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قراءة كتاب Observations on Insanity With Practical Remarks on the Disease and an Account of the Morbid Appearances on Dissection
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Observations on Insanity With Practical Remarks on the Disease and an Account of the Morbid Appearances on Dissection
granted, that imbecility of memory must create confusion, by obstructing the action of the other powers of the mind; and that if the judgment be impaired, a man must necessarily speak, and generally act, in a very incorrect and ridiculous manner.
Dr. Ferriar, whom, to mention otherwise than as a man of genius, of learning, and of taste, would be unjust; has adopted the generally accepted division of Insanity, into Mania and Melancholy. In Mania, he conceives “false perception, and consequently confusion of ideas, to be a leading circumstance.” The latter, he supposes to consist “in intensity of idea, which is a contrary state to false perception.” From the observations I have been able to make respecting Mania, I have by no means been led to conclude, that false perception, is a leading circumstance in this disorder, and still less, that confusion of ideas must be the necessary consequence of false perception.
By perception, I understand, with Mr. Locke, the apprehension of sensations; and after a very diligent enquiry of patients who have recovered from the disease, and from an attentive observation of those labouring under it, I have not frequently found, that insane people perceive falsely, the objects which have been presented to them. It is true, that they all have false ideas, but this by no means infers, a defect of the power by which sensations are apprehended in the mind.
We find madmen equally deranged upon those ideas, which they have been long in the possession of, and on which the perception has not been recently exercised, as respecting those, which they have lately received: and we frequently find those who become suddenly mad, talk incoherently upon every subject, and consequently, upon many, on which the perception has not been exercised for a considerable time.
It is well known, that maniacs often suppose they have seen, and heard those things, which really did not exist at the time; but even this I should not explain by any disability, or error of the perception, since it is by no means the province of the perception to represent unreal existences to the mind. It must therefore be sought elsewhere, probably in the senses, or in the imagination.
I have known eight cases of patients, who insisted that they had seen the devil. It might be urged, that in these instances, the perception was vitiated; but it must be observed, that there could be no perception of that, which was not present and existing at the time. Upon desiring these patients to describe what they had seen, they all represented him as a big, black man, with a long tail, cloven feet, and sharp talons, such as is seen pictured in books. A proof that the idea was revived in the mind from some former impressions. One of these patients however carried the matter a little further, as she solemnly declared, she heard him break the iron chain with which God had confined him, and saw him pass fleetly by her window, with a truss of straw upon his shoulder.
It must be acknowledged, that in the soundest state of our faculties we sometimes perceive things which do not exist. If the middle finger be crossed over the forefinger, and a single pea be rolled under their extremities, we have the perception of two. By immersing one hand into warm, the other into cold water, and afterwards suddenly plunging them both into the same fluid, of a medium temperature, we shall derive the sensations of heat, and cold from the same water, at the same time.
The power, by which the mind perceives its own creations and combinations is perhaps the same, as that by which it perceives the impressions on the senses from external objects. We possess the faculty of raising up of objects in the mind which we had seen before, and of prospects, on which we had formerly dwelt, with admiration and delight; and in the coolest state of our understanding we can even conceive that they lie before us. If the power which awakens these remembrances in a healthy state of intellect, should stir up distorted combinations in disease, they must necessarily be perceived; but their apprehension, by no means appears to imply a vitiated state of the faculty by which they are perceived. In fact, that which is represented to the mind, either by a defect or deception of the senses, or by the imagination, if it be sufficiently forcible and enduring, must necessarily be perceived.
That “confusion of ideas” should be the necessary consequence of false perception, is very difficult to admit. Perhaps much may depend, in the discussion of this point, on the various acceptations in which confusion of ideas may be understood.
It has often been observed that madmen, will frequently reason correctly from false premises, and the observation is certainly true: we have indeed occasion to notice the same thing in those of the soundest minds. It is very possible for the perception to be deceived in the occurrence of a thing, which, although it did not actually happen, yet was likely to take place; and which had frequently occurred before. The reception of this as a truth in the mind, if the power of deducing from it the proper inferences existed, could neither create confusion, nor irregularity of ideas.
Melancholy, the other form in which this disease is supposed to exist, is made by Dr. Ferriar to consist in “intensity of idea.” I shall shortly have an opportunity, in the definition I propose to give, of attempting to prove, that this division of Insanity, is neither natural nor just, upon the ground that the derangement is equally complete in both forms of the disease. We ought to attend more to the state of the intellect, than to the passions which accompany the disorder.
By intensity of idea, I presume is meant, that the mind is more strongly fixed on, or more frequently recurs to, a certain set of ideas, than when it is in a healthy state. But this definition applies equally to mania, for we every day see the most furious maniacs suddenly sink into a profound melancholy; and the most depressed, and miserable objects, become violent and raving. We have patients in Bethlem Hospital, whose lives are divided between furious, and melancholic paroxisms; and who, under both states, retain the same set of ideas.
Insanity may, in my opinion, be defined to be an incorrect association of familiar ideas, which is independent of the prejudices of education, and is always accompanied with implicit belief, and generally with either violent or depressing passions. It appears to me necessary, that the ideas incorrectly associated, should be familiar, because we can hardly be said to have our ideas deranged upon subjects, concerning which we have little or no information. A peasant, who had heard that superior comforts of life, with fewer exertions, were to be obtained by emigrating to America, might saddle his beast with an intention of riding thither on horse-back, without any other imputation than that of ignorance; but if an old and experienced navigator, were to propose a similar mode of conveyance, I should have little hesitation in concluding him insane.
Respecting the prejudices of education, it may be observed, that in our childhood, and before we are able to form a true, and accurate judgment of things, we have impressed upon our minds, a number of ideas which are ridiculous; but which were the received opinions of the place in which we then lived, and of the people who inculcated them; such is the belief in the powers of witchcraft, and in ghosts, and superstitions of every denomination, which grasp strongly upon the mind and seduce its