The physiology and pathology of the mind

Preface

The aim which I have had in view throughout this work has been twofold: first, to treat of mental phenomena from a physiological rather than from a metaphysical point of view ; and, secondly, to bring the manifold instructive instances presented by the unsound mind to bear upon the interpretation of the obscure problems of mental science. Indeed it has been my desire to do what I could in order to put a happy end to the " inauspicious divorce " between the Physiology and Pathology of Mind, and to effect a reconciliation between these two branches of the same science. When I first applied myself, upwards of ten years since, to the practical study of insanity, having laid up beforehand some store of metaphysical philosophy, it was no small surprise and discouragement to find, on the one hand, that the theoretical knowledge acquired had no bearing whatever on, no discoverable relation to, the facts that daily came under observation, and, on the other hand, that writers on mental diseases, while giving the fullest information concerning them, treated their subject as if it belonged to a science entirely distinct from that which was concerned with the Eound mind. This state of things could not fail to produce vi PREFACE.

an immediate mental disquietude, and ultimately to give rise to the endeavour on my part to arrive at some definite conviction with regard to the physical conditions of mental function, and the relation of the phenomena of the sound and unsound mind. Of that endeavour the present work is the result. It can claim no more authority than what is due to a sincere purpose faithfully pursued, and to such truth as may be contained in it. The First Part, resting as it does mainly on the physiological method of inquiry into mental phenomena, will certainly not command the assent of those who put entire faith in the psychological method of interrogating self-consciousness ; it must appeal rather to those who have made themselves acquainted with the latest advances in physiology, and with the present state of physiological psychology in Germany, and who are familiar with the writings of such as Professor Bain, Mr. Herbert Spencer, Dr. Laycock, and Dr. Carpenter, in this country. The Second Part of the book may stand on its own account as a treatise on the causes, varieties, pathology, and treatment of mental diseases, apart from all question of the proper method to be pursued in the investigation of mental phenomena. Even those who advocate the psychological method of interrogating self-consciousness do not insist on the application of it to the scientific study of the madman's mind.

In laying down the plan of this work, and in thus entering upon a task not before systematically attempted, I could not fail to experience the serious disadvantage, not only of havin^ no guide to follow, but of being compelled by the scope of the work to deviate from the paths already made in metaphysics, physiology, and pathology respectively. In order to bring the results of the cultivation of these different branches of science into any sort of harmony, it was plainly necessary not to travel too far on paths which diverged more and more with every step forward. For this reason I have passed by

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many interesting questions which have long occupied a large space in metaphysics, and have deliberately omitted many discussions which were at one time intended to form a part of the book. In like manner, it seemed desirable, when treating of the physiology of mental action, to omit anatomical description of the nervous system, leaving the knowledge of it to be obtained in a more complete and satisfactory form from books specially dealing with the subject. Lastly, the pathology of diseases of the nervous system generally, although throwing much light on the pathology of mental diseases, could not find fitting place, and was after some hesitation sacrificed, in order to preserve the harmony of design, and to prevent the book growing to an immoderate bulk. Indeed, as may easily be conceived, it has been throughout far more difficult to determine what to leave out than what to put in, the proportion of material collected for the purposes of the project, but not directly used, exceeding that which has been actually used in its execution. I am fully sensible of the disadvantages resulting from these omissions : an amount of knowledge on the reader's part is taken for granted which he may not have, and without which many things may appear obscure to him, and many assertions unwarrantable. It may well be, too, that either the metaphysician, or the physiologist, or the pathologist, looking at the work from his particular standpoint, will see reason to pronounce it defective. Whosoever will, however, be at the pains to compare the discordant results of metaphysical, physiological, and pathological studies of mind, remembering that they are actually concerned with the same subject-matter, cannot fail to recognise and confess the uselessness of an exclusive method, and the pressing need of combined action and of a more philosophical mode of proceeding. If the work now offered to the public be successful in its aim, it will make evident how indispensable v iii PREFACE.

is the method advocated, and how full it is of promise of the most fruitful results.

In conclusion, I am glad to add a sincere expression of thanks to my friend Dr. Blandford, for his advice and assistance during the passage of the book through the press.

The Lawk, Hanwell, W.

Feb. 5th, 1867.

Chapter I. On The Method Of The Study Of Mind

Aspects of nature terrible to man in the infancy of thought ; whence superstitious feelings and fancies regarding nature. As these disappear metaphysical entities are assigned as natural causes, and man deems himself the "measure of the universe." Finally, the interrogation and interpretation of nature, after the inductive method, begin ; fruitful results of this method. Is the inductive method, objectively applied, available for the study of Mind? Difficulties in the way of such application. Development of biography, and absence of any progress in metaphysics are evidence of its value. Psychological method of interrogating self-consciousness palpably inadequate ; contradictory results of its use, and impossibility of applying it inductively. Self-consciousness unreliable in the information which it does give, and incompetent to give any account of a large part of mental activity : gives no account of the mental phenomena of the infant, of the uncultivated adult, and of the insane ; no account of the bodily conditions which underlie every mental manifestation ; no account of the large field of unconscious mental action exhibited, not only in the unconscious assimilation of impressions, but in the registration of ideas and their associations, in their latent existence and influence when not active, and in their recall into activity ; and no account of the influence organically exerted upon the brain by other organs of the body. Incompetency of self-consciousness further displayed by examination of its real nature. Physiology cannot any longer be ignored ; henceforth necessary to associate the Physiological with the Psychological method. The study of the plan of development of Mind, the study of its forms of degeneration, and the study of its progress and regress, as exhibited in history, should not be neglected. The union of empirical and rational faculties, really advocated by Bacon as his method, is strictly applicable to the investigation of mental as of other natural phenomena. The question of relative value of inductive or deductive reasoning often a question of the capacity of him who uses it ; difference between genius and mediocrity. — Conclusion Page 1 — 37

Chapter II. The Mind And The Nervous System

The term "Mind" used in different senses ; in its scientific sense as a natural force; and in its popular sense as an abslraction made into a metaphysical entity. The brain certainly the organ of the Mind, and the nervous cells the immediate agents of mental function. Mental power an organized result in the proper centres — a mental organization. No nerve in lowest animal forms ; perception of stimulus being the direct physical effect in a homogeneous substance. The differentiation of tissues in higher animals demands special means of intercommunication ; the nervous system, at first very simple, subx CONTENTS.

serving this function. With increasing complexity of organization, a corresponding complexity of the nervous system. Organs of special senses appear in very rudimentary form at first ; corresponding central nervous ganglia constitute entire brain in Invertebrata. Eudiments of cerebral hemispheres and rudimentary ideation in fishes. Convolution of the grey matter of the hemispheres in the higher mammals, and corresponding increase of intelligence in them. Differences in the size of the brain, and in the complexity of its convolutions, in different races of men, and in different individuals of the same race ; corresponding differences in intellectual development. Human embryonic development conforms with general plan of development of Vertebrata. Discrimination of nervous centres : (a) primary, or Ideational ; (b) secondary, or Sensorial ; (c) tertiary, or Reflex; (d) quaternary, or Organic. The evidence of the different functions of these centres is anatomical, physiological, experimental, and pathological. Discriminating observation of mental phenomena necessary, and metaphysical conception of Mind no longer tenable. Mind the most dependent of all the natural forces ; relations of mental force in nature. Concluding remarks Page 38—62

Chapter III. The Spinal Coed And Keflex Action

Spinal cord contains the nervous centres of many reflex or automatic movements. Earliest movements of infant are reflex ; automatic acts of anencephalic infant and of decapitated frog. Analysis of Pfliiger's experiments on the frog. So-called design of an act not necessarily evidence of consciousness. Spinal cord the centre of many acquired or secondary automatic movements ; illustrations. The motor faculties mostly acquired in man by education and exercise, but innate in many animals. Bearing of instances of acquired adaptation of means to end on the doctrine of final causes. Motor faculties are exhausted by exercise, and require periodical rest for restoration of power by nutrition. Quantitative and qualitative relation of reaction to the impression. Hereditary transmission of acquired faculties implants the germ of innate endowment. Pfliiger's laws of reflex movements. Causes of disorder of function of spinal cord : (a) original differences of constitution ; (b) excessive action ; (c) quantity and quality of the blood ; (d) excentric irritation ; (e) interruption of its connexion with the brain. Close sympathy between different parts of the nervous system. Clear conceptions of the functions of spinal centres indispensable to the study of the functions of the higher nervous centres . . . Page 63 — S6

Chapter IV. The Sensory Centres And Sensation

Collections of grey matter constituting the sensory ganglia intervene between the spinal centres and the supreme hemispherical ganglia. Anatomical relations of different grey nuclei yet uncertain, but nerve-fibres certainly connected with their cells. Sensory ganglia with connected motor nuclei the centres of independent reaction — of sensori-motor movements : examples. Sensations not innate in man, but acquired by gradual formation ; difference between him and the animals in this regard. The idea of organization necessary to the just interpretation of sensation ; assimilation and differentiation. Association of sensations. Sensori-motor acts both irregular and co-ordinate ; of co-ordinate acts, some are primary automatic, others secondary automatic. Persistence of sensori-motor acts in animals after the removal of their cerebral hemispheres. Acquired sensori-motor acts constitute a great part of the daily action of life ; illustrations. Psychological view of sensation at variance with physiological facts. Subordination of the sensory centres to the cerebral ganglia. Causes of disorder of the sensory ganglia : (a) original defects ; (b) excessive stimulation ; (c) quantity and quality of blood ; (d) reflex irritation ; (e) influence of cerebral hemispheres {'!). Concluding remarks on the analogy between the functions of the sensory centres aud of the spinal centres Page 87 — 105

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Chapter V

THE SUPREME CEREBRAL CENTRES AND IDEATION. Cortical cells of the hemispheres the centres of Ideation. No certain knowledge of the functions of different convolutions. Cortical cells the centres of independent reaction ; of ideomotor movements, which may take place without will and without consciousness ; illustrations. Notion of innate idea untenable. Idea a gradual organization. Different signification of an idea according to different states of culture. The so-called fundamental or universal intuitions. Different modes of action of idea : (a) on movements, voluntary and involuntary, conscious and unconscious ; (b) on the sensory ganglia, — physiologically, as a regular part of mental function ; pathologically, in the production of hallucinations ; (c) on the functions of nutrition and secretion : illustrations ; (d) on other ideas : reflection or deliberation. Relation of consciousness to Ideational activity. Comparison of ideas with movements in regard to their association, their relation to consciousness, and the limited power which the mind has over them. The character of the particular association of Ideas determined by («) the individual nature, (b) special life-experience. Need of an individual psychology. General laws of association of ideas. Concluding remarks on the illustration of Von Baer's law of progress, from the general to the special in development, alforded by the development of ideas Page 106 — 128

Chapter VI. On Emotion

Relation of emotion to idea. Influence of the state of nerve-element on emotion. Idea favourable to self-expansion is agreeable ; an idea opposed to self-expansion disagreeable. Appetite or desire for agreeable stimulus, and repulsion or avoidance of a painful one, as motives of action. Equilibrium between individual and his surroundings not accompanied with desire. Intellectual life does not furnish the impulses to action, but the desires do. Character of emotion determined by the nature of external stimulus, and by the condition of nerve-element, original, or as modified by culture. Ccenajsthesis. Nervous centres of ideas and emotions the same : emotions as many and various as ideas. Psychieal tone ; how determined ? The conception of the ego and the moral sense. Intimate connexion of emotion with the organic life ; illustration of their reciprocal influence. Primitive passions, according to Spinoza. Difficulties of the psychological method of studying emotion. Hereditary action in the improvement of human feeling. Law of progress from the general to the special, exhibited in the development of the emotions.

Chapter VII. On Volition

The will not a single, undecomposable faculty of uniform power, but varies as its cause varies : differs in quantity and quality, according to the preceding reflection. According to the common view of it, an abstraction is made into a metaphysical entity. Self-consciousness reveals the particular state of miud of the moment, but not the long series of causes on which it depends ; hence the opinion of free-will. Examples from madman, drunkard, &c. The design in the particular volition is a result of a gradually effected mental organization : a physical necessity, not transcending or anticipating, but conforming with, experience. Erroneous notions as to the autocratic power of will. Its actual power considered (1) over movements, and (2) over the mental operations. 1. Over movements : (a) no power over the involuntary movements essential to life ; (b) no power to effect voluntary movements until they have been acquired by practice ; (c) cannot control the means, can only will the event. 2. Over mental operations : (a) the formation of ideas, and of their associations independent of it ; (b) its impotency in the early stages of mental development — in the young child and in the savage ; (c) cannot call up a particular train of thought, or dismiss a train of thought, except through xii CONTENTS.

associations of ideas that are beyond its control, and sometimes not at all. A9 many centres of volitional reaction in the brain as there are centres of ideas. Volition built up from residua of previous volitions of a like 'kind. To the freest action of the will there are necessary an unimpeded association of ideas and a strong personality. Character not determined by the will,_but determining it in the particular act. Relation of emotion to volition. Will the highest force in nature ; its highest function creative — initiating a newdevelopment of nature Page 146 — 166

Chapter VIII. On Actuation

Movements leave behind them residua in the motor centres, whence a repository of latent or abstract movements. Motor residua or intuitions intervene between motive and act, and are related to conception on the reactive side as sensation is on the receptive side. A ctuation proposed for the psychological designation of this department. Motor intuitions mostly innate in animals, acquired in man. Illustrations from vision, speech, the phenomena of hypnotism, paralysis, insanity, &c. Muscular hallucinations. Co-ordinate convulsions. The muscular sense ; its relation to the motor intuitions, and the necessary part which it plays in mental function. The will acts upon muscles indirectly through the motor nervous centres. Orderly subordination of nervous centres in the expression of the will in action. Natural differences between different persons, in the power of expression, by speech or otherwise.

Chapter IX. On Me1ioey And Imagination

Memory exists in every organic element of the body — an organic registration of impressions. No memory of what we have not had experience, and no experience ever entirely forgotten. Physiological ideas of assimilation and differentiation necessary to the interpretation of its phenomena. Power of imagination built up by the assimilation not only of the like in ideas, but also of the relations of ideas. Its productive or creative power is, in its highest display, involuntary and unconscious : it is the supreme manifestation of organic evolution. Relation of memory to imagination. The action of imagination. Differences in the character of memory in different persons. Manifold disorders to which memory is liable. The memory of early youth and of old age. No exact memory of pain : why? Pane 182 194

Chapter I. On The Causes Of Insanity

Concurrence of causes in the production of Insanity. Moral and physical causes cannot be exactly discriminated. Predisposing causes : the influence of civilization ; over-population and the struggle for existence ; over-crowdin" and insanitary conditions ; eager pursuit of wealth, and deterioration of the moral nature ; sex ; education ; religion ; condition of life ; age and period of life ; hereditary predisposition. Proximate causes of disorder of the ideational centres : — (1) Original differences in constitution — (a) imperfectly developed brains of the microcephalic type, (b) cretinism, (c) arrest of development by disease, (d) the insane temperament, or neurosis spasmodica ; (2) Quantity and quality of the blood — anaemia and congestion ; alcohol, opium, and other medicinal substances, organic poison introduced from without or bred in the body and defective development of the blood itself ; ,3) Reflex irritation or pathological sympathy— illustrations ; (4) Excessive functional activity— overwork

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emotional agitation, depressing passions, physical exhaustion, &c. ; (5) Injury and disease of the braiu— abscess, tumour, tubercle, syphilis. Concluding remarks on the special causation of the different forms of insanity. Mental derangement a matter of degree. Appendix of cases, illustrating the causation of insanity Page 195—258

Chapter II. On The Insanity Of Early Life

Insanity of young children must be of a simple kind, the mental organization being imperfect. Convulsions prove fatal at the earliest age : more or less sensorial insanity associated with them in some cases. Comparison of infantile insanity with the insanity of animals, and with epileptic fury. The organization of sensory residua, and hallucinations of the senses : hallucinations not uncommon in infancy ; examples. Choreic insanity and the phenomena of somnambulism. Organization of idea. Incoherent conversation and fallacious memory of children. Delusions. Resemblance between mania of children and the delirium of adults. Hallucinations produced by morbid ideas. The difference between fancy and imagination corresponds with the difference between delirium, and mania. Forms of insanity met with in children grouped : — (1) Monomania, when there is a powerful impulse to some act of violence ; (2) Choreic mania — examples ; (3) Cataleptoid insanity — illustrations ; (4) Epileptic insanity, preceding, taking the place of, or following, the usual convulsions — examples; (5) Mania; (6) Melancholia; (7) Affective insanity— (a) Instinctive or impulsive; perversions of the instinct of selfconversation and the instinct for propagation, (b) Moral insanity — examples. The insane child is a degenerate variety of morbid kind — never reverts to the type of any animal : theroid degenerations of mankind are pathological specimens. Concluding remarks upon the seeming precocity of vice in some insane children Page 259—293

Chapter III. The Varieties Of Insanity

1. The insane temperament — its characteristics. Eccentricity and insanity. The relation of certain kinds of talent to insanity displayed ; also, the wide difference between the highest genius and any kind of madness. The bodily and mental characters of a strong hereditary predisposition. The different varieties of mental disease fall into two great divisions — Affective and Ideational.

2. Affective Insanity : {a) Impulsive — the nature of it described and illustrated by examples ; enumeration of its causes and exposition of its frequent connexion with epilepsy; (b) Moral Insanity — precedes the outbreak of other forms of insanity sometimes, and persists for a time after disappearance of intellectual disorder ; displayed chiefly in the degeneration of the social sentiments : examples ; vicious acts not proof of moral insanity ; its connexion with other forms of mental derangement and with epilepsy. 3. Ideational Insanity ; (a) Partial, including monomania and chronic melancholia ; (b) General, including mania and melancholia, chronic and acute. Modified classification of mental diseases. The nature, varieties, symptoms, and course of partial ideational insanity discussed and illustrated by examples. The nature, varieties, symptoms, and course of general ideational insanity.

4. Dementia, acute and chronic. Causes of acute dementia, and examples. Chronic dementia ; three groups of cases according to the degree of mental degeneration. 5. General paralysis — its causes, symptoms, ami course.

Chapter IV. The Pathology Of Insanity

Absence of morbid appearances after death no proof of the absence of morbid changes : illustrations of abolition of nervous function without recognisable changes of structure. 1. Summary of latest physiological researches into xi v CONTENTS.

nervous function : time-rate of conduction ; electro-motor properties of nerve, and the changes produced by the electrotonic state ; Katelectrotonus and Anelectrotonus; chemical changes produced by functional activity. 2. Individuality of nerve element considered : functional relation between the individual element and its supply of blood ; state of the cerebral circulation during sleep ; results of the extreme exhaustion of nerve element, and of the effects of poisons upon it ; its modification by the habit of exercise through the residua of previous activity. 3. Reflex pathological action or pathological sympathy— illustrations. Morbid anatomy of insanity : (1) Morbid products, such as tumour, Abscess, Cysliccrcus, &c. ; 'intermittence of mental symptoms, and extreme incoherence of them when they occur in such cases. (2) Morbid appearances in the Brain and Membranes— in acute insanity; in chronic insanity ; in general paralysis ; in syphilitic dementia. "Weight and specific gravity of the brain in insanity. Microscopical researches, and interpretation of the results of them. Summary of the kinds of degeneration met with m the brain after insanity : (a) Inflammatory degeneration : (b) Connective tissue degeneration; (c) Fatty degeneration ; (d) Amyloid and colloid degeneration ; (e) Pigmentary degeneration; (/) Calcareous degeneration. (3) Morbid conditions of other organs of the body— of the lungs, the heart, the abdominal organs, and the sexual organs. Concluding observations . . Page 368 — 408

Chapter V. The Diagnosis Of Insanity

The difficulty of the diagnosis in some cases. Acute mania : the difference between acute mania caused by intemperance, and delirium tremens. _ Chronic mania and feigned insanity. The mode of detecting partial ideational insanity, monomaniacal or melancholic. Eccentricity and insanity — the impor- > tant differences between them. The diagnosis of moral insanity. The detection of general paralysis in its earliest stages. Dr. Bucknill, on the mode of conducting the examination of an insane patient . . Page 409 — 416

Chapter VI. The Prognosis Of Insanity

Insanity reduces the mean duration of life. The indications of a fatal termination. The probability of recovery depends on the form, the duration, and the cause of the disease. Melancholia the most curable, acute mania coming next. The indications of recovery. The prognosis very bad in chronic mania, monomania, and moral insauity, but good in acute dementia. The causes of the disease influencing the prognosis. The age most favourable to recovery. The proportion of recoveries, relapses, and deaths. Evil effects of injudicious interference Page 417 — 421

Chapter VII. The Treatment Of Insanity

The difficulties in the way of treatment ; the working of the Lunacy Acts ; the public horror of insanity, and the social prejudices regarding it. The practice of indiscriminate sequestration unjustifiable. The true principle to have in view : argument in favour of it. The treatment of the insane in private dwellings. Condition of the Chancery patients. The evils of monstrous asylums. Necessity of early treatment. Moral treatment of insanity ; change of residence, occupation, amusements, &c. Medical treatment : warm and cold baths ; blood-letting ; counter-irritants ; diet ; stimulants : the use of opium' ; digitalis ; hyoscyamus, hydrocyanic acid and bromide of potassium ; tonics. Concluding remarks upon the treatment of chronic insanity.

PART I.

THE PHYSIOLOGY OF MIND.