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CHAPTER I

Insanity

INSANITY is the name given to a collection of symptoms of disease of the brain or disorder of brain nutrition or circulation. The principal test of insanity lies in the adjustment of the patient to his surroundings, as evidenced in conduct and speech. Yet one must not include within the field of insanity the improper conduct and speech of the vicious, nor of the mentally defective. Crime is not insanity, though there are undoubtedly some insane people confined in prisons who have been arrested because of the commission of crime.

Then, too, while mental defect may exist in the insane, there is a certain class of mental defectives whose condition is due not to disease of the brain, but to arrest of development of the brain during childhood or youth, and these we call idiots or imbeciles; but they are not classed with the insane.

Mental Disorder Not Insanity

We frequently hear repeated the assertion, "Everybody is a little insane," and the quotation is reported as coming from an expert in insanity. This quotation is untrue. The fact is that anyone is liable to mental

disorder; but mental disorder is not insanity. To illustrate a green glove is shown to a certain man and he asserts that its color is brown, and you cannot prove to him that he is wrong, because he is color-blind. Green and brown appear alike to him. This is mental disorder, but not insanity. Again, a friend will explain to you how he can make a large profit by investing his money in a certain way. He does so invest it and loses it, because he has overlooked certain factors, has not given proper weight to certain influences, and has ignored probable occurrences, all of which were apparent to you. He was a victim of his mental disorder, his judgment, reason, and conception being faulty; yet he was not insane. Again, you answer a letter from a correspondent, copying on the envelope the address you read at the head of his letter. A few days later your answer is returned to you undelivered. In astonishment, you refer to his letter and find that you have misread the address he gave, mistaking the number of his house. This was an instance of mental disorder in your not reading the figure aright; but it was not insanity.

What Autopsies of the Brain Reveal

The changes in the brain accompanying or resulting from disease, as found in some chronic cases of insanity

⚫ in which autopsies are made, consist largely in alteration of the nerve cells of the brain. The cells are smaller and fewer than they should be, they are altered in shape,

and their threads of communication with other cells are broken. Nerve cells and often large areas of gray matter are replaced by connective tissue (resembling scar tissue), which grows and increases in what would otherwise be vacant spaces. All areas which contain this connective tissue, this filling which has no function, of course, cease to join with other parts of the brain in concerted action, and so the power of the brain is diminished, and certain of its activities are restricted or abolished.

Curious Illusions of the Insane

In the normal brain certain impressions are received from the special senses: impressions of sight or of hearing, for example. These impressions are called conscious perceptions, and the healthy brain groups them together and forms concepts. For instance, you see something which is flat and shiny with square-cut edges. You touch it, and learn that it is cold, smooth, and hard. Lift it and you find it heavy. Grouping together your sense perceptions you form the concept, and decide that the object is a piece of marble. Again, you enter a dimly lighted room and see a figure in a corner the height of a woman, with a gown like a woman's. You approach it, speak to it and get no reply, and you find you can walk directly through it, for it is a shadow. Perhaps you were frightened. Perhaps you imagined she was a thief. Your first judgment was wrong and you correct it. The insane person,

however, has defective mental processes. He cannot group together his perceptions and form proper conceptions. His imagination runs riot. His emotions of fear or anger are not easily limited. He has to some extent lost the control over his mental actions that you and other people possess if your brains are normal. The insane man will insist that there is a woman there, and not a shadow, and to his mind it is not absurd to walk directly through this person. He cannot correct the wrong idea. Such a wrongly interpreted sense perception is called an illusion. Another example of illusion is the mistaking the whistle of a locomotive for the shriek of a pursuing assassin.

What Hallucinations Are

The insane man may also suffer from hallucinations. A hallucination is a false perception arising without external sensory experience. In a hallucination of sight, the disease in the brain causes irritation to be carried to the sight-centers of the brain, with a result that is similar to the impression carried to the same centers by the optic nerves when light is reflected into the eyes from some object. An insane man may be deluded with the belief that he sees a face against the wall where there is nothing at all. When the air is pure and sweet and no odor is discoverable, he may smell feathers burning, and thus reveal his hallucination of smell.

Delusions Common to Insanity

The insane man may have wrong ideas without logical reason for them. Thus, an insane man may declare that a beautiful actress is in love with him, when there is absolutely no foundation for such an idea. Or, he may believe that he can lift 500 pounds and run faster than a locomotive can go, while in reality he is so feeble as scarcely to be able to walk, and unable to dress himself. Such ideas are delusions. Sane people may be mistaken; they may have hallucinations, illusions and delusions; but they abandon their mistaken notions and correct their judgment at once, on being shown their errors. Sane people see the force of logical argument, and act upon it, abandoning all irrational ideas. The insane person, on the other hand, cannot see the force of logical argument; cannot realize the absurdity or impossibility of error. He clings to his own beliefs, for the evidence of his perverted senses or the deductions from his diseaseirritation are very real to him. When we find this to be the fact we know he is insane.

Yet we must not confound delirium of fever with insanity. A patient suffering from typhoid fever may have a delusion that there is a pail by his bed into which he persists in throwing articles. Or he may have the hallucination that he is being called into the next room, and try to obey the supposed voice.

Certain delusions are commonly found in certain

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