Library Collections: Document: Full Text

The two leading ideas of the paper, reversing the order in which they are stated, are as follows: 1. The inherent, essential, constant, and characteristic element in insanity is a morbid action in the cerebral structure, and this diseased condition is always precedent and causative of the mental derangement. 2. The non-efficiency of moral causes in the production of insanity.

Dr. Gray not only believes that the former is true from the observation of the past, but that future pathological investigations will make it demonstrably certain in every form of insanity. Thus he says: "We believe that physiological science will so advance that every process in the complex phenomena of physical life, in health and disease, shall be read and revealed and understood." Cherishing these views, as a matter of prevention, he thinks there is little occasion to guard and admonish individuals and society against those habits of thinking, and modes of feeling, and yieldings to impulse and passion, that undermine the mental health, as the violation of physiological laws breaks down the physical constitution. As a matter of treatment, the only course he suggests is one of "rest, nutrition, sleep, and medication."

From this paper, it would appear that the only idea of moral treatment he has, or would put in practice, is developed in the following passage:

"We do not treat the mental phenomena which appear as indices of the cerebral disorder; but we point out to the patient his changed mental condition, and endeavor to show him that his delirious conceptions are delusions, and result from the morbid condition of his brain; and that, with restoration to health, these delusions and misconceptions will vanish. Many may be convinced of this; and, though the delusions do not disappear with this conviction, yet persons may, and often do, so far keep constantly in mind their true condition, and exercise such control, as largely promote their recovery. The mind by this effort uses the brain; and, by the exercise of its legitimate dominating power, moderates its action in some directions and increases it in others. The mind exercises choice, and controls itself, and by limiting and modifying its use of its organ, the brain, aids in the restoration of that organ." (6)

Maudsley, whose writings would seem to have shaped the views of Dr. Gray in some respects, differs widely from him in these last-mentioned opinions. He makes some admirable suggestions for the moral treatment of the insane in the last chapter of his book, from which I borrow a couple of passages: "When insanity has become chronic, or when fixed delusions are established, there is small hope of special benefit from drugs. The general health being duly attended to, a systematic moral treatment will be best adapted to restore health of mind." After showing the principle which should guide, i. e., a proper diversion of the mind from the morbid trains of thought and feelings, he adds: "If there is some fixed delusion, it will do no good to enter upon any systematic argument against it; there would be almost as much hope of an argument against the east wind, or against a convulsion; but, by engaging the mind in other thoughts as much as possible, and thus substituting a healthy energy for the morbid energy, the force of the delusion will be most likely to abate and finally to die out."

It might be suggested at this point that, reasoning backward from effect to cause, the success of moral treatment, in certain cases of insanity, might be an argument, not to say an invincible one, that moral causes might have been efficient in producing them, and that without the intervention of any physical agencies. So, too, some of the modes in which Reason assumes her throne after derangement point to the same view. Says Griesinger: "Sometimes recovery resembles simple waking; when the individual, astonished, seeks as it were to know himself, the masses of ideas belonging to the disease soon disappear, and the old idea returns uninjured and unimpaired to its former place."

Take another fact, that, according to the best authorities, mental shocks or violent emotions have not unfrequently brought a sudden termination, not to say cure, to even insanity of long standing. Sometimes such shock acts directly upon the mental status, and at others indirectly through the physical system.

Holding theoretical views such as are set forth in the paper under discussion, we should expect to find that the method of treatment adopted at the asylum under the management of its author would be correspondingly shaped and moulded. What the treatment at Utica has been, and is now, may be gathered from the annual reports of that institution. In its early days the moral treatment was made very prominent, as the reports of Dr. Brigham show. Nor did he neglect the varied resources of the medical art in meeting the physical symptoms either underlying or associated with the mental derangement. Not only in his reports, but in his other writings, he laid great stress upon keeping a sound body to secure mental health; and, when the balance of the mind was lost, he showed the importance of efforts at reestablishing the physical health as the first step toward sanity. Since this day, I think it may be said that discoveries have been made that bring out in a more clear and definite light what was formerly spoken of as sympathetic action in disease, that is, the frequent occurrence of affections once supposed as originating exclusively in the nervous centres, that are now known to be owing to a reflex influence through peripheral nerves, from distant organs. Of course, this changes the direction of the remedial efforts of the physician.