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INSANITY

INSANITY (from Lat. in, not, and sanus, sound), a generic term applied to certain morbid mental conditions produced by defect or disease of the brain. The synonyms in more or less frequent use are lunacy (from a supposed influence of the moon), mental disease, alienation, derangement, aberration, madness, unsoundness of mind. The term Psychiatry (ψυχή, mind, and ἰατρεία, treatment) is applied to the study and treatment of the condition.

I. Medical and General

There are many diseases of the general system productive of disturbance of the mental faculties, which, either on account of their transient natureDefinition., from their being associated with the course of a particular disease, or from their slight intensity, are not included under the head of insanity proper. From a strictly scientific point of view it cannot be doubted that the fever patient in his delirium, or the drunkard in his excitement or stupor, is insane; the brain of either being under the influence of a morbific agent or of a poison, the mental faculties are deranged; yet such derangements are regarded as functional disturbances, i.e. disturbances produced by agencies which experience tells will, in the majority of cases, pass off within a given period without permanent results on the tissues of the organ. The comprehensive scientific view of the position is that all diseases of the nervous system, whether primary or secondary, congenital or acquired, should, in the words of Griesinger, be regarded as one inseparable whole, of which the so-called mental diseases comprise only a moderate proportion. However important it may be for the physician to keep this principle before him, it may be freely admitted that it cannot be carried out fully in practice, and that social considerations compel the medical profession and the public at large to draw an arbitrary line between such functional diseases of the nervous system as hysteria, hypochondriasis and delirium on the one hand, and such conditions as mania, melancholia, stupor and dementia on the other.

All attempts at a short definition of the term "insanity" have proved unsatisfactory; perhaps the nearest approach to accuracy is attained by the rough statement that it is a symptom of disease of the brain inducing disordered mental symptoms—the term disease being used in its widest acceptance. But even this definition is at once too comprehensive, as under it might be included certain of the functional disturbances alluded to, and too exclusive, as it does not comprehend certain rare transitory forms. Still, taken over all, this may be accepted as the least defective short definition; and moreover it possesses the great practical advantage of keeping before the student the primary fact that insanity is the result of disease of the brain (see Brain, and Neuropathology), and that it is not a mere immaterial disorder of the intellect. In the earliest epochs of medicine the corporeal character of insanity was generally admitted, and it was not until the superstitious ignorance of the middle ages had obliterated the scientific, though by no means always accurate, deductions of the early writers, that any theory of its purely psychical character arose. At the present day it is unnecessary to combat such a theory, as it is universally accepted that the brain is the organ through which mental phenomena are manifested, and therefore that it is impossible to conceive of the existence of an insane mind in a healthy brain. On this basis insanity may be defined as consisting in morbid conditions of the brain, the results of defective formation or altered nutrition of its substance induced by local or general morbid processes, and characterized especially by non-development, obliteration, impairment or perversion of one or more of its psychical functions. Thus insanity is not a simple condition; it comprises a large number of diseased states of the brain, gathered under one popular term, on account of mental defect or aberration being the predominant symptom.

The insanities are sharply divided into two great classes—the Congenital and the Acquired. Under the head of Congenital Insanity must be considered all cases in which, from whatever cause, brain development has been arrested, with consequent impotentiality of development of the mental faculties; under that of Acquired Insanity all those in which the brain has been born healthyClassification. but has suffered from morbid processes affecting it primarily, from diseased states of the general system implicating it secondarily. In studying the causation of these two great classes, it will be found that certain remote influences exist which are believed to be commonly predisposing; these will be considered as such, leaving the proximate or exciting causes until each class with its subdivisions comes under review.

In most treatises on the subject will be found discussed the bearing which civilization,nationality, occupation, education, &c., have,Causation. or are supposed to have, on the production of insanity. Such discussions are as a rule eminently unsatisfactory, founded as they are on common observation, broad generalizations, and very imperfect statistics. As they are for the most part negative in result, at the best almost entirely irrelevant to the present purpose, it is proposed merely to summarize shortly the general outcome of what has been arrived at by those authorities who have sought to assess the value to be attached to the influence exercised by such factors, without entering in any detail on the theories involved. The causes of insanity may be divided into (a) general, and (b) proximate.

(a) General Causes.—1. Civilization.—Although insanity is by no means unknown amongst savage races, there can be no reasonable doubt that it is much more frequently developed in civilized communities; also that, as the former come under the influence of civilization, the percentage of lunacy is increased. This is in consonance with the observation of disease of whatever nature, and is dependent in the case of insanity on the wear and tear of nerve tissue involved in the struggle for existence, the physically depressing effects of pauperism, and on the abuse of alcoholic stimulants; each of which morbid factors falls to be considered separately as a proximate cause. In considering the influence of civilization upon the production of insanity, regard must be had to the more evolved ethical attitude towards disease in general which exists in civilized communities as well as to the more perfect recognition and registration of insanity.

2. Nationality.—In the face of the imperfect social statistics afforded by most European and American nations, and in their total absence or inaccessibility amongst the rest of mankind, it is impossible to adduce any trustworthy statement under this head.

3. Occupation.—There is nothing to prove that insanity is in any way connected with the prosecution of any trade or profession per se. Even if statistics existed (which they do not) showing the proportion of lunatics belonging to different occupations to the 1000 of the population, it is obvious that no accurate deduction quoad the influence of occupation could be drawn.

4. Education.—There is no evidence to show that education has any influence over either the production or the prevention of insanity. The general result of discussions on the above subjects has been the production of a series of arithmetical statements, which have either a misleading bearing or no bearing at all on the question. In the study of insanity statistics are of slight value from the scientific point of view, and are only valuable in its financial aspects.

5. Inheritance.—The hereditary transmission of a liability to mental disease must be reckoned as the most important among all predisposing causes of insanity. It is probably well within the mark to say that at least 50% of the insane have a direct or collateral hereditary tendency towards insanity. The true significance of this factor cannot as yet be explained or described shortly and clearly, but it cannot be too definitely stated that it is not the insanity which is inherited, but only the predisposition to the manifestation of mental symptoms in the presence of a sufficient exciting cause. The most widely and generally accepted view of the exciting cause of insanity is that the predisposed brain readily breaks down under mental stress or bodily privations. There is, however, another view which has been recently advanced to the effect that the majority of mental diseases are secondary to bodily disorders, hereditary predisposition being the equally predisposing causal factor. There is probably truth in both these views, and such an admission accentuates the complexity of the factorship of heredity. If insanity can be induced by physical disorders, which must essentially be of the nature of toxic action or of mechanical agency which can alter or influence the functional powers of the brain, then it is probable that hereditary predisposition to insanity means, not only the transmission of an unstable nervous system, but also a constitution which is either peculiarly liable to the production of such toxic or poisonous substances, or incapable of effectively dealing with the toxins or poisonous substances normally formed during metabolic processes. Such a view broadens our conception of the factorship of hereditary transmission and offers