Page:The American Cyclopædia (1879) Volume IX.djvu/314

 302 INSANITY names of homicidal and suicidal insanity. Some authorities contend that such a classifi- cation should not be made ; hut there are too many cases furnished by insane asylums, and which have occurred under the notice of in- telligent physicians, where lunatics have shown morbid impulses to commit wrong acts which they had not sufficient will to resist, to leave much room for doubt that such states of the mind do occur. Patients have under some circumstances committed deeds of violence under the influence of impulses, and have at other times, in anticipation of the coming on of those impulses, asked to be restrained, say- ing that they feared they would not be able to resist them. Considering the morbid perver- sion of the nervous system and the unhappy condition of the mind in some instances, it is not strange that the combined effects of these and of insane delusions and hallucinations should result in such acts, nor that the disposi- tion to commit violence should under the cir- cumstances take these forms. Classification. There have been many classifications of insani- ty, but they have not thrown much light upon its nature, and in many cases have rather been hindrances to the discovery of the most important conditions (pathological) of the pa- tient. The older writers divided insanity prin- cipally into mania and melancholia. Thomas Arnold in 1806 made a general division into ideal and notional insanity. The ideal he sub- divided into : 1, phrenetic, or raving ; 2, inco- herent ; 3, maniacal ; 4, sensitive. Notional insanity he divided into : 5, delusive ; 6, whim- sical; 7, fanciful; 8, impulsive; 9, scheming; 10, vain or self-important; 11, hypochondria- cal; 12, pathetic; 13, appetitive. The pa- thetic he subdivided into 16 varieties: 1, amo- rous ; 2, jealous ; 3, avaricious ; 4, misanthro- pic; 5, arrogant; 6, irascible; 7, abhorrent; 8, suspicious; 9, bashful; 10, timid; 11, sor- rowful; 12, distrustful; 13, nostalgic; 14, su- perstitious; 15, enthusiastic; 16, desponding. Pinel made four divisions, viz. : mania, melan- cholia, dementia, and idiocy. Esqnirol added to these another, monomania. Dr. Prichard, whose work, published in 1835, was for a long time high authority, made two general divi- sions, moral and intellectual insanity, subdi- viding the latter into three, monomania, mania, and dementia. The existence of such a dis- ease as moral insanity is not recognized by a majority of modern alienists, and it is contend- ed that the moral sentiments are often want- ing in persons who are considered sane, as well as in the subjects of mental disease. Dr. Daniel Tuke divides insanity according as it affects 1, the intellect; 2, the inoral senti- ments ; 3, the propensities. Maudsley classifies insanity into two great divisions, which are sub- divided into varieties as follows : I. Affective or pathetic insanity, including: 1, maniacal perversion of the affective life, mania sine delirio ; 2, melancholic depression without de- lusion, simple melancholia ; 3, moral alienation proper. Approaching this, but not reaching the degree of positive insanity, is the "in- sane temperament." II. Ideational insanity, subdivided into : 1, general (a, mania, acute and chronic ; 6, melancholia, acute and chron- ic) ; 2, partial (a, monomania; b, melancholia) ; 3, dementia, primary and secondary ; 4, gen- eral paralysis ; 5, idiocy, including imbecility. In the first division the intellect may be com- paratively unaffected, but there is insanity of feeling and action. In the second there is in- sanity of thought, or delusion. The "insane temperament" is a kind of potential insanity introduced by Maudsley to characterize a con- dition of mind in which great eccentricity of thought, feeling, and action, proceeding from a morbid nervous organization, does not make the person actually mad, but queer and mor- bidly eccentric. Individuals having this tem- perament have certain marks of genius, though never of the highest order. Griesenger, one of the highest modern authorities, says : " A classification of mental diseases according to their nature, that is, according to the anatom- ical changes of the brain which lie at the foun- dation, is at the present time impossible." He therefore classifies insanity according to the nature of the psychical symptoms, and says " that while it is the aim of clinical instruction to render conspicuous and to analyze the multi- plicity of mental disorders in the concrete, no- sology must content itself with establishing fewer principal groups, fewer abnormal states to which all the varieties of individual cases may be referred." He divides mental diseases into two grand groups. In one there is a morbid condition of the emotions, affecting, according to its nature, the whole mental life of the pa- tient. In the other group insanity consists in disorders of the intellect and will, which exhibit, "without profound emotional excite- ment, an independent, tranquil, and false mode of thought and of will, usually with the predominant character of mental weakness." In most cases the conditions found in the first group precede those in the second, the latter generally being consequences and terminations of the former. The different forms of insani- ty may be conveniently considered under the following divisions : 1, melancholia ; 2, mania ; 3, general paralysis of the insane ; 4, dementia ; 5, imbecility ; 6, idiocy. Melancholia. This may be acute or chronic. The great majority of cases of insanity commence with a state of emotional perversion of a depressing and sor- rowful character, which has been called the stadium melanchoHcum, or initiatory period of mental disease, or the period of incubation. The first stages of melancholia are generally preceded by a condition called hypochondria- sis, which may be considered as the mildest form of insanity. There is a feeling of bodily illness at this time more than at any other, or in any other form of insanity. It is often vague, and depends upon irritation of the nervous centres arising from disorders, some-