Insanity

Insanity. The term insanity as popularly understood is commonly held to include those forms of mental derangement which are accompanied by such loss of self-control as to constitute the patient a danger to himself or others, and to make it desirable that he should be subjected to some form of restraint. The term is not ordinarily held to include the delirium met with in fever, or as the result of alcohol, or hysterical conditions. The symptoms may be classified under three heads - sensory, motor, and intellectual. Under sensory symptoms hallucinations and illusions may be especially referred to. An illusion may be described as a perverted sense impression, while in hallucination sense impressions are created in the organs of sense apart from any actual exciting cause from without: the patient hears voices, sees objects, or detects odours, which have no existence outside his own consciousness. Among motor symptoms, conditions of spasm or paralysis may be present; in general paralysis of the insane, phenomena of the latter kind play an important part in the development of the disease. The symptoms of disturbance of intellect are very various; the despondency of melancholia and the restless excitement of mania, moral perversion, the existence of delusions, and suicidal or homicidal tendencies represent some of the most common kinds of mental alienation. The chief forms of insanity are as follows:

Melancholia. In this condition mental depression is the characteristic symptom; it is often associated with defective powers of digestion and sleeplessness; sensation is commonly impaired; hallucinations are often present. Delusions (possibly associated with ideas of religion) may occur, and a tendency to suicide is common. Melancholia attonita or melancholia with stupor is a peculiar variety of this form of insanity. Melancholia may end in recovery, or become chronic and finally pass into a condition of-dementia; it may precede or follow mania.

Mania. In mania there is excitement as opposed to the depression of melancholia. The patient is noisy and restless, his memory is usually very defective, and he often proceeds from one train of thought to another with that rapidity and aimlessness of transition which is characteristic of incoherence. There may be complete recovery from the condition, or the mania may become chronic, the patient chattering incessantly and his mental condition steadily degenerating. In some cases mania forms part of what is called folie circulaire, in which condition mania is succeeded by melancholia, which in its turn gives place to a further development of the maniacal condition, and so on.

Monomania. In monomania the characteristic symptom is the presence of fixed delusions, often relating to the exalted condition of the patient or to his being persecuted by imaginary foes.

Bcnientia is the condition of mindlessness to which all chronic forms of insanity gradually tend. It may be developed primarily and apart from the conditions of mania or melancholia. The characteristic symptom of dementia is the loss of mental and moral qualities rather than their perversion. There is marked loss of memory, the delusions developed in the primary attack of insanity often persist, and hallucinations are common. The weak-mindedness of idiocy and the manner in which it differs from dementia have been discussed under that head. [Idiocy.]

General paralysis of the insane is a form of insanity which stands quite apart from the other varieties; it is much more common in men than in women, and usually attacks subjects in the prime of life. Paralysis is a marked phenomenon, and is associated with tremor; speech is affected in a characteristic manner; the pupils are often unequal; and the patellar reflex may be lost. The mental symptoms often assume the form of what is known as grandiose delusion, the patient imagining himself to be possessed of certain qualities or attributes to a preposterously exaggerated degree. General paralysis is a disease which always proceeds from bad to worse; it usually runs its course in the space of about three years, and in its final stages the patient is reduced to a condition of complete helplessness.

Causes of Insanity. Among the predisposing causes of insanity the existence of an hereditary tendency to nervous instability is perhaps the most important. Nationality does not appear to play a very important part in the matter, and as regards sex there is no marked difference in the incidence of the disease on males and females. General paralysis, however, affects men far more frequently than women, while women are specially liable to develop insanity in connection with the period of child-bearing.

As regards exciting causes, intemperance, certain chronic forms of disease affecting the nervous system, and the association of attacks of insanity with pregnancy, labour, and lactation may be alluded to. Patients sometimes become insane during the period of convalescence from acute febrile diseases, and certain chronic affections such as phthisis have distinct relationships with insanity.

The treatment of insanity is directed mainly on the lines of securing quiet for the mind just as rest is enjoined in the case of an injured limb. Change of associations is often beneficial, and such restraint as may be necessary must be judiciously exercised. A great improvement has been brought about within recent years in the treatment of pauper lunatics; the victim of insanity is no longer regarded as a malefactor to be chastened into a return to normal conditions, but as a patient demanding systematic and scientific treatment.

A person for whom restraint is deemed necessary is placed under certificates - that is to say, he is certified to be insane by two medical men, and an order for his admission to an asylum is obtained. In cases where questions of the disposal of property are concerned, the much more elaborate procedure of an inquiry by a "Master in Lunacy" is resorted to.

The licensing and inspection of public and private asylums, control in matters relating to certificates of insanity, regulations concerning the admission of patients, etc., are vested in a body known as the Commissioners in Lunacy.