How To Care For The Insane Part 2

INSANITY; OR, DISEASE OF THE MIND.

In common language we speak of the mind diseased.

This is not strictly true, as it is the brain that is diseased and, in consequence, we get disturbed mental action.

Every person has individual characteristics. As no two faces are alike, so the mind, character, and manner of no two are alike, and it is by the manifestation of these, that each is known.

When a person becomes insane there is always a change from his natural way of thinking, feeling, and acting, due to disease of the brain. Sometimes the change is slight, or concealed by the patient, and is apparent only to near friends, or after a careful examination. Sometimes it is so great as to attract immediate attention, when it may present the features of raving madness, or of the most abject melancholy.

To ill.u.s.trate this change, we may suppose both a king and a pauper to become insane: there is, of course, a vast difference between them, but the king may be so changed by the disease as to believe that he is a pauper, and himself and his family starving, and he may also wish and even try to work and dig like a laborer to support them; or a pauper may think himself a king, and try to act like one. Such conditions show a _marked_ change in the manner of thinking, feeling, and acting, which involves diseased action of the intellect, the emotions, and the will.

Sometimes the appet.i.tes are also changed, or control over them is lost, and sometimes the moral nature is affected as well, sometimes a single faculty of the mind appears more disturbed than do others; it is, however, doubtful, or at least denied, that one faculty can show such disturbed mental action as to indicate insanity, and the rest of the mind appear perfectly healthy and normal. With the changes that have been spoken of, there is generally disturbances of the physical health, and often of a marked character. It must be remembered that mere oddity of appearance or eccentricity of conduct, however marked, if natural, do not of themselves const.i.tute signs of insanity.

_Some Mental Symptoms of Insanity._--There are some important mental symptoms which quite generally accompany insanity, and are found either alone or combined in the individual case. These are:

_a._ Delusions.

_b._ Hallucinations.

_c._ Illusions.

_d._ Incoherence of speech.

_Delusions_ are false beliefs. We think a belief in the religion of Mahomet is a delusion, but not an insane one. Insane delusions arise from disease of the brain, and are a part of those mental changes that appear during its progress. The king, who, under the influence of disease, thinks himself a pauper and that he and his family are starving, and the pauper, who thinks himself a king, with all the wealth and power of one, have each insane delusions.

Some delusions are fleeting and changeable, lasting a few days, weeks, or months, while others are fixed, lasting a lifetime; some are impossible and beyond rational belief, as when a man thinks himself Queen Victoria, or that his head is made of bra.s.s, or that he is dead, and yet sleeps and eats and talks; other delusions are possible, as when a king thinks himself a pauper, because such a thing may and even has happened, or when a pauper thinks himself a king, because people of very low degree have risen to such a station, but they are very improbable, and we do not expect such things among Americans, much less among our patients. Other delusions are not only possible, but relate to things that may or do happen, or are within the bounds of a rational belief, as that of a person who insists he has a cancer, or that he has committed the unpardonable sin, or that poverty is impending and the poorhouse not far off; or that of a woman that she has been violated, or that, when her child was sick she so neglected it, that it died. Such beliefs as these are delusions, when they have no other reason for their existence than that they are caused by disease.

Some delusions are called homicidal, suicidal, or dangerous, because they cause a patient to do, or want to do, acts that are dangerous to himself or others, or property.

_Hallucinations._--When a patient has hallucinations, he thinks he sees, hears, smells, tastes, or feels something, when there is really nothing to cause the sensations or ideas except diseased action of the brain; nothing being sent to the brain from any special organ of sense, he really sees, hears, smells, tastes, or feels nothing, it is all imagination, though seemingly very real.

For instance, a person thinks he hears a voice, perhaps that of G.o.d, or of some one who is dead, or of an absent friend, or thinks he sees these persons, when there is nothing external to the brain to excite the sensation or give the idea.

_Illusions._--When illusions are present, the mind fails to perceive correctly what the eye sees, or the ear hears, or the impressions that are brought to the brain from any of the organs of sense. For instance, a person looks at a row of trees, and they appear to him to be a row of soldiers; or the whistle of a locomotive may be so changed as to seem to be the voice of G.o.d; or the odor of a rose, burning sulphur; food may taste like poison, or the hand of a friend feel like a piece of ice or a red-hot iron, and is so believed to be. These are deceptions of the senses.

In insanity, the truth and existence of delusions, hallucinations, and illusions are fully believed in, and the patient cannot be argued out of the belief, however absurd or unreal it may be.

_Incoherence of Speech._--When a person is incoherent, he rambles in talk; there is little connection between different sentences, or the sentence itself is meaningless, being a mere jumble of words; sometimes ideas come too rapidly into the mind, and some new subject is begun and talked about before the first is finished; sometimes the mind is slow, and memory forgets what is being talked about.

_General States of Insanity._--There are a few general mental states in insanity, one of which being present gives the character and name to the disease. These are:

_a._ A state of exaltation of mind, or mania.

_b._ A state of depression of mind, or melancholia.

_c._ A state of enfeeblement of mind, or dementia.

But one of these first two states of feeling can be present at the same time, for a person cannot at any one moment be both exalted and depressed, though he have mania to day, and afterward be so changed in his feeling as to have melancholia to-morrow, or next week, or next month.

In a general way all disease is divided into acute and chronic forms. An acute disease is one of recent origin, and from which recovery is to be hoped for; a chronic disease is prolonged and does not tend to recovery; an acute disease may become chronic.

Mania and melancholia are at first considered acute and curable, but, if recovery does not take place, they pa.s.s into either chronic mania or chronic melancholia, or, if the mind is much enfeebled, into a condition of dementia.

_Mania._--In mania the mind is generally very active, though lacking in control, and is irregular and illogical in its action; the patient talks rapidly, and upon many subjects, and is often incoherent, or he laughs, sings, dances, or cries, perhaps in turn; he is often irritable and unreasonable, and perhaps threatening, and becomes more violent if interfered with.

Accompanying this mental excitement there is frequently persistent loss of sleep, constant restlessness, and great bodily activity, and indifference to or refusal of food. Sometimes the brain excitement is so great that all self-control is lost, and the patient becomes a raving maniac.

The delusions of mania are largely of grandeur and self-exaltation; the patient thinks himself in the best of health, and very strong, or of a superior mind, or, that he is a great singer, poet, actor, or preacher; perhaps, taking a higher flight, he thinks himself possessed of the wealth of Vanderbilt, or that he is the Pope, or the President, or even G.o.d himself.

Sometimes the excitement comes on in paroxysms, lasting a few days or weeks, with periods, more or less prolonged, of comparative mental quiet.

_Melancholia._--In melancholia the expression of the face often tells the character of the disease; the eyes are downcast, the lines of the face are lengthened, and the whole appearance is that of unhappiness.

In this form of insanity the patient may refuse to speak or interest himself in any thing, or he may moan, groan and cry, and walk back and forth wringing his hands; when he is quiet, the mind, however, may be very active and full of delusions, which occupy it to the exclusion of every thing, driving away sleep, and making him indifferent to the taking of food or attending to his most necessary wants; sometimes the patient talks a great deal, but always about his delusions, which are generally connected with himself, his family, or his affairs.

Melancholiacs are often tortured by fears, and, therefore, become frenzied and as wild and violent as in mania; or they may be very suspicious, thinking that some one is persecuting them, or poisoning their food, or following to kill them. On account of their delusions they frequently refuse food, they generally sleep poorly, and are often very suicidal.

_Dementia._--This form of insanity is most frequently the result of acute mania or melancholia, and comes after the force and intensity of the disease has spent itself, leaving the mind crippled and weakened. The perceptions are blunted and distorted, memory fails, the reasoning powers are weakened, the will has ceased to control, the emotions and appet.i.tes are dormant or changed, and the mind may become almost a blank, though in the narrow circle of thought there is left remains of delusions, illusions, and hallucinations. The patient is frequently careless of the ordinary necessities and decencies of life, and requires constant care.

There are degrees of dementia: it may be slight, partial, or nearly complete. During the first few months or years dementia often ends in recovery, but, as it continues, the case becomes more and more hopeless.

_Monomania._--This is a term belonging to common speech, but there is not an agreement of opinion as to the existence of such a special form of insanity, nor among those who believe in it, as to what it is and what are its symptoms.

Monomania really means an insanity with but one, or, at most, a small cla.s.s of delusions of the same character, the rest of the mind showing no disease. Hardly any one believes in the existence of such a narrow limit to insanity, and, getting beyond this point, there is no agreement where the limit should be set up to mark and bound it.

Some think there is a special insanity of the emotions only, and call it "emotional insanity." There is not an agreement of opinion as to what emotional insanity is; the idea seems to be that the emotions, or one of them, so overpower reason and will as to make the person irresponsible.

This condition is supposed to exist without disturbances of the intellectual faculties, and to be unaccompanied by delusions, hallucinations, or illusions. Others see in these cases no evidence of insanity; nothing but over-indulgence of the emotions, or a want of exercise of self-control, or an excuse for crime.

Some persons believe that the appet.i.tes over-indulged become morbid and produce disease of the nervous system, and as a consequence the reason and will are weakened in relation to this indulged appet.i.te, and the opinion is reached that it is a form of insanity. An indulged appet.i.te for drink is called dipsomania. Others believe that unless there are present the usual symptoms, a.s.sociated as they generally appear in insanity, these cases are nothing but unbridled appet.i.tes or vices.

_Moral Insanity._--There are those who claim that the moral nature alone may be diseased, and the persons in whom this occurs are said to lose the appreciation of right and wrong, or have an uncontrollable propensity to do some wrong act, and take a peculiar pleasure in so doing. Special names are given to these acts, according to their character, as "kleptomania, an impulse that prompts to steal"; or "pyromania, love of setting things on fire"; or "homicidal mania, an intense desire to kill." Other persons considering these cases and finding no delusions, or intellectual disturbances, or change in feeling, thinking, or acting due to disease, call the condition one of crime only.

These are difficult matters to understand, and those who make a life-study of insanity do not fully understand them, or agree together as to what they know. They are, however, terms of common speech, and it is well to have some idea of them, as it will add interest to the study of the patients under care and charge.

CHAPTER IV.

THE DUTIES OF AN ATTENDANT.

_What an Attendant Should First Learn._--The duties of an attendant upon the insane are varied, arduous, and exacting; they are a.s.sociated with irritations, perplexities, and anxieties, bring grave responsibilities, and call for the exercise of tact, judgment, and self-control.

These many duties are not quickly nor easily learned, and the new attendant must be willing to fill, at first, a minor position, to begin at the beginning and learn gradually all the details of ward work; he must acquire habits of caution and watchfulness, and learn in a general way the care of the insane, before he can a.s.sume a position of authority over other attendants, the control of a ward, and the responsibility of the direct care of patients.

This last duty is the most difficult of all, because it brings the attendant into intimate relations with a cla.s.s of persons, whose true appreciation of themselves, of their conditions and surroundings, is changed, whose thoughts and desires are unreasonable, whose conduct is unnatural, and who are largely controlled by insane delusions, hallucinations, and illusions.