DR. MAUDSLEY'S PATHOLOGY OF MIND.*

IT is not long since we made some remarks on Dr. Maudsley's article on Materialism, in the Fortnightly Review. That able writer was then before us in his character of ethical philosopher, and of metaphysician, the latter being a character which, in common with all of his school of thought, he

would probably repudiate. In noticing this third and corn- -pletely recast edition of his work on mental pathology, we

have, in some respects, a more agreeable task ; for however much we dissent from the author's ontological views, it is quite possible to separate them from his very valuable disquisitions in connection with the strictly scientific aspect of his subject,—a subject which has of late years made considerable progress, and which, both in its medical and its social and legal relations, daily becomes more interesting to all thoughtful men. Dr. Maudsley has had opportunities inferior to none of observing the aberrations of the mental portion of our nature from its normal and healthy state, and he has brought to its study an amount of patience, honesty of purpose, and acute analysis seldom equalled, with a power of scholarly and clear expression in which medical books are too often deficient.

The analogy of dreaming to insanity has been long familiar -to us ; and the opening chapters on sleep and dreams 'afford a

key to much that is valuable in those parts which treat of mental disease. In the great majority of cases of insanity '(indeed, probably in all, with the exception of those in which nothing is discoverable but the purely motiveless and passion- less impulse to commit some special act), Dr. Maudsley finds that the first departure from the healthy condition takes place not in the intelligence or reasoning power, but in the region of desire, passion, and emotion generally. Insanity of the intelli- gence follows, taking its peculiar form, whether there are distinct hallucinations or not, from the morbid propensities or passions which have become predominant. Esquirol, no mean authority, long ago declared" moral alienation to be the proper characteristic of mental derangement." "There are madmen," says he, "in whom it is difficult to find any trace of hallucination, but there are none in whom the passions and moral affections are not perverted and destroyed. Ihave in thie particular met with no exception." After describing the premaniacal brilliancy of emotion and action, and even of thought, with startling changes f character and habits, which is often the forerunner of ap- proaching mania, Dr. Maudsley says—and the passage is inter- esting and graphic, as well as very characteristic of the writer and of hi,e opinions,—

" Let it ho particularly noted here how the overthrow of reason is accompanied and, indeed, preceded commonly by a perversion or destruction of moral fooling, the last acquisition of social culture in the most advanced races of men being the first to show the effects of the disorder whose end is to make the individual a social discord. Candour is supplanted by craft ; veracity by cunning, misrepresenta- tion, or actual falsehood ; reserve by impudence, modesty by in- decency, refinement of feeling by coarse indelicacy, family affection by indifference, or even by hatred or malice. The delicate and re- fined inhibitory inhibitory feelings, 'which are the last acquisitions of culture, are

i submerged, while the storm n the supreme centres lasts, and the coarse and deeper-rooted impulses of the animal nature, and of the human nature in its lower relations, come to the front and dominate the conduct."

Positive illusions, either rapidly changing, or, in the so-called monomaniac, permanent, follow, and do not precede this emotional disorder, taking their forms. from the prevailing morbid emotion, as excessive vanity, suspicion, malice, or animal passion. In like manner, in dreams, a physical sensation, or unusually intensified instinct or emotion, seems to be the primary phenomenon. The impression or emotion "acts downwards on the sensory ganglia," and takes the shape of a distinct image or an actual perception, vividly seen or heard, because there is In sleep no distinction of consciousness by objects of external sense or by related ideas, "as we see the stars from the bottom of a deep well in broad daylight, because the line of vision alone is illuminated."

In dreams, the disorderly succeseion of images or transforma- tion-scenes is the result of antecedent sensation or emotion, and in madness the intellectual disorder and delusion are the Tesult or sequence of antecedent affectional disorganisation. All this is perhaps contrary to the popular idea, because the intellectual derangement is something more marked and specific, easier to distinguish from the natural state, than the moral dis- ease. There is, however, such consensus on the part of almost * Tim Palhotogy of Mind. Being the Third Edition of the &wend Pure of the '" Physiology and Pathology of Mind." Recast, Enlarged, and Rewritten. By Henry idaudaley, M.D. Landoll: Macmillan and Co. 1879.

all those who alone are qualified to decide, that the fact not only of moral or emotional insanity as a frequent phenomenon, but the fact of its being the natural precursor of intellectual aberration, must be accepted, whatever troublesome and diffi-

cult practical questions this conclusion may give rise to. It is perfectly possible to accept the doctrine, without denial of Free- will, as an essential attribute of moral and responsible beings in their normal state. That such freedom may be abolished, or its action diminished, in certain morbid conditions, is simply a question of science, not a principle of ethical philosophy ; and the difficulties which such facts may give rise to in legal ques-

tions must be met and grappled, with, as best we can. There is the same consensus in regard to another form of insanity, the impulsive, the existence of which it has become the fashion to deny. Not a book has been written by an expert during the last half-century that has not teemed with cases of persons forced by a motiveless impulse, as of a demon within, to commit some act, often of violence, which their souls utterly abhorred at the very moment of commission. Dr. Mandsley's discussion of this, which may sometimes almost deserve the name of automatic madness, is extremely interesting, especially where he deals with the insanity of early childhood, and with tho well-known connection between impulsive madness and epilepsy.

Nothing can be more convincing than his demonstration of the blundering character of the tests of insanity so often laid down in our Courts of law, such as the" existence of distinctliallucination," the "knowing of right from wrong," and the "knowledge of the unlawful nature of the act committed." It requires only a very superficial study of the subject in the writings of those whose lives have been devoted to its investigation, to see that these tests, if rigidly applied, would allow the escape of many who however morbid, are yet, to an appreciable extent, morally re- sponsible, and quite amenable to the deterring influence of possible punishments, and would, at the same time, condemn not a few of the most pitiable victims of uncontrollable disease.

This is a weighty and a bulky subject; we cannot now outer upon it, but we recommend all who are tempted, in order to escape from a very troublesome and responsible analysis of the mental condition of some of their fellow-men, to adopt the con- venient expedient of denying the existence of impulsive insanity, and of that which has its seat in the affective and moral part of humanity, to study the work now under our consideration. We have often had occasion to animadvert on the evidence of experts

and the findings of Courts, where too much weight seemed to have been given to the plea of insanity ; but we would give no quarter to the argument ab inconvenienti, which, from mere in- dolence, ignores the conclusion universally arrived at by the only persons entitled to a hearing either on the general scientific facts, or on those of any individual case. The application of the rules of jurisprudence or of justice to those facts is quite a different matter, and one on which the scientific experts often err as far on the one side as judges and lawyers go astray on the other. Is not the priority in the chain of causation of impulsive and emotional madness to intellectual delusion and incoherence, all merging finally in the utter chaos of complete dementia, what we might a priori expect, on psychological grounds P Is it not an illustration of the "wish being father to the thought P" The desire or appetency, be it merely animal, or be it in the region of love, or hatred, or ambition, or in higher regions still, is the man himself, and the intelligence, strictly 80 called, is merely his instrument, by which he gives definite shape to, compares and tests, what lie has got by his senses from without, or his intuition from within. The pathological fact corresponds with the psychological order. Perhaps the most interesting part of this book is that which treats of the insane temperament, that semi-morbid condition of mind which we often find in persons who belong to an insane family, and are strongly predisposed to actual disease, a condition at once allied to original genius and to ridiculous eccentricity. Intense egoism, extreme suspicion and distrust, gross miserli- ness or extravagance, a habit of vacillation and self-torture, a congenital defect of conscience, are among the common signs of this ; but among the most curious are such small propensities as the following,—it is given in the words of the 'patient himself, a man who never became insane, but had several rela- tions who were so :—

"As a very little child, I remember, I attached a peculiar import- ance to certain numbers ; this or that trivial action must be accom- panied by counting so many, or the action must be repeated so many times ; later, certain of these numbers assumed a special import- ance; three, or any mnitiple, must be avoided in ordinary action, as

being in some sort sacred to the Holy Trinity. An imperative necessity seemed laid upon me to touch or move this or that object, though I might have no desire to do so; and as, I think, is related of Dr. Johnson, I would submit to no little inconvenience to avoid treading on the joints of the paving-stones. Generally, I may say that that which was least pleasant seemed most strongly obligatory ; for example, if I chanced to be walking with any one, the impulse to pick up a chance straw in the path was greatly stronger than if I were alone, though (or, perhaps, because) I was very sensitive to fear of my peculiarities being known ; and again, though I was fantastically particular as to cleanliness, I was especially impelled to touch some dirty or offensive object. I remember putting myself to considerable trouble to go out again, after reaching home, to move some trifling thing which I had chanced to notice on the pavement."

In later years, this man was tormented by an impulse to utter blasphemous or obscene words, which he conscientiously

abhorred. In order to resist this, he used to hold the tip of his tongue between his teeth, so as to render articulation physically impossible.

Admirable as are Dr. Maudsley's descriptions and analysis of the varied forms of mental disease, the whole is, as might be expected. from his known opinions, thoroughly interpenetrated by the materialistic ideas of the period. Allowance must be made for this, in the roadiug of almost every page. It is easy, in general, to separate the wheat from the chaff, and to translate his statements into the language of old-fashioned psychology, without the loss of anything really valuable. Subjective phenomena which might have been presented simply and effec-

tually from the mental side, are frequently sot forth as identical with, and consisting of, certain supposed. molecular changes in the nerve-centres, and their propagation along certain sup- posed nervous tracts, not as the necessary concomitants, or even results, of such changes. ,The Ego, and what we call its Will, are spoken of as mere names given to the cumulative results of

those nervous forces, acting in due co-ordination and harmony.

The author, in this work, seems to have somewhat more of the courage of his opinions, and more consistency, than he

showed in his essay in the Fortnightly Review. The Ego and the Will are in general here represented as effects, not as a regulating or controlling entity, which has in its power to

choose an upward. or a downward. track ; and Dr. Mandsley has here more successfully avoided the temptation to lapse into the language of the opposite school of thought, to which, in his zeal for proving that materialism is not a negation of moral

responsibility, he yielded in that essay. Even hete, however, now and then, the author seems to forget the more thorough aspect of his Materialism, and allows himself to use language which implies that the cerebral changes give rise to, rather than constitute, mental action, operating on, a so7ncthing which is, implicitly, not the mere cerebral organism itself.

Of course, as the congeries of phenomena which we call mind is, in Dr. Maudsley'e opinion, the mere product of organisation, existence after the death of the physical frame is out of the question. Speaking of the senile decay of the faculties, he writes :—

"it is a robust faith infixes the certitude of a resurrection to life eternal of this mind, which is soon to dawn with the opening functions of the senses, to grow gradually as the body grows, to become matere as it reaches maturity, to be warped as it is warped by faulty in- heritance, to be sick with its sicknesses, to decay as it decays, and to • expire as it expires." • It seems to us that a still more robust power of belief is re- quired in one who finds no difficulty in holding that any con- ceivable or inconceivable changes in the molecules of nerve-cells should constitute thought, passion, feeling, or any modification of consciousness. Modern science tends to reduce the operation of all the physical forces to motion. What identity, or even distant resemblance, there can be between motion or change of position in space, and mental phenomena, it is hard to imagine. The transformation of heat, light, or electricity into each other, is at least conceivable ; but the change of any of these things into thought is absolutely unthinkable. Even the late G. H. Lewes, himself a quasi-materialist (for he mingled his materialism with a semi-Kantism), seemed to have difficulty in believing even that nerve-structure could be the immediate cause of mental changes,—much less that its changes could constitute them. " Nerve-cells, fibres, and centres," says he, "may be the biological conditions of modes of consciousness, but not the pre-conditions." There is one pas- sage in Dr. Maudeley's book in which he almost seems to think that the extreme minuteness of the molecular nerve-structure, and its changes, and the impossibility, with our present instru- ments, of detecting them, affords an argument in favour of his

views. That these structures and changes exist, are infini- tesimally minute and complex, and that they have some con- nection with mental phenomena, we of course admit ; but we fail to see that the ultra-microscopic nature of things which no- body doubts to be material, in the most ordinary sense of that term, helps us out of the difficulties of that phase of materialism which we are now considering. It is, however, useless to dwell on these vexed qnestions ; they have been discussed in the great controversy of the day, over and over again.

Dr. Maudsley frequently refers to the distinction between

" vice " and " disease," and seems, in a general way, to admit, in common with ordinary men, that the former is the proper

object of moral reprobation, while the latter is only the object of pity, although he does hint at some possible Utopia of the future in which the distinction will be ignored. On his own

principle, both are the results of certain misdirected nerve- currents, both are dangerous and hurtful, and place the indi- vidual out of harmony with the social sphere in which he lives ; but the ouly difference is that the former is caused by a dis- ordered condition which may be congenital, or may be partly

congenital and partly the effect of surrounding circumstances, while the latter is more of the nature of acute disease. It is difficult to see why the one should be reprobated, and the other not. It cannot be that the one is irresistible and the other capable of being resisted, for even diseased impulse is ad- mittedly resistible up to a certain point. "Resistible," in Dr.

Mandsley's philosophy, cannot have any intelligible meaning, except in relation to that state of brain in which there is still sufficient normal action to allow the influence of conscience or of the fear of punishment to operate as a counteracting cause, provided these motives are strongly enough presented front without. Both in the so-called vicious and in the morbid being, the mere fact that the criminal act is committed proves for Dr. Maudsley that the impulse to commit it has been too strong

for such restraining cause, in the circumstances in which and at the moment when it happened. Dr. Maudsley is also fond of the words "witting" and "wilful." These terms cannot, in consistency with his philosophy, point to any intelligible distinc- tion, except that which may be drawn between automatic morbid action in its extremest shape—as in HOMO of the worst cases of impulse, on the one hand, and of complete dementia, on the other—and other actions, whether morbid or healthy. All acts, with these exceptions, arc, according to his own analysis, both " witting " and. " wilful ;" and the quality of an act expressed by these words cannot be available as a test either of morbidity, or of moral or legal responsibility. One more quotation we

cannot resist making. After endeavouring to show the inutility of prayer and of all recognition of a Personal Deity, Dr. Maudsley says (the italics are ours) :— "But there is another side to the question, which it would not be right for the free inquirer to leave out of sight. It will be said that the belief in an ever-present help in time of need is a priceless stay and comfort in all the sorrows, needs, afflictions, and other adver- sities of life, and that it sustains, in the hour of trial, many a sore- stricken and horivy-laden soul which, but for it, would give way and strive no more. Certainly there are few ills that have not some com- pensating element of good, and it were strange indeed, if a creed which has plainly been a necessary phase of thought ilL the progress of mankind, had been all mischief."

Those words appear to free our author from the charge of Atheism, though most readers of his book will think it is at the expense of his consistency. If a certain phenomenou has been a" necessary" step in the progress of the race, and therefore could not have been all evil, there must have been an intelligent and benevolent author of that scheme of progress. Intelligence and benevolence are human attributes, and that author must, pro /onto, be an Anthropomorphic Deity.

What is the genesis of this epidemic of Materialism which now prevails ? It is easy for its advocates triumphantly to attribute it to the great advance of biological science. No doubt it is partly due to the attention of scientists having been strongly drawn of late years to that special study; but let us recollect to what a large extent the very existence of the nerve-structure and nerve-cur- rents, which threaten to supplant mind as a distinct entity, is purely hypothetical. Perhaps much is due to the desire for more definite knowledge, leading the mind to cling to the delu- sion that it has found something more real and tangible than a dualistic philosophy offers to it ; and. much to a longing to escape from the trammels of some of the more rigid and inhuman theologies of the last generation. Like the intellectual delusions of the insane which spring from the disturbance of the emo- tional nature, the philosophical doctrines of this time may un- 'consciously have their roots in the moral disgust created by forms of faith, recently rampant, but now threatening to expire. We believe the phenomenon to be a transitory one, and that in the healthy evolution of human thought an equilibrium will be more nearly approached, if not perfectly attained.

The chapters of this book devoted to the practical question of treatment and cure are not hopeful. Immense as the improve- ment in the management of the insane has been during the present century, by far the greater part of the reform has been negative. The comparative merits of public and private asylums are discussed with much judgment. Mental therapeutic, in the sense of the uso of actual drugs and other material agents, seems to be even more unprogressive than that which is appli- cable to physical disease. We are glad to see Dr. Maudsley's condemnation of the indiscriminate use of that group of nar- cotic and sedative medicines now 90 largely administered, and so much abused.