THE
SYDENHAM SOCIETY
INSTITUTED
MDCCCXLIII
LONDON
MDCCCXr.VM.
f\
r
THE PRINCIPLES
OF
MEDICAL PSYCHOLOGY
BEING THE
OUTLINES OF A COURSE OF LECTURES
BY
BARON ERNST VON FEUCHTERSLEBEN, M.D.
(VIENNA, 1845)
TRANSLATED FROM THE GERMAN
BIT THE LATE
H. EVANS LLOYD, ESQ.
0 REVISED AND EDITED BY
B. G. BABINGTON, M.D. F.R.S.
ETC.
LONDON
PRINTED FOR THE SYDENHAM SOCIETY
MDCCCXLVII.
-RC
C. AND J. ADLABD, PRIXTKHS EAKTHul OH I
EDITOR'S PREFACE.
The following work on a subject of permanent interest and importance is remarkable for the clear and methodical arrange- ment of its matter, for its depth of erudition and research, and for the impartial and philosophical spirit in which it is written. It may even be said to possess no small share of novelty ; for many of the authorities cited being German, we are thus intro- duced to the views and opinions of writers with whom we are not familiar, in a department of medicine hitherto compara- tively little studied.
As a general rule, the Council of our Society is unwilling to present its members with works which have not received the stamp of public approbation. Newly published books, like newly discovered ores, may be rich or poor; but to test their value, they require that the stream of time should flow over them, which fails not to carry away what is light and worthless, and leave the sterling metal alone behind. I ventured to suggest a departure from our rule in the present instance on account of the great interest which medical psychology at this time excites ; and in justification of that suggestion I may state, first, that such was the avidity with which our author's pro- duction was sought at Vienna, that the publisher found it necessary to recall all those copies which had been distributed to the trade, in order to supply his own customers, a fact which I learned on endeavouring in vain to procure a dupli- cate copy for myself; and, secondly, that the author is no new
vi EDITOR'S PREFACE.
labourer in the field of medical literature, but is well known and of high reputation in his own country.
It may not be out of place if I here give so much of his history as is connected with his professional writings and official character. Baron Ernst von Feuchtersleben was born at Vienna in 1806. His father was a nobleman holding office under the Austrian government, and would easily have been able to give him the opportunity of pursuing a more brilliant career than medicine offers to its votaries, had not a love of independence, and a thirst for natural science, led him to make choice of our profession. He took his degree of Doctor of Physic at the University of Vienna, in 1833. In 18 K) he was chosen Secretary to the Imperial and Royal Society of Physi- cians, then just formed in that metropolis, and not long after turned his attention to the revival of the study of psychiatric medicine, at that time much neglected in the Austrian domi- nions. To this end he commenced a course of lectures on the subject, and had the satisfaction of finding, not only that he himself was borne out in his views, by obtaining general sup- port, but also that a new lunatic institution was forthwith planned and built in consequence of his exi it ions. Two years ago he had the honour of being elected Dean of the Faculty ;it Vienna, and in the Hamburgh Correspondent and other Ger- man newspapers of last mouth we find the following notice : "Baron von Feuchtersleben, Dean of the Medical Faculty at Vienna, Avho is well known as a profound literary character, has just received an autograph letter from his Majesty the Emperor of Austria, nominating him Vice-Director of Medical and Chirurgical studies at the University of that metropolis. This nomination has given the liveliest satisfaction, as beine a marked proof of the high sense entertained by the Emperor of the eminent qualifications of Baron Feuchtersleben." The Prussian States Gazette pays our author a still higher compli- ment by observing that "this is an appointment which, as fo
EDITOR'S PREFACE. mi
not often the case, has been generally acknowledged to be well deserved." His principal works having relation to medicine are as follows :
1. Doctrina de Indicationibus, perlustrata. Disscrtat. Inau-
gural. Vienna?, apud N. Beck, 1833.
2. Das erste Buch des Hippocrates von der Diajt. (7rept Sia/rrjg).
The First Book of Hippocrates on Diet, a Philosophico- archaeological Commentary. AVien, Gerold, 1835.
3. Zur Diaetetik der Seele. AVien, Gerold, 1838. On the Diete-
tics of the Mind. This is the author's most popular work, which last year reached a fourth and enlarged edition.
4. Die Gcwisshcit and Wurde der Ileilkunst fur das nicht-
aerztliche Publicum dargestellt. AVien, Gerold, 1839. The Certainty and A'alue of the Medical Art, addressed to the non-medical Public.
5. The present work. AVien, Gerold, 1846.
6. P. C. Hartmann's Pest- Rede vom Lebcn des Geistes mit
Erlauterung. AVien, Gerold, 1816. P. C. Hartmann's Anniversary Discourse on the Vitality of the Spirit, with a Commentary, being a generalisation of the work on its philosophical grounds.
7. Eble's Geschichte der Medicin, von 1800 bis 1825, ebeuda
1840. Eble's History of Medicine, from 1800 to 1825, likewise for 1840. Of this production he was publisher and editor. Eble was his personal friend, and charged him on his death-bed with the completion of the work.
8. As Secretary, he edited the Transactions of the Imperial
and Royal Society of Physicians at Vienna, from 1810 to 1811; and, in addition to these substantial proofs of his talents and devotion to science, he is the author of various other literary and scientific publications, to which, as they have no connexion with medicine, it is only necessary here to make general allusion.
viii EDITOR'S PREFACE.
Our Council having, after due deliberation, founded upon the usual examination and recommendation of a sub-com- mittee, adopted my suggestion that this work should be pre- sented to the Society, I offered to become responsible for the English version as its medical editor, with a proviso, which was readily acceded to, that I should be permitted to avail myself of the services of Mr. H. E. Lloyd in the translation. I was induced to make this proposal because I felt that I had neither leisure nor knowledge sufficient to undertake the task alone, and because I was well aware that, for a critical acquaintance with German literature, and with the niceties of the German language, I could find no oue more deservedly esteemed than the gentleman whom I have named.1 Both Mr. Lloyd and myself soon found that we had undertaken a more arduous task than we had anticipated ; and it is my earnest hope, as it was that of my late able coadjutor, that the difficulties which we experienced may not be apparent in the result of our labours. If our united efforts have not always proved adequate to render our author easy of comprehension, this depends in part, at least, on the abstruse nature of the subject. I would therefore entreat the reader not to set out with a supposition that this book can be estimated by a cursory perusal. Nay, I shall not consider him fairly entitled to criticise it, until he shall have given the whole his deliberate attention, re-studying every section to which the author, in elucidation of his subject, lias referred. I would further entreat him not to be discouraged or offended by the occasional occurrence of unusual words of clas-
1 Mr. Lloyd's numerous translations from the German language, his original productions in general literature, and his philological works for the Germans them- selves— at the present time text-hooks in several of their universities, hear ample testimony to his skill as a philologist and talents as a writer. Our Society had the benefit of his latest labours. My excellent friend, after several minor attacks which for some months much impaired his bodily strength, was seized with a fatal fit of apoplexy in July last, just as he had looked over a proof of the last sheet of the body of the present work.
EDITOR'S PREFACE. ix
sical derivation. Both authors and readers of scientific works in Germany are, I suspect, more generally familiar with the ancient languages than ourselves. It is true that our educated classes spend much time in youth upon their study ; but judging from their neglect in after life, from their disuse as a medium of scientific communication, and from their virtual abandonment by the examining bodies of our profession, it would seem that they are no longer considered by us as useful for any other purpose than to exercise the faculties of aristo- cratic schoolboys, or to test the comparative merits of candi- dates for university honours. Perhaps Ave may flatter ourselves with the notion that we are in this respect in advance of our Teutonic neighbours — that in the progress of civilisation we have advantageously exchanged ancient literature for practical science, and that the Germans do but now occupy the same position which we held a century ago. However problematical this explanation may be, if we grant the fact that they are generally better classics than ourselves, it will follow as a con- sequence that they are enabled to borrow from classical sources with a freedom which would with us be disallowed as pedantic, or condemned as unintelligible.
As the present work, however, ought the more especially to be easy of comprehension, because it was expressly intended by its author for students of psychological medicine " in a state of transition from theory to practice ;" and as, on this ground, I may presume that it will be read, not only by the members of our Society, but also by the pupils who are under their guidance, I have, in the " Index of Subjects," whore most of the classical terms of Greek origin employed in this volume are to be found, given an explanation of them, and inserted the Greek themes from which they are derived.
At the top of page 215 the author alludes to the passage which he is writing, as not being in the body of the work. This has reference to the circumstance, that here and there
x EDITOR'S PREFACE.
paragraphs are introduced in the original, which are printed in smaller type than the rest of the page, and seem to have been designed bv the author sometimes to mark more minute observations than the nature of outlines of lectures required, at others to serve as commentaries on the more general text. As all the paragraphs in question, however, are to be read, if at all, as an integral part of the book, and at the same time, it has not been thought of importance to preserve this difference of type at the sacrifice of uniformity in the appearance of the text.
In the 249th, and two following pages, the German word " Narrheit" has been translated " Fatuity." The word " Folly" was avoided from its being so generally used to signify rather a wilful disregard of propriety of conduct than an irre- sponsible state of mental aberration. Subsequent reflection, after the sixteenth sheet had gone to press, led to the belief, however, that the word " Folly," in its original and proper meaning, was the more correct interpretation of u Narrheit," and it has accordingly been so employed throughout the rest of the work.
I would in conclusion observe, that although in a general sense I approve of the doctrines set forth in this volume, and admire the talent and learning displayed in their elucidation, I by no means hold myself pledged to every dogma laid down or opinion promulgated. The reader, like myself, will form his own judgment ; and I may safely promise him, however he may differ from the author on particular points, that he will not rise from a careful study of his work without being stimu- lated to a useful exercise of reflection on its subject, or without being rewarded by an addition to his own knowledge of it.
November, 1847.
CONTENTS.
PAGK
Author's Preface . . . . . .1
Introduction. Subject; object; use; plan of the lectures ; their spirit and
method . . . . . . .7
CHAPTER I.
PRELIMINARY OBSERVATIONS.
Isolation of the doctrine ; spirit; matter in general ; relation to other doctrines ; foundations; sources; auxiliaries; results; difficulties; qualifications of the psychological physician . . . . * .13
CHAPTER II.
HISTORY.
Introduction ; division ; primitive ages ; characteristics ; history of health and
disease ; science and art ; results . . . .23
Antique period ; characteristics ; history of health and disease ; science ; art ; results. Plato ; Aristotle ; Eticurus ; Stoics ; art; Pythagoras ; Hippocrates ; Erasistratus ; Asclepiades ; sects ; Celsus ; Thes- salus of Tralles; Aret^eus ; C^elius Aurelianus ; Galen; results 2C
Middle ages. a. b. (characteristics) history of health and disease ; a. b. (Epidem.) Science, a, scholastic ; b, reformative ; Theophrast. Paracelsus ; Bacon of Verulam ; Des Cartes ; Spinoza ; Art, a, Avicenna ; Theophrast. Paracelsus; b, F. Plater ; Helmont, &c. ; Stahl ; residts . . . . . . .41
Modern times; characteristics; a. b. history of health and disease; science. a, Locke; French writers ; Leibnitz; Wolf; Kant; b, Fichte ; Schelling ; Hegel ; Herbart. Art, a, Stahl ; practitioners and others ; b, physiological aids ; Sommering ; Reil, and others. Mesme- rism ; craniology, Gall ; Physiognomy, Lavater ; journalism ; lunatic asylums, Pinel ; Chiarugi, &c. ; results . . . .49
Present state of psychiatrics ; somatic view (Friedreich) ; psychical view
(Heinroth) ; mixed view (Blumroder and others) : practice, results 68
XII
CONTENTS.
CHAPTER III.
PHYSIOLOGY.
1.
2. 3. 4. 5.
Methods (analytical, synthetical)
Fundamental notions ; facts of perception ; of consciousness Ego ; spirit, matter ; mind ; hody .
On the explanation of these relations Method, the separating, the combining, the true ; a, ideal ; b, real ; c
identical .••••• Recapitulation and more accurate determination of the limits of the doc trine of mental health, and of mental disease
r.\GE . 76 . ih.
. 77 . 70
80 82
7.
8.
9.
10.
11.
12. 13.
14. 15. 16. 17. 18. 19. 20. 21.
22. 23. 24.
25.
26.
27. 28. 29.
30.
In a physical point ofvirtr.
General corporeal sensation .....
The nervous system. It is a medium of conduction .
It conducts the sensation .....
To the brain ......
The ganglionic system, semi-conduction, hypothesis of these investigations ; retrospect; vegetative; cerebro-spinal syvtcin
Function of the nerves in sensation ; relation to the blood ; structure
Ccenacsthesis, or common sensation •. a, focus of generation ; b, phrenic focus ; c, solar plexus .....
Sympathetic nerve ......
More precise determination ; objects of the ccenrcsthesis
The senses, touch, or feeling ...
,, taste ••••••
,, smell ......
„ sight ......
,, hearing ......
Results (unity of the perceptions of sense ; inutility of assuming more senses ; vicarious offices of the senses) ....
The brain ......
Is the sensorium commune (notion ; no individual organ of it) .
Further confirmation (1-6); question of the consciousness of persons beheaded ......
Attention realises the image (rests on spontaneity, and this on conscious- ness) ; culminating point .....
Unity of consciousness is, 1, not to be accounted for by unity of the organ ; 2, there is no seat of the mind or soul ....
The supposition of an internal sense is useless (1-2) .
Obscure ideas (a, b) . . .
Further course of the inquiry; spontaneity in motion and sensation ; motion. Sensible and motor nerves ; reflex theory ; function of the nerves in motion .... ...
a, voluntary, b, involuntary motion; emotions; innervation; laughing; weeping .......
83 85
il). 86
ib. 88
91 92 ib. 93 94 95 96 98
99 100 104
105
107
108
109
ib.
112
114
CONTENTS. xiii
PAGE
31. Spontaneity in perception, in the common sensation, or coenaesthesis ;
feeling, taste, smell, sight, hearing ; general result . .117
32. Imagination (organ : sensorimn commune) ; further confirmation . 119
33. Memory ; its organ ; further confirmation ; process in the organ . 121
34. Laws of association . ... ib.
35. Attempt to explain them physiologically ; recollection . . 122
36. Fancy (general) ; is only relatively creative ; individualises (genius, &c),
harmonises the higher energies with sensation ; the lower energies with thought ; the sensations of individual men with those of others ; appears as the vegetative power of the mind (sympathy, antipathy) . . 123
37. Its effects upon the body (physiology) .... 125
38. Progress of the inquiry ; spontaneous limits of our task ; feeling ; will ;
(reasons for this division) ..... 126
39. Feeling ; scheme — pleasure ; displeasure (humour) ; next to the coenaes-
thesis or common sensation (psych.) self -feeling . . .130
40. Next to fancy, sympathy . . . . .132
41. Connected with it — ideal feelings .... ib.
42. Limits in this direction ; intellectual feelings; heightened in degree ; emo-
tions . . . - . . . ib.
43. Self-feeling (according to the scheme) ; rapture ; melancholy ; sympathy ;
participated joy ; compassion ; the ideal feelings ; enthusiasm ; disgust ; intellectual feeling ; rapture; despair; fanaticism ; repentance (moral) . 133
44. Effect on the body (physiological) ; in general ; in particular ; hope ; joy ;
hopelessness ; grief, &c. ..... 134
45. Desire ; scheme — love and hatred ; impulse . . . 136
46. Arising from self -feeling — self-love ; from sympathy — sociability; from the
ideal feeling — eccentricity ; from the intellectual feelings — love of research ib.
47. Passions (general observations); from self-love, from sociability, from
eccentricity, from love of research .... 138
48. Effect on the body (physiological) in general; in particular ; stages and
degrees ; love, anger ; relations to single organs reducible to individual organisation (transition) ..... 140
49. Differences between men, determined from within and from without ; limits
of our task (predominance of the psychical or somatic principle) ; tem- peraments (history of the notion) ; division, according as the principle is active; 1, with, and 2, without perseverance ; 3, passive with, and 4, without energy . . . . . .142
50. The sanguine, melancholic, choleric, phlegmatic temperaments ; with re-
ference to psychical and physical relations ; vitality of the nerves and blood ; fancy ; feeling ; emotion, passion . . . 144
51. The sexes; male, physico-psychical ; active temperament ; female, physico-
psychical ; passive temperament .... 145
52. a, races; b, nations ; c, occupations and conditions . . . 147
53. Individual differences : a, education ; b, natural faculties (hereditary quali-
ties) ; c, time of life ; a, childhood (sanguine) ; ft, youth (choleric) ; y, manhood (phlegmatic) ; 8, old age (melancholic) ; further observations, physico-psychical; d, habit ; e, idiosyncrisy (transition) . .119
xiv CONTENTS.
PAGE
54. Expression of the intellect through the corporeal organism: ^physio-
gnomy; principle; general remarks; for, against; a, hard, b, soft struc- tures. Observations: a, three divisions of the countenance ; b, harmony; e, assimilation from similar habits ; d, strength, elasticity, weakness ; e, emotions and passions ; f, nationality ; g, conditions of life, trades ; h, intellectual culture ; i, external co-operating circumstances ; admonition 153
55. Cranioscopy, principles (phrenology and cranioscopy) ; examination ;
maxims; result ...... 157
56. The question of freedom; the difference between metaphysical and psycho-
logical freedom ; threefold limitation (ethical, mechanical, organic) ; re- trospect of the whole ; result ; consciousness within personality ; objec- tion ; examples ; difficulties ; half-free conditions . . . 159
57. Sleep; causes (1-6); process (psycho-phys.) ; teleological ; affinity with
intoxication and vertigo . . . . .161
58. Dreaming ; explanation (from the preceding) ; obscure ideas ; no sleep
without dreaming ; impressions on the senses in dreaming ; teleological ; Lichtenberg's questions; my own observations ; individual world, and individuality of the dreamer ; children ; intellectuality . . 163
59. Intoxication; explanation; causes; 1, spirits; 2, narcotic substances;
3, psychical exaltation . . . . .167
60. Vertigo; origin; predisposition; causes; 1, impressions on the sight;
2, impressions on the hearing ; 3, emotions (fear) . . . 169
61. Remarks on dying; threefold causes or modes of death (w. Bichat) ;
(originating from the body) ; individual difference (originating from the mind); examples; immortality . . . .170
CHAPTER IV.
ETIOLOGY, SEMEIOLOGY.
62. Plan of division ; principles; connexion .... 173
63. Individual relations to the vitality of the blood . . . ib.
64. „ „ to the respiration . . . .177
65. „ „ to the functions of the skin . . .178
66. „ „ to the function of digestion . . .179
67. Sexual function; general observation; development; puberty; coition;
menstruation ; pregnancy ; child-bed ; climacteric period ; diseases ; ex- amples ....... 180
68. Individual structures of the body ; hypertrophy ; atrophy ; distortion ;
spleen, &c. ; examples ..... 182
69. To the nerves ; cosmical influence, &c. ; transition to pathological condi-
tions of the personality ; retrospect and further plan . . 183
70. Feeling ; general observations ; diseases arising from intense feelings of
desire ; diseases arising from intense feelings of unsatisfied desire ; nos- talgia . . . . . . .185
CONTENTS. x\
PAGE
71. Will; general observations ; pathological consequences (emotions preceding
and intermingled with the passions) ; habit, &c. ; disorders of vegetative life (description). Muscular action ; law of oscillation (trembling) . 188
72. Perception ; general observations ; action of the senses ; too much, too
little; unequal; imagination; too much, too little ; thought (its effect on the functions) ; examples, &c. . . . .190
73. Semeiotics ; retrospect from §§ 63-7 ; special signs ; amnesia ; dysmnesia ;
fear; moroseness; apathy ..... 193
74. Physico-psychical ; retrospect from §§ 70-2 ; special ; pathognomonics . 194
75. Of the skull ; small size ; large size ; conical form ; square form ; unsyrome-
trical ; of the countenance ; nervous connexion ; particulars ; Jadelot's three lines ...... 195
76. Transitory conditions ; sleep ; too little ; etiological import, semeiotic
import; too much ; etiological import, semeiotic import . . 196
77. Dreaming; etiological indication, semeiotic indication (medical interpreta-
tion of dreams) ; psychical, ethical . . . .197
78. Intoxication ; vertigo ; etiology, somatic, psychical ; semeiology, somatic,
psychical ...... 199
CHAPTER V.
PATHOLOGY.
79. Resuming the thread of our investigations, &c. ; the states of transition ;
further plan . . . . . .200
80. Sleep-walking (idio-somnambulism) ; phenomena (somatic, psychical) . 201
81. Explanation (connected with dreaming); is a more profound sleep, con-
trary to Hartmann's view ; conclusion ; not a more exalted, but a pathological state ...... 202
82. Causes ; predisposition (somatic, psychical) ; occasional causes (somatic,
psychical) ...... 204
83. Course; issue . . . • • -205
84. Idio-magnetism (as § 80); phenomena; 1st degree (somnambulism); 2d
degree (more profound sleep) ; 3d degree (exalted sleep, clairvoyance) ; dubious symptoms . . . • • . ib.
85. Explanation ; conclusion (as above) .... 207
86. Principal obstacles to the doctrine of magnetism : 1st, the teachers ; 2d,
neglect of the pathological element .... 209
87. Causes of idio-magnetism ; course; results . . . 210
88. Delirium (connected with vertigo and intoxication, definition) ; pheno-
mena (somatic, psychical); divisions: 1, fixed, vague; 2, mussitans, furibundum ; 3, cheerful ; extravagant (not to be divided according to the objects); 4, acute, chronic (psychical and somatic import) . 211
89. Explanation ...... 212
90. Is insanity identical with delirium ? .... 213
91. Causes . . . . • • -214
xvi CONTENTS.
PAGE
92. Further progress. States" of disease ; psycho-physical functions of the
ccenresthesis (division) ..... 215
93. Hyperesthesia ; phenomena ; causes .... ib.
94. Anaesthesia; phenomena; causes .... 216
95. Pseudaesthesia ; phantasms of the ccenaesthesis differ from the fixed idea ;
transition into the fixed idea ; examples ; causes . . • 217
96. Locally deranged ccensesthesis ; focus of generation . . 218
97. Satyriasis (as a state of transition) ; phenomena ; causes . • 219
98. Nymphomania ; phenomena ; causes (somatic, psychical) . . ib.
99. Phrenic focus ; solar plexus ; causes .... 221
100. Hypochondriasis ; definition (sine, cum materia); arising from morbid
attention, the ccenaesthesis being abnormally heightened ; phenomena ; somatic, psychical ; reflections .... 222
101. Causes; proximate; predisposing; occasional . . • 224
102. Course (combinations) ; excludes other diseases ; result . . 226
103. Hysteria ; definition ; phenomena . . . . ib.
104. Causes . . . . . . .228
105. Course; results ...... 229
106. Further course ; morbid state of the senses ; hyperaesthesis and anaesthesis;
illusions ; hallucinations (states of transition) . . . ib.
107. Illusions of sight, of hearing, of smell, of taste, of touch . . 230
108. Hallucinations of sight, deuteroscopy ; of hearing, of smell, of taste, of
touch ; visions ...... 231
109. Causes of illusions and hallucinations ; course and results . . 233
110. Attention : 1, overstrained (deep musing) ; 2, weakened ; 3, wrongly directed
(absence of mind) ...... 234
111. Causes (psychical) ...... 235
112. Course ; termination . . . . . ib.
113. Motion: 1, overstrained; 2, diminished (paralysis) ; 3, altered (cramp ;
convulsions) ; involuntary abnormal direction . . . 236
114. Causes; course; issue ..... ib.
115. Memory : 1, abnormally heightened; 2, weakened; destroyed (amnesia) ;
3, altered ; examples ; phantasms of the memory; 4, relatively diseased, 237
116. Causes ....... 238
117. Course ; terminations ..... 239
118. Fancy (last link of transition) ; heightened (even to the extent of being con-
founded with the ideal images presented by the external senses) ; depressed (altered so as to represent phantasms, seusu strictiori) ; other relations ib.
119. Causes ....... 210
120. Course and issue, immediately resulting in mental disorders ; fancy as the
root of . . . . . . .241
121. The so-called mental disorders ..... 243
122. Explanation: 1, compound conditions ; 2, diseased in several directions;
3, empirical personality ..... 244
123. Retrospect of the somatic, psychical, and mixed theories . . 246
124. Division ; on division in general ; divisions hitherto attempted ; all give
four principal forms : folly ; fixed delusion ; mania ; idiocy . 217
CONTENTS. xvii
PAGE
125. These divisions variously explained by a reference to the powers of the
mind ; the organism ; the temperaments ; the logical categories . 249
126. General pathological observations on psychoses : 1, local, general; 2, idio-
pathic, sympathetic ; 3, conformably with the subjectivity of the patient ; 4, epidemic, endemic, contagious (sympathetic). Geography of the psychoses 251
127. With respect to duration ; chronic ; acute ; stages (increase and decrease) ;
type ; remittent (raptus) ; issue ; relapse .... 254
128. Necroscopy in general ; its importance ; head; dimensions; bones; mem-
branes ; weight of the brain ; substance of the brain ; cavities of the brain ; structure of the brain ; cerebellum ; chemical nature of the brain ; medulla oblongata ; spinal marrow ; heart ; blood ; lungs ; stomach ; colon ; liver ; spleen ; gall-bladder ; additional remarks . . . 256
129. General pathogeny of the psychoses; internal; predisposing, occasional,
proximate causes ; hereditary nature ; psychical and physical tempera- ment ; sex ; age ; education (structure as an opposing force) ; employ- ment ; nationality ...... 260
130. Occasional causes ; psychical: 1, neglected culture ; 2, partial culture, espe-
cially of the fancy ; 3, emotions ; passions (illustration) ; civilisation (am- bition, love) ; physical : 1, cold and heat ; 2, atmospheric circumstances ; 3, wounds ; 4, poisons (spirit-drinking) ; 5, somatic diseases ; 6, the moon (?) ; complications ; proximate causes (in nervous vitality) ; (central); 1, reciprocal action of the blood and nerves ; 2, association ; abnormal (through isolation) ; thence the transitional neuroses which are their essence ...... 263
131. Natural description; folly or moria; synonymes ; whence proceeding;
description ...... 268
132. Varieties ; transitions ..... 273
133. Necroscopy ...... 274
134. The so-called proximate causes .... 275
135. Remote causes . . . . . . ib.
136. Course ....... 276
137. Fixed delusion; synonymes; whence proceeding; description . . ib.
138. Varieties (according to the objects) : 1, fixed delusion respecting per-
sonality (mania metamorphosis) ; 2, ambitious fixed delusion ; 3, religious fixed delusion (contrition, joyous ecstasy) ; 4, love-delusion (erotomania) ; 5, melancholy, strictiori sensu (thanatophobia, spleen) ; (mania erra- bunda, mania attonita) ; desire of knowledge . . . 279
139. Necroscopy ...... 283
140. The so-called proximate causes .... 284
141. Remote causes ; physical hallucination ; psychical fixed delusion . ib.
142. Course; examples; slow transition; change of the object (examp.) ; tran-
sition to folly ; idiocy ..... 287
143. Madness ; mania ; description ..... 289
144. Varieties; mania sine delirio; insane conduct; description; subdivision,
according to the objects ; pi/romania, pica gravidarum ; monomania of theft, of murder, and of suicide ; mania gravidarum, mania puerperarum ...... 292
xviii CONTENTS.
PAGE
145. Necroscopy .... • 294
146. The so-called proximate causes .... 295
147. Remote cause; disposition; excitement, psychical, physical; especially of
monomania ....•• 296
148. Course; acute; chronic; remittent, intermittent, complications ; results 299
149. Idiocy — synonymes; definitions; whence proceeding; description; lower
degree, stupidity ; higher degree (sensu strictiori) fatuitas, a total in- capacity for mental activity ; highest degree, cretinism (a variety) . 300
150. Cretinism: 1, goitre; growth; leucEcthiopia ; a deaf and dumb state with
idiocy ; phenomena ; description of a cretin . . . 302
151. Necroscopy; idiocy; cretinism; observation on the value and contradic-
tions ....... 305
152. The so-called proximate cause of the first and second degree of idiocy;
of cretinism ...... 307
153. Remote causes acting directly, indirectly ; cretinism . . ib.
154. Course; transitory; continued; results; cretinism; complications; its
power of excluding other diseases .... 309
155. Prognosis of the psychopathies in general ; statistics; criteria of curability 311
156. Leading points for the prognosis in general: 1, personality (tempera-
ment ; sex ; mode of life ; education ; age ; hereditary tendency) ; 2, causes (physical, psychical) ; 3, course and duration ; 4, complications ; 5, external circumstances . . . . .312
157. Leading points for the individual forms: folly; fixed delusion; mania;
idiocy (cretinism) ; review; complications; isolated prognostications . 314
158. Criteria of cure: 1, reflections on the previous conditions of curability;
2, consideration of the phenomena which precede cure ; 3, consideration
of the phenomena of restored health .... 316
CHAPTER VI.
THERAPEUTICS.
159. Task; plan; the psychopathic physician ; difficulties . . 319
100. Division of remedies ..... 320
161. Remedies applied through the senses; general; how they act; touch;
taste; smell; sight; light; darkness; colour; hearing; noise; silence; music ....... 321
162. Remedies through the attention: 1, diversion (object, means); maxims
(a-f); 2, concentration of attention (object, means); a, order; b, em- ployment ; 3, the awakening of obscure ideas, and repressing such as are too predominant ...... 323
163. Remedies through the memory; according to the laws of association;
practice ; objects ; maxims. ..... 325
164. Remedies through the fancy (general) ; effects of art; phenomena, &c. . 326
165. Remedies acting through the understanding; direct instruction; general
culture ; psychogogics (maxims) .... 327
CONTENTS. xix
PAGE
106. Remedies through the feeling (general); pleasure, displeasure; rewards and punishments ; maxims (1-5); object of discipline ; means; different individual feelings may be employed ; emotions . . . 328
167. Remedies through the will (general); love; hatred; desire; aversion;
paralysed will ; exalted will ; constraint ; the several impulses . 332
168. Physico-psychical remedies; in relation to — 1, mental action itself; a,
exercise ; b, lowering treatment ; c, alteratives, derivatives ; d, stimu- lants {note), transfusion; 2, with respect to diseases as causes; 3, to diseases as accompanying psychopathies . . . 334
1 69. Mixed remedies ; animal magnetism ; its therapeutic import ; mode of
application; 1, physical manipulation; 2, psychical rapport . . 336
170. Objects of its application: 1, to calm; 2, to excite the nervous system
(metasyncritical) ; 3, to obtain prescriptions by clairvoyance ; when ? in middle states ; how ? as a middle state ; wherein does the efficacy con- sist ? misuse ; mode of inquiry .... 338
171. Treatment of mental diseases; causes; forms; convalescence; prophylactics
(physical, psychical) ; dietetics of the mind (notion, means) ; self-know- ledge ; self-command (maxims for the feeling, will, and understanding) 340
172. Cure of the different forms; folly; in general, according to the several
psychical symptoms ; somatic ; causal states (general nervous erethism) ; complications ...... 343
173. Fixed delusion (general obs.) ; negative; positive; particular varieties;
somatic ; caused by abdominal disorders accompanying it ; disease of the heart; in the erotic kind, sexual, conditions, causal or consecutive . 345
174. Mania (general obs.); constraint : 1, mischievous conduct must be checked
as a matter of policy ; 2, treatment in and out of the fits ; 3, degrees of mania : 1, coercive remedies (psychical or physical) ; a, which check the motion ; b, which shock the nervous system ; c, which cause pain ; d, which act as alteratives ; 2, during the fit, mostly negative ; out of the fit (psychical, physical), somatic (irritation of the brain) ; bloodletting ; suppressed secretions, &c. ..... 349
175. Idiocy (general obs.) ; degrees (psychical, physical) ; cretinism . 354
176. Treatment of convalescence ; prevention of relapses . . 355
177. Maxims respecting intercourse with lunatics . . . 356
178. Public institutions, preferable to private treatment; advantages above pri-
vate institutions : 1, isolation; change of situation ; 2, discipline; 3, the institution itself is a remedy ; disadvantages of public institutions are avoidable ...... 359
179. The lunatic asylum ; situation; extent; style of building; garden . 361
180. Internal organization; division: 1. Three plans; 1, absolute separation;
2, absolute union ; 3, relative union, combining an hospital and infirmary. 2. Separation of the sexes. 3. Form and degree of diseases ; states ; (cretinism) ...... 363
181. Arrangement; apartments; windows; doors; floors; dress, &c. . 364
182. Direction and administration; admission; visiting; secrecy; officials;
superintending physician; director; sub-physicians; clergyman; atten- dants ; question of the connexion of clinical instruction with the insti- tution ....... 365
xx CONTENTS.
APPENDIX.
FORENSIC PSYCHOLOGY.
PAGE
183. Object of the application of all science and research, including therefore
medico-psychological doctrines, to judicial objects ; questions . 369
184. Is the physician competent to determine psychological responsibility ? . ib.
185. What constitutes the principle of responsibility ? . . .371
186. Half-free conditions (?) the states of transition do not alter the principle
of responsibility, but modify the punishment ; or render superintendence necessary (intoxication, hypochondriasis, anaesthesia, amnesia, somnam- bulism, &c.) ; application difficult .... 372
187. In actual psychopathy: a, lucid intervals ; b, fixed ideas ; c, mania without
delirium; difficulties in concrete cases . . . .373
188. Investigation of the existence of psychopathies ; diagnostics; the inquiry
how to be made ; examination of lunatic patients ; some rules ; records
of attitudes and gesticidations ; medical reports . . . 374
189. Examination of dissimulated and simulated states; discovery of the dissi-
mulated; unmasking of the simulated . . . . 37o
190. Conclusion; state of literature . . . 378
List of fundamental works in the principal departments of medical psychology . 379 Index of Subjects ... . 383
Index of Names . . . . . • . 389
ERRATA.
Page 81, line 31, for 11 read 16.
92, !t at.d 22, for cerebellum read pituitary •
140, 39, insert i 48.
144, 17, omit
223, 4, for normally read i isly.
249, 35, for Munich read i...
AUTHOR'S PREFACE.
Instead of the allurements which usually abound in a Preface, I will only premise a few words for the purpose of pointing out the light in which this work should be viewed, in order that it may be properly understood.
The primary object contemplated by me has been to write a Compendium for a limited class of readers — Medical Students in a state of transition from theory to practice.
The chief aim of a compendium, in any branch of science, should be to furnish the pupil with its elements and funda- mental principles as his guide; with the existing materials, critically selected, as his subject; and, with the whole duly confined within its proper limits, as matter for consideration.
The leading principles of such a compendium, enable the pupil to ascertain his exact position in the new territory ; they are designed to qualify him to explore for himself, and to make further advances in knowledge, to conduct him on the first stages of the road he has to travel, merely noting the most important of those which are more remote, and to point out to him the distant goal. It is not the office of the pre- ceptor to perform the journey in his stead ; the elements are sketched out, but the details must be supplied by oral instruction, and by the reading, experience, and reflection of the pupil himself. These principles must be free from the im- press of any particular school, and agreeable to the dictates of a sound and cultivated understanding ; and they must con- form, as closely as possible, to those on which other branches
1
2 AUTHOR'S PREFACE.
of the science (in this instance Medicine) are imparted to the pupil, in order that there may be no incongruity in his educa- tion. It is a hazardous attempt for a preceptor to develop his own individual views in a compendium. If he consider this incumbent upon him as a duty which he owes to science, he must at all events be most scrupulous and cautious in stating them. Generally speaking it is a sign of ignorance to allege, as a reproach to the author of such a work, that " he gives a compilation of existing opinions, and perhaps some of the arguments in their support, while he leaves the unfortunate pupil in uncertainty as to the views which he shall adopt." This uncertainty is in truth greatly to the ad- vantage of the pupil, for it is a guarantee to him that further research is possible. "Where all the arguments in a scientific in- vestigation are exhausted, the preceptor should state the result ; but where they are not, he should modestly and impartially represent to the pupil the progress that has hitherto been made, and not, by prematurely teaching hypotheses, increase and perpetuate error and confusion. "Where, however, he feels himself called upon to decide a point, he should proceed accord- ing to the admirable advice of Goethe : " Let the inquirer consider himself as one summoned to sit upon a jury. His part is merely to see how far the indictment is borne out by the evidence." The preceptor therefore should judiciously compile what has been clearly established by the labours of his predecessors : he should use their own expressions, when there is no good reason for changing them ; and never fail to point out what belongs to each as a matter of history. He should be original where he considers it necessary ; and not promise to solve doubts, but explain them where it is requisite. If I might claim credit for anything in these lectures, it would be for the frequent repetition of the expression " This is undecided," and perhaps I might have introduced it with advantage still more frequently.
AUTHOR'S PREFACE. 3
The existing materials carefully sifted, should form the foundations of the doctrine which is to be propounded; and here much judgment is indispensable to discriminate between the essential and the accessory, the important and the insigni- ficant, and to avoid oppressing and overwhelming the pupil by a superabundance of matter. The preceptor should give him as much information as possible in the smallest compass ; non multa, sed multum. Problems must be laid before him as such. Truth and distinctness of object are here of primary importance ; while here also, it is as prejudicial as it is ridicu- lous, to pretend to originality in a compendium. Nothing could be easier than to do so — it would only be to form a so-called new system out of old materials, and this merely by using new terms and a new arrangement — it would only be to draw on the imagination, that is (in science) to falsify. Originality in a compendium, is as absurd as a strict adherence to system is in a science founded on practical experience. Can we be original in teaching a youth geography ? Why, yes, if we choose to multiply the fictions of travellers. Let the judi- cious preceptor be content with truth instead of novelty ; let his merit consist in the selection and arrangement of his materials, and in the connexion and clearness of his style ; let him not promise to fill up all the blanks of his science, but only to point them out; and his pupil will be more indebted to him than if he veiled them in hypothetical fables. How many entertaining stories might, for instance, be introduced here of the consentient, antagonist, organo-chemical, electro-magnetic, &c, actions of the nerves, and of the fanciful notions connected with each. Be it mv humble merit not to have related them.
Lastly, the form and extent of the work must be determined by the comprehensiveness of its plan. All branches of human research and knowledge are naturally blended with each other. Whatever be the science under consideration, if we intend to give a complete view of it, we cannot avoid treating of what is
4 AUTHOR'S PREFACE.
partially discussed in other departments. This is especially the case with a subject which has hitherto been scarcely treated independently, and the individual parts of which have been occasionally handled in examining other collateral branches. The question here is to give to every division that which appertains to it, and each must be so arranged as to afford a clear scientific view.
This is my idea of the light in which a compendium should be considered ; whether I have applied these principles to my own essay, must, of course, be left to the judgment of the reader, and especially of one who has himself studied the same subject.
He will form a just estimate when he compares the plan with the performance, and bears in mind that what I have written was intended to form the basis of a course of lectures. The work is a mere skeleton, to which svmmetrv and vitality must be imparted by viva voce instruction ; indeed the language throughout bears evident traces of this colloquial style, which I have not endeavoured to obliterate, and I therefore beg that the whole may be considered as an outline only of my lectures, which remains to be filled up by future labours.
The treatment of that branch of medicine, the principles of which are sketched in the following work, is alike important and difficult ; and the endeavours of an individual can at most only fix the limits and the direction of the whole. The united labours of many must be added to fill up, to correct, to con- tinue, and to complete what he has begun. Germany is the country of all others where, from a combination of the ample results of experience, with profound thought and indefatigable diligence, we may hope for the success of such united labours.
It has become the fashion whenever conversation turns on these subjects, or whenever a work on mental diseases is brought under consideration, to lament with affected humility that these studies are unfortunately too much neglected, and
AUTHOR'S PREFACE. 5
that we are consequently in comparative ignorance of them. These complaints have become so trite that this fashion, like every other, must go out, because it is antiquated and unsuit- able to the present times. Sheer ignorance of many excellent works, which have appeared of late on this subject, or the in- ability duly to appreciate their value, can alone lead to the renewal of such complaints. Every science has its peculiar difficulties. It may be affirmed that this branch, considering its obscurity, has advanced with as much activity as others ; nay, even during the short time that these sheets have been going through the press, much has arisen which demands further at- tention. Instead therefore of lamenting that we know so little, let us rather seek to profit by what others have gained, and use our best endeavours to add, however gradually, further acquisitions of our own.
F.
1844.
INTRODUCTION.
Before entering upon these lectures I feel it incumbent on me to explain their subject, object, and advantage, as well as the manner in which I intend to treat them.
The title, ' Medical Psychology/ has not been adopted without mature consideration. It expresses neither more nor less than it ought, and it shall be my business to develop all that this title comprehends, and to exclude, as foreign to our purpose, all that it does not comprise.
If we consider the science of medicine in general, and especially its present state, there is perhaps nothing so essen- tial to its advancement as psychology, carefully adapted to medical purposes. The study of psychology in itself, both the rational and the empirical, forms a portion of the study of philosophy, in which no regard is, or can be had to the special requirements of the physician. In the study of medicine, the psychical element is almost obscured by the abundance and prominence of the somatic portion, and its claims to attention » are more imperatively felt, when we come to the study of psychiatrics proper — the doctrine of the diseases of the mind, — to the treatment of which few young physicians turn their attention; and one of the principal objects of these lec- tures is to encourage and qualify them for this branch of their profession. It is owing to this preponderance of the somatic, that such an important, fundamental doctrine of medical study has been far less attended to than its importance demands. According to Hartmann, who was indisputably the most learned of medical psychologists, and whose memory it will ever be the pride of our University to cherish, the reason of this neglect, is the fact that philosophers by profession are no phy- sicians, and on the other hand that physicians are seldom
8 INTRODUCTION.
enough of philosophers to handle this subject successfully. Everything that can serve to effect this union of characters for medical purposes is a part of our object. The boundaries of our doctrine are, on the one side, philosophy, — in the stricter meaning of the word, metaphysics and ethics, which we only take for granted, but whose domain we dare not encroach upon any further than to mark its confines j aud on the other side, practical medicine, for one branch of which it is our intention to prepare you. The whole of our subject, therefore, bears the same relation to psychiatrics proper, as what we call theoretical medicine does to clinical medicine, by which comparison the scope, and even the divisions of the subject to be illustrated in the sequel will be clearly understood.
Hence too the subject of these lectures explains itself, namely, to form psychological physicians. It is superfluous to demonstrate that such a course of instruction as is here con- templated is indispensable not only to the psychiatric prac- titioner in lunatic asylums, but to physicians in general, every one of whom ought to have a clear view of the relations of the body to the mind. Nay this is so obvious, that even the un- professional public express their sense of this necessity by designating an able physician as a thinking, psychological physician.
The advantage of these studies is comprised in their object, but they are also the source of some secondary benefits. The i study of medicine has been branded with the reproach that it favours a disposition to materialism, that is, to a view which denies the independent rights of the mind; and our age, especially with regard to medicine, has been taxed with favour- ing this tendency. The first of these reproaches is unjust. No one has more occasion than the physician, to recognise the power of mind and the perishable nature of matter ; and if he do not attain to this recognition, the fault is not in the science, but in himself, in not having thoroughly studied it, for here, we may say as Bacon did of philosophy, " when super- ficially studied it excites doubt, when thoroughly explored it dispels it."
The second reproach regarding our age is perhaps not quite so ill-founded: the extraordinary advance of experimental science, has directed attention only to what is perceptible to
INTRODUCTION. 9
the senses, and the errors of speculation, which have been but lately surmounted, have verified the good old proverb, " ex- tremes meet." On this subject I am of opinion that in the domain of physiology the empirical mode of inquiry, whether by chemical reagents, by the microscope, or by physical aids, can never be prosecuted too zealously, because it has definite limits ; whereas the too early determination of these limits by intellectual powers checks the possibility of further research. Be this as it may, the two above-mentioned reproaches can never be so honorably and triumphantly controverted, as by the diligent cultivation of the psychological branch of our science ; and in fact, if we find that, in some instances, too exclusive a regard is paid to material changes in diseases, the more earnest attention, which is beginning again to be directed to psychiatrics, especially in Germany, proves, on the other hand, that the necessity of which we have spoken is felt and acknowledged. As, however, we have not to treat merely of mental disorders, separately considered, we may be permitted to show more in detail the importance of the doctrines which we have to expound to the general physician ; though, as we cannot here anticipate, their value will not be completely under- stood till after they have been fully developed.
The idea of an organism in general consists in this, that it can only be understood teleologically, that is, with reference to an object to which all the parts are subservient; while the idea of the human organism in particular, can be duly comprehended only in relation to the higher destination of man and his spi- ritual nature. Even his material nature is not wholly material; his very organisation is calculated for his higher destination ; and, it may be affirmed, that not only the philosopher but the naturalist, if he would duly understand the physical nature of man, must be strongly impressed with this truth, the evidence of which will appear in the course of the followiug observations. What is meant by understanding but translating into ideas? and the idea belongs to the mind. This notion is applicable to theory, with reference to refined physiology. Therapeutics make its utility much more evident with reference to practice. Body and mind are most intimately blended in every part of the structure of the living individual ; and as the disorders of the mind are often removed by pharmaceutical remedies, so,
10 INTRODUCTION.
on the other hand, the diseases of the body as frequently re- quire the aid of the psychological physician. In disorders of the nerves especially, the physician can often effect nothing, if he do not in the first place direct his treatment to the mind. The numerous varying symptoms which, under the name of spasms, act so conspicuous a part in pathology, and unhap- pily a still more conspicuous part in real life, are often re- moved most successfully and effectually by judiciously directing, controlling, and taking advantage of the state of the mind ; and how few disorders are there of any organic system in which the nerves do not at least symptomatically suffer. "VVe see, therefore, how extensive is the application of psychical methods of cure throughout the whole domain of the healing art. Numerous examples in proof of what has been advanced may be found in the writings of psychological physicians, and especially in the admirable work of Marcus Herz, on e Vertigo' (1791, pp. 6-22) ; but our present business is only to poiut out the use of psychological medicine in general, and to confirm the words of Schiller.1 " A physician whose horizon is bounded by an historical knowledge of the human macliine, and who can only distinguish terminologically and locally, the coarser wheels of this piece of intellectual clockwork, may perhaps be idolised by the mob ; but he will never raise the Hippocratic art above the narrow sphere of a mere bread-earning craft."
It now only remains for me to state more in detail, the plan and the division which I mean to adopt in these lectures, and the spirit in which I hope to deliver them. After I shall have said something more for the purpose of exactly defining the sub- ject, and the limits of our task, as well as its relation to other branches of learning, and shall have touched upon its difficulties, and on the qualifications which are requisite in a psychological physician, such as preliminary education and methodical arrange- ment, I sball prefix a concise history of psychological medicine from its first traces to its present state ; so that when we come to our proper subject, we may at once find ourselves in a position to understand it, and not build without a foundation ; for it may be said emphatically of this department, which, considered
1 See his inaugural dissertation on the Connexion of the Animal Nature of Man Mill the Intellectual. 1780.
INTRODUCTION. 1 1
as a whole, is altogether new, that the history of a science is the science itself.
The work, according to the above statement of its contents, separates naturally into three divisions : The first, namely, the physiology of the mind, contains a phenomenology, genetically developed, of all the healthy states of the mind, that is, to a certain extent, a practical psychology treated with reference to medicine. The second part, namely, the pathology of the mind, is again divided into the pathogeny, which endeavours to trace the causality existing between the diseases of the mind and the body, and the nosography, which aims at exhibiting the phenomena, the natural history, and the so-called system of psychoses. The third part, namely, the therapeutics (the theory of psychological medicine), develops the means by which mental diseases may be prevented — the dietetics of the mind, and those means by which they are removed, in which the institutions for the insane will be especially considered. By way of appendix, the relation of this subject to regulations for the public health, and to forensic medicine, as the most important objects of all medical efforts, is briefly treated, and thus, I be- lieve, that I shall have done all that is in my power to complete the whole, and to assign to each part its proper place.
Finally, with respect to the spirit and the method pursued in these lectures, I beg your attention to the following points : we do not aim at amusement, but at complete and, as far as possible, solid instruction. Far from metaphysical reasoning and half poetical tittle-tattle (a side path which, in these regions of research, is particularly attractive to many, and these the most highly-gifted, labourers), we must attach ourselves to approved facts rather than to hypotheses, to obser- vation, rather than to reflection, and never forget that we have to satisfy, not the requirements of the philosopher, but those of the practical physician. If we would derive time and real profit from our inquiries, we must renounce the vain pride of having exhausted the whole subject, and where these inquiries in their present state afford no result, we are not to invent any, but honestly to acknowledge the blanks which exist in our knowledge, and to point out those barren spots of the domain which are to be rendered productive by future labourers. We must pay less regard to the uncommon and wonderful, than
12 INTRODUCTION.
to that which is of daily and common occurrence, (because the latter affords more abundant and safer materials for induction than the former, because laws may be more easily deduced from it, and because the key to what appears to be wonderful is often to be found in what is obvious,) a procedure which, to the great detriment of true knowledge, has been too often over- looked in medicine as well as in other sciences. Excursions for pleasure, rather than voyages of discovery, have been made in the domain of medical psychology, and a department of our science, Avhich is as real and practically important as any other, has been treated as an amusement, and as if it had no con- nexion with the rest. We cannot refrain on this occasion from warning you against an error so dangerous in all seri- ous researches, and especially in ours, I mean that dilettante spirit, unhappily so common, which loves to prate without an object, to confuse without improving, and to flatter with an appearance of knowledge. In what department has it more am- ple opportunity to practise its pernicious arts than here, where so much is still unexplored, so much inscrutable, and where the endless variety of intellectual energies so easily tempts us to pass the boundary of ascertained truth ? Yet there are some meritorious inquirers who have been eminently successful in this branch, aud it is our present business to appropriate to ourselves the fruits of their researches and meditations. Let us then set about it with earnestness and perseverance, deeply impressed with a scuse of its great importance.
MEDICAL PSYCHOLOGY.
CHAPTER I.
PRELIMINARY OBSERVATIONS.
Though I have already stated in the Introduction the subject and the limits of our investigations in general, aud can only support them by proofs as we proceed in the inquiry, it is yet necessary to be as precise as possible at its commencement. The success of our researches depends on the clearness of per- ception with which we begin them, the solidity of the building on the soundness of the foundation. In this respect we cannot proceed with too much caution, and I request your especial attention, because I must enter at the outset into some philosophical discussions, that I may be able in the sequel to pursue more certainly and uninterruptedly the thread of my observations. Every science is in itself a complete whole, and in giving instructions in it always presents the difficulty that what is to be proved must first be assumed for the under- standing of the proofs, and can be only half developed because the general and the particular must be reciprocally compre- hended and explained by each other. Thus the pupil must bring with him to the sick bed the general idea of fever, in order to understand fever as it actually occurs, and, vice versa, it is onlv the careful abstract consideration of a fever as it actually occurs, which furnishes the general idea of fever. In our field of inquiry, therefore, we will endeavour to obviate this difficulty by premising what is general, and recapitulating it when we descend to particulars.
If we would treat of a science systematically and profitably, it is above all things necessary duly to isolate it. Nothing
14 PRELIMINARY OBSERVATIONS.
causes so much confusion and useless trouble as attempting to do more than is needful, and this, in our department, is the chief source of the errors of even the most ingenious observers, and consequently of the mass of uncertainty with which it is not unjustly reproached. Fearing to be blamed for partiality, they desired to have the credit of comprehensiveness in principle, and thus overstepped the limits here laid down, which is worse than falling short of them. They drew metaphysics, ethics, and theology into the circle of their contemplations, and thus diverted them from their legitimate and proper object. That blame, however, which originates in ignorance should be de- spised, while that partiality which arises from a rigorous dis- tinction of ideas has always produced the greatest and most beneficial results to the human race.
When we speak of the physiology, pathology, and thera- peutics of mental life, we would observe at the outset that wo are not here treating of the mind except at most in a figurative sense, for this would be what is called metaphysics, a dis- tinction which is clearlv indicated bv the etymology. But if any one should infer from this that, like the mystics of the ancient schools, and some natural philosophers of the modern, we here assume three distinct principles, the triad, spirit, soul, and body, we must protest against this inference, though this view is founded on a sense of a truth which is here concealed (the presentiment of the problem). What constitutes the cor- poreal world is sufficiently known to us, and though we are not acquainted with all its laws, — which it is the business of phy- sics to know, — the idea of them is clear, and we can determine their limits. This is not the case with the mind. That its laws are beyond those limits is a bare negation, and gives us no positive information respecting them. We only know that physical observation here terminates, and that another domain (/ifra ra (pvaiKci), metaphysics, begins. The word spirit (Geist) is one of those words which we have been accustomed to hear from infancy, and which are always and everywhere present where man has attained to a consciousness of himself, — which every one pronounces, repeats, and understands without further inquiry, and does not call in question, because he does not see them called in question by others. It is nevertheless one of those ideas which Kant calls " surreptitious." and of which he
PRELIMINARY OBSERVATIONS. 15
says : " that tliey sometimes deceive, and sometimes may be true, because obscure conclusions are not always erroneous." It would therefore be our best way, in order to come to a right consideration of the word " spirit," to inquire into its source, and to go back to the point at which it may have crept in.
If we make this historical retrospection attentively, and with- out prejudice, we shall find that it has certainly not come in the course of physical research, but in a precisely contrary direc- tion. People did not begin by examining anatomically the nature of man, and it was not until a late period that they were thus ultimately led by the functions of the brain to the notion of a spirit (Geist), but the facts of consciousness as well as those higher manifestations of the mind, its relations to the Good, the True, and the Beautiful, the law of duty, the belief in something more exalted than that which is earthly, existed, and that in their fairest form, long before the thought was con- ceived of seeking the source of such wonderful effects in the organisation of the human frame. Two worlds, the one in- tellectual, the other sensual, were equally given to us from the beginning, and all attempts to deduce them from one prin- ciple (except the Deity) have failed. This duality is the boundary line of humanity ; to have drawn it is the triumph of philosophy ; to efface it, if that were possible, would be its destruction. All we can say is, that an intellectual world reveals itself to us, by the law of the true, the good, and the beautiful, and that a physical world manifests itself by those laws which act in space and time. What lies beyond these laws, as it were the substance of both worlds, we know not ; we only call that of the physical world, matter or body in the abstract, that of the super-physical, we call spirit (Geist), and must never forget that hereby we have only pronounced an abstraction.
But now Ave ask further, wherein does this higher law manifest itself to us, as the physical law does in the material world? Nowhere but in man,1 and in him only through the
1 " Nature never becomes spirit (Geist), but spirit and nature are two divine spheres, which, from the beginning of all things, presuppose each other, which re- flect each other, but only in man combine as factors of a new and third element, which is man himself." Had this principle pervaded the work in which it is Laid flown (Klencke, ' System of Organic Psychology,' page 216), many analogies and their consequences would have been brought forward less boldly.
16 PRELIMINARY OBSERVATIONS.
medium of his cultivated and refined reason. What we feel, what we remember, nay, the very inmost sensations of our individual existence, may be referred to the world which sur- rounds us. Thought alone, exalted to the highest degree, shows us another world. We are ourselves therefore not spirit, but we watch, as it were, what we call by that name, and which manifests itself to us only by its laws. (Est Deus in nobis.) Man, therefore, should be the link which connects the two worlds ; and this is the problem, this is the enigma, which never can be solved : for it is wholly inconceivable how two essentially different principles, each of which obeys different laws, can be combined in one being ; for though there is one law for both, that of self-preservation, yet the operations of this law practically contradict each other, in the two spheres. The self-preservation of the spirit may interfere with that of the bodv. Dutv mav demand the sacrifice of life, while of the reverse, daily experience affords us too many examples ; but, apart from this, it is inconceivable how a causality can exist between the two, how the ideal can be felt, how the im- pression on the nerves can be conceived. But the inconceiv- able ceases to be inconceivable for the purposes of science so soon as we conceive why it is inconceivable, and that is pre- cisely the case here. We cannot conceive the ego because it is ourselves, any more than a hand can take hold of itself. Happily we need no more, since the law of the mind suffices us to think and to will, and that of the bodv to direct its action; the real thinker is content with having founded and marked the limits of thought, which none but the never- satisfied visionary oversteps — " Truth has its limits, Absurdity has none."
It was conceivable enough that man's ever restless spirit of inquiry would not be so easily satisfied, but its very efforts afforded the most convincing proofs that those efforts were vain. The history of psychology gives more precise informa- tion on the subject. We shall here notice only that which is most essential.1 Spinosa declares mind and body to be
1 Materialism, that is, the view which will not allow the separation of the intel- lectual principle from the corporeal, but looks upon the former as a higher power of the latter, not only explains nothing, but makes the enigma still more obscure. In duality we at least conceive the existence of each principle in itself, though not the
PRELMINARY OBSERVATIONS. 17
modifications of one and the same substance ; by which mode of representation (though there may be no better, for that which cannot be represented) the knot is cut, but not untied. Neither Fichte's attempt to treat the body as a phenomenon only, of the mind, which it certainly is to us, but by which we do not advance one step towards an explanation, — nor . Schelling's ingenious view, which so unites the two worlds, that each ceases to exist for itself, — nor Hegel's acuteness, which has most profoundly analysed, and described conscious- ness, but has not deduced its origin, has solved the enigma. Kant alone has clearly defined this enigma, and declared the impossibility of solving it, and what have all his followers done more, than overstep those limits, for the discovery of which, mankind owe him an eternal debt of gratitude ? A false conception of the continual progress of the human mind has misled them ; but there is a definite truth in perception, and a limit to this perception as respects man, and this limit has been fixed by a wise Providence, because where he ceases to think he should begin to act, which is, in fact, the purpose of his being. I have always been struck with Kant's remark on the subject of similar investigations : " Let not him who is in possession of superior knowledge, refuse to impart instruction to the inquirer who is desirous to receive information, and who, in the prosecution of his studies, fancies that mountains rise before him, while the initiated sees a plain path, in which he wanders, or fancies he may wander, securely and leisurely."
Such was the language of the man, who, in profundity and acuteness, far excelled all of us, who have mounted upon his shoulders. Excuse this digression, to which I have been led by the memory of one, who, though often misunderstood, was the greatest of all German thinkers. To return to my subject :
We have thus represented spirit and matter as distinct from each other ; we see hence that neither matter, the investigation of which appertains to the domain of physics, nor spirit, the laws of which are the province of ethics and logic, comes before
mode of their connexion, which, however, is proved hy the fact; and besides the object of our existence, is thereby established and explained. In materialism we do not conceive how matter can think, and our whole existence loses all sense and meaning. Materialism annihilates itself when it subtilises so far as to exalt body into mind, and this is the only way to make it think and will.
2
18 PRELIMINARY OBSERVATIONS.
the tribunal of our consideration. But in man spirit is united, in a manner inconceivable by us, to matter. In this state of union, through which inert matter becomes an animated body, we call it mind, and the denominations above chosen are justified without our being obliged to recognise three different principles. Now it is this mind that constitutes the proper subject of our inquiries — spirit in its relations to corporeal life, organism in its relations to psychical life. Thus I think I have sufficiently indicated the nature of our subject. So much and no more, by way of lemmas, I found it necessary at the outset to borrow from philosophy properly so called, in order to lay a foundation for the understanding of what will follow. In like manner, I must, on the material side of the question, presuppose a knowledge of anatomy and physiology, especially that of the brain and nerves.
Although the bounds of medical psychology are thus duly fixed, it is nevertheless mixed up with every branch of human knowledge, so that some sciences stand to it in the relation of foundations; some of sources; some of auxiliaries; and some again of consequences; and lastly, others, in common with all the ramifications of human action and knowledge, are in further reciprocal relations to it and to each other.
With, regard to all these relations, the rule is to avoid par- tiality on the one hand, and confusion on the other, and everywhere to have regard to the whole, while we adhere to the individual parts. The foundations of medical psychology, as we have already shown, arc philosophy and physiology, which treat, the former of the spirit, the latter of the organism, while the subject of medical psychology is the relation of each to the other. A partial preponderance of the philosophical basis leads to a false spiritualism, and a partial preponderance of the physiological basis, to an equally erroneous materialism, of both of which the history of our subject will furnish examples.
As sources of medical psychology, wc may mention history and ethnography, and, above all, biography,1 especially auto- biographies, which, however, are of value only to the competent judge, because we must see in them not so much what they
1 The important biographies of insane patients by Ideler, published at Berlin in 1841 by Schroeder, deserve to be especially noticed here.
PRELIMINARY OBSERVATIONS. 19
relate as what, by their manner of relation, is undesignedly be- trayed j1 and further, what is called a practical knowledge of man- kind, such as we find displayed in the writings of Montaigne, La Bruyere, and similar writers, and the observation of man in general in a state of health and of disease.
The study of animal psychology (zoo-psychology, comparative psychology) may, it is justly hoped, throw much light on human psychology, especially with regard to instinctive im- pulses, but in using it we must never forget that man, even with respect to his organism, is not to be understood without reference to his higher destination, and that while the teleology of animal organism has reference to itself; that of man refers to something above himself. The inferior animals, strictly speaking, have not even that analoyon rationis, which is commonly assigned to them, and which, in fact, is only another expression for thought or reason in its lower state of development. If we more closely examine those actions of animals which have given occasion to this expression, we shall find that in them the body always acts upon the miud by means of impulses, and that these impulses are ruled by instinct and, as it were, by an innate law of nature which is manifested in them, as are other laws of nature, by the phenomena to which they give rise.2 Since, therefore, the higher spontaneous power of man's mind acts downwards on his body, and descends even to the most material functions, we must be very cautious in the use of this comparative psychology, and must consult it only when there appears in man, whether in a physiological or pathological state, something of the nature of instinct.
Among the auxiliaries to our studv it is usual, and not without reason, to class poetry, inasmuch as it represents the human character, exaggerated, indeed, in degree, yet in kind true to nature. We must, however, take care not to make too much use of this aid, lest we run into the danger of sub- stituting poetry for research, and of taking quotations from poets for axioms, a proceeding of which history, even that of the latest era, furnishes numerous examples. A more advisable auxiliary is logic, which teaches us duly to arrange a given
1 Jeitteles, in the Med. Jahrb., n. f., 22 bd., s. 180.
2 See Graevell, Menscli. p. 227.
20 PRELIMINARY OBSERVATIONS.
subject and carefully to criticise it, and guards us against needless digressions. That all the sciences which are funda- mentally auxiliary to philosophy and physiology, such as ma- thematics, physics, anatomy, and anthropo-chemistry, are like- wise so many aids to the understanding of our subject, is of course self-evident.
Medical psychology does not indeed form the foundation, yet it furnishes important doctrines, which are applicable to several sciences ; for instance, to education, of which one of its sections, mental education makes a part, — to special pathology and therapeutics, to which the subject of mental diseases belongs, — and to forensic medicine. Its other relations are more general and more remote, and will be self-evident in their proper places.
I. Even a superficial glance shows the great and pecu- liar difficulties with which the subject of our study is beset. On closer inspection they seem to multiply, and we only ac- quire a fundamental knowledge of it, in the first instance, by an accurate investigation of what passes within ourselves. But how few men are capable of taking such a view of themselves as is neither prejudiced nor hypochondriacal! v exaggerated, nor superficial ? We do not observe the springs of our ps}rchical functions when they are in active operation, but only when they are quiescent and cannot be investigated. Self- love, habit, the almost insensible influences of the external world, and of our social relations, render it extremely difficult to obey the precepts of the Delphic Oracle, " yvwOi treavrov."
II. The observations we make on others arc partly rendered uncertain by the same causes, and partly impeded by precon- ceived opinions.
III. The physiology of the nervous system, with the or- ganic function of which we are compelled to associate, in the most immediate connexion, the psychical function, docs not unfortunately, in its present state, afford us the requisite degree of certainty, while on its part, it is not duly supported by anthropo-chemistry, and, if I may use the expression, by anthropo-physics j for we shall see in the sequel, that the changes of somatic life, which accompany the psychical pro- cesses, affect not only the structure of organs, but the organic processes going on in them.
PRELIMINARY OBSERVATIONS. 21
IV. With respect to the more practical part of our science, which is chiefly derived from the observance of persons afflicted with mental diseases, we meet with new obstacles. Most lunatics are distinguished by the greatest cunning and dissimu- lation; the results of observation on them in public establish- ments are unsatisfactory, because the attention is divided among so many individuals ; the representations of others can- not always be depended on ; and, finally, it is precisely this obscure enigmatical state of the mind which awaits its solu- tion from our science.
V. Lastly the application of the psychical mode of cure is particularly difficult. Supposing us, notwithstanding the above- mentioned obstacles, to have obtained a thorough insight into the character, the peculiarities, and the actual state of a lunatic patient, we are nevertheless still in want of a comparative standard by which we might accurately determine the degree of every affection which we intend to employ as a remedy, so that this mode of treatment becomes very uncertain, and, from the delicate operation of such mental influences, we may do as much harm, as we mean to do good. We know that one or two grains of ipecacuanha will allay spasms, and that from 10 to 30 grains will excite them (namely vomiting) ; but we do not know how many grains of pleasure are necessary for a melan- choly patient, that he may be cheered and not made still more sullen. In no department of medicine is it more necessary to individualise; while in none is this left so entirely to the tact of the physician as in the treatment of mental diseases.
These difficulties sufficiently indicate the endowments which are especially required in a good psychological physician. In enumerating the qualifications necessary for the practice of any art or science, the mistake is generally committed of naming all those that might be desirable. Now, it is true that it is most beneficial to every art, that such men should devote themselves to it as are eminent beyond the rest of mankind for perfec- tions of all sorts ; but, it is evident that by such a requirement, the great majority of well-meaning men who might be inclined to devote themselves to those pursuits, for which, without being such beau-ideals of perfection, they felt themselves most qualified, would bo left in uncertainty as to the choice of an employment. That we may not fall into this error, we will
22 PRELIMINARY OBSERVATIONS.
here mention only those qualifications which are peculiarly requisite in the psychological physician.
I. To acquire a knowledge of this most delicate and re- condite branch of medical science, he must possess, together with that quick apprehension and correct judgment, which are equally indispensable in all the other branches, a refined per- spicacity and a philosophically cultivated understanding; for, as we have already intimated, man is not to be understood, even organically, without rcfrrence to his higher destination.
II. The application of this knowledge to the psychologi- cal patient, requires a very rare and peculiar combination of natural qualities, namely, as much sympathy on the one hand, as firmness, capable of assuming the expression of in- flexible sternness, on the other. He who is not able to act this twofold part, must not be a psychological physician, lest his patients, nay, he himself, should become victims to a mistaken choice of his profession. Besides this, his circumstances must be such as to allow him to devote himself more or less exclu- sively to this branch of medicine, that is, to give it the greater portion of his time, which is more necessary in this than in other branches, because the treatment, in most instances, de- mands a second education. He must be able, by his per- sonal demeanour, to obtain influence over the minds of other men, which, though in fact an essential part of the psychical mode of cure, is a gift that Nature often refuses to the most distinguished men, and yet without which, mental diseases, however thoroughly understood, cannot be successfully treated.
Lastly. He ought to possess a high moral character, which, indeed, no person should be without in any branch of science, but which is here especially needed. It will appear in the sequel of these lectures, what he who is versed in this branch has daily opportunities of observing, how indispensable are the re- quirements (and particularly the last) which we have demanded of those who desire to qualify themselves as psychological physicians. Let every one, therefore, sincerely and carefully examine his conscience, his powers, and his wishes, before he devotes himself to this most difficult of all the departments of medicine ; for more confusion has been produced in the world by careless and incomplete efforts than by total inertness.
CHAPTER II.
HISTORY.
c ' All professional men/' says a profound writer, 1 " labour under a great disadvantage in not being allowed to be ignorant of what is useless. . . . Every one fancies that he is bound to transmit what is believed to have been known." — If we more closely examine this complaint, which is made with reference to the history of the sciences (and this in truth is but too often a history of errors), we find a great difference in different departments. In some of them a knowledge of everything that has been previously supposed or conjectured respecting their objects, may be well dispensed with ; such are the sciences which are purely empirical. If the facts necessary for the at- tainment of their practical objects be once ascertained, the erroneous opiuions previously held may, with advantage to pro- gressive improvement, be consigned to oblivion. In other departments, which themselves consist chiefly of opinions, the knowledge and examination of previous opinions are not only desirable, but indispensable to a thorough study of them. Such are the philosophical doctrines, the progress of which is marked by a regular arrangement, and represents epochs of the development of the human mind. To these may be applied the maxim : " The history of a science is properly the science itself." With respect to medical psychology it belongs, as I have already shown, to both spheres, since it is a compound of both elements. That part of it which is philosophical, con- tains an abstract of the state of philosophy in every age, while that which is empirical has by no means attained such pre- cision and clearness as to render a knowledge of previous opinions superfluous, on the contrary, even at this nio-
1 Goethe, 50, pp. 129 and 153.
24 HISTORY.
ment, the opinions of some are diametrically opposed to those of others.
I am therefore obliged to treat the history of our branch of the profession, though this is not the chief object of my work, in a concise outline it is true, yet with more earnestness and depth of research than is usual at the commencement of a course of lectures ; for by this sketch we at once obtain a preliminary delineation, or profile, if I may so call it, of the whole science. In order to give you a view of this ample and interesting subject, without having recourse to hypothetical fancies and analogies, I shall arrange it in the following manner : I shall divide the whole history, up to the present day, conformably vrith the usual arrangement (for there is absolutely no internal ground for division in the organic members of a chain of transitions) into — I, The primeval and pre-historical epoch, to the development of the sciences in Greece ; II, The ancient epoch, by which I understand the state of the sciences among the Greeks and the Romans ;
III, The medieval epoch, which falls under two sections — A, the scholastic, which accompanies the decline of ancient art and science, and B, the revival, the dawn of a new era ; and
IV, The new epoch, to which we are compelled to add the most recent, in order to maintain a due proportion in our materials, and to comprehend the present subject of the science as a whole. In each of these epochs we have to premise — 1st, the general character of the age, so far as it is necessary to understand our subject ; 2dly, the history of the health and diseases of the age, sketched uith a psychical view ; 3dly, the history of the science, i. e. of the theory of our doctrine ; 4thly, that of the art, i. e. of its exercise, both given as succinctly and simply as possible ; and 5thly, a critical re- capitulation with respect to each epoch. I must here premise that an exposition of the manner inwhich nosologists,who do not treat of psychical conditions exclusively, introduced them into their systems, and again systematised these conditions, has ap- peared to me entirely useless. I shall speak more particularly on this subject when treating of the classification of mental diseases. Considering further, however, that every division is arbitrary so long as the basis of that division is so far from being clearly ascertained, as is here the case, I shall deal only with
HISTORY. 25
generalities, referring for particulars to Friedereich's1 works on this subject. Almost all the divisions are too full, that is, they lay down far too many species and varieties, by making the symptoms or objects of Insanity especial reasons for division. These few preliminary remarks may suffice.
1. 1. The most ancient period furnishes us with a pheno- menon which is in every respect remarkable ; for while, on the one hand, his rude sensual wants led man, prior to all theo- rising, to practical efforts, an innate, religious poetical sense led him, on the other, to those presentiments, which are, as it were, preparatory symbols, to all subsequent knowledge.
2. The state of health during that period we may imagine to have been perfect, and that it gradually deteriorated, by the conflict of social circumstances, to a state of relative health, till diseases, which began with wounds, spread more widely, and became more intense. Psychical sufferings must have been as rare in that infant state of society, as they are in the infancy of every individual man. Yet solitary examples are not wanting. Saul's disorder2 is considered as the representation of a psychical malady, consisting of melancholy combined with rage. Nebuchadnezzar's condition3 bore a resemblance to lycanthropy, nay, even to pellagra. Many of the narrations recorded in the Old Testament, and some of the ^ai^ovito/nevoi in the New, are ascribed to madness. Greek mythology, in the stories of Hercules, Ajax, Orestes, Athamas, and Alcmseon, touches on these phenomena and on lycanthropy, and the mad- ness of the dfiughters of Proetus and the uterine disease of the Scythians are even quoted as examples of epidemical psychopathies.4
3. It is evident that during this period there was nothing like science or theory, the idea of which originated with the Greeks, among whom the existence of self- consciousness was first conceived by Aristotle.
• Litteratur-Geschichte der Pathologie und Therapie der Psych. Krankheiten ; Wiirzburg, 1830. Systernatische Litteratur der Aerztlichen Psychologie ; Berlin, 1833.
2 1 Sam. xvi, 23. 3 Daniel iv, 13-33.
4 Frieder. Litt. Gesch. 17, &c. &c. With respect to the disease of the Scythians, I agree with Hippocrates in opposition to the moderns, and find in his opinion, which is that of phrenology with regard to the cerebellum, his usual perspicuity,
26 HISTORY.
The childlike simplicity of that first age ascribed every im- portant phenomenon to the immediate operation of higher powers, which it poetically personified as living Gods, and re- garded the revelations of spiritual existence as miracles.
4. But the claims of practical necessity were acknowledged prior to all theory. Fathers of families first performed the office of physician among their own circle, in a rude empirical manner ; and in the first dawning of the above-mentioned reli- gious notions, this office was most naturally blended with that of the priest, in whose hands it remained, till the Greek philo- sophers took it on themselves as belonging to their province. Some cures of psychical affections are mentioned by the medi- cal historians of this period ; nay, it is interesting that the first cures which they record were psychical. The cure of Saul by music, and that of the Proetides, which was effected by Melampos, partly by psychical remedies (?), partly, as Sprengel,1 relying on Herodotus, relates, by hellebore (veratrum album), may be quoted here as examples.
5. Where there is no science, there can be no result, and no criticism. We pass on, therefore, to the second period.
II. 1. In the lovely and salubrious climate of Greece, under circumstances which do not concur a second time, there arose, in the purest sense of the expression, a golden age, not only for the development of the arts and sciences, but likewise for humanity. That gradual transition from an uncorrupted state of nature to a state of free, great, and universal education, rendered possible the existence of a moment wrhen, without over- refinement and without coarseness, the highest intellectual culture was in one nation simultaneouslv combined with ori- ginal simplicity and purity — a moment which stands unpa- ralleled in the history of the world, a combination which, as it cannot be attained by design, gave birth to works such as no subsequent age has ever been able to equal. But it was only a moment ; as the purely beautiful style in art is followed by the voluptuous, so was culture succeeded by refinement, and simplicity by luxury, and, when the Romans, a people naturally alien from the Muses, contrary to their innate clis-
1 Vol. i, p. 118.
HISTORY.
position, imitated the refinement of the conquered Greeks, and, as is usual with all imitations, exaggerated what they copied, it degenerated into that effeminate luxury, which was not the least among the causes that led to the downfall of the ancient world.
2. It is susceptible of proof that, with the increase of re- finement, the occurrence of nervous and mental disorders increased in a proportion which has beeu maintained to the present day. So long as Greek heroism continued to echo the natural simplicity of the Homeric age, so long as the un- sophisticated manners of the old Romans subsisted, there was no occasion to notice the occurrence of such diseases. With the ad- vance of civilization in Hellas they appeared now and then, though in truth but rarelv. But so soon as civilization degenerated into voluptuousness, they increased in number and intensity ; and, when at Rome, unbridled debauchery and insane luxury sur- passed even the pomp of Athens, from which the Graces had not wholly departed, then did those psychical anomalies in- crease, and such in particular as are frequently mentioned in Galen's work on Diseases of the Mind. The monomania for suicide of the Milesian maidens,1 and the feverish psychical excitement of the inhabitants of Abdera, after witnessing the performance of the Andromache of Euripides, are adduced as being in some degree Instances of an epidemic psychopathy.
3. Here science commences. The human power of thought developed itself in all directions, and, diverging in numberless radii, filled that circle assigned to it by Providence, beyond which it cannot pass.
An inquirer into the history of philosophy who is well acquainted with its labyrinthine ramifications, must be struck by the remarkable fact, that all modes of thought, which have subsequently appeared, and have been repeated even in the most modern times, so far as they rest on specific fundamental differences, may be recognised as anticipated in the systems of the Greek philosophers. It is the pro- vince of the history of philosophy to point this out in detail, | and to show that, however the forms may change, the human mind was always obliged to entertain essentially the same thoughts, and the human heart to cherish the same feelings. Here we have only to point out the most important
' Plutarch de virtut. mulierum.
28
HISTORY.
views, those which were most influential in determining men's notions of the relation of the soul to the body ; as such, we have, in Greece, the philosophical sj^stems of Plato and Aristotle, and, in Rome, those of the Stoics and of the Epi- cureans. In these four types, the entire philosophy of Antiquity is represented, and if we pursue them to their whole depth and extent, we may with truth affirm that they symbolise every direction of human thought Avhich has assumed a complete and consistent character. If wc would express their general scope in a few words, we might perhaps say, that Plato re- presents the freedom of rationalid cal i ty ; Aristotle the legality of intelligible realism: Zcno the intellectual view of the world ; Epicurus the mate rial view ; tendencies which are repeated at all times and in all places. Since I am not here giving a history of philosophy, I must content myself with these few hints, which I intend only as a basis for the observations which 1 shall now proceed to make on the relations of those philo- sophical systems to our subject.
In representing the merits of Plato,1 it is usual to repeat the notion frecpiently expressed by him of two souls; the more noble of which is inclosed in the spherical form of the head, while the earthly is subdivided into two — its better part, the Will, being seated in the breast, and its inferior part, the Appetites, in the organs of the abdomen. Hence we may make out the relations which psychical life bears to the com- bined functions of the brain, of the circulation, and of the abdominal organs, and may draw particular inferences respect- ing the morbid alterations of these relations, as Plato has in fact done in several places.2 When a large and rather cold body is combined with weak intellectual power, or, when ex- cessive mental exertions weaken the head, the source of disease arises in that organ. When excessive pleasure, or melan- choly, or violent passions agitate the breast, the disease arises there. It springs from the lowest region, when sexual desire, or an accumulation of diseased matter in the abdomen, impedes the free action of the mind. Madness {fiav'ia), or imbecility [afi- Oia) ensues. A patient thus afflicted must not be looked upon as wicked, for he is only ill. The health of the body,
Born, 429 B. C, ob. 348 B. C.
- Phaedr. Tim.
HISTORY. 29
as well as of the mind, consists in this, that neither be excited without the other ; that they reciprocally support each other, and remain in a state of health by preserving the equilibrium. Let him, therefore, who devotes himself to mathematics or other profound studies, which demand the whole energy of the mind, take care duly to strengthen the body by gymnastics or other exercise, and let him who is called to use much bodily exercise, not forget to strengthen the mind by music and philosophy.
All this is excellent, but there is something quite peculiar in Plato's theoretical dogmas. We must never forget that his works are poetical, and that he is enabled, by adopting the style of free dialogue, to set forth with playful pointedness, and even with irony, the most various and opposite notions, leaving the reader, whom he merely stimulates to think for himself, to make his own conclusions. The same form, which is based upon the free ideality of the Platonic mind, necessi- tates his poetical figurative language, from which we gather a hint that there is much which we are to understand, as being, not a formal declaration, but rather stated in the way of com- parison or symbol. The want of attention to this circumstance has given occasion to great errors in the explanation of the Platonic philosophy. I think it advisable in this place to ob- serve that whatever is known to us as appertaining to the opinions of that age, furnishes no precise information respecting Plato's views of them, for he has only made use of them as of any other material ; but whatever is brought forward by him as new, must be examined with reference to his whole train of thought, and, when it agrees with this, deserves the greatest attention. In this sense there is a passage in Philebus which appears to me especially worthy of observation. It is the key to his psychology which has justly been designated as teleological, and which, as it is quite in accordance with the ideality of his ethical mode of thinking, authorises me to consider him as having in fact anticipated Staid. The passage is as follows : "The hungry man, as such, i. e. in so far as he longs to ap- pease his appetite, feels in a state opposite to that in which he really is ; the hungry man can only feel pain — only the pre- sent disorder of his body, but not what will relieve it, no desire for food, unless previous experience has taught him that
30 HISTORY.
the pain will be removed by food. But appetite scents, seeks, and finds its object previous to all experience ; it perceives what is positively not found in the subject of its perception. Thus, desire sees further than sensation reaches ; it perceives what the opposite sensation can produce, to save an existence which is threatened with destruction. This internal physician, this counsellor and aid, is the power itself which, in every indivi- dual being, binds and holds together, in a suitable manner, the finite and the infinite — the soul. It cannot have derived the knowledge which it evinces from its body, of whose exist- ence and life it is the cause ; nor from the experience which it has had in common with the body, for that knowledge, in fact, preceded this experience, and in the first instance made it possible." This passage seems to contain more clearly than any other, Plato's psychological creed. At all events, it is extremely remarkable in itself; according to the axiom, that " nothing new and peculiar has been said, which had not been previously thought," it confirms our remark on the preformation of Stahl's doctrine, and justifies the designation of modern medical historians, who call Plato's physiology " Teleological." This appears sufficiently to determine the position which this great philosopher occupies in relation to our department, and did it not do so, the above-mentioned difficulties remaining in the way, still a Plato was well worthy a slight digression.
The opposite mode of thought is represented by Aristotle.1 This extraordinary man may be considered as the real founder, not only of philosophy, but of science in general. The immense influence which he exercised for above a thou- sand years, and which has so often been condemned as blind idolatry, was not without a profound cause. For inde- pendently of the rich materials which he, far more abun- dantly than any other ancient writer, transmitted to posterity, he furnished to all ages a handle, as it were, for employing the powers of the human understanding, so as to render it and its applications useful ; inasmuch as he taught us how to study it in a methodical manner ; it would, however, be out of place here to demonstrate this in any other department than that of psychology.
1 Born 384 B. C, died 321 B. C.
HISTORY. 31
The mind, according to Aristotle, is distinct from the body, but inseparable from it, as a conjunctive form; as the regulating unity of its manifold uses (svTtXiy^eia). He sepa- rates, however, with remarkable precision the power of thought from everything material. Sensation, he says, "is a motion of the soul, through the intervention of the body." He deve- lops in such order the relations of thought to objects, to the senses, and to common sensation (the idea of which he was the first to unfold), that his disciple and follower Theophrastus, of Eresus, was able to leave a critical treatise on the Theory of the Senses, as contained in his book 'On the Sensations/ The analytical investigation of nature, which Aristotle first prose- cuted by means of autopsy and comparative anatomy, taught him that man has, in proportion to his size, the largest brain; and he gave a description, which was true to nature, of its membranous coverings. Thus we here find ourselves in the midst of a regularly arranged world of experience, and feel that Plato and Aristotle reciprocally complete each other's labours; that, combined from their foundations, they fill up on one plan the circle of human opinions.
Without stopping to examine the other philosophical schools of the Greeks, — the Ionian, Eleatic, &c, which in fact are either only modifications of the above types, or have no refer- ence to our doctrine, — we will here mention only the Epicu- rean and the Stoic, as existing among the Romans. It is true that both these philosophical systems originally belonged to the Greeks, but they were chiefly developed by the Romans, were truly incorporated into their very flesh and blood, and are known to us with accuracy only through their representa- tions ; namely, the doctrine of Epicurus through the poem of Lucreljus, ' De Rerum Natural that of Zeno, through Seneca and Marcus Aurelius.
Atomism (or as we now say, materialism, for the latter, if it proceeds methodically, must result from the former), in the doctrine of Epicurus, is carried through in the most decisive manner, and with a consistency for which his modern adherents have neither the courage nor, as it seems, the requisite self- knowledge. The ancient doctrine of Democritus, of repre- sentations through images (a&uAa) which emanate from bodies, and, through the medium of the sether, unite themselves with
32 HISTORY.
the soul, which differs from the body only in being more re- fined, remained as the psychological basis of the system. This union becomes a sensible image, and therefore every image corresponds with the object, and is true, so long as it is an object of sense. What is false proceeds only from those dark and confused ideas that differ more and more from the object in the imagination, which is too refined and volatile a matter.
It is well known with what acuteness, with what clearness, and with what accessory features, drawn from quick observa- tion, Lucretius has treated, in the most poetical manner, this very unpoetical system. With respect to our subject, the Se- cond_and Third Books in particular, on the reciprocal relations of the psychical and physical world, afford most important and attractive representations. They may be characterised as tracing all freedom to intelligible mechanism, and seeking to merge all practice in theory.
Diametrically opposite to this is the aim of the Stoics, who, with the most exalted notions of the higher connexion of the universe, yet do not place the value and spirit of their doctrines in these notions, but solely in delivering the only possession which man really has, namely, his Identity, from all peri liable forms and appendages. We may conceive that such a tho- roughly practical system of philosophy was especially adapted to the Romans, whose life was all action, and must have been still adapted to them when the utter ruin of that immense empire compelled the noble-minded individual to fall back upon himself. It is not our business to pursue such reflections. Of the physiological theory of the Stoics, that doctrine may be of importance to us which teaches that even sensible images, the emotions of the mind (iraOt) and oo/i»j), resting as they do on the belief in their truth, and on the approval which the judgment of the mind gives them, belong to the power of thought which is an immediate emanation from the Divine Soul of the world. Hence arises the possibility of an empiri- cal self-government, and of the accountability of the affections.1
Still more important to us are their practical directions, which, in a moral point of view, offer the best preservative
1 Cic. Tusc. i, 9 ; iv, 6, et alib.
HISTORY. 33
against mental disease, and are real " dietetics of the mind." The notion virtus, which, among the Romans, signified both virtue and physical energy, was admirably adapted to them. Ideler1 has explained in a masterly manner the result which these sentiments had on the practice of medical psychology ; and this transition from theory to practice affords me the most suitable opportunity of passing on to the history of the practical part of medical psychology during the epoch of classical antiquity. But before doing so, I beg leave to justify my preceding remark, — that the four systems, of which we have given a brief sketch, represent general and permanent directions of human thought. Should any one, after duly reflecting on the foregoing sketch, hesitate to admit this justi- fication, we would point out to him the fact that in the course of the history, of even the most recent times, a repe- tition of those views will appear with respect to our doctrine. Thus we find a parallel to the Platonic idealism in Heinroth's theory ; to the criticism of Aristotle, in the reflections of Hof- bauer and others ; to the Epicurean view of nature, in the extreme of the so-called somatic theory of Psychopathy as it appears in Combe and Jacobi (not in Friedreich) ; lastly, to Stoicism, above all in the writings of the learned Groos. Modi- ficatis modificandis of course in all these instances. Excuse this anticipatory remark, the propriety of which will appear in the sequel.
4. We left the rudiments of practical psychiatrics, if indeed this expression may be here applied, in the hands of the priests. Of the Greek philosophers Pythagoras was the first who practised medicine — who led it forth from the temples into active life, applied it to political economy and legislation, directed his especial attention to dietetics, and who, lastly, must be considered and honoured as the true founder of a system of psychical dietetics. The theories which are circu- lated under the name of this extraordinary man do not con- cern us in this place, and in fact not at all. They belong to the category which we designate by Plato's name, and whoever understands how to read the lessons of history, will comprehend that Pythagoras did not lay so much stress on theories, which he made use of at the utmost as incitements or symbols, as upon
1 Ideler, I, 198—209.
3
34 HISTORY.
actions. I cannot refrain from giving here, as a specimen of the above-mentioned mental diet, an extract from the Pytha- gorean Order of the Day, as represented by Meiner. *
"As soon as they awoke in the morning, and rose from their beds, they walked in quiet retired places in the grove or the temple, not only to refresh their senses and their bodies, but also to compose their minds, and prepare for the business of the day. They had recourse to the sounds of the lyre in order to dispel all the mists of sleep, and to attune the soul to harmonious activity. They considered it as dangerous levity to consort with others before they had held communion with themselves. When they had ended their early walk, they met together, passed the most cheerful hours of the day in the temple or some similar place, and devoted their first energies to teaching or learning. Instructive conversation was succeeded by gymnastic exercises, in order to give strength and activity to the body. Many of them contended in running or wrestling, while others threw heavy weights at a mark, or performed certain dances which were accompanied with violent motions of all parts of the body, especially the hands. After these exercises they repaired to dinner, which, among the Greeks and Romans, was for the most part only a breakfast, but with the Pythagoreans of a yet more simple kind than among the other Greeks. They took neither meat nor wine ; they refrained from the latter the whole day, eating only so much bread and honey as was necessary to satisfy the appetite. After finishing their repast they devoted the greater part of the afternoon to public affairs, and it was not till the evening that they walked out, not alone, but in parties of two or three, when they communicated to each other what they had heard or conversed upon throughout the morning. They concluded these evening walks with a cold bath, and then assembled in a general refectory, for supper, which, however, was always finished before sunset. These suppers, at which, in order to promote sociability, no more than ten brethren were ever seated at the same time, invariably began and ended with libation and sacrifice, and consisted of a greater variety of food and of a more substantial nature than their dinner. They ate
1 Geschichte der Wissenschaft, in Griech. uud Rom., i, 178-602.
HISTORY. 35
not only boiled and raw herbs and vegetables, but meat also, though rarely, and in small quantity. In wine, too, they sparingly indulged. After supper they spent some time in agreeable and instructive reading. The senior of the company proposed what should be read, and the junior read it aloud On break- ing up for the night, the most important duties of life, and the rules of the order were concisely expounded. Before they lay down to sleep, they thought over what they had heard, seen, and done in the course of the day, and then relaxed their minds, which they lulled to rest with the sweetest harmonies of the lyre, thus preparing it for a refreshing, dreamless sleep." This routine of the day is in its principle so conformable with nature, and manifests such deep insight into the reciprocal relations of mind and body, that I consider it a better exposition of the views of Pythagoras on this subject than any half conjectural commentary that I could have given. " Harmony and regularity," adds a commentator, "produce in this daily course of life merit em sanam, in cor pore sano." It is reported that Pythagoras employed music in the cure of those chronic diseases which originated in mental excitement.1 His disciples continued gradually to withdraw the art of Medi- cine from the hands of the priests ; medical schools were formed, the Asclepiades began to reduce the results of their experience to principles ; the Empiric school arose at Cnidos, the Philo- sophical school at Cos, and from the latter issued Hippocrates,2 the Father of Medicine, and the most celebrated of the seven individuals known under that name.
The majority of the observations which Hippocrates has left us on the subject of Medical Psychology, relate rather to the psychical symptoms in various diseases, than to what we are in the habit of calling, diseases of the mind. The attention which the Father of Medicine paid to the psychical state of patients in general, is a proof of the enlarged views he enter- tained with respect to the whole art of medicine. (Epid. vi, et alib.) Among these psychical symptoms his attention is chiefly directed to delirium,3 which however he does not distin- guish from mania and phrenitis ; but the few observations in his works relative to them, evidence that clear and correct view of
1 Seneca, De Ir. iii, 9. s Born B. C. 460. s Neumann in Friedr. 44.
36 HISTORY.
disease which has made this first observer a model to all suc- ceeding times. They refer to the physical insensibility of the insane,1 to the appearance of mental diseases in spring,2 to the occurrence of disorder of the intellect after a continuance of fear and grief,3 to the union of melancholy and epilepsy,4 to the critical importance of hemorrhoidal discharges in mania,5 and the difficulty of curing madness which commences after the age of fortv,6 &c. His treatment of these states consists principally in evacuation, and this he most commonly effects by hellebore, for the use of which he gives many special direc- tions. The books7 falsely attributed to Hippocrates go more into detail on the subject of these disorders, and combine, in a singular manner, Platonic notions with traditional empiricism.
The psychical cure of Erasistratus is well known. Novelists and artists have vied with each other in representing the story of the fair Stratonice, and, in answer to Ideler's8 inquiry why Erasistratus has had so few imitators among physicians, we may deny his premises, and reply that he has had his followers.9
The real founder of a psychical mode of cure seems however (according to Friedreich, 42) to have been Asclepiades. We are indeed obbged to say " seems," for his maxims are known to us only through Celsus and Cselius Aurelianus, since his writings have not descended to our times. His chief maxim, in most diseases, which, in his opinion, needed stimulat- ing to excite the energy of life (and which has caused a comparison of his views with those of John Brown), was mani- fest also in his treatment of the insane. Music, love, wine, employment, exercising the memory, and fixing the attention, were his principal remedies. He recommended that bodily re- straint should be avoided as much as possible, and that none but the most dangerous should be confined by bonds. He was peculiar in advising that the lunatic patient should be engaged in the self-regulation of his mental powers, for which purpose he recommended that books should be read to him in an
1 Aph. ii, 6. 2 Aph# iii( 20.
3 Aph. vi, 23. * Epid. vi, 8.
5 Aph. vi, 21. 6 Aph. vii, 82, or viii, 1.
7 Comp. Fried. Litt., 39, 40. 8 Medical Psychology, ii, 545.
9 Z. B. Galen (d. praecogn. vi, s. Fried. 73), Ibn Sina (Herbel. Fried. 86), Forest (Obs. M. x, 30, Fried. 117).
HISTORY. 37
inaccurate manner, that lie might be induced to correct the mis- takes. The more exact diagnosis of improved science discovers cases in which a similar mode of proceeding is often useful ; and it is usual to modify it by placing before the patient, without ap- parent design, letters, essays, notes, &c, composed by others for him to correct, whereby his own energy is increased and confirmed. Moreover, Asclepiades certainly did not withhold his well-known motto, cito, tuto et jucunde, from the therapeu- tics of insanity, although, notwithstanding Bird's advice, it can hardly ever be fully applied to them.
The schools of the Empirics, Dogmatists, Methodists, and Episynthetics had no appreciable influence, as such, over psychiatric science, which was not yet formed, and as our only concern is with the progress of our department, wherever this was important, we may proceed at once to A. Corn. Celsus,1 who, as Friedreich justly observes, merits the name of the first writer on medical psychology. The eighteenth chapter of the third book of his admirable work, De Tribus Insanice Generibus, the earliest treatise on mental diseases, makes up pretty well for the loss of all that was scattered in older writings, since Celsus must be considered as the de- pository of ancient medicine. With judicious criticism, scrupulous completeness, and incomparable arrangement, Celsus gives a compressed recapitulation of all which, up to that period, had proved to be best and most correct ; and, where no precise result had been obtained, he states point- edly and faithfully such problematical views as were enter- tained. He distinguishes three kinds of insania : phrenitis, which is a continued delirium ; melancholy, which originates in an atrabilarian condition ; and a third kind, which lasts longer than the other two, even sometimes throughout the whole course of life, and which may be divided into two species, according as the patient is deluded by merely false images, or by erroneous perception. The first and the last of these kinds of insanity are sometimes of a melancholy cast, some- times cheerful, by which the psychical treatment is modified; the second is always melancholy. Phrenitis is treated ac- cording to individual indications; melancholy requires the
1 Born B. C. 30.
38 HISTORY.
evacuant and sedative method. In the third kind, when it approaches more to melancholy, it requires purgatives, and when to phrenitis, emetics. Exercise, friction, and an unirritating diet must be resorted to, and psychical influence must never be forgotten. The further details of this treatise are highly worthy of attention.
We must here mention the Methodist, Thessalus of Tralles, who is of little importance in himself except as being the inventor of metasyncrisis (recorporatio), a method which still forms our principal and most essential corporeal means in the treatment of insanity. His object was, in obstinate chronic cases where other remedies failed, or were not indicated, to effect a thorough commotion in the fundamental constitution of the organism (<jvyKp«jiq), and to this end he employed the method which he describes in a work expressly upon this subject. It commenced by the application both internally and externally of strong vegetable remedies, to the use of which, together with the strictest regimen and emetics admi- nistered at intervals, a period of three days was devoted. This treatment was preparatory to a system of fasting, and concluded with a course of restoratives. It is remarkable that the prac- tical view which evidently dictated the discovery of this method originated with a man whom history represents as an ignorant, boastful, low-minded pretender — a charlatan in the worst sense of the term. And here the observation involuntarily obtrudes itself upon us, that the most efficacious of those methods to which the Thessali of modern times are indebted for their reputation and their riches, are, in fact, nothing more than such metasyncrises.3
From this equivocal system the inquirer turns with the greater delight to the admirable Aretams of Cappadocia, that incomparable delineator of diseases, in whose praise all writers are justly unanimous, and whose correct perception, clear com- prehension, sober reflection, and animated style, are evidenced also in our department. In the book on the ' Causes and Symptoms of Chronic Diseases' (chaps, v and vi), he describes melancholy and mania, and in that on the Treatment, his own mode of cure. According to the notions of his age, he attri-
1 Le Roy, Morrison, Priesnitz.
HISTORY. 39
butes the origin of the former to black bile, but cautiously adds, that in some cases it arises from psychical causes alone. He defines melancholy as depression of the mind, without fever, from the constant predominance of a single idea ; he describes its phenomena, and their reciprocal relation to mania; determines serologically that men, and youths near the age of manhood, are most disposed to it, but that females are more violently affected; that summer and autumn bring on these disorders, while spring alleviates them ; he also represents their transition into imbecility and bodily decay. He is well ac- quainted with the unessential differences in the forms of mania, and judges them more accurately than many later system- mongers, (for, says he, there are a thousand kinds, and yet there is only one.) He defines it as permanent torpidity of intellect without fever. He carefully and expressly distinguishes febrile delirium, as well as the effects of intoxication, poison, &c, from insanity ; directs attention to what is typical of its return, but, at the same time, remarks on the uncertainty of this type ; determines with especial circumspection the condi- tional circumstances; quotes some instances worthy of being recorded, and sketches several varieties, among which it is remarkable that the subsequently so-called religious monomania has its place. His therapeutics were those that had been handed down to him from former times. Portal1 attaches par- ticular value to one observation which Aretaeus makes on this occasion, respecting the pernicious influence of coloured walls in the chambers of the insane ;2 and confirms it by his own experience.3 In fact, every one who has observed the effects of colours on the mind, and is acquainted with the doctrine of hallucination, of which we shall have to speak in the sequel, may be easily convinced of the truth of that ob- servation.
Cselius Aurelianus agrees, in his ideas and delineation, with Aretseus, in his treatment, with Asclepiades. His authority is of importance in the history of psychiatrics, and has been already appreciated in this respect.4
Lastly: the ancient epoch of medicine concludes with Claudius Galenus. It is a remarkable circumstance, such, however, as
1 Samml. Auserl. Abhandl. xix, 363. 2 De M. Acut, i, 1. 3 Fried. 66.
4 Pinel, Phil. M. Abhandl. iiber Geisteskrankheiten. Transl. Vienna, 1803.
40 HISTORY.
repeatedly occurs in history, that this extraordinary man, whose efforts were directed to restoring the declining art of medicine from the subtleties of the schools to the Hippocratic method, became himself the idol of a school which was more subtle than any other, and which departed for centuries from the Hippocratic system. So little can an individual effect to stem the current of thought prevailing in his time, which, whether he will or not, he only helps to promote. This re- flection teaches us another lesson, namely, that in all cases where that current has appeared to issue from an individual, the latter was only a product of the former; a conviction which we shall need in the sequel to enable us to understand Para- celsus. The general merits of Galenus have been set forth with great lucidity by C. G. Neumann.1 His medical system is founded on this great truth, that the life of man is everywhere connected with that of the universe, and as one law governs all the phenomena, so disease and its cure depend upon avail- able natural processes. In this sense — which also pervades his doctrine of temperaments, that has survived even to the present day — he likewise taught the dependence of psychical life on all the momenta of human and universal nature, without at all overlooking the reciprocal dependence of the latter on the former : for the man who could say of himself " Et nos segros non paucos quotannis persanavimus, solis animi motibus ad debitum motum revocatis \" is not inferior to any psycho- logical physician of the present times. Galenus may again be considered as a model, on account of his logical method, which rendered him to his age what Gaubius and Hartmann were to theirs. By his separation and definition of ideas, he directed attention to the relations of the mind to the several organs : the brain, heart and lungs, liver and spleen — as also to the gradations between relative health, which he called disposition (SiaOtoic;), and actual disease, which he called passion (-n-aOog), a distinction which will be found highly worthy of attention in the doctrine of mental diseases. We, however, find in his numerous works fewer psychiatric precepts than we should have expected, and they confirm, in essential particulars, the doctrines already handed down.
J. J. Sachs, Medic. Almanach, 1839. Galenus, born 131 A. D.:
HISTORY. 41
Everything belonging to this epoch, including Galenus and his successors, is only a gleaning from Galenus himself and more ancient medical authorities.
5. If we look back on this whole period, in order, if possible, to comprehend its entire bearing upon medical psychology, the following may perhaps be taken as a correct view. The necessity for medical relief, afforded at first in an entirely empirical manner by the heads of families, and then in a simple religious spirit by the priests, led to experiments : these were first projected and carried out by the Greeks, when being taken up by the philosophical school they were brought to certain results, and, as among that happy people, action and thought mutually aided each other, an art was first formed, and then, as it were, an enlargement of it into a science. The relations of mind and body were recognised and discussed in their various bearings, and those problems which still form the nucleus of our knowledge, were even at that early period brought for- ward. At these problems, however, antiquity stopped. A methodically regulated, experimental investigation was still wanting.
III. 1. Henceforth the history of the world is covered with a vast nocturnal shadow, which was not dispelled by a rising dawn till towards the middle of this third period. We see with regret that the entire art and science of enlightened antiquity vanished in the darkness of this night, but we must not judge rashly and unjustly of the ways of Providence ; for in this shadow future births were hidden, and, though we are unable to judge of them, such periods of incubation are perhaps as important to history as the germinating process going on below the surface of the soil, is to vegetable life. It was an age replete with fermentation : all nations were in commotion. The most diverse religions, modes of life, views, and traditions clashed and blended together, and the ancient forms were cast in a new mould, gradually imbuing them with a totally different spirit, till in the sixteenth century the age, roused by repeated impulses, became conscious of itself, embraced with freedom the ancient types, and reverentially preserved them, together with the new, for which it was gradually matured.
2. We may readily comprehend how contagious diseases of
42 HISTORY.
the most violent kind naturally resulted from those manifold collisions, chiefly of a warlike character, -which took place among different nations.
Destructive epidemics, for the most part advancing from east to west, visited the whole of the known earth, manifest- ing themselves in the first half of this epoch more by affections of the cutaneous organs, and in the second more in the abdo- minal organs, and in the system of the motor nerves.1 Of the latter we must especially notice the dancing mania2 (pil- grimage mania?), which first appeared about the year 1212. Thousands of young people, mostly approaching the age of puberty, i. e. from 12 to 18, assembled together, and formed what were called " children's pilgrimages." They proceeded (for instance in 1237) till they sunk exhausted to the ground, so that many died, and the survivors were afflicted with tremors which continued as long as they lived. This disorder seized boys and girls suddenly, and, together with other phenomena, was combined with a morbid antipathy to red colours and to persons weeping, and, when the disease was at its height, tympanitic swellings of the abdomen ensued, and paroxysms of howling, screaming, leaping, and an ex- cessive love of dancing set in. In the time of Paracelsus the form of this disorder became milder, and approached that of St. Vitus's dance. Haser compares this epidemic with the lycanthropy of the ancients. (See above.)
However hypothetical every notion may be which we arc able to form of the nature of this disorder, a psychical momentum was certainly in operation, though I cannot subscribe to the view of a very able writer,3 who treats even the Crusades as an epidemic mental disease, and consequently seems to deduce them immediately from the dancing mania, though something intermediate may well be supposed to have occurred. "Webster speaks of an epidemic madness which prevailed in England in 1354, attacked the lower classes, and subsequently spread through France and Italy. " During periods of plague," he adds, as if by way of explanation, " some general influenza
1 Haser, 145.
2 Hecker. Die Tanzwuth : an admirable monograph , as Ilecker always aims at generalisation and scientific unity.
3 Wawruch, De Morb. Pop. an. (MS.)
HISTORY. 43
appears to have seized the brain, even of persons who were not attacked by the plague itself." I cannot by any means accede to the representation of the learned Leupold,1 who considers that psychical disease was less prevalent and milder in the middle ages. To me, on the contrary, the powerfully operative momentum, which I have above noticed, as recorded in the his- tory of those times, as well as the facts already related, and the numberless cases of demonomania in all its forms, which subsequently occurred, appear to prove the frequency and seve- rity of disorders which affected the mental faculties of man in that epoch. I believe that the want, at that time, of a scientific comprehension of such disorders, and the preva- lence of superstition, are the causes which now close against us any access to those phenomena, thus producing a false im- pression that mental disease was of rare occurrence.
3. The psychology of the middle ages, as well as their philo- sophy in general, was, in the first half of the period, scholastic or mystical, and it was not till towards the end of the second half, that in some intelligent minds it approached that per- fection which it has attained onlv in modern times. But neither could those philosophical systems furnish a sufficient basis for rendering psychology available for the purposes of the physician, nor was the age sufficiently enlightened even to think of it. " The Arabs, an energetic people, devoted to Sabseism, had been transformed, by the religion of Mahomet, which addressed itself to the passions and to the understanding, into a religious warlike nation. In a short time they became masters of a great portion of the known world. By their con- tact with the conquered nations, and the increase of luxury, there arose a want — a demand for foreign medicine, astrology, and science, which the Caliphs did their utmost to supply by translations from Greek works, and by the foundation of schools and libraries. Thus from the most diverse elements — the Aristotelian, the Oriental, and the Theologico-Christian, arose that monster of philosophy, which I have named the Scholastic, in the more extended signification of the word. Ibn Sina (Avicenna), Ibn Rhuschd (Averrhoes), Moses Mai- monides, Albertus Magnus, and subsequently Duns Scotus, who
1 Gesch. d. Ges. u. Kkht. Erl. 1842, p. 108.
44 HISTORY.
died in 1308, may in some measure be said to be its representa- tives. We may with the greater propriety refrain from particu- larising their views, since they contributed to psjchology only verbal subtleties, taking and retaining the materials for their formulae, without addition, from the works which had been left as an inheritance by the ancients. A more substantial spirit developed itself in the second tendency of that epoch — the mystical. Yet here, too, the most heterogeneous ingredients were mingled together ; Plato, Christianity, the Cabala, and an independent system of Metaphysics, so that anything like a consistent representation of the divergencies of these theories, would far exceed our limits. The representatives of this ten- dency are, Bonaventura, Thomas Aquinas, Nic. Cusanus, Marsil Ficinus, &c. With respect to our subject, it may be said in general, that the Scholastic philosophy, by splitting the mind into numerous distinctions of faculty and empty notions, promoted mere formalism ; the mystic philosophy, by ad- hering throughout — like its later emanation, the doctrine of Ideality — to the one, final, divine substratum, promoted mere dogmatism ; but neither of them forwarded a true knowledge of the mind, and, least of all, its relation to the body.
In Theophrastus Paracelsus,1 the mystical school attained, if I may use the expression, its practical culminating point, being introduced into real life equipped with a chemical, medical and popular apparatus. We shall have to return to him in the sequel. After Paracelsus, as the dawn of a new morning evidently approached, mysticism gradually attained that philo- sophic purity which it manifested in Campanella and Giordano Bruno, till the sun of regenerated science itself arose. Two men above all others are worthy of historical mention as the heralds and messengers of that regeneration ; negatively Bacon, and positively Des Cartes. Francis Bacon,2 Lord Verulam, with a clear penetrating judgment, recognised and demon- strated the insufficiency of the current theories, pulled down their edifices, pointed out amid the ruins the simple way of sober observation, and showed the boundless field which he had thus laid open to view. He, therefore, was of negative importance. Des Cartes3 boldly commenced with speculation, and
1 Bom A. D. 1493. ' Born A. D. 1561. 3 Born A. D. 1596.
HISTORY. 45
founded his system of a pure dualism, which essentially con- trasts thinking substances and matter; yet he assigned a seat to the soul, namely, in the pineal gland. The soul h&spassiones and actiones ; among the latter are the functions of will, imagina- tion, and thought ; the vital spirits are distinct from the soul. His psychology, therefore, introduced something positive. The independent train of thought of his profound pupil Spinosa has had no influence on the adaptation of our doctrine to practical purposes, and we, therefore, here break off our delineation of the psychology of the middle ages, which, though on the whole too sketchy to be useful for any other purpose, is yet too diffuse for ours. But my motive for beiug thus brief is that —
4. The practice of medical psychology was upon a par with its theory, that is to say, it did not exist at all during the greater part of this epoch. The Arabs repeated and followed, with less and less happy additions, and with more or less genius, what had been taught by the Greeks, especially the later writers. Anecdotes of psychical cures, performed by their physicians, which are related in their praise, appear to be more suited to poets than to the history of medical psycholog}^ ; they may be seen in Friedreich. Ibn Sina the Persian, as the best of these writers, deserves, however, distinct mention. He paints1 to the life the nymphomania, arising from unhappy, unrequited love, adding some original reflections of his own ; and he gives a contrivance for the cure of melancholy, which has much resemblance to our swing.3
A long pause in medical psychology ensued after this period. The Scholastic formalism furnished only names and distinctions, but no remedy for the cure of the patient. The ordinary practice was only a repetition, without further inquiry, of the prescriptions of Galenus and of the Arabs. The Mystic system had recourse to prayer and exorcism, and whether at this time of the early dawn of science Paracelsus was the man to whom our branch might look for its restoration, or, more properly speaking, its birth, I will, after furnishing you with some data, leave you to decide. This is not the place, nor do I think it
1 Aviceima died 1036. De Morb. Ment. Tract. 1619; comp. Zimraermann, Von der Erfahrung, p. 679.
2 Canon ii.
46 HISTORY.
necessary to enter more fully upon the doctrines of this author. Yet since, contrary to the judicious view of Karl Sprengel, the founder of historical research in medicine, several well-in- formed and. thinking men, have latterly seen fit to attach some importance to the claims of this so-called reformer of Medicine, I am obliged to separate him from the age to which, in my opinion, he entirely belonged, and to consider him apart, which I should not otherwise have done. But, that while performing a duty to individual contemporaries I may not neglect my more important duty to the science, I shall confine myself to what practically concerns our department, and faithfully emote his own words, leaving them, without any addi- tions of my own, to your individual judgment. I have already plainly expressed my opinion in another place1 respecting his general position, which is perfectly clear to any one who has a knowledge of the state of the times, without any explanation of mine. Paracelsus has already become in some sense a my- thical character to us, and hence, as well as from the various and frequently contradictory constructions put upon his rhapsodies (where all depends on the medium through which Ave view them), we may account for the pleasure which even clever men find in making his oracular dogmas the vehicles of their own views.
" That man," says he, " is sick in mind,2 in whom the mortal and immortal, the sane and insane spirit do not appear in due proportion and strength. Men who go astray through weakness of the reasoning mind are called imbecile. The enraged, on the contrary, are called fools and persons out of their senses, because they have become mad from the excess of brute reason, having drunk more of the Astral wine than they can digest. Fools, however, sometimes manifest a degree of wis- dom, which shines amid the confusion of their understanding, as light through a piece of horn ; wherefore it is becoming a wise prince to keep a court fool, but he must not suffer him to be driven about by the servants, that his natural spirit may not be interrupted. Mania is a change in the reason, but not in the senses. Mania comes on with raving and senseless behaviour ; is always restless, causes much disturbance, and is
' Comp. Med. Jahrbuch. n. f. vol. xx, p. 285 ; vol. xix, p. 133. 3 Opera omn., ii, 1G9. (Freidr. 10G.)
HISTORY. 47
recognised by the fact that it abates and ceases of itself, and returns to reason. One kind of mania is almost dull and stupid; the patient falls down, loses his appetite, is subject to vomiting, suffers from diarrhoea, mutters to himself, pays no attention to people or to their dwellings," &c. &c. For setiology he has the over-exercise of the reason, the elements, influences, constellations, conjunctions, microcosm and macro- cosm, in short, anything in the world. His therapeutics are conclusive : " What avails in mania, except opening a vein ? then the patient will recover ; this is the arcanum, not camphor, not sage and marjoram, not clysters, not this or that, but phlebo- tomy," &c. &c.
So much will suffice to enable you to determine what gain physiology on the one hand, and medical psychology on the other, could hope from the opinions of this man, who looked down upon Hippocrates and Galenus as dwarfs in comparison with himself. It was only to perform the duty mentioned above, as incumbent on the teacher, " who must not be igno- rant even of what is useless," and from regard to the predilec- tion of distinguished contemporaries, who would strengthen, by his authority, their own incomparably more scientific views, that I could be induced to tarry so long at this unfruitful spot.1 Paracelsus might himself serve as a psychological example of the result of evidently considerable capabilities and independent energetic efforts, combined with the want of a well-regulated culture of the understanding, and with a confused, luxuriant imagination, under the influence of an age of agitation and an irregular mode of life. For the present, therefore, we must abide by the sober representation of Karl Sprengel, and we may now, without breaking the thread of our history, resume it, and say, as above, that the knowledge and treatment of the mind, so far as they fall under the cognisance of the physician, were not advanced in this period ; Paracelsus not being, in our opinion, as he is in that of most historians, the commencement of a new, but rather one of the last supporters of a more ancient era.
In this spirit matters proceeded for some time after him, and
1 Those who wish to obtain full information on this subject, either for or against Paracelsus, may read Demarow, Parac, uber Psych. Krankh., in Heck. Annal. vol. 28, Lesting, Leben Parac. Berlin, 1839.
48 HISTORY.
of which, as far as our department is concerned, particulars may- be found in Friedreich and others. Towards the second half of this period, when, as we have before observed, the scholastic and mystical philosophies were gradually developed, thus pro- ducing a soil capable of nurturing the germs of general psychology, those of a medical psychology appeared simul- taneously above the surface. Felix Plater first attempted a classification of mental diseases, which, though, as Heinroth1 clearly proves, is wholly inadmissible, nevertheless indicates a real advance towards improvement, because it does not make use of any hypothetical assumptions, but takes the phenomena of mental action, as proved by experience, for the basis of the classification. It must be confessed that the persecution of witches, which was carried far beyond the second half of the middle ages, considerably lowers our expectations in favour of psychological science, but they are some of the most remarkable phenomena of a psychical contagion, which was become almost epidemic.2 Helmont, the opponent of Paracelsus, though he unhappily fights with the same weapons, may be considered as at least the precursor of more enlightened views. Among these I would especially mention his notion that the mind of man itself can never become dis- eased, but that it is always the anima sensitiva alone, which he personifies under the name of Arclueus, that suffers.3 His observation on himself, on the occasion of a transitory hallu- cination after tasting aconite, when he fancied that he thought with his stomach,4 may be welcome to the friends of animal magnetism. AVc may also mention, as particularly interesting to us as Germans, that in this epoch wc find the first mention of Cretinism, and this in the work of an Austrian physician, Wolfgang Hbfer,5 afterwards physician to the court of Vienna, whose observations were made in the Styrian mountains. He traces the cause of this phenomenon to the
1 Lehrbuch d. Seelenstor., i, 106.
'2 See on this subject Moehsen's Geschiclite der'SVissenscb. in rterMark Brandenb. Berl. 1781. (Fried. 127.) In addition to Friedreich Lit., we may mention as yet more important, Bodin de Magor. dacmonomania. Fraucof. 1590. llenkelii cura obsessorum. Ibid. 1689.
;t Op. p. 140. • [bid. p. 64.
5 Hercul. Medic. Norimb., 1675.
I
HISTORY. 49
indolence of the poorer peasantry, and to the gross diet on which they feed.
The nosology and pathology of that age drew the doctrine of mental diseases more and more into their systems : some eminent men, such as Fabricius Hildanus,1 collected observa- tions ; others, as Sennert,2 endeavoured to make distinctions and divisions ; and some even examined the brain and nerves, as Thomas Willis,3 who, being the first that assigned to each particular part of the brain a special influence on the mind, may be considered as the father of phrenology. Some, as Etmuller,4 collected and critically examined what had hitherto existed in a scattered form ; others, as Bonnet,5 ventured to attempt a pathological anatomy of the dead bodies of mentally diseased persons, and thus materials for our doctrine gradually became so abundant and various that G. E. Stahl was able to take it up, and, for the first time, to treat it scienti- fically. Advisedly, then, we begin with him the new and better era of medical psychology considered in a practical point of view.
5. We have now to look back on this short sketch of the state of our science in the middle ages, in order to see what is the result which it affords us. Even the most superficial glance shows us that it has, in fact, been already indicated in the state- ments which we have given. The intimate connexion of our science with philosophy appears most clearly and conviucingly in this long period ; with this it appeared and grew up, and with this it vanished. It made no real progress in the middle ages. The traditions of antiquity ran through all these cen- turies like an unbroken thread ; during the first period it was so obscured by the web of superstition that it could scarcely be identified; in the second it was gradually disen- cumbered from it, till it again became visible, and ultimately, in modern times, was once more connected with nature herself, whence it had originally emanated.
IV. This modern epoch being so extensive and impor- tant, we must subdivide it, detaching from it the most recent,
' Observat. cent, vi, 1646. 2 Practica Medicina, i.
3 Born 1622. * Prax. Med. 1736.
Sepulchret, torn, i, ii, 1679.
4
50 HISTORY.
that is to say, the present century ; and, finally, treating this by itself, as the present state of our branch of the science.
A. 1. After the discovery of a new world, the invention of printing, the reformation, and even wars and epidemics, had called forth that general excitement which became the cradle of a new age, there could not have been a more favorable epoch for gradually aud uninterruptedly developing the powers of the infant science than that period of peace which followed the thirty years' war, a period when love for the arts and sciences awoke to new life. After so many violent struggles the age turned, as it were, inwardly upon itself, and an era of tran- quil exertion arose, which was peculiarly favorable to the culti- vation of the more grave and intellectual sciences. Galileo and Kepler directed their views towards the firmament ; Torricelli and Guerikc investigated the laws of physics; Newton laid down the mathematics of the universe ; Harvey, by discovering the circulation of the blood, threw an equally bright light over the human mechanism ; pathological anatomy was more and more practised, and from having been before used at most for the ex- hibition of curiosities, its importance became better understood ; chemistry having been zealously followed up since the time of Boyle and Boerhaave. was maturing for its reform by Lavoisier. Gaubius gave to medicine logic, and Sauvagea a system ; Hallcr formed physiology : the literature of the ancients was studied in quiet retirement with equal advantage to the free sportive arts, and to the abstruse and profound sciences, and the un- disturbed attempts of individual inquirers, to scan in every direction the empire of thought — the peculiar province of mind, at length enabled Kant to determine its boundaries, and to fix for ever a limit to the domain of philosophy. To these efforts of individuals were added the proceedings of entire corporate bodies, which, by uniting as academics, societies, and institutions, exercised an animating influence over the whole progress of human know ledge.
But this tranquil formation, according to settled laws, in which knowledge was, as it were, crystalli «d, did not remain undisturbed. New and mighty movements, unlike epidemics which advance from east to west, agitated all nations from west to east, awakening men from their dream of permanent repose, and convulsing the civilised world. After these storms had
HISTORY. . 51
subsided commenced that new epoch of peace, the blessings of which we now enjoy, but which differs widely from all that preceded it, inasmuch as nations have come into contact, and have thus become acquainted with each other; they feel and recognise their common wants ; manufactures and trade unite the most distant empires ; the knowledge acquired by experi- ence has taught them wonderfully to facilitate these com- munications, and what Goethe announced with respect to poetry only as universal literature, has at length embraced all the mutually connected regions of knowledge and action.
2. The history of health and disease is in conformity with these phases. During the first half of this period there existed, on the whole, a more than usually vigorous state of health, which partly necessitated the antiphlogistic mode of cure, as pursued, e. g. by Sydenham ; and by its prevalence in later years, and especially, under local circumstances, in the organs of assimila- tion, helped to decide the distinguished Stoll, as well as Kiimpf and others, to adopt their antigastric method. With the com- mencement of those storms in social life, by which many a victim was immolated, many a peaceful existence destroyed, an asthenic state of the general health visibly set in, and mani- fested itself at first, chiefly in the vascular system ; this state was favorable to the diffusion of Brown's dogma, and especially to his generally stimulating mode of treatment, but it gradually affected the roots of life more deeply, and fixed itself in the nervous system. This nervous character is that of the present day, for neuroses of every form have become more and more developed, especially since the middle of the 18th century.1 At the beginning of the eighth decennium, raphania, which often commenced with mania and terminated in imbecility, became particularly prevalent. In the closest connexion with these neuroses are mental diseases, which, in a psychical point of view, are fostered by an education calculated more for the world than for the formation of character, and in a somatic point of view, by that condition, of such frequent occurrence, known by the name of abdominal plethora. In fact, the nearer we approach to the present time, the more manifestly mental disorders increase. It is, however, affirmed that
1 Leupholdt Gescli. d. Ges. u. Krankh. 136.
52 , HISTORY.
since the establishment and improvement of institutions for the insane, a happier state of things has been observed, so that at present1 the number of insane persons in Europe is to the population as 1 to 900 or 1000.
3. Philosophy assumed a more specific form, and it may be affirmed that a scientific psychology originated in this period. The germs were scattered at its commencement by John Locke, who considered the human mind as a tabula rasa, and then examined, by way of induction, how perceptions, notions, and judgments were portrayed on it. He followed this course with great acuteness and with beneficial results, except that, through the fear of losing his impartiality, and taking for granted something that could not be proved, he made the knowledge of the mind to flow into it solely from without, and laid down the maxim, " Nihil est in intellretu, quod non antca fucrat in sensu," to which Leibnitz appositely replied by adding, "Nisi ipse intellcctus." In fact, all the materials of our knowledge come to us through experience j but, tbeu, this is partly external and partly internal. The faculty, how- ever, of perception is altogether internal, and belongs wholly to the intellect. Locke's theory, being quite in accordance with the impulse which Bacon had given to inquiry" spread rapidly and extensively. The French authors Condillac* and Bonnet' were distinguished by the judicious use which they made of this sensual ism in its application to psychology ; and their nation obtained the most refined results with reference to a practical knowledge of mankind, of which the Duke de JAochefoucault,' who is so often misunderstood, may serve as a proof. Contemporary with Locke, there appeared in Germany a kindred thinker, Gottfried "Wilhelm Leibnitz,8 of whom it may be said that it is more easy to confirm or refute his individual philosophical theories than it is thoroughly to define his general position as a philosopher. In a certain sense we may apply to him what we have already said of Plato, and call him, in the highest acceptation of the term, a philosophical dilettante; since, in surveying the systems of the dogmatic philosophers, he brought forward the strong points, sometimes of one, sometimes of
1 Leuph. 1. c. 138. a Ibid. p. 12. 3 Born 1715.
* Born 1720. » Died 1680. « Born lf>46.
HISTORY. 53
another, and occasionally stated new doctrines of his own for the purpose of poetically (ttoisu)) proving the capacity of the human mind for infinite development. Perhaps the most im- portant of these, both generally, and with reference to our depart- ment, is his monadology. The analysis of the compound led him to the idea of the simple (monas), which, without the endowment of perception (body), with that endowment (mind), with inde- finite consciousness (the mind of animals), and with definite consciousness (the mind of man), represents everything simul- taneously existing (space), and everything successive (time), and has its root in the primeval basis of the highest monad, God. This boldest and most profound of all philosophical fictions, could not fail to excite, on the one hand, many and new elucidations and extensions, and, on the other hand, according to the law of contrast, to degenerate, as it did in the hands of the most celebrated of its advocates, Christian Wolf,1 into a destructive formalism, which, with some exceptions that cannot be here explained, remained in vogue till Immanuel Kant,2 indis- putably the most profound of all thinkers, concluded the pre- ceding epoch by a comprehensive criticism, and at the same time facilitated the introduction of every new system.
It is self-evident that it is neither possible nor opportune to furnish here a full account of Kant's merits and exertions ; for who could undertake to give, in a few words, a summary of such immense labours, connected as they are with the most pro- found problems of science? A few general observations to facilitate the comprehension of the history of learning in gene- ral, and some results suited to our purpose, must suffice. Excited by Hume's scepticism, Kant proceeded boldly and im- mediately to the main question : Is it possible to arrive at a scientific cognition ? He was thus led to an examination of the sources of cognition and of the cognitive faculty ; and this exami- nation, which he conducted to its termination with an acuteness never before known, and with perfect sincerity, constituted the business of his life, and the substance of what is called his critical philosophy. Kant has given, to human reason, its self-conscious- ness, but at the same time prescribing its limits he has assigned to every science its principle and its extent. In cases
1 Born 1679. 2 Born 1724.
HISTORY.
which arc beyond our reason, he proves that they are so, and why they are so ; he has, as it were, vanquished philosophy by means of philosophy. He has given us by his criticism, the means of appreciating this very criticism ; and it may be said with perfect truth, that philosophy has not made, and indeed cannot have made, any essential advance since his time. It may appear, at first sight, that this is limiting the infinity of the human intellect, which is eternally progressive ; but when accurately viewed, the case assumes a different aspect. There either is or there is not a philosophical certainty, as there is a mathematical certainty. If this be once attained, research in that direction is concluded: 2x2 are 4, that is settled; to attempt to become more certain than certain, is to be uncer- tain. Truth is truth, and whatever is superadded is false. Certainty is a mould, and the matter which is to be put into it is infinitely various, and is furnished bv the sensual and the moral world. Man was not made to think, but to act. He must be able to come to a final decision respecting the objects and the bounds of his thought, otherwise the purpose of his life is not attained. There must be a philosophy which is true, and which admits of being handed down, unless every man is to pass his life in re-examining all previous systems. To have fixed these boundaries, within which infinite progress is still possible, both ethically and empirically, is the immortal merit of Kant, a merit which will be duly appreciated only by pos- terity. In him, as above hinted, the knowledge of that epoch Avas, as it were, crystallised, and nothing but the storms that we have described could have disturbed the regularity of that crys- tallisation. The agitation of nations had extended to indivi- duals ; no repose was to be found. Fichte1 took up a thought of Kant's, and carried it beyond its due limits ; he endea- voured to prove that which Kant had shown to be undemon- strable, and created an absolute idealism, which destroyed itself ; Schelling2 felt this, and endeavoured to complete the im- possible, by means of a second impossibility, adding to absolute idealism, an absolute realism — resolving all into unity, and thus destroying individuality. Hegel0 perceived that this abso- lutism was not proved ; and when, instead of turning back he
1 Born U"J - Born 1770. 3 Born 1110.
HISTORY. 55
proceeded further, the overblown bubble burst, his prodigious intentions dissolved into a formula.1 Herbart2 was the most careful of all to set bounds to his speculations, and treating his subject in a strictly methodical manner, adhered to given data. This brings us to the safe harbour of the present : when both political and philosophical storms have subsided; people are weary of them, they attach themselves to the empirico-real, to experimental science, which is valuable in its application to arts and manufactures ; but I am happy to see that where a scheme of metaphysical science seems to be necessary, they begin to comprehend and to value that of Kant. If I appear to have digressed too much in this section, the importance of the subject may justify me; but the very best apology is, that I am sensible of having treated it in far too slight and unsatisfactory a manner.
4. The section which now follows is the most important in the history of our whole doctrine ; nay, it may be said that medical psychology properly so called, that is to say, a union of psychology with practical medicine, did not begin till this period, and yet awaits its completion by the blending of both sciences, either at the present, or some future time. In order to understand the actual state of the science, we must here go somewhat more into detail.
The transition to this union of philosophical and physio- logical knowledge for the practical purposes of the physician was, properly speaking, effected by G. E. Stahl,3 before the scientific developments of the second epoch of this period ; the course of scientific improvement being opened, not as pseudo- philosophers usually represent by a systematic development, which they pretend, by the aid of historical evidence, to de- monstrate on paper, but invariably by the eagle eye of genius and by the individual inquirer in calm retirement. The iatromechanical notions of the physicians of that time, urged
1 Of course this is not the place to enter into deep reflections. The above-men- tioned phases might be briefly expi-essed thus : Kant assumed an existence and an action, Fichte an action, Schelling an existence, Hegel an assumption.
2 Herbart is unquestionably the most acute thinker among modern dogmatists, and one whose system affords the best halting-place, especially for the philosophy of nature and of the mind.
3 Born 1660, died 1734.
56 HISTORY.
this profound thinker to a lively opposition ; and this opposi- tion led him to a deeper perception of the influence of the intellectual on all the events of human life. He thus became the first to give a decided and lively impulse to the investiga- tion of their relation to each other, as well in application to physiological and pathological theory, as to the cure of bodily and mental diseases, and in this sense he must certainly be accounted the founder of our doctrine.1 The essence of his system may be summed up, for our purpose, as follows. The collective processes of life cannot be comprehended, unless we comprehend its object. This object can be no other than the soul. The successive development of the epochs of life, and the curative efforts of nature in diseases, gradually bring to light all the destined purposes comprehended in the notion of the individual. This realisation of the notion is its object. Stahl's theory consists in tracing the relations, with reference to this object, whether in a state of health or disease, of all the individual organic processes. The identification of the soul with the basis of the phenomena of vitality, with which this theory was charged, a reproach which has been repeated by one historian after another, and furnishes a convenient excuse for neglecting a more thorough investigation of the theory itself, is owing partly to his first crude essays, which he subsequently in- directly revoked and modified, partly to the state of physiology in his time, which rendered many better explanations impossible, and partly, as is the case with so many theories, to the mis- conception of scholars, who are accustomed to swear in verba ma- gistri, without having fully comprehended their meaning. This, however, was by no means an essential point of Stahl's theory. The medium between the organic movements and the psycho- logical objects of them, was called by Stahl motus tonico-vita/is. This is, as it were, only an expression of that forming and inciting life (or principle of vitality) which is concealed be- hind the phenomena perceptible to our senses. It combines all single processes into one type, all organs and systems into one animal economy, facilitates the comprehension of the organism by a teleological investigation of it, and manifests
1 Joh. Huarte (born 1520?) first carried out the notion of a medical psychology. Mitzger Skiz. einer pragm. Litt. Gesch. p. 211.
HISTORY. 57
itself with respect to sensible perceptions, in a state of health as instinct, in that of sickness as the curative power of nature, by which the practical physician is furnished at one and the same time with a permanent maxim, and a guide to his treatment. The secretions and the excretions, nutrition, menstruation, habi- tual hemorrhages, inflammations, spasms, synergies, and the vi- carious actions of the organs and functions, are explained by Stahl, often in the most ingenious manner, by the normal or abnormal condition, or by the excess or deficiency of the motus tonico-vitalis. He especially derives from them the reciprocal relations which exist between the passions and organic altera- tions. With respect, however, to mental diseases in specie, he will not have us understand thereby, as in the explanation of bodily sufferings, an injury of the substance of the mind ; but only an abnormal relation of the mind to the body, from an impediment to its action. This impediment is caused by an extraneous motive (idea) pressing upon it, and this again pro- ceeds either from the senses or other functions of the body, or from the mind. The former gives those powers of delirium, called by him sympathetic ; the second, those called pathetic. The latter sometimes retain the fantastic representations (phan- tasma) in which they originated. Sometimes, especially in the insane, they deviate into others, but always retain the colouring of the character of their subject or object.1 He explains the insensibility of the insane to cold to arise from the obstruction of their feeling, and from the development of warmth by the existing excitement ; and distinguishes, for instance, the eroto- mania of psychical from that of somatic origin, by the circum- stance that in the former the ideas are, from a predominance of imagination, directed towards a specific person, in the latter from a predominance of sexual desire towards the whole sex. In the sympathetic mental disorders, the morbid ideas which exist furnish Stahl with, what may be termed, telcological hints on the diseased functions of the body, and as in dreams, when plethora exists, the state of the body is often in a manner sym- bolised by fire, objects of a red colour, &c. &c, so in insanity, which in this sense often becomes elucidated by a critical sign
1 Stahl everywhere seeks impartially to discover the causal relation between the body and mind.
58 HISTORY.
of the instinct of self-preservation. An impartial view of these fundamental principles is in many respects instructive. Every theory of the natural sciences is neither more nor less than a mode of perception, an attempt to translate the language of things into the language of the understanding. "With respect to the investigation of organic nature, none of these attempts has vet carried us further than that of Stahl, namelv, to take it up as an idea. He gave in symbolical representations, though not so definitely, the same that Kant afterwards developed in a scientific analysis. The organism is to be comprehended only teleologically ; that is to say, as a whole, of which the parts are reciprocally related to each other as means and object. When, therefore, subsequent inquirers based that fundamental phenomenon — organism, sometimes on excitability, (suscepti- bility,) sometimes on a power of reproduction, (irritability and sensibility,) sometimes on a simple mobility, the essence of which was unknown, wc may at least affirm that we gain little more than bv Stahl's motus tonico-vitalis, which besides has the advan- tage of instituting, instead of divers energies, one motion, modified according to the nature of the organs, and visible in its effects. The self-preserving principle of organisms too, which, since the time of Hippocrates, has been the palladium, the religion as it were, of the practical physician, is here not onlv confirmed but followed out into further relations, and applied to useful maxims. The pathological relations of the mind appear at length to be appreciated on both sides, and thus a foundation is laid for further studies of much promise. Stahl's doctrines were received with equal enthusiasm and oppo- sition,1 yet continued to exercise a secret influence on subse- quent researches ; they reappeared long afterwards in Langcr- mann, and are even now earned out and adapted to the times in Ideler. Among the great practical physicians and teachers of the first half of our epoch, some have enriched our knowledge of mental disorders, or the treatment of them, by many important results of that purer empiricism, which has been revived since the time of Sydenham. Some, like the inestimable Gaubius (Serin, de reg. ment.) (with Avhom none but our ownHartmann can be compared, for truly philosophical views
1 The particulars of which may he seen in Friedreich's Litt. Gesch. p. 251, &c.
HISTORY. 59
in practice), endeavoured to clear up notions and principles, while others exerted themselves in their nosographical systems to assign to the disorders of the mind a positive place and classi- fication. It would lead us too far to enter into a detail of these essays.1 They did not afford any particularly instructive results, had no influence in advancing the therapeutics of the subject in question, and were directed according to the indi- vidual views and limited experience of their authors.
It was not till the second half of this period, when a great impulse was given, on the one hand to experimental physio- logy (in Germany by A. v. Haller), on the other hand to speculation (in Germany by Kant), that the practical part of our subject began gradually to acquire a more solid founda- tion. Anatomists and physiologists on their part were inde- fatigable in endeavouring to obtain, by multiplied dissections and experiments, a more accurate knowledge of the structure, composition, and functions of those organs which are manifestly instrumental in producing the actions of the mind : that is, the brain and nerves ; and we are especially indebted, on this head, to the labours of S. T. Sommering. He established that the size of the cerebrum compared with that of the nerves in- creases in proportion to the mental capacity, and is much larger in man than in animals ; he proved that the sandy sub- stance in the pineal gland belongs to the normal structure; he discovered the yellowish layer between the medullary and cortical substance of the cerebellum ; determined the destination of the cerebral nerves, established by him as consisting of twelve pairs, and transferred the sensorium commune to the fluid of the cavities of the brain as the proper organ of the mind. Wc are greatly indebted to J. F. Meckel for a history of the deve- lopment of the brain, to J. Gall for its anatomy, for a know- ledge of the whole nervous system to Charles Bell, (who first endeavoured more strictly to prove the existence of a double class of nerves, the one for sensation and the other for motion,) and to J. Chr. Reil for the theory of its functions.
The detail of all these efforts belongs to the history of anatomy and physiology, and they are of importance here only
1 They may be seen in Friedreich, Toltenyi's Critique, and elsewhere ; a special mention, however, is due to Kloekhoff (sec Friedreich, 339) on account of the re- markable riches of material and thought so rarely met with in his times (1753).
60 HISTORY.
so far as they offered to those architects of science, who were approaching from another direction, labourers and cement to erect an edifice, of which those who practised psychological medicine might take possession, and who according to their inclination or abilities, laid hold either of these empiri- cal materials, or of the above-mentioned speculative views. Thus arose medical psychology in the form which it then assumed. Two men must, however, be specially distinguished in this period, one of whom (Joh. Christ. Reil,1) starting from the medical side, the other (J. Or. Hoffbauer) from the philo- sophical side, became united in their efforts, marked the culmi- nating point of this period, and exercised great influence on their successors. Reil, who was already provided with an ample store of anatomical researches on the brain and nerves, and of practical experience in the treatment of patients, subse- quently combined with this the views of nature acquired by Schelling and his followers, and was the first who endeavoured, in this sense, to make a rational attempt to found a psychical mode of cure, in which he was successful, and obtained reputa- tion as a psychological physician. Hoffbauer, who was not a physician, treating the practical and pathological department of psychology in a philosophical view, after the sober and solid manner of Kant, united with Reil, and to this union of the physician and philosopher (one most desirable for such labours) Germany was indebted for the first efforts which were made, and for many valuable improvements in this department.
To complete our view of this period we have to notice three half philosophical, half medical systems, which may be most properly introduced here. I mean the so-called animal magne- tism, phrenology, and physiognomy. The actual development of these systems belongs to other chapters, but the history of their origin must be noticed here, and this genetic moment is often of the greatest consequence to explain the internal nature of a received tradition ; at all events the history of the character of an individual, as blended with the svstem which he has founded, is of a degree of importance which must never be lost sight of. Antonius Mesmer2 defended at Vienna, in the year 1766, the thesis, that there is a general influence
1 Born 1758. 2 Born 1733, died 1815.
HISTORY. Gl
exercised by the planets over all living beings on the earth ; and that this influence manifests itself chiefly in those func- tions of life which belong to the nervous system, such as sensation, motion, sleeping, waking, and mental operations. This view excited no interest, and Mesmer, therefore, endea- voured to promote it by joining P. Hell, an astronomer, who manufactured artificial magnets. Mesmer conjectured that the magnet was a symbol of those cosmical influences, and, in conjunction with Hell, tried to effect cures in what are termed nervous disorders, by friction with these magnets. The two friends disagreed, because Hell did not confirm some assertions of Mesmer, but thev were afterwards reconciled. Mesmer, however, shortly declared that he did not require the magnet at all for his cures ; for that he had the power within himself. He accordingly manipulated thenceforth without a magnet, and in 1775 announced his discovery, in a circular, to the most celebrated academies of Europe. From this period the term mesmerism is to be dated. The discoverer immediately set out on his travels. At Paris, where he at first refused to permit an examination of his mode of cure by a scientific com- mission, he subsequently gained over D'Eslou, a member of the medical faculty, to the support of his system, and at this time commenced its most brilliant period, and its propagation among all classes of society. This occasioned the issue of a royal mandate for the formation of two committees of inquiry, one out of the Academy, of which Franklin and Lavoisier were members, and the other out of the faculty, in which Jussieu took a part. The report of these commissions, after several months of observation, were alike unfavorable ; Jussieu, how- ever, gave a separate vote, in which he admitted the essential effects, and ascribed only the unessential secondary effects to the power of imagination. D'Eslon and Mesmer protested against the decisions of the commissioners, and the practice of magnetism continued to make its way. It was introduced into Germany by Lavater in 1787, and completely so by Wolfarth, a physi- cian of Berlin, to whom Mesmer before his death communi- cated his doctrine and his mode of proceeding. In Germany it was, however, an object of science, rather than of fashion, and Kieser, Nasse and Eschenmayer, in particular, by the publication of their ' Archives of Animal Magnetism/ which
62 HISTORY.
appeared from 1817 to 1821, exerted themselves to promote, by observation and reasoning, the scientific investigation of these phenomena. Thus magnetism became the subject of divers interests and modes of treatment ; to philosophers an object of speculative exercise, to enthusiasts an article of faith, to charlatans a source of profit, to the majority an object of curiosity or of contempt, to a small minority a remedy, which, as respects both its basis and consequences, requires further unprejudiced and cautious investigation, and awaits the judg- ment of continually progressive knowlegc. Our business in this place is only to set before you its origin in its most general but faithful outlines.1 We pass on to the second of the theories which we have noticed.
J. Gall" had observed when at school that some bovs, who, in spite of his attention, excelled him in committing subjects to memory, were distinguished by large eyes. He subsequently perceived the same peculiarity in celebrated actors. This led him to conjecture that this structure of the organs might indicate the faculty of memory. He afterwards indeed relinquished this conjecture, yet constantly returned to the idea that particular faculties actually depended upon the structure of certain corresponding parts of the head. He began to collect skulls, and carefully to compare their structure; extended this comparison to the skulls of animals, called to his aid a study of life and organisation, and became convinced that these physiognomical relations depended on something internal, and were not to be otherwise accounted for. This conviction led him to a more profound study of the structure of the brain, which he, by an improved method of dissection, chiefly in- vented by himself, (beginning from below upwards,) prosecuted with the greatest success, so that, according to Reti's testi- mony, he was in this department one of the first anatomists of Germany. Thus supported, phrenology, which, as well as mesmerism, had originated in Vienna, was nevertheless, like it, first propagated throughout the world from Paris, where Gall delivered lectures, and found a zealous coadjutor in Spurzheim. This doctrine, too, which, in its physiognomical part alone, set out with the position that the elevations and
1 Vide Choulant, on An. Magn. Ureslau, 1842. - Born, 1 758
HISTORY. 63
depressions of the bony skull are impressions of the organs of the brain lying beneath, each of which represents a particular faculty of the mind, while it became the common property of the learned, became also the representation of the most diverse interests and notions. Degraded by the thoughtless to a childish toy, abused by enthusiasts, as a foundation for rash deductions, dishonoured by charlatanism, ridiculed by comic writers, despised by the many, investigated scientifically and impartially by the few, prosecuted in Germany physically, in England empirically, and, even in our days, as warmly op- posed as defended, this doctrine, like that of Mesmer, awaits its due place in the domain of scientific development. Here, too, we have only to state its origin, and it appears, from what has been said, that it has been formed into a theory by observa- tion, through the medium of empirical analogy and induction. What was only a secondary consideration in craniology, namely, the investigation of the internal human character from the external, was the main object of another doctrine, which was prior in its origin, but was mutually supported by, and did itself support, the later theory — we allude to physiognomy, which we mention here merely as an enlargement of the other. It is as natural in itself, as it is well known from history, that the language of man's countenance, in connexion with all the other expressions of his inward feelings, has from the most ancient times excited the attention of philosophical observers, as well with reference to the fine arts, as in a social and medi- cal point of view. Aristotle, Theophrastus, Campanella, Porta, Huarte, and, above all, that able and original thinker, Scipio Chiaramonti (Claramontius), &c, had long since made and collected very important physiognomical observations, when in the year 1775, a work under the title of 'Physiognomical Fragments' represented this subject, which had hitherto been considered and treated as an aphoristic contribution to the knowledge of man, as the foundation of a science, and of importance to the human race. It announced the new doc- trine Avith the enthusiasm of an article of faith, and was received in some instances with contradiction, in others with ecstacy, and everywhere with the most lively interest. J. C. Lavater, the author of this work, had already gained the esteem and affection of an extended circle, by his honorable and
64 HISTORY.
fearless sentiments, piety, and poetical talents, and also by his dignified and amiable manners. He spoke tlie energetic language then in fashion, and was soon joined by other high- spirited young men, among whom was Goethe ; while men of matured reflection, like Lichtenberg, expressed their doubts. Both, however, contributed to promote the study, and to in- crease the interest felt in the science. The work was translated into foreign languages, and by its contents, style, and the addition of excellent copperplates, excited the attention of the public till exaggerations of another kind turned that attention into other channels. The zeal which Lavater created for his subject was personal ; he had invested it with a mystical colouring, and made it the centre of a religious idea. When these interests, supported by his personal character, disap- peared, the artificial structure dissolved into its natural ele- ments, which will not fail, as they did before, to exercise a useful influence over the progress of the sciences.
To render the delineation of this division of our subject complete, we must consider the influence which the periodical press exercised over the practical part of our doctiiue in this epoch. It was in Germany that this powerful instrument in the promulgation of such important labours was the most effective, and the above-mentioned connexion of Rcil with pro- fessed philosophy (at first with Kaissler, then with Hoffbauer), Avas what set it in motion. It was this union which created the first psychological journal in Germany, the tendency of which was chiefly philosophical (1806-1808). The increasing and continually extending interest felt on the subject of lunacy, which proceeded from individual institutions and from the dif- ferent states, called for a more decidedly medical organ for its representation ; and there appeared, from the year 1818 to 1826, under the editorship of Nasse, the most important of the psychiatrical journals which had jret been published. This contained highly valuable contributions to all branches of medical psychology, and followed the general course adopted by Reil, only paying more regard to the specially practical requirements of the physician. Friedreich's Magazine, which followed (1829-1838), chiefly furnished extracts, notices, and critiques, which are of importance to a knowledge of the literature of this department ; and a periodical published
HISTORY. 65
in the year 1838 by Jacobi and Nasse, which was announced as an independent organ, proceeding from practical psycopathic physicians alone, was unfortunately not long continued, and only left a conviction of the difficulty of obtaining results by an ex- clusive consideration of one part of a subject. In the year 1841, the able H. Damerow issued from Berlin a public address to the psycopathic physicians of Germany, for the purpose of ex- citing them to establish a general journal for psychiatrics, with a special regard to public institutions for the insane. This circular contains an admirable statement of the results of the endeavours of the above-mentioned journals, and of the objects, the extent, and the contents of the new one projected, together with proposals for the execution of its very extensive plan.1 Finally, the most important step that medical psychology has made of late years, is the general attention which has been and continues to be paid to improvements in lunatic institutions, so that a knowledge of the arrangement and management of these establishments has become a distinct branch of the science. We shall see in the sequel, that besides the esta- blishments themselves, the essentials for the medical treatment of the insane are provided, and that, on this account, the world at large cannot be sufficiently thankful to our governments, as well as to the individual teachers and directors of those insti- tutions, who, besides the safety of the curable and the care of the incurable, now make the treatment of the former a chief object of attention. At the close of the last century, and here and there even at the beginning of the present, they were in a deplorable condition. The unhappy inmates, bound in chains, and confined in dark, noisome dungeons, were treated with harshness and cruelty. The philanthropic Pinel2 was the first who introduced into France a milder mode of treat- ment, and was also the first who positively recommended the psychical method of cure.3 His reforms in the police and the management of madhouses gave the impulse to various bene- ficent imitations. Chiarugi was to Italy what Pinel was to France, and the effects became manifest in all the capitals of Europe. Paris was distinguished by the noble institutions of
' Most happily carried into effect in 1844. Berlin, Hirschwald.
2 Born 1743.
3 Sur 1' Alien, m. Paris, 1791.
66 HISTORY.
the Bicetre for 800 male lunatics, and the Salpetriere for as many females, which, with their dependencies, present the ap- pearance of a little town. Besides these, the institution at Charenton, near Paris, and the admirable one at Rouen are well known. In England, the fine asylum at Hanwell, for pauper lunatics of the county of Middlesex, which accom- modates 1000 patients, the splendid New Bethlehem and St. Luke's hospitals, are the most distinguished. In Italy, there are noble establishments ; namely, in Genoa, Ancona, A versa, and at Palermo, under the direction of the philanthropic Baron Pisani. The establishment at St. Petersburg has be- come eminently useful. In Switzerland great service has been rendered by Dr. Tribolet, near Berne. Spain, torn by intestine troubles, is unfortunately by far the most backward nation in this respect.1 In Germany, the opening of the Son- nenstein, near Pirna, in Saxony, was the dawn of a day which was thenceforth to cheer the most unfortunate of the human race. The able and energetic Langermann came from Baireuth to Berlin to regulate this institution, and to superintend the organisation of other lunatic asylums. The establishment con- nected with the Hopital de la Charite in that city, now directed by Dr. Idelcr, and the private institution of Horn, soon acquired deserved reputation. The other celebrated institutions in Germany are: in Halle (now under Damcrow), in Marsberg for Westphalia (Ruer), in Siegburg for Rhenish Prussia (Jacobi), in YYurtzburg, united with the Julius hospital (Narr), in Munich (Christmullcr), in Leipzig, where Heinroth practised, near Achcrn (Roller), in Merxhausen, in Hesse (Gross), in Hofheim, likewise in Hesse (Amelung), in Winnenthal (Zeller). A splendid new building, which is not yet inhabited, has been erected at Erlangen, and Saxenberg, near Schwerin, offers the first model of a great establishment in which the treatment of curable and the care of incurable cases of insanity are com- bined. The principal institutions in the Austrian empire are: in Vienna (Dr. Yiszanik), in Prague (Dr. Riedel), in Gratz (Dr. Schubert), in Briinu (Dr. Kroczak), in Laibach (Dr. Zhuber), in Clagenfurt (Dr. Jansekowich), in Hall (Dr. Tschallener).2 In conclusion, we have still to notice the remarkable colony for
1 Vide de Turc. in the Annal. de la Soc. d. Med. d. Gand. 1841. s Compare the works of Kiistler, Viszanik, &c. &c.
HISTORY. 67
the insane at Gheel, near Antwerp, wliere between 400 and 500 lunatics are distributed for their cure among the 6000 inha- bitants of the place, and the establishment of the philanthropic Dr. Guggenbuhl on the Abendberg, in Switzerland, for the cure of cretinism. Even in Egypt Mehemet Ali has, under the direction of a European physician, appropriated the civil hospital, Esbekieh, to the reception of the insane, who had hitherto languished in that country in a state of helpless destitution.
This rather detailed, and yet slight sketch, was necessary in order — -
5thly. To state the result as applied to this period, which is unquestionably the most important in the wrhole history of our doctrine, and which, properly speaking, then first attained an in- dependent existence. The period of peace with which it began afforded an opportunity for collecting an ample store of materials, and prepared men's minds by quiet research for the reception of comprehensive notions. The epoch of violent agitation which followed, set materials and ideas in rapid motion. The alternately excited and asthenic state of the public mind, which was a necessary consequence, was peculiarly calculated to direct attention to the morbid state of the intellectual faculties which then appeared more and more frequently. The impulse given, on the one hand, to philosophy by Kant, who discussed those fundamental questions which concern the operations of the mind with a profoundness and precision never before known, and the advance, on the other hand, of experi- mental physiology, which gave us hopes of being able to follow out to the minutest atom the organic apparatus of those operations, knit the two terminating threads of medical psychology together, and promised a durable union. Magne- tism, physiognomy, and phrenology, in the form in which they appeared, — perhaps premature uni'ipe fruits of this union — im- pelled the ardour of inquiry still further into enticing obscurity. The interest taken in these studies increased daily ; periodical publications put the question under discussion into new and clearer forms; a philanthropically practical interest in the or- ganisation of institutions for mental diseases was added, and thus all the elements were at length combined to facilitate the birth of a science, of which more wonders had hitherto been proclaimed than seen.
r»s HISTORY.
B. Before closing this historical sketch, I will give, ac- cording to my promise, a preliminary idea of the present position of our doctrine, together with a history of its develop- ment to the latest period. It is now usual to distinguish, in a medical sense, three different views of the relation of the operations of the mind to those of the body — of intellectual to corporeal life.
1. That called somatic assumes the operations of the mind to be an emanation from those of the body, and considers mental disorders to be merely bodily ailments.
2. That called psychical assumes an independent operation of the mind, and considers its disorders as purely psychical derangements.
3. That called mixed assumes an independent operation (life) of the mind, and sees in its derangements a half psychical, half corporeal disease.
These three designations are, however, only collective terms for very different views comprised in them, and we should be doing much injustice to their representatives if we imputed to them all the consequences that may be deduced from these strongly expressed extremes. They are, besides, variously com- bined and blended by the most diverse limitations and transi- tions, according to the proportion of intellectual and sensitive qualities existing in their respective supporters; qualities which are different in every thinking individual. We must therefore never positively designate any one as belonging to either of these categories, unless he declare himself to that effect, for instance Friedreich, who adopts the somatic view, though many passages might be adduced against him where his view partakes of the psychical. A theory which alleges as one of the arguments for the somatic nature of all mental derangement that the mind is an independent, indivisible energy, and incapable of becoming diseased, cannot, according to the above designation, be properly called somatic. The preceding observations were necessary to obviate any misconception of what follows.
The able J. B. Friedreich1 is generally regarded as the
1 Vide P. R. Lippich, Tract, de Vesav. (Breit et Wieser), where several subdivisions and arguments on both sides are adduced.
HISTORY. H9
representative of the somatie view. According to him, all psychical disorders arc a result of abnormal conditions of the body : 1, because the mind (see above) cannot become diseased; %, because the greater part of the causes producing those con- ditions is somatic ; 3, because in all mental disorders there are somatic symptoms in addition ; 4, because they are too per- manent for pure conditions of the mind ; 5, because they are subject to cosmical and telluric states ; 6, because their crises always take place in a material way ; 7, because they are not unfrequently removed by strong material influences ; 8, because the somatic mode of cure alone has a direct sanatory effect, the psychical at most an indirect effect on the body ; 9, because the occurrence of psychical indisposition on one side only, must arise from the duality of the brain ; 10, because the return of reason before death occurs in cases not only of psychical, but likewise of somatic diseases, and may be physi- cally accounted for ; 11, because mental disorders correspond with the temperaments ; 12, because it may be proved that there are psychical conditions which depend on organic causes, and are therefore very analogous to psychical disorders ; 13, because chronic delirium (mania) can be no other than febrile.1 Though this is by no means the place to decide on these weighty questions, the import of which can be rendered clear only by the development of the whole doctrine, yet some pre- liminary observations on the reasons alleged above may afford a clue calculated to guide us further on our way. 1. The notion conveyed in the words " become diseased" must be more fully defined before we can judge of it. 2. The " greater part" is not the whole ; and moreover occasional causes, and what are called proximate causes, must be dis- tinguished. 3. Will be called in question by the adherents of the psychical view. 4. It does not appear why a pure condition of the mind should not be permanent. 5. These conditions may act indirectly on the mind in the same manner as psychical remedies, according to the somatic view,
1 Historisch-kritische Darstellung der Theorieen iiber den "Wahnsinn. Leipzig, 1836. The special views of individuals — for instance, of the judicious and con- scientious Jacobi and others — must be studied at their sources. What has cost the labour of a life to acquire, cannot be discussed in the compass of a page. Here we have to do only with some final points.
70 HISTORY.
act on the body. 6. Psychopathology has not yet acquired sufficient light respecting these critical processes. 7. " Not unfrequently" is not identical with " always •" these influences may likewise act indirectly on the mind. 8. A circulus in probanda : mental diseases are somatic because the remedies act somatically, and the remedies act somatically because the diseases are somatic ; the adherents of the psychical view may take the converse of these propositions. 9. What are we to understand by a mental disease affecting only one side, if the mind be simple and indivisible ? Will the adherents of the psychical view allow the cases here adduced to be mental disorders ? 10. Does this " likewise" prove anything ? 11. Do not the temperaments correspond conversely with the qualities of the mind ? 12. Can a proof be deduced from analogous conditions ? 13. This proposition is warmly contested by the adherents of the psychical view.
These observations are by no means intended to refute the somatic theory, or to detract from the great merits of Fried- reich in illustrating and enlarging the fundamental principles of medical psychology. It would be a great misapprehension so to consider them. On the contrary, he is as right in his positive propositions as his psychiatric opponents are in theirs. It will appear in the sequel that all parties are wrong only in negative points, by virtue of which they dispute the neutral ground that lies between them. We shall find that as many ob- jections may be made to the so-called psychical theory, and still more serious ones to the mixed theory. This is a matter not to be settled by single propositions and proofs. The argu- ments must be weighed, not counted. The true relations must be established, not bv means of demonstrations, but bv a consideration of the mode of procedure in the organic de- velopment of the whole. My purpose was to prepare the way for this. To discuss the subdivisions and varieties of the so- matic view in this place would lead us too far, and be anticipa- ting our subject. They are amply detailed in the works quoted.
Heiuroth,1 Avho died in 184-3, is considered as the represen-
1 Lehrbuch rler Seelenkunde. Leipzig, 1818. It is ■worthy of remark, however, that both Heinroth and Friedreich entertained different views at two different periods, only conversely.
HISTORY. 71
tative of the psychical view. The diversity of opinions how- ever, among the very eminent men who are generally ranged under this banner (Harper, Heinroth, Benecke, Ideler, &c. &c.) is much greater than in the preceding class.1 It is therefore more difficult to lay down those general positions, in which they agree, than in the other case. The following may perhaps be assumed as such : — The mind is the immediate seat of the disease, the bodily suffering is secondary. Mental disorders may be clearly traced to their origin, Sin, Error, Passion. Diseases of the brain, on the contrary and of all the organs, occur, even in their greatest intensity, without mental disturbance, as also the latter without the former. The psychical mode of cure is that which is properly efficient ; the somatic remedies in reality act psychically ; for instance, through pain, diversion of the thoughts, stupefaction, terror. Pathological anatomy has not discovered any decided re- lation between disorganisation of the brain and mental disorders.
Here again I add a few remarks. 1. Can the modification of the mind in itself be called disease otherwise than per ana- logiam ? Here, as before, the idea " Disease" is not precise.
2. We may very often see them proceed as clearly from bodily suffering ; and sin, error, and passion exist without their fol- lowing as a consequence. Here too occasional causes and what are termed proximate causes must be distinguished.
3. They occur also with mental disturbance, and the latter when it does not arise merely from sin, error, &c. hardly ever without them. 4. The adherents of the somatic view (see above) affirm the contrary of both. 5. Pathological anatomy will make further progress, and where anatomical preparations cannot be made, recourse will be had to the aid of Pathological che- mistry and physics.
As the representatives of what is called the mixed view, we
1 We may distinguish a religious, an ethical, and a psychological view, (Heinroth, Ideler, and Benecke.) The ethical is the most clearly, scientifically, and practically developed by Ideler, whose works breathe a pure, moral intellectual spirit ; but as Ideler is more discursive than methodical in his writings, I would refer any one who desires to be accmainted with the essence of his views, especially to the chapter on the Pathogeny of Mental Diseases, in the second volume of his ' Grundriss der Seelenheilkunde,' pp. 114, 115.
72 HISTORY.
are not to look on some eclectic, empirical French writers, as for instance, Esquirol, that admirable observer, whom Lippich justly calls " Hippocratem pro morbis mentalibus dicendum," or Georget &c. ; nor the English, as Haslam, Perfect, the profound Crichton, &c, but those who, like Groos or Blumroder, hope and endeavour to unite the principles of the two views. On reflection, however, it will appear evident that principles cannot be confounded, and that a question positively stated, must be either positively answered yea or nay, or a protest must be entered against the question itself.
There is something in the ever-recurring squabbles between the best writers on our subject which excites a compassionate smile in those who are in the habit of examining questions calmly and impartially. Who denies, who can deny that often, and independently of bodily causes, erroneous notions, unbridled passion, overpowering feelings, or a want of development may change the regular course of psychical operations in such a man- ner, that it may justly be said that such a mind is diseased ? Who can deny that such a disease is not to be removed by cold shower- baths, tarter emetic, &c, but wholly and solely by an influence on the mind ? But, if we impartially weigh the subject and ex- tent of medical art and science, do we not immediately per- ceive that every psychological physician, who treats the above- mentioned condition in the above-mentioned manner, is called a physician only in a metaphorical sense ? The question in dispute is, properly speaking, not whether the mind cm be- come diseased, but whether the task of treating independent states of the mind by education, instruction, &c. is to be con- sidered as belonging to the province of the physician or not ? The present state of the world seems to reply in the negative, because, since these moral influences are confided to parents, teachers, the clergy, &c, and by diseases, in a non-figurative sense, only the somatic are understood, the physician has to do with them alone. But here, as in human knowledge in general, it hap- pens occasionally that these moral and logical conditions, which, as well etiologically as therapeutically, are wholly independent, trench on the somatic, and enter into the domain of the physi- cian, whose rule, therefore, extends over them. The confines, as in all human knowledge, touch without effacing each other, and this is the main substance and object of all medical psycho-
HISTORY. 73
logy, so that the physician, who is wholly unacquainted with the relations of intellectual to physical life will not be able to comprehend and treat the latter in all its various bearings.
Matter and spirit, when they are united to form body and mind, can no longer be considered otherwise than as unity. When therefore the so-called somatic theory affirms that every mental disorder has a purely corporeal origin, it speaks as par- tially as the psychical theory would in affirming that every bodily suffering proceeds from the mind. If, as Dubois justly observes in hypochondriacs, organic diseases are the most easily formed in those parts on which they bestow particular care, and if (as I have endeavoured in another place to show by many proofs) imagination may contribute as much to the prophylaxis and cure, as to the origin of bodily maladies, a psychical commencement of them is hereby admitted ; while, on the other hand, no one who is acquainted with human nature will deny that those peculiar maladies of the mind, error and vice, originate frequently in states of the body. Here again we have only to do with the determination of the boundaries of the medical domain, not with theories. The end of the former, the beginning of the latter, lie in this domain, and the physician has to find the line of coincidence, the Hue where spirit and matter combine to form a living unity ; he has to appreciate the mind, so far as it acts etiologically or therapeutically on the body. Its peculiar and proper pathology belongs to logic and ethics, for, as it has itself no seat, it cannot be the seat of substantial sufferings. The division hitherto most approved, of what are called mental diseases, according to the deranged functions of the mind, is therefore, at all events, only symp- tomatic— phenomenological. It may, however, answer our pur- pose as well as any other, till we shall have ascertained in every case of these deranged functions the causal relation between mind and organ, before which period many a long year will pass away.
If we now turn from these theoretical views to the practice of medical psychology, which is our proper concern, we shall perceive with pleasure, in considering its present state, that the importance of these theories is by no means so great in the application as might at first sight appear. Different as are the psychological and pathological doctrines of the mind, their ad- herents agree pretty well with respect to the therapeutics ; a new
74 HISTORY.
and consolatory confirmation of the truth that the actions of man, as his most holy duty and most exalted task, may be per- formed without requiring certainty in all the problems of knowledge. As in the healing art in general, the most expe- rienced and best-informed physicians pursue nearly the same treatment at the bed-side, and only explain in a different way, the effect of the same remedies, according to the differ- ence of the schools to which they belong, so those who prac- tise this branch of medicine in particular agree on the whole in the choice of remedies; the psychical employ likewise somatic; the somatic employ likewise psychical remedies; only, as we have seen above, the one party explain the effect of the psychical remedies somatically, and the other the effect of the somatic remedies psychically. Thus each employs both kinds of reme- dies, and the extravagances either way are so easily recog- nised as exceptions, that they cannot mislead the learner. All practical men in this branch are, however, especially unani- mous in acknowledging the importance of public institutions for the cure of lunatic patients ; all eyes are directed to them, and plans for their amusement and improvement are now the primary object of psychiatric science; and though the sanguine admirers of the psychical mode of cure, for instance, by thea- trical representations, &c. undoubtedly go somewhat too far, it is nevertheless generally perceived, that these institutions and their proper organisation offer the only practicable mode of successfully treating mental disorders.
This is a general outline of the present state of the thera- peutical part of our doctrine, and with it the sketch of its history is completed.
Instead of the notions of the somatic, psychical, and mixed views stated above, and the doubtful foundations upon which they rest, you will now naturally wish to be informed which of them are the views that these lectures adopt, or what others they will propose, in order that you may be guided by something not negative, but positive. A well-grounded answer to this point can only be furnished by the lectures themselves ; but from our preliminary basis thus much may be premised. The mala- dies of the spirit alone, in abstracto, that is, error and sin, can be called diseases of the mind only per analogiam. They come not within the jurisdiction of the physician, but that of
HISTORY. 75
the teacher and clergyman, who again are called physicians of the mind only per analogiam. The maladies of the body alone, in abstracto, for instance, of the brain or the nerves, without mental alienation, are not diseases of the mind, but of the body. The notion, mental disease, must therefore be deduced, neither from the mind nor from the body, but from the rela- tion of each to the other. The question does not turn here on the external cause of psychopathies, which may be either psy- chical or corporeal, nor upon what is called the proximate cause, which is inscrutable, because the relation between body and mind is inexplicable ; the question is respecting the pheno- menon itself. Where psychical phenomena appear abnormal, there is mental disorder which hus its root in the mind, so far as this is manifested through the sensual organ, and has its root in the body, so far as this is the organ of the mind. To search after the phenomena in which these relations are re- vealed, with the unprejudiced eye of experience — to investigate them scientifically in every point that is of importance to the physician, and to collect them in one whole, is the province of medical psychology, upon which we are now about to enter.
CHAPTER 111.
PHYSIOLOGY.
§ 1. There are two modes or ways of treating the sub- jeet of our investigation — 1st, the synthetical, which deduces the particular from the unit}r of the scientific idea ; 2dly, the analytical, which takes given particulars as the starting- point, and aims at reaching scientific unity. The first gives the philosophical foundation ; the second, the physical develop- ment, or natural history. The metaphysician takes the first course, the second is prescribed by our object, which requires a physiology of mental operations.
We :sh;dl, therefore, after determining the facts and notions from which we have to proceed, begin with the most simple operations of psychical life, and gradually advance to the more complex and elevated. The latter must be understood from the former, as in the sequel, the pathological from the physio- logical. "When we have reached the highest functions, the reverse or synthetic method, which refers mental to bodily diseases, furnishes, as it were a proof and completion of the analytic, which again opens to our view many new points of the subject. An example of the first method is given in Hart- mann's excellent work, ' The Physiology of Thought j'1 which endeavours to develop the intellectual functions from the organs. An example of the second mode of proceeding is furnished by the able Nasse,2 who seeks to deduce the rela- tion to the several organs from the mental functions.
§ 2. How do we acquire the notions, body, mind, spirit ? Fear not that I shall conduct you into the dangerous domain of metaphysics. AVe have nothing to do with it, though it would be well if we might take it for granted. We have only to seek a firm foundation and a definite terminology for our science, in order that we may be able to take every step with
1 Dcr Cleist des Menschen. Vienna, 1832, second edition. a Zeitschrift. fur ps. Aerzte (1822). and elsewhere.
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security and intelligence. If the practitioner think that he can do without any theoretical basis, and therefore without this, he is mistaken, and in the course of his practice will, alas ! too late perceive his error ; for every human action, even the most mechanical, rests upon, and ultimately requires, principles.
We attain the above-mentioned fundamental ideas by sen- sual perception and consciousness ; the first reveals to us a material, the second an intellectual, world. We have, there- fore, these two facts : the fact of perception and the fact of consciousness, from which we proceed.
The process in man himself, whereby he becomes aware of these facts is, as mentioned in § 1, first analytical, then syn- thetical. First, the material world is perceived by means of the feeling and senses. With the gradual development of man, he learns to analyse it more and more in detail, and thus at- tains, as it were, from below upwards, to abstractions and notions, and gradually to a notion of notions, which he de- signates by the word mind, which notion, however, at this stage of the process, is only negative, being " everything that is not matter." But here, uniting as it were two worlds, the fact of consciousness intervenes, which announces itself by the idea of unity and freedom. When this fact has occurred to man, he endeavours to combine, as it were, from above downwards syn- thetically, into one whole, the world with which he has become acquainted through his senses.
" Something for which man can find no analogy, combines with the organs which he has in common with the higher species of animals, — he calls it mind."1
§ 3. The union of the perception of both facts (§ 2) in one subject, every man designates as " ego." The ego of the mental physiologist is therefore not the ego of the metaphysician. That ego of which we speak, consists of body and mind,2 the other is an abstraction of the most spiritual personality.3 Let
1 Neumann, d. Mensch. 1844, p. 23. 2 Vide Tbltenyi. Kritik. i, 223.
3 Fichte. Professor Lippich appears to agree with us, in his acute essay ' iiber die Verletzlichkeit der menschlichen Leibesfrucht ' (M. Jahrb. n. f. vi, 204), he says, " The principle of human personality, that is to say, the notion of individuality, can originally reveal itself only in the manner of human conception." Cams would say, " Darleben," pervitalisation.
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it not be objected that the ego must be intellectual, for the child at first speaks of himself in the third person, till the in- tellectual personality is developed in him.1 He speaks of him- self in the third person till he perceives the relation of the two worlds to himself. This, however, is arguing in a circle, for he only perceives the two worlds because they unite in his ego as one subject. This circle must not mislead us ; the facts of observation and consciousness are felt by man in his ego, com- pletely as one ; that they are two worlds, of which they give testimony, and which coincide in him, he discovers only by ab- straction.
Matter and spirit are this abstraction ; the former appears in man in concreto as body, the latter as mind. Body being ani- mated matter, mind being incorporated spirit. Both intimately one, and indivisible in the phenomenon.
These ideas cannot be too clearly and profoundly impressed upon the mind ; the security of all further steps in the domain of anthropological medicine depends on a firm adherence to them. They are, then, most deeply impressed upon our minds when we initiate ourselves into them by applying them in various directions, and as it were putting them to the proof. Thus also the Pythagorean scheme of Troxler is explained.2
" We feel ourselves originally as unity ; in the ego of the natural man there is neither spirit nor matter. Thinking first induces the notion of spirit. Spirit, therefore, is something which we think (sceptical realism). But that we do think is itself a proof of the independent existence of spirit, for we cannot think anything without a thinking principle. There must, therefore, be spirit besides sensual existence (dualism.) Matter also, as distinct from spirit, is not conceived by us till after this abstraction ; matter too, as well as spirit, is some- thing within us of which we think (idealism). Spirit and matter arc thus only differences which are thought of; they are, in reference to man, two modes of conceiving a unity, (the philosophy of identity, and its filiations.) But as we are only men, we will be content with this need of a conception, with- out premising anything beyond it." This is our view. " All systems of philosophy in their multiplied modifications move,
1 Kant, Anthropol. a Vide Blicke in d. Wcs. d. Menschen.
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and will eternally move within these limits ; to recognise them, and to be conscious of their limits is therefore, properly speaking, the key to all which unlocks their relative truth, it is the philosophy of philosophies."
§ 4. There are, therefore in man two systems of perceptive faculties, one called body, the other mind. The former is de- pendent on external excitements, the whole of which we collec- tively call nature ; the latter is dependent on internal excite- ments, the whole of which we collectively call spirit.1 We divine these worlds only from the dependence in which we feel ourselves with respect to them. They are generic abstractions of what is specifically individualised in us ; both the abstrac- tions are in themselves inexplicable, nor can they reciprocally explain each other. Such explanation, however, is not at all necessary to our view of the case, or to its medical application. As the naturalist knows and applies electro-magnetism in its relations, without comprehending its essence, as the astronomer calculates the movements of the planets without knowing their nature, so can we duly appreciate spirit and matter in their re- lations to each other as body and mind, without being able to explain their nature or these relations.2 The human mind is satisfied if in any case it can explain to itself why it cannot explain that case. In this determination of what can not be known, by which time is spared and error avoided, consisted the great merit of Kant. What is the meaning of explaining ? To explain means to deduce from a principle ; but this principle must itself be conceivable, for from the inconceivable nothing can be deduced ; that is, rendered conceivable. What is conceivable ? That which lies within our laws of thought. Whether these be objects of sense or of intellect, we cannot, in either case, comprehend their principle, because it does not lie within those laws. Thus, as the phenomenon of the two facts is pre- sented to us, we are compelled, in order not to be forced to deny them, to assume an inconceivable spiritual, and material principle, by which, however, neither spirit, nor mat- ter, nor their unity is explained. Every attempt in other
1 Noval, Kl. Sch. ii, 157.
2 Nasse, Zeitschrift, 1822, 1 Part, p. 3. Yet the examination of the relations of a thing conducted by way of experiment does not necessarily imply a previous know- ledge of the essence of that thing, on the contrary, the former may prepare the latter.
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directions is sophistry, we are everywhere confined within out- laws of thought. Were it otherwise we might create and con- jure up fancies ; or we should not be what we are. It is in vain to attempt to elucidate our unity, because it is given