Lectures on mental disease

Appendix

Classification of Insanity 440

PLATE I.

Sections of Normal Braiu from Specimens prepared by Dr. Herbert 0. Sankey.

Fig. 1. Portion of second layer of cortex.

Fig. 2. Showing giant cells fi-om Paracentral lobe.

Tissues stained with aniline blue, and drawn to the scale of \ of an inch to xxrW* k :

k •

PLATE II.

Sections of Braiu in General Paresis from specimens prepared and lent by Dr. Wigleswortb, M.D. Lond.

Fig. 1. Portion of upper portion of Cortex Cerebri, a vertical section tbi'ougb ■v\liole of first layer, and a small portion of second from middle frontal gyrus. Tbe first layer presents a marked fibrillated appearance (scarcely sufiiciently marked in tbe engraving), and numerous large, mucb brancbed neuroglia corpuscles scattered tkrougbout. Tbere are indications of nerve cells, and brancbes of vessels enveloped in byperplasic tissue.

Fig. 2. Vertical section of a deeper layer of tbe same preparation in wbicb tbe byperplasia of connective tissue (Bindegewebewucberuug) is more apparent. See page 202 et seq.

Drawn from tbe preparations by tbe autbor to tbe scale of ^ of an incb to xoVo.

ai

Cv d

A

V

PLATE III.

Small Arteries of the Pia Mater and Cortex Cerebri, Fig. 1, 4, 5 and 6 prepared under a stream of water, by washing away the cerebral tissue ; Fig. 2 and 3 are from sections prepared in the usual way.

Fig. 1, 2, 3, 4 show the appearance of the arterioles in general paresis as described at pp. 304 and 305.

Fig. 5 and 6 are vessels taken fi-om cases of Chronic Insanity and ImbeciUty and show hypertrophy of the arterioles as described at pp. 236 and 245.

*»* Figs. 1, 2, 3, and 4 were drawn from the preparations themselves by Mr. Tuffen West and before the-author and artist met.

PLA'PR 111

A COURSE OF LECTURES

MENTAL DISEASE.

PAET I.

Section I

Science of Mind — Schools of Philnsophy — History — Augusta Oomte, liis Account of Positive Philosophy — Psycliolooy a Brancli of Physiology — Division of the Subject — Statics ;incl Oynamifxs, or Priiducts and Processes— Products considered — liocke's D(^fiiiition of Ideas — Concrete and Abstract Ideas, their difference — Examples of Concrete and Abstract Ideas, Mind, Life, Ego, &c. — The Products of Sensa' ion —Persistence of Sensation — Memory — Association of Ideas— Consciousness— Emotions — Will— Belief— Imagination— Judgment.

I THINK it expedient in commencing a course of Lectures on Mental Disease to introduce the subject witli some remarks on the science of Mind. In other medical treatises the pathologist may assume that the physiology of each organ, the diseases of which he is about to describe, is already acquh-ed by the student. This cannot be said to be the case when the disease is mental. The physiology of the mental functions or psychology, is omitted of late years in the text books. It is not possible therefore to appeal to the student's knowledge, and besides this the subject is a very wide one and is discussed by writers from very different stand-points.

The study of Mind, formerly called Philosophy as though it were the only subject of learning, is of very ancient date, and was almost the first subject which excited the attention of contemplative minds. In those early times it was of course considered entirely apart from the body. Mental philosophy long preceded the study of anatomy.

The large amount of attention that has been given therefore to this subject, through such a series of years, has resulted in the formation of what is called the various schools of philosophy. Each school in its turn had its own system — one school has yielded to another through many changes. The history of the schools is treated in two volumes by the late Mr. Lewes.*

It would be of no use to us to review these several systems, or the doctrines of the Spiritualist, Materialist, Nominalist, Realist, Idealist, Sensuahst, and others ; though allusion may be made to some of the tenets during our course.

In England the tendency has been to adhere chiefly to the practical, and transcendentalism has not found so much favor with us as with the German schools.

One of the last systems of philosophy is that of Comte, a French professor, and his writings have had a large influence on French philosophy, and have brought it into more accordance with English views — it was called by him the Positive Philosophy.

Comte gives in a short compass an epitome of the history of philosophy, and his part in the progress of it, which I will here quote.

History of the Positive Philosophy of the School of Comte. — Auguste Comte was born in 1798 and died in 1857. His chief work is his Cours de Philosophie Positive in six volumes.

The following passage from vol. i., p. 14, of his work, gives his own account of the Positive Philosophy.

" In order to explain," he says, "the true nature and real character of the Positive Philosophy in a convenient form, it is absolutely necessary to cast a general coup d'oeil over the gradual progress of human knowledge viewed in its entirety ; for any understanding of the subject can only be gained from its history."

"In studying the development of the entire human understanding in its different spheres of activity, from its earliest soarings to the present time, I believe I have discovered a grand fundamental law, to which, by an invariable necessity it is subjected This law consists in the fact that each of our

principal conceptions, each branch of knowledge passes through • Lewea' History of Philosophy.

STUDY OF MIND. 3

three diflferent theoretical states : the first, theological or fictional ; sccouti, metaphysical or abstract ; thii'd, scientific or positive."

He goes on to point out that the mind in its first efforts, and which he would also consider as the lowest point of its development, simply refers all natural phenomena to the direct intervention or operation of an intelligent agent — to God.

That from this simple and early mode of explanation the next stage, which is the metaphysical, invented the hypothesis of an intermediate power as Nature, Life, Vital Principle — as the active cause of the phenomena of the universe — and the object of philosophy at this stage was to enquire into the nature of these prime causes.

This, the metaphysical stage, took as strong a hold on men's minds as did the theological, and to this day it influences the judgments and opinions and modes of thought of a great many. As an example, there is at present no dogma more prevalent perhaps than that which attributes certain phenomena of the body to some distinct agent as " the Will," " Mind," " Vital Principle," etc.

The positive philosophy as described by Comte has, he says, been gradually extending its power during the last two centuries and embraces to day every order of phenomena. All phenomena according to him fall under five grand categories — Astronomy, Physics, Chemistry, Physiology, and Sociology, and the •chief characteristic of this philosophy, or the philosophy of science, is this — "that it seeks no more to investigate the intimate nature or character of causes, but rather occupies itself in the discoveiy of the Eules or Laws which regulate the universe."

The positive school made no sudden change in the views generally entertained. Opinions had been for more than two centuries gradually undergoing change, and tending toward the same direction. The writings of Comte perhaps merely stated positive views more dogmatically, and the name of Comte is now most generally associated with them ; there are many matters, however, in the writings of Comte which are by no means accepted — views on religious and political questions, which partake rather of atheistic and materialistic views, and which, at all events are quite foreign to our present purpose. More especially was there in the later writings of Comte much of the mystical and obscure, and which have given rise to an adverse opinion concerning him. It should be borne in mind that much of tliese peculiar doctrines form no essential part of Positivism, and these views were broached only in the latter part of his life, and after a severe attack of mental disease.

Mr. Lewes sums up the position of Comte in relation to philosophy thus : — " tlie positive philosophy is novel as a j^hilosophy, not as a collection of truths never before suspected. The novelty is in the organization of existing elements. (History of Philosophi/, vol. ii., p. 696J.

Psychology being, then, a section of physiology it is to be stu(3ied in the same way as that pursued with other portions of the subject; we may, however, take advantage of what we find prepared for our use in all previous investigations by former methods.

The subject may be studied, as in other physical investigations, from two points of view — or statically and dynamically. In other words, we may examine the organ and the function — or the process and the product. Only a brief review of the chief matters will be attempted here.

It will be the most convenient to consider, firstly, the products, and secondly, the process. As these, however, are very intimately blended it will not be possible to keep them perfectly distinct thi'oughout our examination.

THE PKODUCTS OF MIND.

I. Products. It is in this division of the subject, in which the earliest labours of the schools will be alone available.

A classification of mental products has been made by many authorities. The division of Professor Bain, and which it appears he adopted from a suggestion of Professor Sharpey, is a good practical arrangement, viz., into the Senses, the Intellect, the Will, and the Emotions.

These, however, are not strictly products, but rather groups of processes, the products of the senses would be Sensations ; of the intellect. Ideas, Beliefs, Judgments, etc. ; of the will, Volitions ; of the emotions, Feelings, etc.

For our purpose I think a more useful mode will be to begin with the most simple product and proceed to the more complex.

Locke, whose work on the Human Understanding really laid the foundations of what has since been called the positive school, commenced his examination of the understanding by the study of the Ideas.

Ideas may be considered the units of our investigation.

Other resultants are as it were secondary as regards Mind ; for example, Sensations and Emotions are mental products when they give rise to Ideas.

It is as well, therefore, to commence with the examination of Ideas. Locke used this term in a very general manner. " It is the term," he says, " which I think serves best to stand for whatsoever is the Object of the Understanding when a man thinks. [On the Human Understanding, chap, i., § 8).

Ideas are of two kinds : —

1. Concrete.

2. Abstract.

It is important that the student should thoroughly examine the differences between these. Very much of the difficulty of the whole subject, in my opinion, lies in the understanding of what these terms signify.

1. A Concrete Idea represents only an object as it is, that is, it is the first impression that is produced upon the organism by the action upon it of an external object; the impression in its crude state, as received, constitutes the concrete idea. In this state the object with all its attributes unseparated — whole — concreted — or in its compound and unanalysed condition, affects the individual and gives him — produces in him — a concrete idea. This will be still more clearly seen by contrasting it with the other kind of idea.

2. The Abstract Idea. — An abstract idea does not relate to an object as, or in the condition in which, we see it, or know it, but to some attribute only of the object or objects. Though an object is acting upon our organism, the abstract idea is in relation only to a particular quality, attribute, or portion of the object, drawn away — abstracted from the whole or concrete object, and presented to us only after analysis ; and since it relates only to a portion of the idea formed, it does not correspond to any object in its actual condition as found in nature.

To illustrate this by an example: — I have before me a table, and I see it exactly as it is before me, in its entirety ; such an idea thus begotten is a concrete idea.

But almost at the same moment of receiving the first positive effect upon my organism, there is another process within the mind which is evoked, for directly I say that the object is a table it is obvious that I liken it to some other table ; beyond the simple passive impression there is an action commencing, and "which is a mental process. I may recognise the object as a table and perceive that it has the attributes of other tables, I must have, therefore, a distinct idea of "table" quite independent of the one before me, or indeed, of any table in particular.

1 know tables of various shape, size, material, colour, uses, etc., and yet all are to me tables, thus I have an idea of table, which is an abstract idea — because it is abstracted from many tables and of all kinds — I call this abstract idea " table," and in making use of the term I conceive it entirely apart from, and independent of the rest of the properties of tables.

As a further illustration of the attributes of the abstract idea, I will take the idea " Blue." "We have undoubtedly a distinct idea of that which is signified by the term "Blue." Yet when used, as it most commonly is, adjectively, there is nothing in existence exactly corresponding to this term — we all know blue Bky, blue paint, blue books, but if we take away (abstract) the idea corresponding to the terms sky, paint, books, we have only blue, but it remains only in idea. We do not imagine that there is anything, any entity in nature, corresponding to the idea.

The abstract and concrete ideas difl:'er then in the following particulars : —

1. A concrete idea results from the action and reaction of an external object on the organism, in which the organism is a passive recipient of the impression.

2. The action has relation only to a single increment of time.

8. The concrete idea carries with it a conviction that it represents a real object as it exists in nature. Consequently "a concrete name is the name of an object ; an abstract name the name of an attribute." (Mill's Loffic, vol. i., p. 80). " A real concrete object, such as a plant could not be annihilated witbout alteration to the whole cosmos. But abstracts as classes — orders genera, etc., — one and all might be annihilated and would cause no perturbation in the system of things." (Lewes).

1. The abstract idea is the result of a process within the organism.

2. It is not in relation only with a single increment of time, but may extend over a wider field.

3. It does not represent objects in then- actual state in nature, but has relation with portions, or the qualities of things.

4. The abstract idea produces conviction, or belief, but not that it corresponds to any thing or things in then- actual state — the conviction only is of the existence of an attribute of an object. There is some difference in different writers in the employment of abstract and general terms as expressing ideas. A general term should properly denote a class of attributes, but it of course then denotes an abstract idea, and an abstract term Mill would confine to denote an attribute of a single object, and to mean the opposite to concrete."'''

There are certain fallacies in regard to these two kinds of ideas which are very commonly met with, viz. : —

1. To attribute a real or objective existence to what is a mere abstract idea.

2. To confound the one kind of idea with the other. Though these are separable they may be conveniently considered together.

Exa'nples in illustration of the above fallacies. With the double view of illustrating the above statement by examples, and pointing out some of the errors which have prevailed, and obscured our present subject, I will select examples bearing on the Science of Mind.

1. The confusion arising from attributing an objedtive existence to an abstract idea.

This error is one abundantly discussed by writers of the positive school. Indeed, a just appreciation of what is a mere abstract idea is the distinguishing feature of this school of philosophy.

* The nietapbysical schools believed that that which we call an abstract really did correspond to a real object, whicli they named the essence; as Mill expresses it, they believed in the existence of real entities corresponding to general terms, for instance, they would believe in a certain general substauiive table. The Anbient Doctrine of Essences, vide Mill, vol. i,, \k 123.

Comte, in fact, points out that this tendency was a distinguishing mark of one era in the history of philosophy, for while in his first era man attributed the origin of all things to one, or Universal, maker; in the second, or metaphysical age of philosophy, everything was attributed to certain general agencies, as gravitation, vital force, &c., and which were viewed as real and existent agencies, or as actual entities.

But there is no difficulty in meeting with illustrations. The word " Mind " itself affords a good example, and we may conveniently give it precedence, for a proper conception of what the word really symbolizes is very necessary to the comprehension of what is to follow.

Mind. I prefer, in explaining errors that have commonly arisen with regard to the abstract idea, to make use of extracts from authors, as such illustrate and give authority to my own statements.

Dr. Maudsley writes* " with regard to the manifold mental phenomena by observation of them, and abstraction from the particular, we get the general conccpt.'o ), or essential idea of mind, an idea which has no more existence out of mind, than any other idea or general term. In virtue, however, of that powerful tendency in the human mind to make the reality conformable to the idea, a tendency which has been at the bottom of so much confusion in philosophy, the general conception has been converted into an objective entity, and allowed to tyrannize over the understanding — a metaphysical abstraction has been made into spiritual entity."

" The mind," says Mr. Lewes, (Problems, &c.,p. 216, vol. i.), " is commonly spoken of in oblivion of the fact that it is an abstract term expressing the sum of mental phenomena : as an abstraction it comes to be regarded in the light of an entity, or separate soui-ce of the phenomena which constitute it."

" By a similar illusion Ave come to regard the process of thinking apart from the product— thought; and, generalizing the process, we call it Mind or Intellect, Avhich then means no longer the phenomena condensed into a term, but the source of these phenomena."

When we speak of mental disease, or disorder of the mind ; • Maudsley'e Physiology and Pathology of Mind^ First Edition, p. 41.

terms wliicli are legitimate because they represent a general notion — it is not that we would intimate that Mind can be separated from body ; but that the body is diseased, and gives rise to alteration of those functions called mental or Mind.

Another abstract term which is often used in the same way is Life.

'■^ Life is often spoken of as something independent of Living." (Lewes, op. cit., p. 110).

" The analogy of Life and Mind is the closest of all analogies, • if indeed the latter is anything more than a special form of the former. Hence what is known of Life, is the best guide to what is knowable of Mind. Both are processes, or under another aspect functional products. Neither is a substance, neither is a force. To speak of Vitality as a substance would shock all our ideas — but many speak of it as a force. What then is meant by Vitality or vital forces ? If the abstraction be resolved into its concretes it will be seen that a certain process, or group of processes, is condensed into a simpler expression. VitaHty and Sensibility, Life and Consciousness, are abstractions having real concretes. These are compendious expressions of functional processes conceived in their totality and not at any single stage." (p. 111).

" Co-ordination, Mind, Life, are abstractions; they are realities in the sense of being drawn from real concretes ; but they are not realities existing apart from their concretes, otherwise than in our conception : and to seek their objective substratum we must seek the concrete objects of which they are the symbols."

The terms denote generalizations and express in a convenient and concise form a wide series of phenomena. But when they are taken to mean something distinct — standing over and directing as it were the functions or actions of the body as so many agents, they are grossly misapplied and lead to much confusion.

" Tke Ego.'' — The next mental product which I will mention is the Idea included in the term " Ego," or " the Ego." Much use has been made of this term, and it may be said to have played a foremost part in metaphysical discussion generally.

What is meant by the term is the subject, as when we say Ego sum, the sum is predicate of Ego, and the Ego is subject of the sum. The word therefore signifies one's self, while Bpeakiiig of one's mental functions — it, the Self — or the " I."

Now the term is used in two ways, and hence the confusion which has arisen in its employment. The error is the same as already pointed out with other ideas, or the confounding the concrete and the abstract ; for the word Ego, or I, is sometimes the symbol of a concrete idea and sometimes an abstract idea.

It is sometimes put merely as one element in a single reaction, in which case it refers also to a single increment of time, as in the expression "I am writing," " I am here," it is then the name of a concrete.

But it is also used, and perhaps more frequently — and especially when the words "the Ego" are employed — to represent an abstract idea, and as such it is not confined to the signifying of one increment of time, as in the following passage from Dr, Carpenter " the control which the Will can exert tends to render the Ego a free agent," or "the conscious Life of every individual man consists in an action and reaction between his mind and aU that is outside it, the Ego and the Non-Ego." In both these phrases the word is clearly employed as a general term to signify a persistent agent, or an agent acting throughout a life.

For illustration's sake, I may say, I know that I have existed 60 years and upwards, and consider myself to be the same individual tln'Oughout> though I have been changing during the whole of that time. When I use the term I, or speak of myself as the Ego — as an abstract term, I include myself throughout all these changes, and in using it in this sense it is a general term as much as any other already alluded to as Life and Mind— and in considering its effect in analysmg any particular act this must be borne in mind : for example, in the expression — I exist — the signification of these words may be either, that I am existing at the particular moment of time, or that I am in a continuous state of existence. As this Ego, or I, is usually one term in every mental analysis of ourselves, it is necessary to thoroughly appreciate its exact value in each proposition. Thus, in the expression "I am a free agent," this is certainly true if the "I" means the abstract condition of " Self," In the expression which Dr. Cai'penter quotes from Mr. H. G. Atkinson and Harriet Martiueau (and with obvious pain at the sentiment

MENTAL PRODUCTS. II

expressed) the Ego or I is used in its concrete sense, and as regards sevei-al distinct and separate acts : " Instinct, passion, thought," they write, "are effects of organised substances, all causes are material ciuses, I am what I am, a creature of necessity, &c., &c." What is true of these statements is this, that each individual concrete act of the individual is the resultant of the concrete Ego, at that particular time under the particular circumstances. The Ego is the concrete idea of the man only as he is at that one increment of time. It includes unseparated all his inclinations, convictions, desires, appetites, feelings, passions, and every other attribute to which a name has been given, and such an Ego, under such an influence gives rise of course to necessary results. If either of the two conditions vary, the result will also vary. But when the expression is used in the abstract sense, as the general condition of the individual and his inclinations, dispositions, &c., then, since the conditions are no longer the same, the result will be different. The proposition then becomes a different one, and the result is no longer predicated as necessary but only probable.

If the surroundings change, the Ego will not be the same Ego mentally. The Ego — the abstract Ego, is thus a changeable not a constant quantity, and the resultant will be a contingency and not necessary, the result changing with the change of the Ego ; the action so far depends on the Ego, that since the man and the Ego are one and the same, the man changes according to his own bent — according to his own inclination generally, and therefore must be said to act just as he chooses.

Sensation. — The next mental product which we have to consider is Sensation.

It will be first necessary to make some remarks as to the meaning of this term. The words sensory, sense, sensible, sensibility, sensational, have become so incorporated into conversational language, that a considerable ambiguity as to the proper application of the words sensation and sense, &c., has resulted. Thus a man has been called sensible, or a man of sense — or of common sense, in relation to his intellectual qualities, rather than his perception. A certain school of philosophy has been called sensual, because they placed a primary importance npon the functions of the senses ; and to the same word sensual has been given the meaning in common phraseology of grossness, immorality, &c. But the word sensation in mental science is entirely used to express the particular function of the different special senses — as Vision, Hearing, SmeUing, Feeling, Tasting, to which various authors would add certain other kinds which may be called organic, or those on which the emotions of appetite and desires seem to depend.

"With respect to the operation of the organs of Sensation, this difference in function may be pointed out, that the idea produced from the sensation is in some objective, and in others, more or less subjective. We attribute the effect produ.ced on ourselves through Vision, Hearing, Smelling and Tasting, to the qualities of the object. We attribute the qualities derived from touch and other organic sensations to ourselves — that is, subjectively, but ourselves considered objectively. Thus we do not imagine after an impression produced on our eye, that the object is near or close to the organ, but we refer it to a distance, and the same with the action of the auditory and olfactory senses — these are senses for distant perception ; there are other impressions — modifications of sensation from touch within the organism and called organic, and whicli are subjective.

Mr. Lewes writes : " When the mental phenomena are considered as wholly within the mind, they are Sensation, Emotion, Impulse. When passing out of the organism, they are Perception, Ideation, and Volition." {Problons, vol. i., p. 138, § 29).

In other words one is the passive and the other the active effect. A sensation thus limited is the impression produced on the organism by external objects, for a sensation to furnish an idea it must become a perception, '•■ in other words it must be a conscious act.

The question involuntarily arises then, what can sensation furnish, and what can it not furnish ? This has been the point on which the different schools have expended much argument ; this part of the question will be more in its place when we come to consider the mental processes, or the dynamics of mind : it may be pointed out, however, that by limiting the meaning of

• Dr. Ferrier {Fundinns of the Brain, p. 4'i) suffpests the use of the word sestbesis — for the sensation as above, and noesis — to signify a perception.

MENTAL PRODUCTS. I3

the ■word to its proper sphere, it will be evident to every one that all that the special senses can directly give us are material objects, and these in the concrete. No abstract notion can be an object of any of the special senses. We may see a man, but not mankind— a brave man, but not valour — a blue book, but not the abstract idea blue.