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The problems of the people who were adjudged to be mad were that
many, if not most, of the practitioners of the day had determined that
mental illness was either the result of organic disease or the punishment
of God. Bacon prompted research and he wrote in Book Two of his
Advancement of Learning that there should be a study of the mental
faculties, in order that one might find their origins in the brain, how they
were affected and their relationship to the body. He believed that an in-
depth study of the individual cases was essential but his views in this
respect were not followed to any great extent until the end of the
eighteenth century. Bacon encouraged a study of anatomy (post
mortem) so that findings could be related to the original symptoms
where possible. Quite strikingly, in addition to these very forward
looking steps, he suggested something even more avant-garde for his
time, what now is referred to as social psychiatry, the understanding of
the relationship between the individual and the society in which he lived.
Sir Kenelm Digby was a Fellow of the first Council of the Royal Society, a
gentleman scientist who died in 1665. He dealt with all categories of
natural phenomena, and in amongst his writings on these are recorded
medical and psychological topics. Two of the most interesting of these
was his understanding of conditioning and folie à deux.
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had four or five women with her as servants or relatives, and her mood
was transmitted to them. He caused these women to be removed from
the situation and they all recovered. This type of reaction is seen today
in a variety of situations, not least in that of the religious sects where a
leader is sufficiently charismatic that he can persuade many followers of
his beliefs and thereby convince them of the righteousness of particular
actions which otherwise they would not contemplate. This may extend
to such activities as crime and sexual deviation.
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Robert Hooke, a scientist, became involved in early psychiatry in two
very different ways. He designed the new Bethlem Hospital which
opened in Moorfields in 1676, and which remained in use there until
1815.
Hooke was also one of the first western scientists to draw attention to
the properties of Indian hemp or marihuana which he found, ‘seemeth to
put man into a dream’. He thought it might be of use for lunatics but this
suggestion was not taken up. Later it was used during WW II, for dealing
with neurasthenia (battle shock), for the purposes of a drug induced
abreaction.
His contention was that, ‘madness and frenzie arise from the extreme
passions such as: love, hate, grief, covetousness, despair, all of which
destroy the senses of the soul; so that it loses its distinguishing and
imaginative property, becoming unconfined of the grosser senses, even
as in dreams’. In other words there is loss of judgement and the cortical
control is to some extent lost.
Locke understood the ‘natural’ defects that separated fools from the
acquired unreality of the madmen. The fools he saw as lacking reason,
whilst the madmen who, not having lost reason, put together ideas in a
mistaken logic accepting their fantasies as truths. They put wrong ideas
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together to make false propositions, whilst the idiots made few if any
propositions and rarely reasoned at all.
Whilst all of us are probably familiar with Robert Boyle and his laws of
physics, many will not realize that he was also a natural philosopher who
wrote a great deal on medical matters. He turned his mind to the
curiosities of medicine, and the unusual methods of treating them.
Some drugs have been specifics for insanity and nervous diseases for
centuries. None of these lasted longer than camphor which was in use
for over a thousand years. Even then its action (in large doses) which
produced epileptiform convulsions was simulated through the use of
metrazol and later still electric shock treatment.
His view was that the mentally ill differed from normal because they
misunderstood past or future facts of a common nature in a way that
separated from others in similar situations. This he noted affected their
happiness, memory and discourse; and the connective consciousness
was impaired. He suspected that the poor judgement of children and
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idiots, the dotage of old people, drunkenness, deliriums, reoccurrence of
ideas, violent passions, melancholy and madness were all connected to
an imperfection of reasoning.
Despite the input to the science from the philosophers psychiatry is still
probably as far behind the other branches of medicine as it was in the
mid-eighteenth century. This despite the contributions of people like
Thomas Reid, professor of philosophy at the University of Aberdeen, and
later professor of moral philosophy at the University of Glasgow. In 1764
he published An inquiry into the human mind, on the principles of
common sense.
Prior to this, theoretical philosophy was directed towards the 'soul' and
how it behaved, together with the senses of motion; imagination, reason
and memory, together with an understanding of the relationship between
passions and ideas. Reid pursued a different course which was more
akin to that followed later by Bentham which we now know as dynamic
psychology. His theory was gained from an understanding of how he
perceived that his own mind worked. This structured analysis brought
him to realize that the mind had an anatomy, as he saw it, 'as
indispensable as that of the body'. A proper understanding of this
required, in his view, 'a distinct and full history of all that hath passed in
the mind of a child from the beginning of life and sensation'. It was
probably not until Freud's time that such a clear understanding of this
aspect of mental illness was again attained.
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words and phrases ... giving different meaning to those that are received
... which create prejudice and misconstruction, and which must wait the
sanction of time to authorize ... Innovations in language ... are always
suspected and disliked by the many, till use hath made them familiar,
and prescription hath given them title’.
Gregory was also concerned about the ethical side of medical practice
particularly that which involved those who were vulnerable because of
mental illness. He drew attention to the 'physicians treating these
complaints with the most barbarous neglect, or mortifying ridicule, when
the patients can ill afford to fee them'. At the other end of the scale he
commented on the way in which the well-off patients were treated,
‘...they foster them with the utmost care and apparent sympathy; there
being no diseases in the stile of the trade so lucrative as those of the
nervous kind’.
Gregory overrode the idea that instinct was the prerogative of lesser
species than man. Some had thought that mankind had been given the
power of reason in order to negate what was seen as the lower power of
instinct. Gregory underlined his belief that not only was this not the case
but that instinct was or could be; ‘a sure and infallible guide; tho’ the
depraved and unnatural state into which mankind is plunged often stifles
its voice or makes it impossible to distinguish it from other impulses
which are accidental or foreign to our nature’.
Indeed he went further and suggested that reason was a weak principle
in man compared to instinct, ‘and generally is a more unsafe guide’. He
was quick to point out though that instinct should be carefully separated
from 'those cravings which bad habits have occasioned'.
He reflected on the way that medicine had fiddled with theories over the
centuries, and prevailed upon his fellow practitioners to follow his edict.
‘...To cure the disease of the mind there is required that intimate
knowledge of the human heart which must be drawn from life itself and
which books never teach. Of the various disguises under which vice
recommends herself to the imagination, the artful association of ideas
which she forms there, the many nameless circumstances that soften the
heart and render it accessible, the arts of insinuation and persuasion, the
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art of breaking false association of ideas or introducing counter
associations, and employing one passion against another; and when such
knowledge is acquired the successful application of it to practice
depends in a considerable degree on powers which no extent of
understanding can confer.’