which the individual has been connected seem to be entirely forgotten, the impression of the malingerer being that silence is a stronghold. The real maniac almost invariably remembers all the events with which he was concerned, although his disease may cause considerable distortion of some of the facts. Through the madman's delusions and manifestations, there runs a thread which gives a sort of order and method even to the chaos of his thought: through the manifestations of him who would feign insanity, this order is wanting. It is like the difference between a building which Time, even while she beautified from her rouge-pot with lichens, tears down with slow, inexorable fingers, and a building which the malice of mankind has razed to the ground and left not one stone upon another. The one has the order which a Godmade chaos must have: it is pregnant with an order which will be born-the other is a chaos aforethought. In the vagaries of the madman, there is one invariable recurrence to the main drift of the delusion: in the impostor's delusions, there is an increasing changeableness. There is an earnestness in the madman: he believes what he says, for the most part. The earnestness in the man who imitates is only to produce a certain impression upon his audience. He has no affection for the shape of his delusion: he will alter it much. and often to bring it more nearly to correspond with what he considers best suited to attain the end he has in view. In most cases, a careful observer might trace a distinction corresponding to the above explanation in the mode of manifestation. The one, whose delusions are objectless, whose erroneous beliefs are ends in themselves, is unhesitating in their expression-his utterance is usually rapid, and his incoherence trips merrily from his tongue: the other, whose delusions are buoys to which he clings to save him from the waves of circumstance, whose erroneous beliefs are means to an end, takes time-he has to consider whether this will do under the circumstances: his style differs from that of the madman-he hesitates, and his incoherence has the appearance of being studied. All these circumstances are calculated to show where certain manifestations have their rootsin the sad truth, disease; or in the sad untruth, a lie. BR. INS. 36 The 413. The State of the Affections to be considered.— [282] Not unfrequently much light will be thrown on the question of feigned or unfeigned (?) by the state of the affections and desires of the individual. Every thought a man thinks is shaped and fashioned in a mould of feeling. Thought is, as it were, the shape of a vessel; and feeling, as it were, the figuring and embossing, or painting, of the same. Thought, the skeleton; and feelings, the flesh and blood of a body. Now, in mania many of the most prominent features which marked the character are lost. As magicians could change gold to lead, so does this magician, disease, change love to hatred. Very often those persons that were loved best while the individual was in health, are hated worst when the individual is diseased. If suspicion is on the wing, it alights upon some intimate friend or near relation-home-ties seem changed from blessings to curses, and a former affection seems to be reason good for hostility and war. There is no more promising symptom of a remission of the disease than a return of the rivers of the heart to their old courses. man who would feign insanity invariably shows much animosity, but it is usually directed not against those who love him, and now weep for him: he sees disadvantage in alienatting affection, so his wrath is directed against some one who formerly injured him. If the madman has a delusion concerning a conspiracy, his wife, or children, or friends, will be looked upon as the conspirators, and loathed in consequence. If the sane man sees reason to feign such a delusion, other persons will usually be regarded in the light of his persecutors. But not merely are the affections diverted from their objects in mania, but many things cut into a man's heart by habit seem to be erased. A man or woman of the most scrupulously pure and refined habits will, under the influence of this disease, become insensible to the common decencies of life. Words and actions utterly strange to the individual's whole life and character are the ordinary expressions of their insane vitality. All those actions which are most filthy and horrible have been, and will be again and again, made use of with the view of inducing a belief in the genuineness of assumed insanity; but the entire change of character under the influence of the disease from what it was in health is not likely to be counterfeited. 2414. Physical Tests. It is said that in mania the pulse is usually more frequent than in health; but although it is reported that, owing to this circumstance alone Dr. Rush was convinced of the unfeignedness of the insanity in a certain case, we would not be inclined to place (283 implicit reliance upon this symptom. The sphygmograph might write a man down an impostor. We have already, in another connection, alluded to the importance of physiognomical diagnosis, and we would only add that each disease has a distinct facesymptom, an invariable type of expression, running through the transient shades, which are dependent upon an evervarying train of thought. The impostor can't really feign that. In mania, too, there is generally discoverable a slight febrile action, and a peculiar odor of the skin. 2415. Sleeplessness an Indication of Disease.-The want of sleep is a symptom which is useful in the diagnosis of genuine mania. The impostor cannot stave off that enemy long. His exertions and feigned excitement, and the anxiety as to the success of his scheme, all weary him, and after a day or two at most, he will fall into a deep, quiet sleep. The maniac on the other hand passes days, and sometimes weeks, without any apparent necessity for sleep; and when sleep does come, it is restless and unhealthy sleep. The shutting of the doors of sense allows you to look into the heart, as it were. The restlessness of health with a purpose is very easily distinguished from the purposeless and animal-like motions of disease. The madman will show the same indifference with regard to food that he does with regard to sleep: the appetite of the sane man will often betray him. 416. Insensibility to Drugs a Test. The insensibility of individuals laboring under mania to certain drugs, such as opium, is a test of some value. The dose which would send an impostor to sleep, however determined to resist its influence, would have little or no effect upon a person really suffering from this disease. The same remark applies to cer tain other medicines, as purgatives and emetics. It requires a larger dose of tartar emetic to produce its depressant effects upon a madman than it does upon a sane person. But not only is the body insensible to the ordinary effects of certain drugs, but some of the senses appear to be insensible in such a high degree to the ordinary effects of over-stimulation. It is said that the madman can, eagle-like, look full in the sun's face, and thus insensibility, in certain cases, to cold is a well-marked peculiarity. 417. The Early Symptoms to be Considered. The genesis of mania ought, in all doubtful cases, to be carefully inquired into. The preliminary symptoms of a genuine attack of mania are not likely to be simulated. Feigned mania begins suddenly. Where the insanity is real, many instances of strange and, at the time, unaccountable conduct will be remembered. The inquiry as to the occurrence of the disease should also extend to [284) circumstances which might have predisposed to its invasion. The habits of the individual, the health or disease of other members of the family, the inherited or acquired peculiarities of constitution, the previous tendencies of the individual and the moral and physical circumstances which surround him, should be made the subject of diligent and intelligent inquiry. The irritability of temper of the real maniac differs from the grand, showy outbursts of the impostor. This is, however, a symptom of less importance, and it is somewhat easy of imitation. The periodicity of the attacks which has been remarked in real mania will not occur in the feigned disease. 418. Feigned Monomania.-It is much more difficult to feign partial insanity than to feign what is called mania. In proportion to the difficulty is the rarity with which it is simulated. In partial intellectual mania, many of the symptoms are present which characterize the general disease, yet in most cases they are not so obtrusive, and a more careful examination has to be conducted, before the fact of the insanity discloses itself. The same prejudices, however, have possession of the mind, the same irritability of temper, the same unfounded likings and dislikings, affections and aver sions, the same sleepless restlessness and insensibility to impressions, and the operations of drugs, are to be found in this form of disease. The pretended monomaniac will, however, parade those symptoms, while in the individual really suffering from partial mania there will be a tendency and effort to conceal them from observation. He is generally quiet and reserved, but will become querulous and sometimes violent in an argument. "A real monomaniac," says Marc, "is strongly prejudiced in favour of his opinions-the slightest contradiction excites his temper; while the simulator readily overlooks this essential point in his part, if the contradiction is skilfully managed. The taciturnity peculiar to the real subjects of monomania frequently leaves simulators at fault, since the complaints of the latter were sure of being seen and heard, and their repugnance to dwelling in solitude is not met with, or at least not in the same degree in the others." 419. Feigned Epilepsy.-Epilepsy can be and is feigned. Beggars live by fits, and one detected in the act confessed that he had been taught the trick by his father, who studied the symptoms in a book. Would there, we wonder, be primogeniture in the property in a fit? would it go to the heir or next of kin? A case of well-simulated epilepsy is mentioned in Legrand de Saulle. To show that there is sometimes a difficulty in distinguishing between the simulated attack and the real disease, we may mention a case that came under the notice of Esquirol, who, during one of those conferences which took place during the clinique, boasted that no cunning could deceive his power of diagnosing a case of assumed epilepsy. One of the pupils shortly afterwards fell suddenly, was convulsed, and presented all the other symptoms of severe epilepsy. Esquirol, watching with deep anxiety, turned to those around, saying, "Ah, poor boy, he is an epileptic." The boy sprang to his feet, crying, "You see, my master, that we can simulate an attack of epilepsy." That simulator was Calmiel, the greatest authority upon general paralysis, and still, although old, the physician of Charenton. Sailors who See Journal of Mental Science, vol. ii., p. 357. ย Page 442. |