Alienist Physician Research Articles

Homicide et folie morale dans Richard III de Shakespeare : essai historique

The author first notes that the human species is peculiar in the animal world for the capacity of its members to commit violence intentionally. He recalls the philosophical thinking of Albert Camus on individual and collective crime and the theoretical position of Dr De Greeff on the neurobiological bases of homicidal behaviour. He then makes some general remarks about Shakespeare and his theatrical creations before demonstrating how the classic French psychiatric studies on madness are epitomized in the work of the brilliant English playwright. After briefly presenting the historical fresco that Richard III represents, the author attempts to define the criminological profile of king Richard III and to analyse the characteristics of his voluntary homicides driven by political ambition. The king's terrible physical congenital malformations are listed along with his pathological mental characteristics. While the former alienist physicians would have considered him as a depraved individual suffering from “moral insanity”, Shakespeare’ Richard might nowadays be diagnosed as a serial killer with personality disorders characterized by antisocial, narcissistic and paranoid traits. The author concludes that only the moral education of children and the fear of criminal repression can protect human beings from their innate tendencies to commit criminal violence, i.e. the dichotomy between nature and nurture constantly underpins their existence.

The Disabilities of Alienist Physicians

The Disabilities of Alienist Physicians

Sleep in Relation to Narcotics in the Treatment of Mental Disease

Sleep, the state in which man spends a third of his existence, is so intimately related to bodily and especially to mental health, that it must ever be a subject of the greatest interest to alienist physicians. No apology therefore is needed for once again bringing under discussion a subject so familiar.

On the Restoration of the Peripheral Nerves [Ueber die Regeneration peripherischer Nerven]. (Arch. f. Psychiat., Bd. xxxv, H. 3.) Bethe

At the meeting of German neurologists and alienist physicians in Baden-Baden, June, 1901, Dr. Bethe, of Strasburg, explained that during the last decade a new nerve-cell theory had come into vogue. It was assumed that the so-called neuron was an anatomical, functional, pathological, and developmental entity. But it had been shown by Apáthy that there is a direct and intimate connection between the neurons through the primitive nerve-fibrillæ, and Dr. Bethe himself had demonstrated that in the carcinas mænas the nervous system performs its function without any ganglion cells. Thus the cell cannot be a necessary instrument in the process like the pendulum of a clock, or the wheel of a watch. Nissl has shown that the observations of pathologists give no sure support to the neuron theory. Further objections may be taken from the fact that several organs are affected after section of the nerves supplying them. In the case of degeneration of muscles and glands, it may be said that this process may be owing to atrophy from inactivity of their functions; but degeneration of the papillæ circumvallatæ et foliatæ of the tongue in the rabbit has been observed to follow, in from about two to three weeks after section of the glossopharyngeals, although the stimulus has not ceased to be applied to these organs. From this it appears that the pathological process goes further than the boundary of the neuron.

On Post-Epileptic States: A Contribution to the Comparative Study of Insanities

Section VIII. Need of Wide Clinical Knowledge.—If anyone thinks that the study of Diseases of the Nervous System as they are Dissolutions will take his attention from their clinical or practical consideration he is mistaken. I urge two methods of study, one scientific and one clinical. Without a considerable clinical knowledge of cases no one is fitted to begin the scientific, comparative, study of nervous diseases. For the scientific study of insanities a very wide clinical knowledge is necessary. It would never do to confine attention to cases described in text-books by Alienist Physicians, to what I may call “orthodox” cases of insanity. Not being an Alienist Physician I say this, and what follows in the present Section, under correction by the Members of this Society, who of necessity know very much more of “Diseases of the Mind” than I do. I should not presume to address Alienist Physicians on their special subject had I not the hope that from a long study of simpler diseases of the Nervous System, I might contribute something of at least indirect value for the elucidation of the most complex problems they have to deal with. In a later section I shall urge a study of cases of abnormal mental affections, many, of which are not, in a clinical regard, cases of insanity at all, and, so far as I know, are not dwelt upon in books on Insanity.

A Case of General Paralysis in a Woman

In the Asylum Report of last year I published the case of a woman suffering from general paralysis. The post-mortem was somewhat different from that generally met with in this disease. After reading the article of Dr. B. Mendel I venture to publish this ease, as I arrived at nearly the same conclusions as this able alienist physician.

German Retrospect

Dr. Goltz, at the meeting of neurologists and alienist physicians in Baden, held in June, 1880 (“Archiv.,” xi. Band, 1 Heft), described a new series of experiments in order to ascertain the functions of the cortex cerebri. By the help of an instrument specially made for the purpose, he removed portions of the pia mater of the brain in animals. Even after removing a large portion of the cortex cerebri he never saw enduring paralysis of any muscle, nor enduring anaesthesia of one side of the body. The animals became demented, and showed permanent dulness of all the senses. What is especially remarkable, Goltz, by destroying the white substance under the so-called motor zone, could produce convulsions in the opposite side; but as long as the instrument only touched the grey matter there were no convulsions. Mechanical irritation of the parts was followed by the same results. Dr. Goltz therefore believes that, in electrical irritation of the brain as practised by Fritsch and Hitzig, we have not to do with irritation of the grey matter, but of the underlying white substance.

A Case of Typical Melancholia from Hereditary Predisposition

A Case of Typical Melancholia from Hereditary Predisposition

The Mental Aspects of Ordinary Disease

The relations of body and mind are becoming not only much more comprehensible, but even much better understood, since science has shaken off the incubus of theological teaching as to the severance of soul and body. As long as the mind was something separated from the body, or only united to it by slack and loosely fitting ties, mental phenomena could have nothing to do with bodily conditions—insanity was a disease of the soul; and the monk, standing over a miserable lunatic chained to a staple in a wall, and flogging him in order to make him cast his devil out, was a logical outcome of this hypothesis, however repugnant to more recent and correcter views. The baneful psychology of theologians is now thoroughly undermined, and the erroneous and mischievous superstructure is cracking and gaping on every side, and ere long the ground occupied by a crumbling ruin will be covered by a gradually growing erection based on a foundation of facts, and reared by an expanding intelligence. The union of psychology and physiology is the closing of the circuit, in one direction, of the pursuit after knowledge, and forms the initiation of a rational and intelligible comprehension of the mind and of its relation to corporeal conditions. How such mistaken and false ideas of the word melancholia, as those entertained by the monk as an alienist physician, could have attained their sway in the face of such maxim as mens sana in corpore sano, only becomes intelligible when we remember the ignorance, the superstitious prejudices, the contempt for the knowledge of the natural man, which ever characterise the theological mind, and which found their highest expression during the monkish supremacy of the dark ages—that interval of black ignorance which intervened betwixt the decadence of Latin civilisation and that intellectual evolution, the Renaissance, which indicated the advent of the reign of human intelligence. Slowly but surely was the emancipation of the intellect from the fetters of priestly tyranny achieved, as death thinned the ranks of its opponents, and the grim despotism of Torquemada and his coadjutors waned into the pettier and less terrible persecution of more recent ecclesiastics, and the tremendous grip of hierarchical supremacy gradually merged into the palsied, nerveless grasp of a doting and dying theology, the mere spectre of its former self. Curious men were the Church's leaders of the middle ages. In their cathedrals the light of day was only permitted to enter to a limited extent, and that too through the medium of coloured glass, so as to produce the “dim religious light,” while artificial lights burnt up before their altars; so were their minds closed to the natural light of the human understanding, and artificially illumined by the creations of their diseased imaginations, amidst whose coloured rays the white light of truth was always obscured, if not rarely utterly lost. But in the mortality of man lies the hope, the salvation of truth.

The Mental Aspects of Ordinary Disease

The relations of body and mind are becoming not only much more comprehensible, but even much better understood, since science has shaken off the incubus of theological teaching as to the severance of soul and body. As long as the mind was something separated from the body, or only united to it by slack and loosely fitting ties, mental phenomena could have nothing to do with bodily conditions—insanity was a disease of the soul; and the monk, standing over a miserable lunatic chained to a staple in a wall, and flogging him in order to make him cast his devil out, was a logical outcome of this hypothesis, however repugnant to more recent and correcter views. The baneful psychology of theologians is now thoroughly undermined, and the erroneous and mischievous superstructure is cracking and gaping on every side, and ere long the ground occupied by a crumbling ruin will be covered by a gradually growing erection based on a foundation of facts, and reared by an expanding intelligence. The union of psychology and physiology is the closing of the circuit, in one direction, of the pursuit after knowledge, and forms the initiation of a rational and intelligible comprehension of the mind and of its relation to corporeal conditions. How such mistaken and false ideas of the word melancholia, as those entertained by the monk as an alienist physician, could have attained their sway in the face of such maxim as mens sana in corpore sano, only becomes intelligible when we remember the ignorance, the superstitious prejudices, the contempt for the knowledge of the natural man, which ever characterise the theological mind, and which found their highest expression during the monkish supremacy of the dark ages—that interval of black ignorance which intervened betwixt the decadence of Latin civilisation and that intellectual evolution, the Renaissance, which indicated the advent of the reign of human intelligence. Slowly but surely was the emancipation of the intellect from the fetters of priestly tyranny achieved, as death thinned the ranks of its opponents, and the grim despotism of Torquemada and his coadjutors waned into the pettier and less terrible persecution of more recent ecclesiastics, and the tremendous grip of hierarchical supremacy gradually merged into the palsied, nerveless grasp of a doting and dying theology, the mere spectre of its former self. Curious men were the Church's leaders of the middle ages. In their cathedrals the light of day was only permitted to enter to a limited extent, and that too through the medium of coloured glass, so as to produce the “dim religious light,” while artificial lights burnt up before their altars; so were their minds closed to the natural light of the human understanding, and artificially illumined by the creations of their diseased imaginations, amidst whose coloured rays the white light of truth was always obscured, if not rarely utterly lost. But in the mortality of man lies the hope, the salvation of truth.

Kleptomania

The injudicious defence of two lady thieves on the plea that they were subject to that form of mental unsoundness to which Mathey and Marc have given the sounding title of kleptomania, has attracted public attention to this form of mental disease, and has given rise to a considerable amount of written and spoken nonsense upon the subject. Even “our facetious contemporary” has had his jests and his caricatures thereupon, and in the slang of the day a burglar has become a kleptomaniac, and a prison a kleptomaniac hospital. Alienist physicians have of course received their full share of sarcastic remarks, as theorisers not over-wise nor over-useful to society, who would willingly provide for every crime a decent veil, by referring it to some strange form of mental disease. Now there is such a tiling as theft which is the result of mental disease; and also, let us boldly avow our conviction, though we write within the precincts of a madhouse, that there is such a thing as theft which is simply a crime, an attack made by the selfishness of one individual upon the rights of another. Let us even take the broader ground, and avow our profound conviction that insanity and crime are distinct and separate entities, wide as the poles asunder in all instances where their distinctive characters are well marked; although undoubtedly there are instances which are divided by partitions as thin as those which Dryden places between wit and madness, or rather instances in which the qualities of crime and insanity are so intimately combined that the task of analysing the nature of the act becomes no easy one either to jurist or physician.

On General Paralysis

In attempting to describe the rise and progress of the paralysis, that forms one of the most remarkable symptoms of ‘paralytic insanity,’ I propose to notice first the affection of the muscles of the tongue, which is generally that which most strongly arrests the attention of the physician, who sees a patient in the second or fully-developed stage of the malady. In the last stage, the power of articulation is entirely gone; in both of these the paralysis is so marked, and the evidence of mental disease so clear, that the nature of the case can hardly be mistaken. It is in the very onset of the malady, that the peculiar lisp or failure of utterance, indicating disorder of the nervous centres, at or near the orifice of the nerves supply in the tongue muscles, is of paramount importance in the diagnosis, because if this symptom be superadded to eccentricity of conduct, or distinct delusion, there can remain but little doubt as to the existence of this special and almost invariably fatal form of disease. The alienist physician accustomed to watch the progress of general paralysis, and to recognize its slightest indication, cannot mistake the faulty pronounciation in question, for that of any other form of malady; but inasmuch as there are several affections of the speech that might mislead an unskilled practitioner, it may be useful to describe some of these derangements of the apparatus of articulation, and specify their points of difference. In the first place, an affection of the speech, very much resembling the embarassed articulation of incipient paralytic insanity, may be the result of temporary local congestion at the base of the brain, or may be produced by sudden fright, or by the action of poisons, particularly aconite; the indistinct utterance attending intoxication, is a familiar instance of poisoning of this kind: and all these are easily distinguished by the suddenness of their occurrence, and by their history, from the stutter of general paralysis. The articulation of the habitual stammerer is sometimes not unlike that which is the result of serious organic mischief; and still more striking in its resemblance, is the hesitation of speech, that may be observed in some cases of poisoning by lead. The ordinary signs of saturnine poisoning, the blue gum-line, the dropping of the wrist, &c., will mark this latter malady—the history of the case will prevent any mistake in the former. I may mention here, that I believe it to be an exceptional occurrence to find a person of unsound mind who stammers; such a case at least must be very uncommon, a fact which I can only account for on the supposition that the greater disease prevents any manifestation of the minor nervous derangement.

On General Paralysis

In attempting to describe the rise and progress of the paralysis, that forms one of the most remarkable symptoms of ‘paralytic insanity,’ I propose to notice first the affection of the muscles of the tongue, which is generally that which most strongly arrests the attention of the physician, who sees a patient in the second or fully-developed stage of the malady. In the last stage, the power of articulation is entirely gone; in both of these the paralysis is so marked, and the evidence of mental disease so clear, that the nature of the case can hardly be mistaken. It is in the very onset of the malady, that the peculiar lisp or failure of utterance, indicating disorder of the nervous centres, at or near the orifice of the nerves supply in the tongue muscles, is of paramount importance in the diagnosis, because if this symptom be superadded to eccentricity of conduct, or distinct delusion, there can remain but little doubt as to the existence of this special and almost invariably fatal form of disease. The alienist physician accustomed to watch the progress of general paralysis, and to recognize its slightest indication, cannot mistake the faulty pronounciation in question, for that of any other form of malady; but inasmuch as there are several affections of the speech that might mislead an unskilled practitioner, it may be useful to describe some of these derangements of the apparatus of articulation, and specify their points of difference. In the first place, an affection of the speech, very much resembling the embarassed articulation of incipient paralytic insanity, may be the result of temporary local congestion at the base of the brain, or may be produced by sudden fright, or by the action of poisons, particularly aconite; the indistinct utterance attending intoxication, is a familiar instance of poisoning of this kind: and all these are easily distinguished by the suddenness of their occurrence, and by their history, from the stutter of general paralysis. The articulation of the habitual stammerer is sometimes not unlike that which is the result of serious organic mischief; and still more striking in its resemblance, is the hesitation of speech, that may be observed in some cases of poisoning by lead. The ordinary signs of saturnine poisoning, the blue gum-line, the dropping of the wrist, &c., will mark this latter malady—the history of the case will prevent any mistake in the former. I may mention here, that I believe it to be an exceptional occurrence to find a person of unsound mind who stammers; such a case at least must be very uncommon, a fact which I can only account for on the supposition that the greater disease prevents any manifestation of the minor nervous derangement.

Asylum Architecture and Arrangements

A commodious and conveniently arranged asylum is the first requisite for the skilful care and treatment of the insane. Without this no alienist physician can deal successfully with any number of patients. It is, indeed, the bad workman who complains of his tools; and it will be found in practice that a superintendent fertile in resources, and skilful in their application, will do more with a bad building than another can effect with the newest, the most expensive, and the most commodious asylum that ever was constructed. It is not the bricks and mortar which cure patients, but the living spirit which, as it were, animates them. Nelson, in his old tubs, effected deeds at which the world grew pale; his braggadocio and vituperative successor has exhibited the gigantic masterpieces of naval architecture in an useless and ridiculous parade. In like manner it has happened that some of the worst asylums have been the best conducted, and some of the largest and most costly have. brought more disgrace than honour upon the psychiatric branch of the profession.