Forms of insanity

by Richard Johnson

Forms of Insanity[i]

These are definitions used by the Commissioners in Lunacy (a government department responsible for the overseeing of mental health care in the 19th century).  Although dating from the 1840s, these definitions still appear in case books and post mortem books into the 1880s.I have tried to keep as much of the original language in place. I’ve kept the present tense. Note the acknowledged difficulties in diagnosis![ii]

I have also included a breakdown of ’causes’ of insanity of those admitted to asylums etc in 1878.

  1. Mania

Maniacs ‘cannot function in a calm and collected manner’ and this is generally detected in their conversation, their ‘absurd and irrational’ behaviour and general restlessness. When symptoms exist to an excessive degree, the disorder is termed Acute (or Raving) Mania. Acute Mania is the first stage of the disease, which often becomes gradually milder, and is then termed Chronic Mania, or simply Mania.

In other cases, high excitement or ‘raving’ continues throughout the whole course of the disease and sometimes becomes fatal through exhaustion caused by perpetual agitation and lack of rest.

Chronic Mania may not be immediately diagnosed but is betrayed by the patient’s incapacity for rational speech or self control. Most maniacs labour under illusions and hallucinations; but in these illusions there is no consistency or permanence. Patients are generally tranquil and harmless, and capable of being employed in ‘agricultural and other active pursuits’, and of amusing themselves by reading, music, and various entertaining games. Although quiet and manageable they are ‘quite unfit to be at large and mix with ordinary society’.

Intermittent Mania is attended by lucid intervals. Generally, after the alternations of raving fits and periods of relative calm have continued for some time, the intervals become less clearly marked, and the mind is found to be weakened and the intellectual faculties become more and more disordered.

Recurrent Insanity and Intermittent Mania are often confused. In Intermittent Mania paroxysms occur either after regular or irregular periods, and this is the ordinary character of the disease. Recurrent Insanity is a name applied to any mental disorder, when the patient recovers perfectly, but suffers relapses after considerable periods of time.

  1. Dementia

Dementia is the ‘decay and final obliteration of the mental faculties’ and is often the end result of Chronic and protracted Mania. In some forms, Dementia is the primary form of ‘mental derangement’ and its symptoms are the first onset of the disease. Cases of this kind are chiefly from ‘depressing’ causes such as a deep and overwhelming grief, extreme poverty, destitution and old age’. Where Dementia is the sequel of protracted Mania, it is not easy to determine when Mania ends and when Dementia begins.

  1. Melancholia

Those diagnosed with Melancholia comprise a considerable proportion of those in asylums. At its mildest, the patient experiences ‘merely lowness of spirit’ and exhibits no lack of understanding or other mental defect. This state often alternates with periods when the patient is buoyant and ‘morbidly’ active. It is frequently very difficult to determine in what degree Melancholy without delusions constitutes Insanity. ‘A great number of persons whose disorder is precisely that which is above described, and who betray no particular error of judgment or hallucination, are confined in lunatic asylums as a precaution against suicide, to which they are prone, in many instances, from ‘a disgust of life’.

Another class derive grief and despondency from some ‘unreal misfortune’ which they imagine to have befallen them. This class may believe they have lost all their money and are ‘utterly ruined’, or

that they are suffering from some physical disease. Many believe they have committed ‘unpardonable sins, and are doomed  to eternal perdition’.

  1. Monomania

Monomania, which is often misdiagnosed, is used to describe persons whose intellectual faculties are unimpaired, except with relation to some particular topic. A frequent illusion of Monomaniacs is, that they hold conversation with supernatural beings. It is only strictly Monomania if power of reasoning ‘correctly’ regarding other subjects is retained.

  1. Moral Insanity

Moral Insanity is where affections, sentiments, habits, and, generally speaking, the moral feelings of the mind, rather than the intellectual faculties, are in an unsound and disordered state. Understanding remains unimpaired and there is no apparent reason to account for the ‘moral perversion’. Cases were formerly seen as ‘unaccountable’ but are now recognised as a distinct form of mental disorder. They are characterized by a total lack of self-control and a propensity to excesses of various kinds, including intoxication. This is often followed by an attack of Mania, which can be ‘cured’ on confinement but will likely return upon release. ‘Among the female inmates…there are many whose disorder principally consists in moral perversions connected with hysterical or sexual excitement’.

 

  1. Congenital Idiocy.

Idiots are persons whose intellectual faculties have never been developed

  1. Congenital Imbecility.

Imbeciles are persons who, as a result of some original defect, are limited in operations of the mind. There are many degrees found in asylums and although many are persons labouring under this weakness in an extreme degree, it is evident that more discrimination ought to be used than has hitherto been practised in selecting from persons of this class proper objects for confinement.

  1. General Paralysis of the Insane (and other forms of Paralysis complicated with insanity)

General Paralysis is not infrequently complicated with Insanity, and is almost an invariable indication that the case is incurable and hopeless. In some instances, Insanity is the consequence of an attack of apoplexy, or of hemiplegia. This happens more especially in aged persons.

In others, apoplexy or paralysis supervenes on protracted Mania or Dementia.

The most strongly marked case of the complication of paralytic symptoms with those of mental disorder, is the disease termed General Paralysis of the Insane (GP). This is more properly to be considered as an affection distinct both from ordinary paralysis and from Insanity. The paralytic symptoms in this affection are sometimes observed to follow those of mental disturbances. GP seldom occurs in females, and is the result almost uniformly of a debauched and intemperate life. It has a short duration, at most three years, and is usually fatal.

Initial symptoms include speech defects such as mumbling or stuttering. In the second stage, patients will have difficulty walking and will experience increased feebleness. In the third stage, the patient loses both the power of locomotion, cannot feed himself and becomes incontinent.

The patient becomes weaker and emaciated but generally dies under some secondary disease such as gangrene, sloughing of the surface of the body or diarrhoea unless cut off at earlier period by apoplectic or epileptic attack, to which these patients are liable.

The disorder of the mind is peculiar in this affection. It is generally a species of Monomania, in which the individual affected fancies himself possessed of vast riches and power.

  1. Epilepsy

Epilepsy is often complicated with Insanity. ‘There are, however, some Epileptics in …asylums who are not insane, or in any way disordered in mind during the intervals of their paroxysms’. This is not

so much a problem with adults but ‘we have been informed that children, when they have become a source of anxiety and trouble as well as dangerous to themselves, have sometimes been sent…to asylums for protection’. Epileptics should be placed in wards by themselves, or at least separated from the Insane; but there are many asylums where this is not the case’.

Epileptic Idiots require greater care (than normal idiots), on account of the accidents to which this disease renders them liable. Epileptics who are imbecilic or demented, that is, when paroxysms are frequent and severe, and the disease is of long duration, have impaired intellectual faculties. Torpor, weakness, and imbecility come on, which, if the patient survives for many years, terminates in fatuity, similar in every respect to the fatuity which ensues in protracted Mania

Epileptic Mania – some persons subject to severe paroxysms of Epilepsy without suffering obliteration of their intellectual faculties and even without obvious disorder of the mind during the interval between paroxysms are nevertheless subject to occasional fits of a maniacal character. It has been observed in asylums that when Epileptic fits are coming on such persons are irritable, morose, malicious and sometimes exceedingly dangerous and often prone to acts of violence such as homicide, infanticide, suicide or arson. Another, rare, form of mental disorder displayed by Epileptics has the form of Acute Mania – sometimes immediately after it has ceased the patient is seized with sudden fury during which he sings, roars, shrieks, or resembles a man in a violent fit of intoxication.

 

  1. Delirium Tremens.

Some asylums mention Delirium Tremens as a form of Insanity but there are comparatively few cases in asylums. The disorder is well known and is the result of ‘intemperance’ and frequently follows on from a bout of intoxication. It is named from the muscular tremors and agitation, and the  the peculiar affection of the mind, resembles the delirium of fever rather than the phenomena of insanity. The disease is of long duration but terminates, in the most part, in a short period either in death or recovery.

 

Breakdown of identified causes of Insanity of those admitted to asylums, hospitals, licensed houses etc in 1878.[i]

 

All patients (male and female), except where specified (even if obvious!).

Moral domestic trouble (including bereavement) 911
  adverse circumstances (including financial difficulties) 703
  religious excitement 323
  love affairs (including seduction) 244
  fright and nervous shock 224
Physical intemperance (drink) 1951
  intemperance (sexual) 153 (94 male, 59 female)
  Venereal Disease 90 (61 male, 29 female)
  self-abuse (sexual) 173 (159 male, 14 female)
  puberty 52 (12 male, 40 female)
  change of life 248 (all female)
  pregnancy 78 (all female)
  childbirth 467 (all female)
  lactation 130 (all female)
  uterine and ovarian disorders 189 (all female)
  over-exertion 123
  sunstroke 177
  accident or injury 413
  fevers 102
  privation and starvation 212
  old age 510
  other bodily diseases/disorder 1350

[i]Lumley, W G, The New Lunacy Acts, Shaw & Sons, London 1845: Appendix pp221-226 [The Internet Archive]

[ii]William Sizer (see my previous blog entry) exhibited a classic symptom of General Paralysis but this is nowhere mentioned in his asylum record.

[iii]33rd Report of the Commissioners in Lunacy (1879) [Norwich Library]. For those of you who love statistics! As a sample on 1 January 1879 there were 69885 registered ‘lunatics and idiots, and persons of unsound mind’. Of these, 62107 (or almost 90%) were paupers and of these 38395 were in county or borough asylums, 1227 in hospitals or licensed houses, 250 in Broadmoor Criminal Lunatic Asylum, 16005 in workhouses and 6230 out-door paupers (ie, with relatives or friends). The principal establishments (for both pauper and non-pauper lunatics) in Norfolk were: the Norfolk County Asylum (554 patients), Norwich Borough Asylum (123), Heigham Hall, Norwich (80), Bethel Hospital, Norwich (79) and The Grove, Catton (13).