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from being actually cured, their troubles are alleviated, they are kept from growing worse, they are preserved in the ranks of the sane and the responsible, and pass through life in a manner not altogether unworthy of beings created in the image of Almighty God.
At what precise points the deficiencies of minds of this character become actual disease, or, in other words, where real insanity begins, it is often difficult, or even impossible, to define. Practically, the determination of the question is not generally of any importance; as the fact that a person is really insane is often very far from a proof that he is not fit to live at large among his fellow-creatures. There are persons who are perfectly sound in mind, to such an extent as to make them morally responsible both to God and man, and yet whose mental deficiencies are such as to require the constant superintendence and control of their connections. And there are others, on the contrary, who are so clearly afflicted with positive mental disease, that we can hardly conceive them to be morally responsible, and yet who may be very safely trusted to be their own masters in actual life.
Nevertheless, as we said at the outset of our remarks, a certain degree of scientific study of the forms and phenomena of mental incapacity in its various modifications, is a thing almost necessary for those who in any way are called to guide the actions of their fellow-creatures. Above all, we think that such a study must be of material advantage to our own clergy, called as they are to deal with the very subtlest motives of human action, and to heal the diseases of the soul in every possible variation of intensity and caprice.
Take, for instance, that extremely common affection of the mind which we term "scrupulosity.” Here is undoubtedly a peculiar phase of abnormal mental action, to which the strongest and healthiest minds are subject, and yet which is peculiarly apt to be found in a certain class of Righty or deficient minds; a complaint, on the right treatment of which the very progress of the spiritual life may be said to depend, yet most difficult to deal with, and whose origin it is often most difficult to discover. It is a complaint which may be intimately connected with disordered bodily health; or it may result from an actually diseased condition of the brain; or it may have no connection whatever with such causes, but be apparently a merciful infliction coming direct from the hand of God, as a means of humbling and sanctifying the soul. Yet, undeniably, scrupulosity is a mental infirmity, partaking in some slight degree of the nature of a mental complaint. The ordinary action of the reasoning faculties and of the feelings is disturbed. The sufferer—for this is hardly too strong a term to use—is positively unable to employ his faculties with the same vigour, decision, and clearness, which he can apply to every other subject. It is difficult, therefore, to exaggerate the importance of a judicious treatment of a mind thus troubled with an affection which in one case will make a man a saint, and in another will lodge him in a lunatic asylum.
There can be no perfectly satisfactory text-book, then, on mental disease, which is confined to the purely medical or metaphysical point of view. In estimating the effects of a diseased state of the brain, it is absolutely necessary to be well informed as to the operations of the Holy Ghost in the soul, and the phenomena of purely spiritual delusion of all kinds. To treat all mental complaints in a perfectly satisfactory manner, we must unite moral with mystical theology, and both of these with medical knowledge, good sense, and a certain capacity for metaphysical study. Dr. Noble's book now before us will, as we have said, well reward the study of those who wish to master the subject in its medical and metaphysical aspect. It is clear and comprehensible to the unprofessional reader, and bears the impress of thoroughly sound sense and good feeling, and of an unbiased mind.*
* We must take exception, however, to some few passages in which Dr. Noble shows that he is not free from the odium pharmacologicum-if we may coin a new phrase by way of counterpart to the old odium theologicum. Such a one we find at p. 208, in a chapter on the diagnosis of insanity. “How,” says Dr. Noble, « shall we discriminate between fantastic and extravagant convictions, and those delusive ideas which mark the presence of notional insanity? This question demands a few remarks in detail. A man of education and talent believes in clairvoyance, having confidence that mesmeric somnambulists can tell what is going on in distant regions, predict events, and see through opaque substances ; or an instructed physician holds that substances, inert unless taken in large quantities, will cure diseases if administered in doses of inconceivable, impossible minuteness. Are such persons deranged? And if not, why is an individual deemed to be so, who entertains the groundless conviction that he is under the surveillance of police, or that he is the anticipated victim of some hostile conspiracy; the mesmeric and homoeopathic convictions being much less rational?” Now we are not at all concerned to defend the mesmeric and the homeopathic theories ; but we are sure that the truth will not be ascertained by any such misrepresentation of them. What we wish to call Dr. Noble's attention to is this, that he is laying himself open to that identical accusation to which he considers the mesmerists and the homoeopathists are liable. Mesmerism does not pretend that a clairvoyant can
see through an opaque substance.” It asserts that the mind in the mesmeric sleep possesses a new faculty, having nothing to do with the organ of sight, and by which it becomes cognisant of the existence or appearance of the objects in question. The statement as to homoeopathy implies that its principle is, that a substance inert to cure diseases unless in a large quantity, will cure the same when taken in infinitesimal doses. Far from it; its principle is, that it will cure totally different diseases. A homoeopathist, in a cross humour, might fairly retort the accusation, and question Dr. Noble’s “notional sanity.” He might say, “How can an able and honourable man, and an instructed physician, so misrepresent an opponent's opinion, if he has the full use of his reason ? How can he be so irrational as to presume that he has ascertained the utmost extent of the
The following paragraphs will give an idea of its mode of describing the “ debatable ground" which lies between moral responsibility and irresponsibility:
“I must now touch upon a subject of considerable importance, which involves this inquiry : Does disordered emotion, dependent upon pathological states, of itself constitute insanity? and, further, Is an individual, under such circumstances, irresponsible for criminal acts ? Is there, in fact, a moral insanity without intellectual error, as taught by Esquirol, Prichard, and some others ?”
Dr. Noble then gives two remarkable instances, the first of the two being one which came under his own observation:
“ Mr. R., aged forty-one, of a sanguine nervous temperament, a married man, and father of several children, the youngest being but two months old, exhibited the following symptoms, first experienced in a slight degree five years prior to my seeing him, and having, since then, become much aggravated. There was partial paralysis of motion upon the left side, displaying under ordinary circumstances the customary phenomena; but there was this peculiarity, that, although volition was comparatively powerless, any external impression of an unusual character, by provoking, as it were, consensual or emotional reaction, would give effect to the voluntary intention. For example, when the affected arm was raised by another to a certain height, the patient by his will was unable to elevate it still more; but if the hand were smartly struck, or even blown upon, either by himself or by another, movement of a prompt character would at once ensue, and that, too, in conformity with the volitional effort. Upon further inquiry, it appeared that appropriate excitation of the emotional as well as the sensational sensibility was capable, in like manner, of leading to the realisation of an effort vainly made by the simple will ; thus, by accomplishing an incipient run, or trot, by aid of some emotional excitement, he could go on by voluntary effort. He stated, on the case being proposed, that if a hundred-pound note were suddenly placed before him, and he were told that on seizing it, he should have it as his own, he was sure that he should successfully grasp it, however paralysed he might be. Mr. R. stated that, when in health, he had divisibility of matter, and assert that the homoeopathic portion of a grain of calomel is an impossible quantity?” In another passage (p. 159) he calls the decillionth of a grain “practically an impossible, and philosophically an inconceivable, quan
An ill-natured adversary might illustrate his view of mental disease, by laughing at Dr. Noble for using certain words not in their right meanings ; saying “philosophically inconceivable” of a thing because of its smallness, when it is just as conceivable philosophically as a decillion of miles, or even of grains. The eye cannot perceive any thing so small as the decillionth of a grain, nor can it take in any thing so numerous or vast as a decillion of grains or miles. But both are as conceivable as a single grain or a ngle mile. As we have said, we have no vocation to defend or to attack homoeopathy; but, like every one else, we have an interest in seeing the principles of medical science discussed with perfect fairness.
VOL. IV, NEW SERIES,
excellent control over the emotions, but that now their influence was quite paramount, and that movements expressive of sensibility were provoked by the most trifling circumstance. On further questioning him, it appeared that in the matter of laughing and crying he exhibited habitually the hysterical condition. In early life Mr. R. had been what is called a free liver."
The second exemplifies the contrary state of things; the will and conscience remaining, and the affections being deadened. It is quoted from Dr. Reid's Essays on Nervous Affections :
"A curious and interesting case fell some time ago under my professional observation of a new species of paralysis, a palsy of the heart, a sudden congelation of the affections. Although by no means deficient in natural feeling, the patient could now, as she said, see without emotion every one of her family lying dead at her feet. She continued to be influenced by an anxiety to do what was right; almost the only sense, indeed, that seemed to be left to her was an abstract sense of duty."
On these and similar cases Dr. Noble remarks:
“ For deciding absolutely upon the degree of moral responsibility remaining in this class of cases, no general precepts can be laid down. I will adduce, however, certain facts and considerations which have a practical bearing upon the question, and which may aid in the formation of a judgment in dealing with particular instances.
“When disordered emotion is the consequence of changes purely pathological, accountability for actions, I presume, is lessened to the full extent of the conquest which morbid passion obtains over the will. Tuberculosis, and other such perversions of nutrition, affecting the encephalon ; certain inflammatory states, and vitiated blood; diseases of the viscera, and of the reproductive organs especially, acting sympathetically, will, any of them, under some circumstances, develop morbid states of the emotional sensibility. But in a great many instances there is almost insurmountable difficulty in determining whether such conditions have a physical or moral origin. And, as I have already remarked, there are persons who practically disregard the distinction, and who recognise all uncontrollable-or, indeed, uncontrolled - passion, as a species of insanity that acquits from responsibility. But let us consider this point a little more closely. Every crime has its source in some of the passions; these, immediately anterior to the overt act, may always be said, in a sense, to have mastered the will. But how often is this mastery a voluntary surrender? We will trace the several stages of a moral struggle. An idea starts up in the mind, such as is fitted by its nature for operating in a vicious sense upon feeling ; it may be a thought of lust, or of revenge. A very moderate exercise of the will may at once dissipate it. If it be retained, volun
tarily or permissively, in the consciousness, intense feeling---passion -originates an impulse to act; but passion, in its first stage, only solicits, and it is readily subdued by an earnest purpose.
The wicked thought returns, it is dwelt upon with complacency ; passion takes a higher degree, and all but exacts a surrender. Even in these circumstances, the will, vigorously exerted by just means, may effectually resist. But an individual lapses, and he relapses ; and, finally, vicious ideas voluntarily entertained, courted, and sought after, stimulate passion until it may be said to force its victim. But shall we always see insanity-moral insanity--in passion exalted to highest degree ? Ought not every one to be held accountable, not only for his vicious habits voluntarily initiated, but in great measure also for their well-understood consequences? Yes, even though amongst these latter some possible pathological change in the brain should have place.
“Whatever be the predominance of emotional disturbance in those instances which we feel compelled to regard as insanity, I feel myself convinced that perversion of ideas, more or less, is almost always its associate. Indeed, in the opinion of some writers, derangement of thought is always an essential feature. Certainly this latter characteristic will very often for long periods be without manifestation, so far as words go; but yet its existence be very reasonably inferred from some extravagance in the manner and conduct. The explanation sometimes comes out quite accidentally.
“ Although, in some of his later writings, Esquirol admits the occasional occurrence of emotional insanity without any unsoundness of intellect, he was unable to verify it to his own satisfaction for the greater part of his career. This is a fact sufficiently suggestive of the extreme rarity of such cases, when we consider the immense experience and the philosophical acumen of that distinguished ob
• Does there really exist,' says he,' a form of insanity in which patients who are attacked by it preserve their reason in its full integrity, whilst they abandon themselves to the most reprehensible conduct? Is there a pathological state in which a man is drawn irresistibly to an act repugnant to his conscience? I think not.
This last remark from the distinguished French physician is obviously of the highest importance both in the legal and the spiritual treatment of the really or the apparently insane. At the same time there cannot be any doubt that, in numerous cases of actual insanity, the same bewilderment of the reasoning powers must take place which accompanies scrupulosity, and certain other temptations in the minds of the very soundest characters. The physical condition of the body, or the incursion of ideas from without, sometimes throws the clearest judgment into a temporary puzzle, that very puzzle constituting the very force of the temptation, and requiring a more than