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Inmates in an early 20th century insane asylum

Insanity is a anachronistic term for a spectrum of behaviors characterized by certain abnormal behavioral patterns. Insanity may manifest as violations of any number of potential societal norms and mores. In the psychiatric community it no longer has a clinical use, and has been defunct as a diagnosis since the late 19th century. In modern usage insanity is most commonly encountered as an informal unscientific term denoting mental instability, or a vernacular term connotating a psychotic disorder. DSM categories, as well as the American Psychiatric Association have used the term psycho-pathology in place of the archaic notion of insanity. It does currently maintain a narrow legal usage, in the context of the insanity defense. However, in the 20th century the insanity defense is rarely employed, and even more rarely accepted by local and state courts.

In English, the word "sane" derives from the Latin adjective "sanus", meaning "healthy". The line from Juvenal, "mens sana in corpore sano" (Saturae, Book IV, X, line 356) is often translated to mean a "healthy mind in a healthy body". From this perspective, insanity was considered as poor health of the mind, not necessarily of the brain as an organ (This view would not become commonplace until the beginning of the 17th century). Much of the course of western medicine was dictated by the Roman physician, Galen, who dictated that pathological symptoms were the result or an imbalance in the body's humors. Therefore, it followed amongst early physicians that the cure of insanity, as a disease, as a restoration of mental faculties through attaining homeostasis.

Another Latin phrase related to our current concept of sanity, or insanity, is "compos mentis", or "of a composed mind", and the euphemistic term for insanity is "non compos mentis". As maxims of law, "mens rea" means having had criminal intent, when the act "actus reus" was committed. Feigned insanity is also a common modern forensic term. Operationally it is defined as the simulation of a mental illness in order to avoid, or lessen, the consequences of a conviction for an alleged crime. A number of treatises on medical jurisprudence were written during the nineteenth century, the most famous of which was Isaac Ray in 1838; others include Ryan (1832), Taylor (1845), Wharton and Stille (1855), Ordronaux (1869), Meymott (1882).

Through the centuries, and among different cultures, there have been various theories regarding the origin and treatment of insanity. Many of which have been dismissed as pre-scientific, or misguided theories. However, the current understanding and etiology of the theory of the Schizophrenic mind is still currently unknown by modern medicine.

History of the Perception of Insanity[edit]

References to insanity in the ancient world are few and far between, particularly as it was unclear in the context was was a psychiatric condition, and was what believed to be a supernatural occurance. As early as the 6th century BC there are references to King Nebuchadnazzar II of Babylon as acting in a peculiar way that seems consistent with a modern mental health issue. This is an unusual portrayal in the ancient world, as it presents mental illness as being in a completely different category as possession by an unclean spirit, or as a side-effect to the movements of the moon. Common portrayals of insanity are limited to high profile sovereigns, as the majority of historical writings deals with the particulars of their odd behaviors. Some European monarchs include: King Charles VI of France, his grandson King Henry VI of England, King Louis III of Bavaria, and his nephew King Otto, King George III of the United Kingdom, King Christian VII of Denmark, King Charles II of Spain, Queen Maria I of Portugal and the Roman Emperor Justin II.

Mental Illness as Woodness[edit]

The term Woodness was originally applied in Anglo-Saxon circles as a condition where the intelligible mind is separated from the vegetative soul. This appeared to be unaffiliated with either Platonic or Aristotelian conceptions of the anima/animus. Woodness is developed as a social concept from the prior Germanic theory of mind. As a concept, Woodness appears to mean that an individual is literally 'out of their mind'; or rather, that the rational mind is in a disconnected relationship and possessed by a daemon. Traits attributed to 'Woodness' might be related to the modern notion of Schizophrenia, or split-mindedness. However, no clear reason for outset is explained in any text from that period. However, this mental condition is reflected frequently in popular English literature as late as Geoffrey Chaucer's work 'Canterbury Tales', in the 14th century. Lines alluding to Woodness as mental illness include, "What sholde he studie and make hymselven wood", "armed, and looked grym as he were wood", and "the hunted is, for her hunger wood".

Mental Illness as Madness[edit]

The conception of Madness, as a formal pre-scientific medical term, is very fluid and difficult to define. There are various theories of mind that attempt to explain its existence. As a general rule, the theory of madness as a mental illness is related to a perceived excess of emotion, anger in particular. From what can be ascertained, it is an ancient supposition going back to the very cradle of civilization. In the 6th century before Christ, Greek physician Hippocrates frequently wrote that an excess of black bile resulted in irrational thinking and behavior. It was therefore necessary to restore homeostasis by draining the blood of the patient. This practice was common for much of professional medicine's history, and was actively used well into the 19th century. Dr. Benjamin Rush was particularly prolific with his employment of bloodletting to relieve psychotic features.

This view of the balancing of the mind and the senses proposed by Hippocrates was later incorporated into the moralist view of Christianity and became attached the certain ethical precepts of western Europe. This readjusted view was later incorporated into the early treatment of the mental ill. Within Christian Europe, it was deemed the treatment of the "mad" should be reserved to monks and friars for proper moral readjustment. For this reason all early psychiatric care took place within the cloistered walls of a priory, such as the case with Bethlem Royal Hospital in London. This popular association between the "excess of emotions", particularly through mania, and a moral failing on the part of the individual was mainstream until the rise of modern neurological and psychiatric care.

Mental Illness as Lunacy[edit]

The term lunatic, or Lunacy, is taken from the Roman goddess of the moon: Luna, prefix for the word “lunatic. Greek philosopher Aristotle of Stagira, and Roman historian Pliny the Elder, suggested that the brain was the moistest organ in the body, and therefore most susceptible to the pernicious influences of the moon, which triggers the tides. Belief in the “lunacy effect” in behavior, was common in the medical community well into the 19th century. However, by the early 20th century it was deemed archaic by most psychiatrists, and has no current clinical use. The American Psychiatric Association also has no associated modern diagnosis for behaviors relating to the various phases of the moon.

Theories abound about the origin of the myth regarding lunar activity and psychotic conditions. Many modern studies have been composed in the last fifty years regarding the association between observed behavior and the phases of the moon. No substantial correlation has been determined. In recent years it has been suggested that lunacy was a type of Bipolar Disorder. In the past, individuals with this condition were affected by the increase in moonlight, and had their sleep pattern significantly disturbed because of it, thus exacerbating mania/hypnomania.

Mental Illness as Dementia Praecox[edit]

Dementia Praecox, from the Latin meaning "premature dementia", referred to a chronic, deteriorating psychotic disorder characterized by rapid cognitive and affective disintegration, usually beginning in early adulthood. It was first coined, in its Latin form, in 1891 by Arnold Pick (1851–1924), a professor of psychiatry at Charles University in Prague. His brief clinical report described the case of a person with a psychotic disorder resembling what was then known as Hebephrenia. It was later popularized by German alienist Emil Kraepelin (1856–1926) in 1893. Kraepelin regarded the major psychoses as naturally occurring disease entities, and therefore they have a bodily grounding. He further reduced the complex psychiatric taxonomies of the nineteenth century by dividing them into two classes: manic depressive psychosis or dementia praecox. This division is commonly referred to as the Kraepelinian dichotomy and it has had a significant and fundamental impact on twentieth-century psychiatry, though it has also been questioned. It is currently the basis for the DSM's separation of Affective Disorders from Psychotic Disorders.

The primary disturbance in dementia praecox was said to be of the fluidity of cognition. Cognitive disintegration refers to a disruption in cognitive or mental functioning such as in attention, memory, and goal-directed behavior. Kraepelin contrasted this with manic-depressive psychosis, in which he included not just what would be termed bipolar disorder today but also other forms of mood disorder, including major depressive disorder. However, Kraepelin himself noted cases in between and eventually accepted that it was not possible to distinguish his categories on the basis of cross-sectional symptoms. Indeed, a mixed diagnosis of Schizoaffective disorder has also developed.

From the outset, dementia praecox was viewed by Kraepelin as a progressively deteriorating disease from which no one recovered. The three terms that Kraepelin used to refer to the end state of the disease were "Verblödung" (deterioration), Schwachsinn (mental weakness) or Defekt (defect). Although "dementia" is part of the name of the disease, Kraepelin did not intend it to be similar to senile dementia and rarely used this term to refer to the end state of the disease. However, by 1913, and more explicitly by 1920, Kraepelin admitted that although there seemed to be a residual cognitive defect in most cases, the prognosis was not as uniformly dire as he had stated in the 1890's. Still, he regarded it as a specific disease concept that implied incurable, inexplicable insanity.

This formal psychiatric diagnosis was eventually joined from 1918 to 1952, and later replaced, with the modern clinical sub-divisions of Schizophrenia. It was still used actively in French Psychiatric circles well into the 1970's.