Observations on the Nature, Kinds, Causes, and Prevention of Insanity, Lunacy or Madness
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Observations on the Nature, Kinds, Causes, and Prevention of Insanity, Lunacy or Madness, Thomas Arnold, 1782 AD
Thomas Arnold (1742-1816)
M D Edin., FRCP Edin., physician to the Leicester Infirmary and Lunatic Asylum; owner of Belle Grove Asylum
Observations on the nature, kinds, causes, and prevention of insanity, lunacy, or madness, 1782-6. 2 Vols. Leicester, Robinson & Cadell (pp. [iv] +xvi 4.324 +viii; [iv] +xii +541 +iv). Vol. I, pp. 72-4, 8o, 89, 125, 129-3o, 135-7, 144, 158, 172, 177-8, 18o, 195-6, 199-200, 207, 213, 216-7, 220-I, 224, 235-6, 311'4, 316, 319
Second edition London 1806
CLASSIFICATION OF MENTAL DISEASES
Insanity, as well as delirium, may be considered as divisible into two kinds; one of which may be called Ideal, — and the other Notional Insanity.
Ideal Insanity is that state of mind in which a person imagines he sees, hears, or otherwise perceives, or converses with, persons or things, which either have no external existence to his senses at that time; — or have no such external existence as they are then conceived to have : — or, if he perceives external objects as they really exist, has yet erroneous and absurd ideas of his own form, and other sensible qualities : — such a state of mind continuing for a considerable time; and being unaccompanied with any violent or adequate degree of fever .. .
Notional Insanity is that state of mind in which a person sees, hears, or otherwise perceives external objects as they reallyexist, as objects of sense; yet conceives such notions of the powers, properties, designs, state, destination, importance, manner of existence, or the like, of things and persons, of himself and others, as appear obviously, and often grossly erroneous, or unreasonable, to the common sense of the sober and judicious part of mankind. It is of considerable duration; is never accompanied with any great degree of fever, and very often with no fever at all .. .
Insanity, or delirium, according to the above account of them, cannot with propriety be said to exist, but where the Judgment is deceived, the Affections are misguided, or the Conduct is perverted, by some delusive perception, or some notion palpably erroneous, or absurd . . .
There is, indeed, some difficulty in determining the boundaries between what may not improperly be called moral and medical Insanity. Several of the ancient philosophers, and particularly Socrates, and the Stoics, considered every foolish, or vitious person, as insane, or morally mad; and only to be distinguished from the actually and medically mad, by the degree of disorder.
I. Ideal Insanity
1. In Phrenitic Insanity the patient Raves Incessantly . . . and scarcely knows, or attends to external objects about him; and when he does perceive external objects, is apt to perceive them erroneously .. .
2. Incoherent Insanity .. . may arise — from a too active, and almost phrenitic state of the brain; — from that kind of active state of the brain which occasions a slightiness of imagination . . . and from that state of the brain, in which there is a great defect of memory .. .
3. Maniacal Insanity . . . is . . . perhaps, the most comprehensive; since it extends its dominion over the Whole Internal World of Ideas, and comprehends every possible combination of sensible images which can enter into, and delude, a distempered brain .. .
4. By Sensitive Insanity I mean that in which the disorder shows itself chiefly, or remarkably, in the Erroneous Images which are excited in the mind, relative to the person's own Form, Substance, or other Sensible Qualities.
II. Notional Insanity
5. I have placed first in order under this division, that species of Insanity which . . . has a peculiar title to the appellation of Delusive, because . . . with the sound and unimpaired use, in every other respect, of the rational faculties, which in some cases have even been observed to be remarkably acute, the Patient, in relation to some particular subject, or subjects, is Under the Insluence of the most Palpable, and extraordinary Delusion .. . Under this variety may be enumerated the cases of such as have imagined themselves to be dead, — to be deprived of their proper nature as human beings .. .
6. Fanciful Insanity . . . displays itself in almost incessant talking, accompanied with frequent sallies of wit, quick repartee, acute observation, ready invention, lively, and even brilliant fancy, and, in a variety of respects, with much appearance of genius; and arises from a rapid succession of vivid, and sprightly, images; and a wonderful aptitude to catch at the slightest associations, and to run through all the relations, whether natural, or accidental, of whatever objects may chance to present themselves .. .
7. In Whimsical Insanity the patient is possessed with absurd, and Whimsical fancies, aversions, fears, scruples, and suspicions . .
8. I call that Impulsive Insanity, in which the patient is Impelled to do, or say, what is highly imprudent, improper, unreasonable, impertinent, ridiculous, or absurd, without sufficient, with very slight, or with no apparent cause . . . But as we cannot easily conceive of conduct without motives . . . we may . . . rest satisfied that the conduct of these sorts of patients is regulated by notions, however they may conceal themselves from our observation .. .
9. In Scheming Insanity the patient thinks himself . . . by his superior knowledge, or cunning, capable of doing great things, which few, or none, but himself, are able to accomplish .. .
10. The Vain, or Self-Important Insanity; with which they who are possessed, have a very exalted opinion of their own imaginary dignity, consequence, opulence . . . learning, or of some other valuable quality .. .
11. In Hypochondriacal Insanity the patient is for ever in distress about his own State of Health, has a variety of Disagreeable, and sometimes Painful Feelings, to which he is ever anxiously attentive, and from which he can rarely divert his thoughts, either to business, or amusement .. .
12. Pathetic Insanity exhibits a striking and melancholy picture, of the empire of the passions. In this species of Insanity some One Passion is in full, and complete possession of the mind; triumphs in the slavery, or desolation, of reason; and even exercises a despotic authority over all the other affections, which are rarely permitted to exert themselves but in the aid, or to appear but in the train, of this master passion . . . all, or nearly all, the varieties of this species of Insanity, are accompanied with distress, dejection, anxiety, or restlessness of mind .. .
13. In Appetitive Insanity there is an immoderate, and ungovernable, desire, of gratifying an Appetite . . . a disorder of this sort in men, has already acquired the appellation of Satyriasis; and, in the other sex, that of Nymphomania.
I have already mentioned that all these species of Insanity may be variously combined, and frequently interchange, one with another. It may be proper farther to remark, that the same patient sometimes goes through several kinds of Insanity, — which may be reckoned in such cases, as so many degrees, or stages, — during the course of the same illness. Of these combinations, and changes, there is almost an endless variety. One remarkable, and not uncommon transition of Insanity, is from great dejection, and distress, to ease and chearfulness, and sometimes to an uncommon flow of spirits. But most frequently it retains its character of liveliness, or anxiety, elevation, or depression . . . It may, also, be noticed, that Insanity appears sometimes to be Epidemic; and either to derive its origin from some accidental, and temporary, state . . . or to take its peculiar turn from the prevailing notions, and fashionable prejudices, of the times, or places, in which it occurs.
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