Observations on the Nature, Kinds, Causes, and Prevention of Insanity, Lunacy or Madness
Thomas Arnold
(Doctor and Mad house owner)
1782 AD

1. In 1782 AD, Thomas Arnold, Doctor and Mad house owner of Leicester Lunatic Asylum in Britain, went to great lengths to describe 13 different types of insanity, which he divided into two major groups: Hallucinations and delusions. However, he also noted that, "all these species of Insanity may be variously combined, and frequently interchange, one with another." He described the etilogogy of insanity to "derive its origin from some accidental, and temporary, state . . . or to take its peculiar turn from the prevailing notions, and fashionable prejudices, of the times, or places, in which it occurs". In other words, the insane person was influenced by his environment from the outside, not some problem with brain nerves. (Observations on the Nature, Kinds, Causes, and Prevention of Insanity, Lunacy or Madness, Thomas Arnold, 1782 AD)
2. "Arnold was one of the famous provincial psychiatrists of the second half of the eighteenth century who owned a large private madhouse — judging from the number of patients admitted the third largest in the country — and acted as psychiatric consultant for a wide area. Like many owners of private asylums he took in a number of pauper lunatics at the charge of their parish but in addition offered to receive 'into the lower department of his house in the Bond-Street, in Leicester, on the reduced terms, of eight shillings per week' ten lunatics from families in distressed circumstances but 'unwilling to apply for the aid of a parish', and over and above these 'Two others free of all expence whatever' [see FIG. 97]. By this `generous and patriotic institution' his private madhouse became truly a `Hospital for Lunatics' until the Leicester Lunatic Asylum projected at his instigation in 1781 was opened in 1794 in the grounds of the Infirmary with him as its first physician. Unlike Perfect (1787) who aimed at no more than presenting a variety of cases to illustrate his cures, and Pargeter (1792) who set out to show the possibilities of management by the direct human approach, Arnold wrote a much more ambitious and systematic treatise, really a textbook. It was the first two-volume work on psychiatry in this country and modern also for the point Arnold made of giving accurate references for all his quotations having himself 'frequently experienced much inconvenience; often a great waste, and sometimes a total loss, both of time, and labour; by a loose, and negligent mode of reference from one author to another'. Volume I was devoted to classification with a chapter on postmortem appearances; volume II dealt with the causes of insanity. A third volume on treatment to which I and II were preparatory appeared independently as Observations on the management of the insane; and particularly on the agency and importance of humane and kind treatment in effecting their cure, 1809 (pp. viii +6i). Its purpose was 'to give a general outline of the best means of overcoming the violence, composing the perturbations, and regulating the conduct . . . of the insane . . . to urge the importance of mild and indulgent treatment . . . and to evince the great value and efficacy of good nourishment and assiduous nursing'. It was written from 'the experience . . . of two and forty years' of treating the insane 'in my own house . . . in which two-thirds . . . have been sent home again to their friends, perfectly restored to sound- ness of mind and understanding. In the Leicester Lunatic Asylum . . . under my direction . . . the number of patients discharged cured, has been in like manner upon an average two to one'. The book gives a good picture of the difficulties encountered by the early reformers who wanted to improve the lot of the insane. They lacked not only funds, proper buildings, good attendants, and of course precedents, but their main problem was how to deal with violent patients. These made up a large proportion because many asylums, like Leicester, only admitted acute cases, ill for less than six to twelve months, and in any case parishes would only shoulder the cost of hospital maintenance for the severely disturbed and disturbing. In this light Arnold's sincere sentiment that 'Chains should never be used but in the case of poor patients, whose pecuniary circumstances will not admit of such attendance as is necessary to procure safety without them' may be taken as a measure of the social limitations and impediments to psychiatric progress rather than as evidence of any inherent backwardness of the specialty or an unwillingness of psychiatrists to advance on old methods. Historically Arnold's importance was that he attempted a new classification of insanity by mental symptoms 'drawn with some care and exactness immediately from nature' rather than by arbitrary or social assessment of degree of madness, prevailing affective state or presence of fever. He made two main divisions, 'ideal' and 'notional' that is hallucinatory and delusional insanity, with numerous subdivisions supported by case histories gathered from the literature and his own practice, some of which read like descriptions in modern textbooks. Although he hoped that it would lead 'to greater certainty, and precision, in our knowledge of the disorder, and to greater efficacy in our methods of cure' his distinctions and definitions were too detailed and finical for practical use. In consequence they were never accepted and disowned even by his revered teacher Cullen. However Arnold's attention to clinical detail and his thorough historical survey set an entirely new standard of scientific scholarship in psychiatric literature. James Boswell recommended 'whoever wishes to see the opinions both of the ancients and moderns upon this subject, collected and illustrated with a variety of curious facts, may read Dr. Arnold's very entertaining work' (Life of Johnson)." (300 years of Psychiatry, Richard Hunter, 1963, p 467)

Thomas Arnold (1742-1816)

M D Edin., FRCP Edin., physician to the Leicester Infirmary and Lunatic Asylum; owner of Belle Grove Asylum

Observations on the nature, kinds, causes, and prevention of insanity, lunacy, or madness, 1782-6. 2 Vols. Leicester, Robinson & Cadell (pp. [iv] +xvi 4.324 +viii; [iv] +xii +541 +iv). Vol. I, pp. 72-4, 8o, 89, 125, 129-3o, 135-7, 144, 158, 172, 177-8, 18o, 195-6, 199-200, 207, 213, 216-7, 220-I, 224, 235-6, 311'4, 316, 319

Second edition London 1806

CLASSIFICATION OF MENTAL DISEASES

Insanity, as well as delirium, may be considered as divisible into two kinds; one of which may be called Ideal, — and the other Notional Insanity.

Ideal Insanity is that state of mind in which a person imagines he sees, hears, or otherwise perceives, or converses with, persons or things, which either have no external existence to his senses at that time; — or have no such external existence as they are then conceived to have : — or, if he perceives external objects as they really exist, has yet erroneous and absurd ideas of his own form, and other sensible qualities : — such a state of mind continuing for a considerable time; and being unaccompanied with any violent or adequate degree of fever .. .

Notional Insanity is that state of mind in which a person sees, hears, or otherwise perceives external objects as they really exist, as objects of sense; yet conceives such notions of the powers, properties, designs, state, destination, importance, manner of existence, or the like, of things and persons, of himself and others, as appear obviously, and often grossly erroneous, or unreasonable, to the common sense of the sober and judicious part of mankind. It is of considerable duration; is never accompanied with any great degree of fever, and very often with no fever at all .. .

Insanity, or delirium, according to the above account of them, cannot with propriety be said to exist, but where the Judgment is deceived, the Affections are misguided, or the Conduct is perverted, by some delusive perception, or some notion palpably erroneous, or absurd . . .

There is, indeed, some difficulty in determining the boundaries between what may not improperly be called moral and medical Insanity. Several of the ancient philosophers, and particularly Socrates, and the Stoics, considered every foolish, or vitious person, as insane, or morally mad; and only to be distinguished from the actually and medically mad, by the degree of disorder.

I. Ideal Insanity

1. In Phrenitic Insanity the patient Raves Incessantly . . . and scarcely knows, or attends to external objects about him; and when he does perceive external objects, is apt to perceive them erroneously .. .

2. Incoherent Insanity .. . may arise — from a too active, and almost phrenitic state of the brain; — from that kind of active state of the brain which occasions a slightiness of imagination . . . and from that state of the brain, in which there is a great defect of memory .. .

3. Maniacal Insanity . . . is . . . perhaps, the most comprehensive; since it extends its dominion over the Whole Internal World of Ideas, and comprehends every possible combination of sensible images which can enter into, and delude, a distempered brain .. .

4. By Sensitive Insanity I mean that in which the disorder shows itself chiefly, or remarkably, in the Erroneous Images which are excited in the mind, relative to the person's own Form, Substance, or other Sensible Qualities.

II. Notional Insanity

5. I have placed first in order under this division, that species of Insanity which . . . has a peculiar title to the appellation of Delusive, because . . . with the sound and unimpaired use, in every other respect, of the rational faculties, which in some cases have even been observed to be remarkably acute, the Patient, in relation to some particular subject, or subjects, is Under the Insluence of the most Palpable, and extraordinary Delusion .. . Under this variety may be enumerated the cases of such as have imagined themselves to be dead, — to be deprived of their proper nature as human beings .. .

6. Fanciful Insanity . . . displays itself in almost incessant talking, accompanied with frequent sallies of wit, quick repartee, acute observation, ready invention, lively, and even brilliant fancy, and, in a variety of respects, with much appearance of genius; and arises from a rapid succession of vivid, and sprightly, images; and a wonderful aptitude to catch at the slightest associations, and to run through all the relations, whether natural, or accidental, of whatever objects may chance to present themselves .. .

7. In Whimsical Insanity the patient is possessed with absurd, and Whimsical fancies, aversions, fears, scruples, and suspicions . .

8. I call that Impulsive Insanity, in which the patient is Impelled to do, or say, what is highly imprudent, improper, unreasonable, impertinent, ridiculous, or absurd, without sufficient, with very slight, or with no apparent cause . . . But as we cannot easily conceive of conduct without motives . . . we may . . . rest satisfied that the conduct of these sorts of patients is regulated by notions, however they may conceal themselves from our observation .. .

9. In Scheming Insanity the patient thinks himself . . . by his superior knowledge, or cunning, capable of doing great things, which few, or none, but himself, are able to accomplish .. .

10. The Vain, or Self-Important Insanity; with which they who are possessed, have a very exalted opinion of their own imaginary dignity, consequence, opulence . . . learning, or of some other valuable quality .. .

11. In Hypochondriacal Insanity the patient is for ever in distress about his own State of Health, has a variety of Disagreeable, and sometimes Painful Feelings, to which he is ever anxiously attentive, and from which he can rarely divert his thoughts, either to business, or amusement .. .

12. Pathetic Insanity exhibits a striking and melancholy picture, of the empire of the passions. In this species of Insanity some One Passion is in full, and complete possession of the mind; triumphs in the slavery, or desolation, of reason; and even exercises a despotic authority over all the other affections, which are rarely permitted to exert themselves but in the aid, or to appear but in the train, of this master passion . . . all, or nearly all, the varieties of this species of Insanity, are accompanied with distress, dejection, anxiety, or restlessness of mind .. .

13. In Appetitive Insanity there is an immoderate, and ungovernable, desire, of gratifying an Appetite . . . a disorder of this sort in men, has already acquired the appellation of Satyriasis; and, in the other sex, that of Nymphomania.

I have already mentioned that all these species of Insanity may be variously combined, and frequently interchange, one with another. It may be proper farther to remark, that the same patient sometimes goes through several kinds of Insanity, — which may be reckoned in such cases, as so many degrees, or stages, — during the course of the same illness. Of these combinations, and changes, there is almost an endless variety. One remarkable, and not uncommon transition of Insanity, is from great dejection, and distress, to ease and chearfulness, and sometimes to an uncommon flow of spirits. But most frequently it retains its character of liveliness, or anxiety, elevation, or depression . . . It may, also, be noticed, that Insanity appears sometimes to be Epidemic; and either to derive its origin from some accidental, and temporary, state . . . or to take its peculiar turn from the prevailing notions, and fashionable prejudices, of the times, or places, in which it occurs.

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