances, abandon or drive away the member that is incapacitated by bodily illness from holding its ground, and whose presence would be an encumbrance ; so, in like manner, civilized nations, until recently, thrust out of sight into vile receptacles, where no mention of them more was heard, those members of the community who, through loss of reason, were unable to hold their own in the struggle for existence, and whose presence was felt as an encumbrance, a reproach, and a danger.* One of the saddest chapters in human history is that which describes the cruel manner in which the insane were treated in times past. Notwithstanding that it is happily a thing of the past, it will be instructive to inquire from what causes the barbarous usage sprang : for it was not common to all nations and all times; on the contrary, it had its birth in the ignorance and superstition of the dark ages of Christian Europe. Whatever may have been thought of madness among the peoples who preceded the ancient Greeks — and there is evidence that the Egyptians adopted a singularly enlightened and humane treatment — ^it is certain that the Greeks had comparatively sound theories of its nature as a -disease to be cured by medical and moral means, and adopted principles of treatment in conformity with those theories. Their dramatic poets, it is true, present terrible pictures of madmen pursued by the anger of the gods ; but these * In the four or five pagea whicli follow, I have repeated in nearly the same -words what has been already published in an address on "Conscience and Organization," in the second edition of my work on "Body and Mind." ANCIENT VIEWS OF INSANITY. 7 were poetical representations, which must not he taken as a measure of the hest knowledge of the time. Then, as now, and indeed as ever in the history of man- kind, the true thinkers were emancipated from the fables and superstitions of the vulgar: the just measure of Greek intellect must be sought in the psychology of Plato, in the science of Aristotle, and in the medical doctrines of Hippocrates. This eminent physician and philosopher expressly re- pudiates the notion that one disease is of more divine origin than another. After saying that the Scythians ascribe the cause of certain disorders to God, he goes on to give his own opinion that these and all other disorders are neither more nor less of divine origin, and no one of them more divine or more human than another; that each has its own physical nature, and that none is produced without or apart from its nature. In what he says of the psychical symptoms of various diseases of the body he evinces such enlarged views of the scope of medical observation and practice as are not often evinced at the present day; and the few observations in his works respecting the symptoms of delirium " evidence that clear and correct view of disease which has made this first'observer a model to all succeed- ing times." He directs attention to such facts of obser- vation as the physical insensibility of the insane, the appearance of mental diseases in the spring, the occur- rence of disorder of the intellect after a continuance of fear and grief, the union of melancholy and epilepsy, the critical importance of heemorrhoidal discharges in mania, 8 RESPONSIBILITY IN MENTAL DISEASE. the difficulty of curing madness which commences after the age of forty, and the like. And as there was no superstition in these doctrines, so there was no barbarism in his treatment, which was medical, and consisted principally in evacuation by the use of hellebore. But moral treatment was not unknown among the Greeks; for Asclepiades, who seems to have been the real founder of a psychical mode of cure, made use of love, wine, music, employment, and special means to attract the attention and exercise the memory. He recommended that bodily restraint should be avoided as much as possible, and that none but the most dangerous should be confined by bonds. Without, going further into par- ticulars, enough, has been said to show that the Greeks had acquired accurate notions of madness as a disease, which was to be cured by fippropriate medical: and moral treatment. How came it to pass that these enlightened views ever fell into oblivion ? The question is really only a part of the larger question, how it came to pass that the high EBsthetic culture and brilliant intellectual development of the Grecian era, which might have seemed possessions of mankind for ever, were lost in the darkness and barbarism of the middle ages. To trace the causes of this, so sad decline would be far beyond my present purpose ; suffice the fact that philosophy, which had mounted so high, was for a time sunk so low beneath the waves of superstitioii and ignorance, that it might well have never been in existence. And when at last a revival of learning took place, things were little better ; empty scholastic subtleties EFFECTS OF THE THEOLOaiCAL SPIEIT. 9 and metaphysical mysticism engaged the whole attention of men, who rivalled one another in verhal disputations, without a'greement in the meaning of the terms they used, and in blind worship of the authority of Aristotle, without real regard to the true method of his philosophy or to the facts with which it dealt. As if knowledge were nothing more than a process of ingenious excogitation, they made no attempt to observe the phenomena of Nature, and to search out the laws governing them,- but laboriously " invoked their own spirits to utter oracles to them ; " wherefore philosophy was little more than a web of un- meaning terms and of empty metaphysical subtleties. With this sort of intellectual activity was joined, as the result of the detestable spirit which inspired monastic teaching and monastic practice, a harsh religious asceti- cism, through, which the body was looked down upon with contempt, as vile and despicable, the temple of Satan, the home of the fleshly lusts which war against the soul, and as needing to be vigilantly kept in subjection, to be crucified daily with its affections and lusts. It was the earthly prison-house of the spirit whose pure im- mortal longings were to get free from it. Such was the monstrous doctrine of the relation of mind and body. What place could a rational theory of insanity have in such an atmosphere of thought and feeling ? The con- ception of it as a disease was impossible :' it was ascribed to a supernatural operation, divine or diabolical, as the case might be — was a real possession of the individual by some extrinsic superior power.* If the ravings of the * The most learned physicians only put the devil a step further hack. 10 EESPONSrBILITr IN MENTAL DISEASE person took a religious turn, and his life was a fanatical practice of some extraordinary penance — if, like St. Macarius, he slept for months together in a marsh, exposing his naked body to the stings of venomous flies, — or, like St. Simeon Stylites, he spent the greater part of his life on a pillar sixty feet high, — or, like St. Anthony, the patriarch of monachism, he had never, in extreme old age, been guilty of washing his feet, — ^he was thought to have reached the ideal of human excellence, and was canonized as a saint ; more often his state was deemed to be a possession by the devil or other evil spirit, or the degrading effect of a soul enslaved by sin ; from some cause or other he was a just victim of divine displeasure, and had been cast down in consequence from his high human estate. It was the natural result of such views of madness that men should treat him whom they believed to have a devil in him as they would have treated the devil could they have had the good fortune to lay hold of him. When he was not put to , death as a heretic or a criminal, he was confined in a dungeon, where he lay chained on straw ; his food was thrown in, and the straw raked out through the bars ; sight-seers went to see him, as they went to see the wild beasts, for amusement; he was cowed by the whip, or other instrument of punishment, and was more neglected and worse treated than if he had been a wild beast. Many insane persons, too, were acknowledging "such a preparation and disposition of tlie tody through distemper of humours, which giveth great advantage to the devil to work upon ; which distemper being cured by physical drugs and potions, the devil is driven away, and hath no more power over the same bodies." EFFECTS OF THE METAPHYSICAL SPIEIT. 11 without doubt executed as witches, or as persons who had, through witchcraft, entered into compact with Satan. It is a striking illustration, if we think of it, of the con- dition of thought at that time, and of the great change which has taken place since, that such expressions as the black art, witchcraft, diabolical possession, and the like, have fallen entirely out of use, and would be thought to convey no meaning if they were used now. They were fictitious causes invented to account for facts many of which undoubtedly lay within the domain of madness. Now it is a fact, abundantly exemplified in human history, that a practice often lasts for a long time after the theory which inspired it has lost its hold on the belief of mankind. No wonder, then, that the cruel treatment of the insane survived the belief in diabolical possession, though it is justly a wonder that it should have lasted into this century. The explanation of the seeming anomaly is to be sought, I believe, in the purely metaphysical views of mind which prevailed long after inductive science had invaded and made conquests of other departments of nature. Theology and metaphysics, having common interests, were naturally drawn into close alliance, in order to keep entire possession of the domain of mind, and to withstand the progress of inductive inquiry. With the notions they cherished of the nature of mind, and of its relations to body, it was thought impossible, and would have been denounced as sacri- legious, to enter upon the study of it by the way of physical research. To have supposed that the innermost sanctuary of nature could be so entered through the 12 EESPONSIBILITy IN MENTAL DISEASE. humble portals of bodily functions, would have been re- garded as an unwarrantable and unholy exaltation of the body, which was full of all uncleanness, corruptible, of the earth earthy, and a gross degradation of the mind, which was incorruptible, of the heaven heavenly, and joint partaker of divine immortality. Whosoever had dared to propound such a doctrine would assuredly have been put to death as a blasphemer and a heretic. And yet he ought to have been hailed as a benefactor. It is impossible to say of any false belief which mankind have had that it has been the most pernicious in its effects ; but we may truly say of the theological notion of the relations of mind and body that it has been surpassed by few false doctrines in the evil which it has worked. The spirit of metaphysical speculation was scarcely less hostile to physical researches into mental function. For when inquirers had struggled successfully out of mere verbal disputation, and had applied themselves to the observation of mental phenomena, the method used was entirely one-sided ; it was a system of mental introspection exclusively, each one looking into his own mind and propounding as philosophy what he thought he observed there ; the external observation of mind in all its various manifestations, and of the bodily conditions of all mental action, was ignored. When all knowledge of mental action was gained in this way by observation, of self-consciousness, men naturally formed opinions from their own experience which they applied to the mental states of insane persons ; feeling that they themselves had a consciousness of right and wrong, and a power of EFFECTS OF THE METAPHYSICAL SPIRIT. 13 will to do the right and forbear the wrong, they never doubted that madmen had a like clearness of conscious- ness and a like power of will — that they could, if they would, control their disordeily thoughts and acts. The dungeon, the chain, the whip, and other instrume^jts of punishment were accordingly in constant use as means of coercion ; the result being that exhibitions of madness were witnessed which are no longer to be seen, " because they were not the simple product of malady, but of malady aggravated by mismanagement." What with the theological notion of madness as a work of Satan in the individual, and what with the erroneous views of it subsequently begotten of the metaphysical spirit, it came to pass that the barbarous system was abolished only within the memory of men yet living. In sad truth may it be said that, so far as a knowledge of the nature of mental disease and of the proper mode of its treat- ment is concerned, mankind owe no thanks, but, on the contrary, much error and infinite human suffering, to theology and metaphysics. It was when men recognized insanity as a disease, which, like other diseases, might be alleviated or cured by medical and moral means — when they regained the standpoint which the ancient Grecians had held — that they began the struggle to free themselves in this matter from the bondage of false theology and mischievous metaphysics. But the emancipation is not yet com- plete. In many quarters there is the strongest desire evinced, and the most strenuous efforts are made, to exempt from physical researches the highest functions 14 EESPONSIEILITY IN MENTAL DISEASE. of mind, and particularly the so-called moral sense and the will ; while the old metaphysical spirit still inspires the criterion of responsibility which is sanctioned and acted upon by courts of justice in cases of insanity. If a ma«lman be supposed to know he is doing wrong, or doing that which is contrary to law, when he does some act of violence, he is held to be not less responsible than a sane person. The conclusions reached by the observa- tions of self-consciousness in a sane mind are strictly applied to the phenomena of diseased mind ; not other- wise than as if it were solemnly enacted that the disorder amil violence of convulsiolis should be measured by the order and method of voluntary movements, and that whosoever, being seized with convulsions, and knowing that he was convulsed, transgressed that measure, should be punished as a criminal. The unfortunate sufferer, or others on his behalf, might, it is true, innocently argue that the very nature of convulsions excluded the idea of full voluntary control ; but the metaphysical in- tuitionist would rejoin that it was certain from experience that man has a power of control over his movements ; that the convulsive movements were a clear proof to all the world that he had riot exercised that power ; and that his convulsions, therefore, were justly punishable as crime. This pathological comparison is scientifically just, and its justness has oftentimes received terribly striking illustration in the effects of the legal criterion of responsibility ; for it is certain that in conformity with it many persons unquestionably insane, who have done homicide, not because they would not, but because they MIND A FUNCTION OF THE BEAIN. 15 could not, exercise efficient control, have been, and still from time to time are, executed as simple criminals. Harsli and exaggerated as this statement might seem, there is not, I believe, in this or any other civilized country a physician, practically acquainted with the insane, who would not unhesitatingly endorse it. No one now-a-days who is engaged in the treatment of mental disease doubts that he has to do with the dis- ordered function of a bodily organ — of the brain. What- ever opinion may be held concerning the essential nature of mind, and its independence of matter, it is admitted on all sides that its manifestations take place through the nervous system, and are affected by the condition of the nervous parts which minister to them. If these are healthy, they are sound; if these are diseased, they are unsound. Insanity is, in fact, disorder of brain pro- ducing disorder of mind; or, to define its nature in greater detail, it is a disorder of the supreme nerve- centres of the brain — ^the special organs of mind — pro- ducing derangement of thought, feeling, and action, together or separately, of such degree or kind as to incapacitate the individual for the relations of life.* The opinion that insanity is a disease of the so-called immaterial part of our nature we may look upon as ex- ploded even in its last retreat. The arguments that have been adduced in favour of it — first, that madness is pro- duced sometimes by moral causes, and, secondly, that it is * Mind may be defined physiologically as a general term denoting tho eum total of those functions of the brain which are known as thought, feeling, and will. By disorder of mind is meant disorder of those functions. 16 EESPONSIBILITY IN MENTAL DISEASE. cured sometimes by moral means — are entirely consistent with the theory of material disease, while the arguments in favour of the materialistic theory are quite incon- sistent with the spiritualistic hypothesis, which has the further disadvantage of not being within the range of rational human conception. To the argument that madness is produced sometimes by moral causes, which must be admitted, it is sufficient to reply, first, that long-continued or excessive stimu- lation of any organ does notably induce physical disease of it, and that in this respect, therefore, the brain only obeys a general law of the organism ; and, secondly, that it is possible to produce experimentally, by entirely physical causes, mental derangement exactly similar to that which is produced by moral causes. There are many facts which would justify us in laying it down as a generalization of inductive mental science, that a state of consciousness may be changed experimentally by agents which produce changes iii the molecular constitution of those parts of the nervous system which minister to the manifestations of consciousness. Take, for example, the way in which, by the administration of opium or haschisch, we modify in a remarkable manner a person's conceptions of space and time and of other relations. To the second argument in favour of the immaterial nature of unsound mind, which is founded on the distinctly curative influence of moral treatment, the easy reply is, that moral means are beneficial in insanity by yielding repose to parts much needing repose, and by stimulating to activity parts much needing to be active; by yielding repose to PHYSIOLOGICAL IN(iUIEY INDISPENSABLE. 17 morbid thought and feeling, and by rousing into action healthy thought, feeling, and will. The aim of the physician in the treatment of insanity is to bring the means at his command to bear, directly or indirectly, on the disordered nerve-element. But, in striving to do this, he soon learns with how many bodily organs and functions he has really to do. To call mind a function of the brain may lead to much misapprehension, if it be thereby supposed that the brain is the only organ which is concerned in the function of mind. There is not an organ in the body which is not in intimate rela- tion with the brain by means of its paths of nervous communication, which has not, so to speak, a special correspondence with it through internuncial fibres, and which does not, therefore, affect more or less plainly and specially its function as an organ of mind. It is not merely that a palpitating heart may cause anxiety and apprehension, or a disordered liver gloomy feelings, but there are good reasons to believe that each organ has its specific influence on the constitution and function of mind ; an . influence not yet to be set forth scientifically, because it is exerted on that unconscious mental life which is the basis of all that we consciously feel and think. Were the heart of one man to be placed in the body of another it would probably make no dif- ference in the circulation of the blood, but it might make a real difference in the temper of his mind. So close is the physiological sympathy of parts in the commonwealth of the body, that it is necessary in the physiological study of mind to regard it as a function 18 EESPONSIBILITY IN MENTAIi DISEASE. of the whole organism, as coini)rehendiiig the -whole bodily life. 