Thursday, 21 June 2012

Madness in 1860

An article from The London Review, 7 July 1860.  I'm parking it here because it interests me, and may be of use a little later.


""Be warned, you victims to an ill-regulated ambition, you money-grubbers, you pleasure-seekers, you sad bigots, and yon who allow your souls to be filled with an all-engrossing passion. Yon are mad!—mad!—all downright mad! Come, listen to me, and I shall convince you of your insanity."
The Obscure Diseases of the Brain and Disorders of the Mind, 4c. By Forbes Winslow, M.D. London: John Churchill.

Civilization, or something that is called by that name for want of a better, is rapidly advancing, and insanity is on the increase: can there be any connection between the two facts?  Horace—regarding Rome in the very height of its glory, when arts most flourished, when the state was most prosperous, and the empire most wealthy—detected a dark vein of insanity running through the Commonwealth :— 

Audire, atque togam jubeo componerc, quisquis
Ambitione mala, ant argenti pallet amore;
Quisquis luxurut, trigtive superstitione,
Aut alio mentis morbo ealet. Hue proprius me,
Dum doceo insanire omnes, vos ordine adite

The lines of Horace seem to be as applicable to us—the foremost people on the globe—as they were to the Romans. It is the boast of the age in which we live that the efforts of human industry during the last fifty years have outstripped in ingenuity of invention and in importance those of any half-century in the history of the world. Future generations will, in all probability, admit the justice of our self-congratulation; for it would be impossible to take even the most cursory view of the progress of science and art without appreciating the vast strides that have been made within the period indicated. We have had the galvanic current applied to the purposes of daily intercourse so effectively that no event of political or commercial importance can occur in any capital of Europe without its being known, within a few hours, from Stockholm to Lisbon and Constantinople. The progress of engineering stands recorded in the Britannia and Victoria Bridges, and the world has wondered at its last effort in the construction of the Great Eastern. Labourers in the field of chemistry have been rewarded with prodigious success,—the organic division of the science may almost be said to have come into existence within the century, and so rapid has been its development that at times the explorer seems to stand upon the very verge of final causes. The various branches of natural philosophy have shared the same rapid onward movement. Arts and manufactures have not lagged in the race of progress; every day ushers new inventions into life, and—alas! for our civilisation—the art of war has in an especial manner crowned its votaries with success in the extent and precision of destruction at which their inventions aimed. And do we not all know that our commercial operations are conducted upon a scale and with a boldness of which our predecessors never entertained a conception,—their happy ignorance or caution, however, saving them from the periodical throes of a commercial crisis. But the proudest laurels of the age have perhaps been won in the cause of education.

The labouring classes have had the opportunities of self-improvement afforded them, and how successfully they have availed themselves of the privilege is daily forced upon the attention of those who care to study the subject. A market sadly overstocked with candidates who as clerks seek to earn their livelihood at the desk, the introduction of middle-class and competitive examinations, and still more the severer competition of life itself, have given a powerful impetus to mental culture amongst the middle classes. The overcrowded state of the learned professions, and the resulting severity of the competition amongst their members, have operated strongly, though indirectly, to raise the standard of education. It is unnecessary to pursue farther the retrospect, nor is it desirable to add to the self-laudation of the age. There are other facts intimately connected with the same period which, if they are not so pleasant to contemplate, do not the less demand serious reflection.

Of these facts one of the most undoubted is the lamentable increase in the prevalence of insanity at the present time. The advance of science, the progress of civilization, the extension of education have been great, but insanity, in its various forms, has advanced pari passu with these triumphs of our day. We are forced to the conclusion that there is a connection between advanced civilization and the increased prevalence of mental disease. Upon no other supposition can we explain the fearful amount of insanity in our large cities, and its steadily increasing ratio as we ascend from the least to the most cultivated class of those who subsist by the labour of their brains. Such a state of things is not encouraging. What are the circumstances mainly productive of insanity, and at the same time prognostic of its increase? The causes which so operate appear, unfortunately, to be the very triumphs that we regard so complacently as the boast of the century; but in an especial maimer they are the extension of education and that competition of the day which may be designated as "the struggle of life." Nowhere is life so "fast" as in America,—nowhere is insanity so common, or manifested at so early an age. In England the number of persons in the various professions is so incommensurate with the demand for their labours that the severest competition results. Fearful of being outstripped in the race, men systematically and continuously overtax their mental powers, and, when they flag from want of repose, too often spur them on by artificial stimulus. Little physical exertion, constant mental strain, excessive brain-work by day, stimulants which exhaust nature's small reserve of power, while they appear to create new energy,—nights, how often disturbed by anxieties for the morrow, and all this for a series of years! What must be the last chapter of such a feverish existence? Unfortunately, too, the competition of life does not begin when the professional man enters the arena fairly to earn his livelihood: it operates at college, it is felt at school, and anxious parents whisper the first promptings of emulation as they strap the child's satchel on his back. The boy of eight or nine is too often urged on to study, while little heed is taken of his physical development. What was emulation at the preparatory school becomes hard mental labour in his teens, feverish work at college, fierce mental competition in his profession, until'at last the prematurely overwrought brain loses its coordinating balance, and madness or softening of the brain and dementia close a short and often a promising career. And, to descend a step lower than the learned and literary professions, amongst the class designated as "clerks," what continuous and anxious mental labour is often required; and, apart from the onerous duties which they have to discharge, how many there are of their number who, from the competition of the age, are unable, though willing, to find employment. When in a situation, uncertainty of tenure; when out of work, uncertainty of bread,—no wonder they furnish their quota to the lunatic asylums.

In England we are happily free from one great source of mental disease—violent political excitement,—and it is unnecessary to allude to such endemic causes of madness as religious excitement, evidenced, however, of late in the revival movement in the north of Ireland. A deeply interesting class of predisposing causes to insanity presents itself for consideration in our social state with regard to marriage and other cognate subjects, but the discussion of these could not be undertaken within the limits of this article. We have already alluded to the commercial operations of the present day, and on this subject it must be remarked, that whether it arises from the anxiety and tension of mind inseparable from the uncertainty of speculation or from the nervous consciousness of overtrading and daily impending embarrassment, it is an unquestionable fact that the commercial world furnishes an astounding number of lunatics to our asylums, and most medical men in London practice have had professional experience of the frequency of premature softening of the brain amongst the same classes. Absolute mental alienation, frequent as its manifestations have become, although the most evident, is not the only imperious result of excessive intellectual labour and the daily anxieties of life. There is a degree of mental disturbance short of well-marked insanity, but often its precursor, which is unhappily much more common than would' be suspected by those who have not had their attention particularly directed to this subject There are few physicians who devote their attention to psychological disease, who are not almost daily consulted respecting symptoms of premature mental decay, loss of memory, fancies and illusions of the most distressing and even hideous character amongst the educated classes of the community, and which long experience has taught them to recognize as the frequent heralds of advancing insanity. We might almost venture to say that a large majority of the brain-working classes have at tunes experienced mental symptoms of a character which their own judgment recognizes as so nearly allied to the diseased class of psychological actions that they have for a short time occasioned suspicions of the gravest nature in their own minds. Is there any remedy for this prevalence and increase of mental diseases 1 The question is full of difficulty. It would be hopeless to attempt to answer it shortly and satisfactorily, but its suggestion will at least attract attention to the subject, and perhaps induce people to pause and consider whether they are not living too recklessly. Its mere discussion may induce our brain-working classes to labour less continuously than they now do, and to give their minds that reasonable amount of repose which is essential to a healthy discharge of their functions. It has been our purpose throughout less to dogmatize on a subject so difficult, than to remind the reader of facts which, in the hurry of life, rarely attract his attention ; and after having suggested their existence, to leave him to make his own reflections. Great as | is the capacity of the human mind, it can be taxed beyond healthy limits; ami this observation, applicable to the individual, holds equally good when applied to a generation. Does not society en masse lose more than it gains by that feverish and railway speed of life of our day? The age has much to boast of, but it is possible for even an age to attempt too much. Festina hnte is the moral of our theme—a moral which requires iteration in this "go-ahead" nineteentli century. These reflections have been suggested by the perusal of Dr. Winslow's latest production, a valuable work upon obscure diseases of the brain and mind. Dr. Winslow has been long and honourably known to the medical profession and the public as one of the most earnest and enlightened labourers in the difficult field of psychological medicine. The work before us is worthy of Dr. Winslow's high reputation. We need hardly say that it is a volume intended for the professional reader, and in respect to mental dise.ises, and more particularly their premonitory symptoms, it is a valuable contribution to medical literature. Dr. Winslow earnestly impresses upon the profession the importance of recognizing and treating the early symptoms of brain disease, of which he gives a masterly outline for their guidance. To the professional reader his description of what he very happily names "the choreic phase of insanity," will be deeply interesting, and his hypothesis of molecular alteration in the nerve corpuscles, as influencing aberration of intellect, will be found of interest. We are glad to notice that the book is, to some extent, prefatory of a more extended work upon psychological disease, and we cordially commend the present volume to the attention of the profession.

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