INTRODUCTION.

Psychiatry, or the science of mental diseases, is one of the fruits of the century now drawing to its close. It was only in 1792 that Pinel struck the fetters off the patients at the Bicêtre and began to treat them humanely; and as late as 1818 Esquirol reported to the ministry that criminals, not to say brutes, were better treated in France than were the insane. The progress of this youthful science within the last decades may, however, be contemplated with some degree of satisfaction, and with a strong confidence that the stream of knowledge will be poured out in still fuller volume in the years to come.

Maturer studies and better-reasoned treatment are gradually enlarging the class of mental disorders that are curable. Society has also to thank modern researchers into the causes—the etiology—of those diseases. By this study we are enabled to oppose the production and spread of those maladies; and general information about their causes will directly contribute to the well-being of the community.

Derangement of mind has in all ages had no inconsiderable influence upon the course of history and the development of civilization; there is much in society that is mentally unwholesome and many crazes that psychiatry can show how to avoid. That insanity is a disease of a particular organ, biologically indistinguishable from a somatic disorder, was, in former times, not understood. The notion of madness was mixed up with religious faiths and metaphysical theories. Thousands were burned at the stake simply because men were not so far enlightened as to recognise that their victims were mentally sick, instead of being, as they imagined, bewitched or possessed by devils. Think, too, of the multitudes of entirely sane and innocent persons who were sent to the rack and the stake upon the accusations of madmen—mere crazy delusions! Along with such dreadful results of ignorance, and contributing to them, we find, in ages widely separated, men’s general conceptions of the course of nature influenced by superstitions and religious enthusiasms fostered by the behaviour of the insane, and accepted largely in deference to teachings of bewildered minds.

About the end of the eighteenth century the sad veil of superstition began to be lifted. Yet the pathway of knowledge was still a thorny and difficult one. Many an obstacle remained to be removed. Many a hot fight had to be fought out. Often and often, even in this nineteenth century, theologians set their traps to render the scientific pathway personally perilous. Even as elevated a mind as Heinroth declared that the cause of insanity was sin.

Alienists to-day no longer regard mental and bodily maladies as distinct. In the majority of bodily diseases some affection of the mental powers is observable; so that no scientific physician will overlook the importance of psychical influences. On the other hand, bodily symptoms occur in by far the greater proportion of cases of insanity. We can sometimes predict a severe and almost fatal derangement of the mind, at a time when hardly any aberration has yet appeared, on the strength of somatic symptoms that no ordinary person would remark. Thus, mental and bodily disease are quite inseparable; and a rational treatment of psychoses must be based upon a solid foundation of general medical skill.

In spite of all these facts, attempts are still made to withdraw the care of the insane from the hands of physicians and to intrust it to the clergy. At a meeting of the German Union of Evangelical Curates of the Insane, the Rev. von Bodelschwingh, while admitting that “modern medico-scientific psychiatry had done good service in the recognition, treatment, and cure of the insane,” yet censured it as “at bottom materialistic and temporal.” “It leaves,” he said, “sin and grace, conscience and guilt, quite out of sight, and does not recognise that forgiveness of sins brings life and spiritual health.” He continued as follows: “Speaking broadly, the less the bodily physician uses his materia medica in mental maladies, the better. Such things, for the most part, only damage body and soul. The bodily physician may be helpful in the care of the insane, but the prime thing is the treatment of the sick soul; and this should not be intrusted to the physician in the main.”⁠[1]⁠

Such utterances are, of course, merely the efforts of the clergy to extend their power. But inasmuch as they tend to injure patients, not to say society itself, the interests of civilization call upon men of science to combat them.

Nor is it by the clergy alone that attacks upon psychiatry are made. Various causes have conspired to create of late years some distrust of this branch of medicine. The general public is naturally liable to misinterpret cases of insanity in which the symptoms are not so obvious that no onlooker can mistake them, and where the practised eye of the specialist is required to detect their real nature. Then, too, the not infrequent differences of opinion among experts in insanity, leading, as they often do, to contrary judgments about the nature of individual cases, are cited as so many proofs that psychiatry is an illusory science, and that its practitioners are not to be trusted to decide upon the fate of a man.

But this is altogether fallacious. Similar objections would lie against any other practical science. Name, if you can, the branch of clinical medicine in which doubtful cases do not occur, or where divergences of opinion are less frequent than in psychiatry itself. No science whatsoever is perfect or infallible. In every field our knowledge and skill have their limits, and there are disputed marches between the completed conquests of science and the regions her armies have not yet invaded. Cases in law, as everybody knows, are continually arising concerning which the greatest jurists pronounce diametrically contrary opinions. Yet the ideas and terms with which the lawyer has to deal are, from the nature of things, susceptible of more rigidly exact definition than those which form the stock of the alienist.

In point of accuracy, psychical pathology simply stands upon the general level of other branches of clinical medicine. There are cases upon the border line between insanity and mental sanity, and concerning them differences of opinion are unavoidable. But how can that be considered to detract from the value of the general science? Mistakes occur wherever human judgment has to be exercised. Indeed, every remarkable advance of human knowledge is secured at the cost of temporary errors.

No doubt many tendencies in modern psychiatry spring from erroneous conceptions. The very purpose of this book is to contribute something toward the clearing up of certain psychological and psychiatrical notions which have already occasioned not a few disputes and misunderstandings.

The wisdom of early ages burned the insane as witches and sorcerers, or, at best, incarcerated them in dismal dungeons and loaded them with chains. Down to the very beginning of this century insanity was hardly recognised as a branch of medical science. But now the pendulum has swung the other way, and there are efforts in many quarters to narrow more and more the boundaries of mental sanity, until every mind, decidedly unlike those we daily come in touch with, or manifesting any extraordinary characteristics is labelled as diseased. Not only are the less gifted—particularly criminals—frequently considered as insane, but eminent writers go so far as to pronounce every mind whose capacity greatly surpasses the average to be a pathological subject.

Such doctrines are examples of a class of errors which frequently arise from the gradual modification of the meanings of scientific terms that had never been distinctly apprehended. Among such terms are those of Genius and Degeneration; and to analyze these conceptions is the purpose of this work. Their psychological and psychiatric significations have, as we shall find, been most diversely conceived, and this has led to many misunderstandings.

Before we enunciate our proper theses it will be convenient briefly to consider the main symptoms of insanity, so that we may be able to estimate how far we are in a condition to draw any sharp line of demarcation between mental sanity and mental disease.