Library Collections: Document: Full Text

The fact was, Dr. Brigham was no novice when he went to Utica, but carried with him, not only quite superior natural endowments for the position he was to fill, but a ripened experience in all questions relating to insanity. We are not, however, left to surmise as to his opinion upon the subject at any period of his connection with that institution. In the very last report he wrote, he repeated his former opinion:

"We believe that moral causes are far more operative than physical in the production of insanity" -- and then added that, in his opinion, of the some sixteen hundred patients admitted to the asylum up to that time, whose history was known, less than two hundred of them could properly be attributed to physical causes.

His views, then, upon the subject of the efficiency of moral causes did not undergo a change under the light of experience, as is alleged in the paper. On the contrary, if we may believe his own words, he was only the more confirmed in his formerly-expressed views. The truth is, the change in the ratio of causes was not all the result, as it is expressed, "of the steady progress of medical knowledge deduced from patient investigation, intelligent observation, and careful analysis of facts." There were no such wonderful changes in these respects at the Utica Asylum, that should bring down the percentage of moral causes from 41 in 1849 to 26 in 1850, if that were the tendency under such conditions. The change was in the new theory of causation that came in with Dr. Brigham's successors.

As in all tables of a similar character, it must be conceded that this one is made up of part fact and part inference. Thus, while, in the last four years included in the table, all cases from moral causes have disappeared -- not one remaining -- yet, on consulting the records of the asylum upon which this table is based, I find that quite a percentage of the cases are put down as "from ill health produced by overwork, grief, anxiety, loss of sleep, and domestic trouble."

A patient is brought to this or any other asylum. The friends allege that the insanity came on as the result of injury of the head, meningitis, or other sufficient physical cause. It is so recorded in the case-book.

Another patient comes, and the friends of this one assign a different cause. It was from a sudden fright, excessive grief, long-continued anxiety, intense and protracted dwelling upon some especial train of thought, extreme religious excitement, or other moral cause. The superintendent, or person entering the case on the register, however, does not believe in the efficiency of moral causes in the production of insanity; there is, at all events, now, some physical disease associated with the mental disturbance or derangement, and he goes behind the statements of these friends or informants, and records the cause, ill health from domestic trouble, or ill health from religious excitement, or what not.

We have now to add, in a certain class of cases, another stage of the succession of phenomena in insanity, as given by Dr. Gray. First, a severe mental shock, followed by anxiety or grief; then disease of some part of the system outside the brain; then disease of the brain or some positive and pathological modification of the cerebral structure; and, finally, mental derangement. Interrupt this sequence anywhere short of the last feature, and no insanity occurs. But, every day in the year, in some individual, grief, severe care, domestic trouble, anxiety, or excessive mental labor, produces ill health, and the ill health results in some disease of vital organs, and there is also some cerebral disease ensuing; but no mental derangement follows; the person is not insane. In other words, mental derangement is only a symptom of insanity, according to this theory, and yet, if this particular symptom is not present, then there is no insanity.

I have dwelt thus long upon the tables, because they are made the foundation of the general argument of the papers Dr. Gray concedes that the weight of authority (at all events down to a recent period) seems to favor the opinion that the moral predominate over the physical causes in the production of insanity. These tables were offered as a refutation of such opinions; and, in part also, as showing that those who held the former views had themselves undergone a partial conversion to the theory he advocates, constrained by the logic of these and kindred facts.

He kindly apologizes for the mistaken notions of his predecessors, by the suggestion that it was owing to the fact that insanity was regarded as a moral state, a spiritual or demoniacal possession, and influenced by the moon. Many of the older medical authorities refer to and describe demonomania as a form of mental disease. The disinthralment of the professional as well as the public mind, on this subject, has been slow and gradual. However, we have similar ignorance and superstition in other fields of medical research."

The thought is, it will be observed, that these eminent alienists held erroneous ideas upon the subject of causation in insanity, because they were the victims of a lingering medical ignorance and superstition. In the case of one of them, however (Dr. Brigham), this cloud which overhung and obscured his mental horizon was gradually yielding to the rays of "experience and recorded facts."