RESPONSIBILITY IN MENTAL DISEASE.* AMONG the many books constantly being
issued from the Press,. few furnish food for genuine thought, or bear practically on life. Dr. Maudsley has, however, in the volume before us supplied thinkers with much that is worthy of deep consideration, and with that which closely affects all of us. The title of the work is somewhat misleading,—it is really a popular scientific treatise on Mental Disease, and not essentially devoted to Responsibility.
Madness is not a pleasant topic, nevertheless it is a most import- ant one, for it is a startling fact that a very large proportion of the community is mentally deranged, and that this derangement may affect anyone, irrespective of age, sex, or position in life. Looking at the subject in the light that Dr. Maudsley has thrown on it, we shall see that it concerns us much more closely than we have probably any idea of. Insanity is not a necessary evil, it is not dependent on blind chance, nor the possession by an evil spirit, with whom we cannot cope. It is as much within our power as the cause or prevention of physical ailments.
Dr. Maudsley begins well by endeavouring to remove the popular erroneous ideas of a lunatic, such as painters have de- lineated him, as a constantly raving, violent maniac. He gives an account of Mr. Burke's visit to an asylum, and his surprise at finding the lunatics able to argue in a rational manner. A lunatic asylum does not resemble, it seems almost unnecessary to say, a menagerie of wild beasts ; to a casual observer, the inmates would not, on the whole, appear very different from other men, even a skilled observer would find man changed indeed, but not trans- formed. It is to be deplored that the public still look upon disease of the mind as something quite special, conceal it as a disgrace, and often brand it, as a crime. Man, at least in a state of civilisation, does not thus act towards those who have bodily ailments, and as it is only the ignorant who treat the infirm cruelly, so it is through ignorance that the insane have been ill-treated ; a more enlightened understanding will deal tenderly with the mentally infirm.
Dr. Maudsley regards crime as an expression of insanity, and thinks that it should be treated accordingly. This is true in many cases, though it would be absurd to imagine it true in. all, and it may be possible to discover sometimes that it is so, but in by far the majority of cases it is impossible to know.
* Responsibility in Mental Disease. By Henry Mandsley, M.D. London : Henry S. Sing.and Co. VoL VIIL International Science Series.
But even supposing it could be known, it would hardly be safe to the public, though it might be beneficial to the individual, to exempt from the punishment of a serious crime, a lunatic who has knowledge of right and wrong, and to place him under -care in an asylum. Even according to Dr. Maudsley, prison discipline is "the best treatment for the sort of insanity from which criminals suffer," and he seems to think that the present system of asylum management is conducted on too indulgent a plan,— therefore, according to his own showing, prison life would be best for a lunatic, at least a criminal lunatic. But it is very doubtful -if our present prison system is likely to do good to the individual ; it is probable the constant association with other criminals would -have the effect of fostering insane acts ; of course the same can be said of asylums, but these have the advantage over prisons in that the inmates are more closely observed, and can be isolated from dangerous associates, the only element wanting being compulsory labour.
Looking at certain criminals as afflicted with an insane neurosis leads us further than the mere question of present treatment; we are carried back to the foes et origo, that we may endeavour to find a remedy that shall prevent its development. For "it is certain that lunatic and criminals are as much manufactured articles as are steam- engines and calico-printing machines, only the processes of the -organic manufactory are so complex that we are not able to follow them." We know that an hereditary predisposition is a potent cause of both crime and insanity. The manner also in which the lower classes live, crowded in rooms too small, with no regard to the de- cencies of life, and giving free licence to all their animal passions, -predisposes to either or both. Hence we have both moral and physi- cal causes producing either insanity or crime (for in these cases the -terms are almost synonymous), and the two causes blended together with debauchery, drink, and disease to accelerate them. The remedy for this is evidently compulsory education of the lower classes, -education that shall not be mere head-cramming, but that shall bring out the individual's mental activity, and put a higher pur- pose before him. But more is required ; it is necessary to attend -to their physical condition, their dwellings must be improved, their life should be regulated, and improper intercourse and irregular marriages prevented. Of course, at present the achieve- ment of all these changes seems hopeless, yet the importance of them is immense ; if even only something could be done, it would be of vast utility.
In seeking thus for the cause and its remedy, we must do away with many of our metaphysical theories, and theologians and physicians must meet on one common ground, to fight this battle against crime and insanity. "There is a borderland between crime and insanity, near one boundary of which we meet with something of madness and more of sin, and near the other 'boundary of which something of sin, but more of madness. A just estimate of the moral responsibility of the unhappy people inhabiting this borderland will assuredly not be made until we get rid of the metaphysical measure of responsibility, as well as of the -theological notion that vices and crimes are due to the instigation of the Devil, and proceed by way of observation and induction to sound generalisations concerning the origin of the moral sen- timents, the laws of their development, and the causes, course,
and varieties of moral degeneracy." Dr. Maudsley does not merely tell us what, in general, insanity is, but he very -clearly explains its varied forms and the relations they bear. He treats on law and insanity, and gives epitomes of important trials. In reference to hanging madmen, he says, "The execution -of them would be of use only if it deterred persona from going mad, which no one has asserted that it does." But then no one supposes that the execution of a madman would be for an example to other madmen. "The argument that it is necessary to execute them in order to protect society would be incontrovertible, if society had no other effectual means of protecting itself." Still it is a serious question if an asylum is really a safe place wherein to shut up homi- cidal lunatics, since we have had several escapes of such dangerous characters recently from our Criminal Lunatic Asylums. The absolute necessity of placing criminal lunatics in asylums to be under medical control is not very obvious ; surely there are doctors connected with our prisons who could treat these cases, and their isolation from other lunatics would probably be an advantage. Of course, as a mental hospital, asylums are better adapted for -treating curable cases.
Turning now from the criminal aspects of insanity, we come to what more closely concerns ourselves. "Most persons who have suffered from the malady of thought must at one period of their lives have had a feeling that it would not be a hard matter to 'become insane, that, in fact, something of an effort was required to preserve their sanity." Hence, the important question arises, how may a man prevent himself from going mad ? Dr. Maudsley enters into this, and his answer is briefly :—First, he must devote his mind to one great purpose earnestly, even though this verge into eccentricity, for eccentricity may be " a vicarious relief, a sort of masked madness." And here we are reminded of "Mr. Dick," in David Copperfeld. Secondly, there must be a strengthen- ing of the will by constant exercise. Thirdly, we have education in its highest and truest sense,—the understanding of man's rela- tion to himself and his surroundings. He must be taught to act consistently with his belief. Religion must be as real as it is reputed to be. Men generally perform their religious duties auto- matically, without any real thought as to their purport or logical consequences. Dr. Maudsley strongly condemns as conducive to insanity the slovenly habit of thought so frequently engendered by particular modes of worship, and the unhealthy excitement and mor- bid egoism that are sometimes the results of mistaken religion. Fox- hunting he considers to be inconsistent with "the teaching of the Nazarene," and tending to blunt the finer feelings of man's nature. Alcoholic liquors are to be avoided, as not only unnecessary, but as absolutely harmful. "I am not prepared to say," Dr. Maudsley observes, "that it does any demonstrable harm, but at the same time, it is not wise to have recourse to an alcoholic stimulant when recourse ought to be had to food or rest ; and it is a serious harm to the mind to gain, as is sometimes done, by the fictitious aid of a stimulant, the energy which should come from the calm resolu- tion of a developed will." And again, "Were men with one con- sent to give up alcohol and other excesses,—were they to live temperately, soberly, and chastely, or what is fundamentally the same thing, holily, that is, healthily, there can be no doubt that there would soon be a vast diminution in the amount of insanity in the world." These are strong words, and coming from one who has had ample means of judging, should be seriously considered.
Lastly, the reasoning powers must be most carefully exercised on the matter of marriage. Misplaced affection, disappointment in love, an unhappy union, are all more or less most potent factors in the cause of insanity. Falling in love should not be allowed to be a mere matter of propinquity. Men should keep out of the way of all dangerous attractions, not only for their own sakes, but on be- half of their offspring. "When one considers the reckless way in which persons, whatever the defects of their mental and bodily constitution, often get married, without sense of responsibility for the miseries which they entail upon those who will be the heirs of their infirmities, without regard, in fact, to anything but their own present gratification, one is driven to think either that man is not the pre-eminently reasoning and moral animal which he claims to be, or that there is in him an instinct which is deeper than knowledge." Men care for the breeding of their farm stock and stud, and know that good or bad qualities will be produced in the animals, according to the selection of the pairs. But "they act habitually as if the same laws were not applicable to themselves." The consequence is that those who have a tendency to insanity are not unfrequently prone to seek others having the same mental qualities. Then after their marriage they allow ex- ternal circumstances to foster their special tendencies, and the children who are born are doubly cursed ; "they are cursed in the inheritance of a bad descent, and in the training which they get," or rather do not get. Here, then, are causes of insanity which it is within man's power to remove ; "hereditary predisposition, by abstention from marriage or by prudent marriage ; intemperance, by temperance in living ; mental anxieties, by the wise cultivation of the mind, and by the formation of self-government." Of course the application lies with individuals, and the result will not appear in our generation, but men must learn to be less selfish. There is much wisdom in this valuable book, in spite of its crotchets, which it pushes too far. We especially commend it to those who are interested in the welfare of the community and the instruction and improvement of the rising generation.
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