Library Collections: Document: Full Text

They saw the reciprocal influence of body upon mind and mind upon body. They knew that ill health did produce morbid feelings, and that morbid feelings would bring on ill health; and that it was only necessary to protract a reciprocal action in these respects, to have organic disease of body or derangement of mind. They thus conceived of two classes of causes as operating in producing insanity, either as predisposing or exciting causes. In singling out one as the assignable cause, and that the most obvious and direct antecedent, it was not to the exclusion of other less palpable influences, working to the same end. They knew also that insanity could not be predicated, with certainty, upon any given amount or degree of mental shock or bodily affection. Each individual, by his constitution, endowments, and habits, was a law unto himself.

In applying their ideas of causation to the prevention of insanity, they advised the proper care of the body, as well as the avoidance of the other and more subtle influences which experience had shown to be instrumental in inducing the condition. Dr. Brigham's reports were full of valuable suggestions upon this point.

Their mode of treatment was based upon the same comprehensive views. "Rest, nutrition, and medication," they had for the physical symptoms; but, above all, they met the manifestations of mental derangement by a judicious moral treatment. Then, as now, the majority of patients sent to an asylum were cases of some standing. The organic or functional diseases associated with the mental derangement were past the curative stage, as to direct remedial agencies. As specialists, then, while not neglecting the general remedial means common to the profession, their business was to apply the peculiar resources of their own departments.

Moral treatment, so called, acts in two ways: Thus, indirectly, in a reflex manner, proper mental exercise, when possible, contributes to the restoration of a normal condition of the brain itself; and, directly, the mind is diverted from morbid trains of thought, and its power to act in a normal way, in spite of any physical unsoundness, is increased. By these means, too, the insane individual is led to compare his quasi or present consciousness with that of those by whom he is surrounded, and, in some cases, with occasional glimpses of his own natural consciousness or former trains of thought.

Now, by what reasoning are these plain facts and clear evidence of science and consciousness met in this paper before us? It has been assumed by its author, it will be remembered, that those who held to the doctrine of the adequacy of moral causes were influenced by old superstitions. He then goes on to say that the effect of these old-fashioned notions was especially seen in their accepting religious excitement so commonly as a cause of insanity. He gives what he calls a solution of these cases, with the assertion, that it is, similarly, the solution of the other cases of mental disease usually ascribed to moral causes. The professed solution is only this: The decrease of the percentage from religious causes, in the Utica tables, fell from seventy-eight to six per cent. in the six or seven years of Dr. Brigham's administration. (I have shown, by revising the table, that the number of these cases is really quite uniform.) This is the premise. Here is his conclusion:

"Thus we perceive" (or therefore) "that more extended experience and more careful observation of these cases revealed " (to Dr. Brigham, understood) "the existence of disordered physical health as the efficient cause of insanity, and the religious depression, or other moral manifestation, as only exciting causes, or as incidental effects." Now, does the table show this? He adds, "This established was an important advance." But has it bean established? "Rest, nutrition, medication, could then be presented, in truth, as the relief of sorrow." Observe, if you please, not one word is said about "moral treatment" in conjunction with the physical treatment. And that this is not an accidental omission, a page farther on the following language is used: "To discover, then, under such supposed moral causes that the true source of disease lies in physical disorders is equivalent to substituting rest, sleep, food, and medication, for moral reasonings, and difficult and vexed theological problems." But is there no alternative, it may be asked, in the treatment of insanity, in all its various forms, between hygienic and remedial means, on the one hand, and moral reasonings and difficult and vexed theological problems on the other hand?

Among the unfortunate inheritances of this specialty, it would seem, is the expression "disease of mind." But Dr. Gray would banish this. And yet, the question may be asked, Pray, why discard this term from the nomenclature of modern medical science, as he proposes; that is to say, if we believe, as he does (and as mankind generally have done and do), in the existence of mind as mind, and not as a mere secreted force? Even conceding the invariable presence of certain abnormal bodily conditions, or the constant sequence of phenomena, as described in the paper before us, still the characteristic feature is the mental derangement. Etymologically, mental disease is the precise expression to be used in such cases. As well banish the kindred terms melancholia, hypochondria, phrenitis, derangement, psychological medicine, and insanity itself. Even if the word disease had by general consent come to be used commonly in a more restricted sense, there could be no harm in its figurative use under such circumstances. The object of language is to express ideas. Alienists like Maudsley, who can conceive of mind only as a function of the brain analogous, in its exercise, to other bodily functions, are constrained to speak of mental health as well as bodily health, of mental life as well as physical life.