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INSANITY (from Lat. in, not, and sanu...

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Originally appearing in Volume V14, Page 599 of the 1911 Encyclopedia Britannica.
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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 (>Gvxi , mind, and iarpeia, 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 Definition. of their transient nature, 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 junctions. 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 he considered all cases in which, from whatever cause. brain development has been arrested, with consequentproximate. (a) GENERAL CAUSES.—I. 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 de-pressing 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 woo 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 in-sanity. 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 explanation as to the manner in which insanity may appear in importance: the man or woman of middle life passes into advanced. families previously free from the taint. Very frequently we find in age without serious constitutional disturbance; on the other hand, the history of insane patients that although there may be no in- there may be a break down of the system due to involutional changes sanity in the family there are undoubted indications of nervous in special organs, as, for instance, fatty degeneration of the heart. alongside of physical instability, the parental nervous defects In all probability the insanity of. the climacteric period may be taking the form of extreme nervousness, vagabondage, epilepsy, referred to two pathological conditions: it may depend on structural want of mental balance, inequality in mental development or changes in the brain due to fatty degeneration of its arteries and endowment, extreme mental brilliancy in one direction associated cells, or it may be a secondary result of general systemic disturbance, with marked deficiency in others, the physical defects showing as indicated by cessation of menstruation in the female and possibly themselves in the form of insanity; liability to tubercular and by some analogous modification of the sexual function in men. rheumatic infections. The failure of constitutional power which The senile period brings with it further reduction of formative allows of the invasion of the tubercle bacillus and the micrococcus activity; all the tissues waste, and are liable to fatty and calcareous rheumaticus in certain members of a family is apparently closely degeneration. Here again, the arteries of the brain are very generally allied to that which favours the development of mental symptoms implicated; atheroma in some degree is almost always present, in others. but is by no means necessarily followed by insanity. 6. Consanguinity.—It has been strongly asserted that con- The various and profound modifications of the system which sanguineous marriage is a prolific source of nervous instability. attend the periods of utero-gestation, pregnancy and child-bearing There is considerable diversity of opinion on this subject; the do not leave the nervous centres unaffected. Most women are liable general outcome of the investigations of many careful inquirers to slight changes of disposition and temper, morbid longings, strange appears to be that the offspring of healthy cousins of a healthy likes and dislikes during pregnancy, more especially during the stock is not more liable to nervous disease than that of unrelated earlier months; but these are universally accepted as accompaniparents, but that evil consequences follow where there is a strong ments of the condition not involving any doubts as to sanity. But tendency in the family to degeneration, not only in the direction there are various factors at work in the system during pregnancy of the original diathesis, but also towards instability of the nervous which have grave influence on the nervous system, more especially system. The objection to the marriage of blood relations does not in those hereditarily predisposed, and in those gravid for the first arise from the bare fact of their relationship, but has its ground in time. There is modification of direction of the blood towards a the fear of their having a vicious variation of constitution, which, new focus, and its quality is changed, as is shown by an increase of in their children, is prone to become intensified. There is sufficient fibrin and water and a decrease of albumen. To such physical evidence adducible to prove that close breeding is productive of influences are superadded the discomfort and uneasiness of the degeneration; and when the multiform functions of the nervous situation, mental anxiety and anticipation of danger, and in the system are taken into account, it may almost be assumed, not only unmarried the horror of disgrace. In the puerperal (recently that it suffers concomitantly with other organs, but that it may delivered) woman there are to be taken into pathological account, also be the first to suffer independently. in addition to the dangers of sepsis, the various depressing influences 7. Parental Weakness.—Of the other causes affecting the parents of child-bed, its various accidents reducing vitality, the sudden which appear to have an influence in engendering a predisposition return to ordinary physiological conditions, the rapid call for a new to insanity in the offspring, the abuse of alcoholic stimulants and focus of nutrition, the translation as it were of the blood supply opiates, over-exertion of the mental faculties, advanced age and from the uterus to the mammae—all physical influences liable to weak health may be cited. Great stress has been laid on the in- affect the brain. These influences may act independently of moral fluence exercised by the first of these conditions, and many extreme shock; but, where this is coincident, there is a condition of the statements have been made regarding it. Such statements must be nervous system unprepared to resist its action. accepted with reserve, for, although there is reason for attaching (b) PROXIMATE CAUSES.—The proximate causes of insanity may considerable weight to the history of ancestral intemperance as a be divided into (I) toxic agents, (2) mechanical injury to the brain, probable causating influence, it has been generally assumed as the including apoplexies and tumours, and (3) arterial degeneration. proved cause by those who have treated of the subject, without I. Toxic Agents.—The definite nature of the symptoms in the reference to other agencies which may have acted in common with majority of the forms of acute insanity leave little reason to doubt it, or quite independently of it. However unsatisfactory from a that they result from an invasion of the system by toxins of various scientific point of view it may appear, the general statement must kinds. The symptoms referred to may be briefly indicated as stand that whatever tends to lower the nervous energy of a parent follows: (i.) Pyrexia, or fever generally of an irregular type; may modify the development of the progeny. Constitutional (ii.) Hyperleucocytosis, or an increase of the white blood corpuscles, tendency to nervous instability once established in a family may which is the chief method by which the animal organism protects make itself felt in various directions—epilepsy, hysteria, hypo- itself against the noxious influence of micro-organisms and their chondriasis, neuralgia, certain forms of paralysis, insanity, eccen- toxins. In such cases as typhoid fever, which is caused by a bacillus, tricity. It is asserted that exceptional genius in an individual or Malta fever which is caused by a coccus, it is found that if the member is a phenomenal indication. Confined to the question of blood serum of the patient is mixed in vitro with a broth culture of insanity, the morbid inheritance may manifest itself in two direc- the infecting organism in a dilution of I in 5o, that the bacilli or tions-in defective brain organization manifest from birth, or the cocci, as the case may be, when examined microscopically, are from the age at which its faculties are potential, i.e. congenital seen to run into groups or clusters. The organisms are.said to be insanity; or in the neurotic diathesis, which may be present in a agglutinated, and the substance in the serum which produces this brain to all appearance congenitally perfect, and may present itself reaction is termed an agglutinine. In many of the forms of insanity merely by a tendency to break down under circumstances which which present the symptom of hyperleucocytosis there can also be would not affect a person of originally healthy constitution. demonstrated the fact that the blood serum of the patients contains 8. Periodic Influence.—The evolutional periods of puberty, agglutinines to certain members of a group of streptococci (so adolescence, utero-gestation, the climacteric period and old age called on account of their tendency to grow in the form of a chain, exercise an effect upon the nervous system. It may be freely arpeirr6s; (iii.) the rapid organic affection of the special nerve admitted that the nexus between physiological processes and elements depending upon the virulence of the toxin, and the resist-mental disturbances is, as regards certain of the periods, obscure, ance of the individual to its influence; (iv.) the marked physical and that the causal relation is dependent more on induction than deterioration as indicated by emaciation and other changes in on demonstration; but it may be pleaded that it is not more obscure nutrition; (v.) the close analogy between the character of many in respect of insanity than of many other diseases. The pathological of the mental symptoms, e.g. delirium, hallucinations or depression, difficulty obtains mostly in the relation of the earlier evolutional and the symptoms produced artificially by the administration of periods, puberty and adolescence, to insanity; in the others a certain poisonous drugs. physiologico-pathological nexus may be traced; but in regard to The toxic substances which are generally believed to be associated the former there is nothing to take hold of except the purely with the causation of mental disorders may be divided into three physiological process of development of the sexual function, the great classes: (a) those which arise from the morbific products of expansion of the intellectual powers, and rapid increase of the bulk metabolism within the body itself " auto-intoxicants "; (b) those of the body. Although in thoroughly stable subjects due provision due to the invasion of the blood or tissues by micro-organisms; is made for these evolutional processes, it is not difficult to conceive (c) organic or inorganic poisons introduced into the system volun= that in the nervously unstable a considerable risk is run by the tarily or accidentally. brain in consequence of the strain laid on it. Between the adolescent (a) Auto-intoxication may be due to defective metabolism or to and climacteric periods the constitution of the nervous, as of the Physiological instability, or to both combined. The results of other systems, becomes established, and disturbance is not likely defective metabolism are most clearly manifested in the mental to occur, except from some accidental circumstances apart from symptoms which not infrequently accompany such diseases as evolution. In the most healthily constituted individuals the gout, diabetes or obesity, all of which depend primarily upon a " change of life " expresses itself by some loss of vigour. The deficient chemical elaboration of the products of metabolism. nourishing (trophesial) function becomes less active, and either The association of gout and rheumatism with nervous and mental various degrees of wasting occur or there is a tendency towards diseases is historical, and the gravest forms of spinal and cerebral restitution in bulk of tissues by a less highly organized material. degeneration have been found in association with diabetes. Until The most important instance of the latter tendency is fatty de- the pathology of these affections is better understood we are not in generation of muscle, to which the arterial system is very liable, a position to determine the nature of the toxins which appear to be In the mass of mankind those changes assume no pathological the cause of these diseases and of their accompanying nervous
End of Article: INSANITY (from Lat. in, not, and sanus, sound)
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