T ZEE IE 
Borderland of Insanity. 
IRA RUSSELL, M. D., Winchendon, Mass. 
Reprint from The Alienist and Neurologist, 
St. Louis, Mo., for July, 1884. The Borderland of Insanity, 
By Ira Russell, M. D., Winchendon, Massachusetts. 
Vice-President of the Massachusetts Medical Society; member of the American' 
Association of Superintendents of Insane Asylums; N. E. Psychological 
Society; Mass. Medico-Legal Society; Sup’t Family Home 
for Treatment of Mental and Nervous Diseases, 
Winchendon, Mass. 
MANY attempts have been made to define insanity,, 
to give a definition that would cover all its phe- 
nomena, All such attempts have been defective, either 
including or excluding too much. 
There is no standard of health and disease; so gradu- 
ally do they shade into each other, that the line between 
them is an imaginary one. It is impossible to tell when 
daylight ends and darkness begins. Equally undefinable 
is the line which separates oddities, eccentricities, the pas- 
sions of love and hatred, religious fanaticism, and many 
other mental manifestations from insanity. 
That which in one person may be normal, in another 
becomes an indication of disease. The borderland of insan- 
ity is occupied by many persons who pass their whole lives 
near that line; sometimes on one side, sometimes on the 
other. Many cases have come under my care or observa- 
tion that have been very difficult to classify. 
A lady, aged sixty, a widow, belonging to one of the 
most distinguished New England families, refined, highly 
educated, energetic and very sagacious in the manage- 
ment of all her affairs, came under my care, with the 
following history: 
She was left a widow with four small children, three 
sons and one daughter. By great prudence and energy,, 
she managed to give them all a superior education. The 
daughter possessed a high order of talents. In short, the 
children were model children, and noted for their devotion 
to their mother. The daughter married a very worthy 
man and made a home for her mother, who had expended Ira Russell. 
3 
her means in the care and education of her children. At 
first the mother was delighted with her new’home, and for a 
while everything went on smoothly. 
By degrees the mother became petulant; small things 
annoyed her. This state of mind grew worse and worse, 
and developed into hatred of both the daughter and her 
husband. At the same time she was very amiable and 
lady-like when in company with those outside her own 
family, and appeared like a model mother-in-law. She 
commences writing complaining letters to one of her sons, 
who is married. The letters have such an air of candor, 
truthfulness and honesty, that the son believes there must 
be some foundation for the complaints, blames the sister, 
sympathizes with the mother, and finally proposes to take 
her to his own home. He does so; she is delighted with the 
change; the son’s wife is more to her than her own daughter. 
Very soon, however, there is a change in her feelings; she 
distrusts her son’s affection for her; his wife is at fault in 
many things. She becomes unhappy and discontented; 
commences writing complaining letters to her daughter, 
setting forth her grievances and imploring her to take her 
back, and threatens suicide unless she does it. The 
daughter takes her back, with the same result as before. 
One of her sons commits a homicide—kills the para- 
mour of his wife. He is brought to trial; the plea of 
insanity is urged. The mother is indignant that such a plea 
should be offered. It would be a disgrace to the family, and 
above all, insists that none of her mental peculiarities shall 
be used to substantiate a hereditary tendency to insanity 
in the family. Neither was she willing that the facts about 
her father, who was subject to strange spells, and a brother, 
who died in an insane asylumn, should be used. The son, 
after an exciting trial, was acquitted as insane, the mother 
expressing no satisfaction at the result. This lady when 
away from her children seemed to have all of a mother’s 
natural affection for them. 
While she had no positive delusions she had a wonder- 
ful faculty to pervert and discolor facts. 4 
The Borderland of Insanity. 
For years she was devotedly attached to her children, 
and made their home life exceedingly happy. Why the 
change ? Was it because her children no longer needed her 
support, and that she no longer could look upon them as 
children? Was it because that part of the brain which pre- 
sided over the love of offspring had no more work to do, 
that she hated those who shared the love that was once 
bestowed upon her? 
Another lady, a widow, fifty-three years old, came under 
my observation, with the following history: 
Left a widow with three children, two sons and a daugh- 
ter. She was remarkable for her happy, genial disposition 
and business capacity. She met with a severe accident, 
and bore great suffering with uncommon fortitude. She 
had a strong affection for her children and devoted herself 
to their welfare. Her daughter marries to her satisfaction 
and provides for her mother a home. At first she enjoys 
her new home ; everything goes on pleasantly for a year 
or two. Finally the mother takes a dislike to the son-in- 
law and then to the daughter. Everything they do for her 
is wrong. The more they try to please her and surround 
her with every comfort, the more disagreeable and fault- 
finding she becomes. As her son-in-law aptly said: “ she 
makes his home a hell.” 
After a most thorough examination, I could detect no 
delusion. She expressed great respect for her son-in-law, 
and affection for her daughter. 
Take another case:—A young lady, twenty-four years 
old, unmarried, well educated and intelligent. She has 
great repugnance and hatred of a younger sister. She 
says she can give no reason for this repugnance except 
that her mother had the same feeling toward her when 
a child, that lasted for several years, and then completely 
subsided. 
In the last number of The Alienist and Neurologist, 
Dr. Hughes, the editor, refers to a lad of fourteen, in 
an article entitled “ The Borderland of Psychiatric Rec- 
ords.” Ira Russell. 
5 
The doctor gives an account of the origin and symptoms 
as shown when he came under his care. Dr. Hughes 
advised his friends to consign him to my care after 
treating him for two months without any marked improve- 
ment. 
I copy what he says of the case: 
In January, 1882, S. A., a slender, but somewhat deli- 
cate youth of fourteen years, came under observation, suffer- 
ing with facial choreaic movements, and slight left ptosis. 
He had been tenderly and indulgently, and probably, 
luxuriously reared. His father and mother were nervous, 
and mentally somewhat peculiar, from a psychologist’s 
stand-point, though not sufficiently singular to attract 
general attention or comment. The mental capacity of 
both parents was good; the business capacity and financial 
success of the father being above the average of his neigh- 
bor, his business now being that of a financier; but, after 
a severe business stress, he had himself been temporarily 
deranged, according to the statement of his son. 
The habits of this youth were very studious, he being 
apt and advanced at school; above his companions at the 
time this affliction befell him, and his moral sensitiveness 
was excessive for his years. He became interested in 
religious matters, and began to question the unsinfulness 
of some of his actions, which are not regarded as violative 
of the decalogue, or usually considered improper. In 
short, his mind at this time had become overwrought 
from over study, too little sleep possibly, together with 
neglect of physical recreation. 
At the season of the year when the potato vines were 
infested with the potato bug, the youth accompanied some 
of the hands into the field, and saw them put Paris green 
on the vines to kill the bugs. At this time also, a toy 
pistol was fired off close to his ear by a companion, pro- 
ducing a profound shock, and some cerebral disturbance. 
A short time after this incident, when potatoes were 
brought on the table, he took a morbid aversion to them, 
fearing they were poisoned, and would not eat them. 
This aversion soon extended to those who had handled 
them, and to the clothing of those who had handled 
either the potatoes from the field or the Paris green. 
He importuned his parents not to eat them, and avoided 
contact with them. Straightway he began the self-ablution 6 
The Borderland of Insanity, 
process, so peculiar to these patients, which he performed 
every time shortly after rising from the table, and after 
touching a member of the family. From a fear of potatoes, 
this delusive, morbid aversion, passed to a fear of every- 
thing that was green. The green wall-paper, table covers, 
book covers and carpets, were all regarded as poisonous, 
and his time was spent in avoiding these colors, and in 
washing away imaginary contamination. He would wash 
his hands after handling anything that any of his family 
had touched, even letters and papers received through the 
mail. Paris green, or arsenic, were pigments in all green 
colors, he thought, and it could not be reasoned out of 
him. It was volatile too, for he had read the reports of 
the Massachusetts State Health Board on that subject, 
and they proved it in regard to green wall-paper, 
because they showed that people were poisoned by 
sleeping in rooms which were papered with green wall- 
paper. 
This boy was not melancholic. He enjoyed himself 
at play, and with the sights of the city, whenever nothing 
occurred to excite his morbid dread of green. Under the 
dominion of this delusive, morbid aversion, this young 
man was in constant misery, wherever there was anything 
green, except the green fields or plants. Our efforts at 
treating him were unsuccessful, because unfortunately the 
wall-paper, carpets, and some of the table covers of our 
house had green shades in them. On other subjects, this 
boy’s reasoning was rational enough, and he was bright 
and observant, but his conviction became intensified, his 
suits of clothing from home having to be cast aside, and 
his trunks sold. He found something to keep alive the 
morbid feeling in the colors encountered by him, when- 
ever we placed him in the city. Under such circum- 
stances, we continued our efforts to treat him but a short 
time. At the end of two months of fruitless endeavor, 
we advised that he should be consigned to the care of 
Dr. Ira Russell, of Winchendon, Mass, hoping that at 
such a distance from home, and knowledge of our profit- 
less experience, would enable the doctor to do him more 
good than we had done. 
He first came to me in company with an aunt. When 
he saw me, he recognized me, having seen me at Dr. 
Hughes’ house in St. Louis. He refused to stay in either 
of my houses; his aunt took him to a hotel, and the next Ira Russell. 
7 
day left for Providence, R. I. A few weeks later his 
father came with him, and he agreed to stay provided 
his father would leave St. Louis, which he promised 
to do. 
The following letter to his father shows his feeling in 
regard to St. Louis: 
WINCHENDON, Nov. 2, ’B2. 
Dear Father: Received your letter this morning. 
Was glad to hear from you. Away off from home as 
many miles as I am, and a cloudy day, is enough to 
make anybody feel bad, especially when unwell. 
0 dear, I wish I was dead and buried long ago. I 
am making trouble for you and myself, and what good 
am I on earth, anyway ? I wish you would not say any- 
thing about this to doctor. I will get a disease that will 
kill me off yet. Now what am I going to do ? Kill me, 
and be done with it. If I was only dead, then you could 
do anything with my things. I would be dead and gone 
to hell—not make any difference to me. 
Why can’t I die and be done with it ? About money: 
I asked ma' to send me some before I received that $2.00 
from her, because with $2.00 you sent, I got a necktie 
for 38cts.; a paper of pins, .05 ; a ring of tape to mend 
my drawers, .05 ; some ink, .05. The rest in postal cards 
and stamps, and have a dollar left. The reason that I 
asked for more was that I wanted to get a hat or cap of 
some kind, and then I wanted to have a little money 
about me. Now, where have I spent anything foolishly? 
—not one single cent. I don’t care whether a disease takes 
me or not. Please don’t write anything I said to any of 
them, will you ? 
A patient here, a young man that is about well, said 
to me, “ I have been well ever since I have been here, 
haven’t I?” I said, “Yes.” 
1 have not done a foolish thing in Winchendon. I 
am going down to take music lessons, but I guess I 
won’t succeed much now after this. Since receiving your 
letter I don’t feel as if I deserved to live at all, and won’t, 
probably, much longer. I received the 52.00 ma’ sent 
the other day. 
Good bye. Write soon. 
Albert. 
Also one to his mother, which shows his feeling about 
dirt. 8 
The Borderland of Insanity. 
WINCHENDON, MASS., Oct, 24, ’B2. 
Dear Mother : I received a letter from pa’ yesterday. 
I have some bundles in my trunk that I am worrying 
over. I must not worry no more you know, because it 
makes my headache, and unless I get them away from me, 
I will worry over them. Now this is the only way to get 
rid of them. O Mamma, if I only had them out of the 
way I would be all right. I had them wrapped up when 
I came here. There is wrapped up my old blue suit of 
clothes, that is not fit to wear any longer, and a pair of 
old shoes and a lot of boxes and old papers of mine, all 
wrapped up together in a large bundle, and some old 
hats not fit to wear any more. Now, I can never get 
well if they are here all the time. They watch so close 
around here that I can hardly do anything with them, 
although they are not fit for anything. The only way I 
see to do, is for you to write to me a note to show to one 
of the young men here, that you said I might send those 
things to you. I can send them by freight, which wont 
cost much. 
We do not want pa’ to know anything about it 
though, and I guess pa’ will be coming to Stratton 
soon. So you can pack them in your trunk when you get 
them, and go to Dixon on a visit right away, and drop 
them down their water closet, as grandma’ wants it filled 
up anyway; that will be killing two birds with one stone, 
and it is a poor stone at that. 
Now, Mamma, I must get rid of them before another 
week, if possible ; then I will have nothing else to worry me. 
Then I can get well, and come home and be happy again. 
If we can’t do that I will have to come home myself and 
do it, ’cause I can never get well if they are here. I am 
sick now worrying over them. I feel like going home, 
and I will, if they don’t get away from here immediately. 
Now, Mamma, don’t worry that I am getting worse, be- 
cause I aint you know. I had them wrapped up when I 
came here, so I cannot be getting worse. Now, Mamma, 
don’t write back something else, because I can’t stand 
this worrying any longer. O dear, I feel like taking them 
down to the depot myself, and now I am worrying so 
about them. I will surely come home if they don’t get 
away from me. Don’t let anybody know that I sent them, 
will you ? and don’t let the folks at Dixon know, will you ? 
If they are too large (the bundles), mash them, and a 
stick and push them down. Don’t you open them by any Ira Russell. 
9 
means, please. lam telling you the truth what is in these. 
Don’t drop any down at Streator (?) If they fill up your 
trunk take out all your things only what you need at 
Dixon, and leave them at Grandma’ Moon’s, as you will 
be coming back soon anyway. I will worry myself if you 
don’t do that. I might die. As this is the last, please do 
it, as I have thrown off so many of my other notions. O, 
you will have to send me five dollars: course it won’t 
take it all, but I will want some now and then. 
Good-bye. Write soon. Albert. 
P.S.—Be sure and write the very minute you get this, 
and send money. I can be so happy. Don’t forget to 
send a note to me, to one of the young men, if they 
should ask for one. 
I placed him in charge of an intelligent tutor, and set 
him to studying. He was favorably impressed with the 
plan, and recited regularly in history, grammar and arith- 
metic, and occasionally took lessons in music. He played 
billiards and other games, and took great pains to conceal 
his fears of dirt and poison. His tutor kept a careful rec- 
ord of his doings and symptoms. 
November 3. During the day appeared happy. In the 
evening complained of a frontal headache, or as he called 
it, not a regular headache, but a kind of corner headache. 
November 4. No recitation, restless, uneasy and dis- 
contented, Refuses to play games; seems absorbed in 
thought. His eyes have a vacant, listless expression. 
After tea became interested in games; his countenance 
brightened up; he became cheerful and happy. 
November 6, Enjoyed his recitations; played games;, 
seemed quite happy. 
November 7. Recitations very good. He talks about 
insane asylums; said the reason so many persons became 
insane was owing to too close study while young, and' 
that his nervousness was due to the same cause. 
From this time onward he continued to recite to his. 
tutor, spending one or two hours a day in study and 
recitation. The remainder of the time was spent in riding, 
games and walking. He exhibited less and less fear of 
dirt and poison. After staying with me four months he 
left very much improved. He returned again in June, 10 
The Borderland of Insanity. 
and remained with me through the summer, no one sus- 
pecting there was anything the matter with him. 
He sometimes admitted to me that his old thoughts 
came into his mind. 
He was treated mainly with tonics, such as iron, strych- 
nine, phosphorus and plenty of outdoor exercise. 
Another case somewhat resembling the preceding, was 
that of a man aged forty-five. A large well developed 
man, of sanguine temperament—a skilled mechanic. 
For fourteen years, he had been foreman in a furniture 
manufacturing shop, employing a large number of men. 
He was very methodical and accurate in all his work, 
selecting and buying material with sound judgment and 
skill. His shop hands first noticed a hesitancy in touching 
anything. When he wished to take hold of anything, he 
would raise his hand, advance toward it slowly, and with 
great effort grasp the object in view. 
Engage him in conversation and in the midst of it, 
carelessly ask him to hand you a paper, or any object, 
and he would do it without hesitation. But if you asked 
him to look at the paper, or to read something in it, he 
would make several efforts before he would succeed in 
doing it. At the table it was with great difficulty that 
he could summon sufficient will-power to take food when 
offered to him. 
He would write a letter and express himself clearly, 
and hesitate a long time before putting it in an envelope ; 
and if he did not utterly fail to do it, he would remove 
it a dozen times perhaps, before sealing it, to see if he 
had not placed something besides a letter in it. After 
mailing it, he would be in agony for fear he had written 
something he ought not, or placed something besides the 
letter in the envelope. 
At times he could hardly persuade himself to dress, 
through his fear of touching his clothing. 
While he was naturally a most methodical man, he 
was utterly incapable of doing anything in a systematic 
manner. Ira Russell. 
He perfectly understood the absurdity of his notions, 
and could reason correctly upon his own case. He would 
say, “ This dread of touching things is perfectly ridiculous, 
and I know it, but I cannot control the spell that holds 
me.” After a most distressing effort to take a news- 
paper from the table, he would shed tears, because, as 
he said, he was so foolish. After passing from one room 
to another, he would return several times, to see if he 
had not dropped something. 
Before coming to me, he had been in this condition 
eight or nine months. I gave him, bromide potass., 
cannabis indica and ergot. I was building a barn at the 
time. I soon got him interested in the work, and he be- 
gan to assist the carpenters. He soon found that when the 
work was marked out for him he could bore a hole and 
make a mortise without trouble. He steadily improved, 
and, after three months’ treatment, went home well. 
This last case is one that Hammond designates 
aboulomania, or paralysis of the will; and Prof. Tam- 
bourini, of Italy, insanity of doubting, with fear of contact. 
There is another class of persons subject to attacks of 
disagreeableness, due to what I may be allowed to call, 
mental epilepsy, in which, as Maudsley says, there is a 
convulsion of ideas, not of muscles—cases in which there 
is no loss of consciousness. 
A distinguished clergyman came under my care. After 
great mental effort, preaching extemporaneously on Sun- 
day, he would appear tired and exhausted. After resting 
a while he would become excited, and would abuse his 
wife and family with the most insulting and opprobrious 
language. After a few hours this state of excitement 
would pass away, and he would become himself again. 
These attacks increased in frequency, until he came under 
treatment. I gave him bromide potass., hyoscyamus, 
canabis indica, chloral hydrate, variously combined ; elec- 
tricity and tonics, iron, strychnine, phosphorus and 
nitro-glycerine. After several months’ treatment these 
attacks subsided. 12 
The Borderland of Insanity. 
Miss A., a lady of marked intellectual ability, of a 
nervous temperament; her father epileptic; mother died 
insane. Although lady-like, refined in manners, lovely and 
affectionate in disposition, and a great favorite in society 
from childhood, she was subject to what her intimate 
friends and family called mad fits. 
Without any apparent reason, she would be very bitter 
toward her mother, or some other member of her family, 
using the severest terms of censure. These turns never 
occurred except in the presence of her own family, or 
most intimate friends. She married quite young; her 
husband was a clergyman, a man of marked ability. She 
was proud of him, and had the greatest love for him. 
Still, at uncertain, unexpected intervals of a few weeks, 
sometimes months, an unusual paleness of the counte- 
nance would appear, and without any loss of consciousness, 
she would go into a paroxysm of scolding, fault-finding and 
vituperation, lasting for a few hours, when she would resume 
her wonted good nature and cheerfulness. She has often 
expressed the fear that she would sometime become insane. 
A distinguished divine, a D. D., married to a cousin,, 
and late in life became insane. 
One son was an imbecile, another a clergyman of un- 
common ability. The latter had periods in which he had 
an overpowering sense of his sinfulness, and would for 
days be plunged into the very depths of despair, followed 
by periods of ecstatic delight, when he felt that he was. 
basking in the sunlight of God’s favor. 
A daughter of the last mentioned, a bright, nervous, 
child, at the age of twelve, joined the church, and 
was looked upon as a model Christian. At eighteen, she 
began to distrust her religious hope, and finally abandoned 
it, and felt that she was forever lost. After six months of 
gloom and despair, she was reconverted, with periods of 
exalted religious enjoyment like her father. She wrote 
many religious books noted for their high spiritualistic 
type; “ Stepping Heavenward,” and others of a similar 
character. Ira Russell. 
13 
Recently I have had under my care a clergyman, aged 
thirty-seven, a large portly man, of a bilious, nervous 
temperament, a popular preacher, possessing fine oratorical 
power. He came from the British Provinces, where he 
had been a successful preacher, but unfortunately had 
become involved in financial difficulties, and was obliged to 
give up his parish. He came to the States, and was soon 
employed by one of our churches as a pastor. His 
creditors from the Provinces followed him, vilified him, 
trusteed his salary, and in various ways annoyed him. 
These annoyances made him moody, melancholic, and 
absent-minded. He goes to a book store, purchases a 
book, and takes another. He is watched, followed, and 
arrested for stealing. He is seen and examined by several 
medical experts, and in view of their opinion, the District 
Attorney declined to prosecute the complaint. 
The mental symptoms that I have noticed, besides his 
moodiness, were occasional attacks of an epileptiform 
character, with only partial loss of consciousness, followed 
by lapse of memory and a disposition to disagree with, 
and contradict whatever was said by those about him. 
After a period of dullness, he would return to his 
former self. He continued to improve, and has resumed 
his pulpit and pastoral labors. 
Several years ago I received a telegram requesting 
me to take charge of a “ quiet lad ” of fourteen years, 
recommended to my care by the late lamented Dr. John 
E. Tyler. Without waiting for a reply, the parents of the 
boy brought him to me. 
I very soon discovered this “ quiet lad ” in a very 
dangerous position on the top of the barn. He readily 
came down, and soon after was found in the garden, 
pulling up the vegetables for the benefit of the pigs. 
Directly afterwards he was found in the pig-pen in pur- 
suit (he said) of a bristle to make a waxed end. At this 
point his parents left. 
Very soon the boy disappeared, but after a while 
returned thoroughly drenched, having fallen into the water The Borderland of Insanity. 
14 
while attempting to launch a boat. He was now placed! 
in the care of an attendant, with instruction, to keep him 
under constant observation. 
In the evening he joined the family circle, was very 
pleasant and happy, showing his familiarity with certain 
games and puzzles, and singing his Sunday school songs, 
being accompanied by one of the ladies of the family on 
the piano. 
At bed-time he was shown by the housekeeper to 
his sleeping room. 
There he knelt and made a prayer, in which he 
remembered his parents and sister and the different mem- 
bers of my family. The housekeeper returned with tears 
in her eyes, saying she had never heard such a beautiful 
prayer as that little harum-scarum had made. I subse- 
quently learned the following facts, in regard to his history, 
and certain hereditary tendencies: 
His father was a quiet, substantial business man, his 
mother a lady of great refinement and nervous tempera- 
ment. 
His maternal grandmother was a woman of marked 
ability, a devoted member of the methodist church, 
eccentric, erratic, domineering, always bent upon having 
her own way, making others conform to her wishes, and 
a terror to her minister. 
A maternal uncle was a dipsomaniac, another was 
noted for his crooked ways of obtaining money. 
Several months before coming to me, this boy wit- 
nessed the death of his maternal grandfather, to whom 
he was very much attached, and with whom he was a 
great favorite. The event made a deep impression upon 
his mind. Death, religion, and a future life, were his 
constant theme of conversation. After a while he began 
to have intervals of depression, followed by periods of 
unusual cheerfulness and vivacity, which finally developed 
into obstinacy and unwillingness to be controlled. These 
periods of obstinacy would last for a few days, when he 
would relapse into a depressed and quiet stage. Ira Russell. 
When he came to me, as already remarked, I placed 
him in charge of an attendant. After a few days he be- 
came very quiet and gentlemanly in his conduct. This 
condition lasted for three weeks, when he began to be 
talkative; then indulged in exhilarated boasting of what 
he could do, reminding one of the exaltation observed in 
general paresis; then obstinate, profane and belligerent. 
This state of mind lasted for three days, when he 
took a religious turn for three days, and then became 
quiet again. These periods occurred regularly every 
month for six months, when they began to be less marked, 
and finally disappeared entirely. 
He remained well until nineteen years old, when, dur- 
ing the last presidential campaign, he joined a drum 
corps. He was frequently out late at night. This was 
followed by an attack of mild melancholia, lasting three 
or four months, from which he has recovered and remained 
well. 
Miss A., aged twenty-three, brought to my Highland 
Family Home on a litter, with the following history; 
Her mother, a widow, belonged to one of the old dis- 
tinguished quaker families in New York. The daughter 
had been an invalid for two years. She had been treated 
in some water-cure establishment for womb trouble and 
special complaints, without benefit, but rather grew worse. 
She left the water-cure and was taken to Newport, 
R. 1., where she consulted Dr. H. R. Stover, who discovered 
no womb trouble that needed treatment, and advised that 
she be placed under my care. 
I found her well nourished, all her bodily functions 
well performed, pulse and temperature normal. She com- 
plained of a great variety of symptoms ; pain in her back, 
in her head and in her limbs. She was unable to sit up, 
hardly able to move in bed. I soon found that when 
complaining of pain, if by any means her attention could 
be diverted to something outside herself, she would for- 
get all about it. I placed her in charge of a judicious 
attendant, and every effort was made to arouse her ambi- 16 
The Borderland of Insanity. 
tion, and to commend her whenever she made any attempt 
to exert herself. Such attempts were gradually success- 
ful. At first she thought she could bear no light or noise 
in her room. I prescribed sun baths. Before she was 
taken sick she was fond of playing on the piano. Her 
attendant was a good pianist; so I put a piano in her 
room. Her attendant performed such pieces of music as 
she had been accustomed to admire. She began to sit 
up a little, then to walk a few steps at a time, none of 
which she had done for two years. Then, with consider- 
able urging, she played for two or three • minutes at a 
time on the piano. The next step was to have her go 
to the table, and take her meals with the family, and 
finally take long drives, all of which she found she could 
do without inconvenience. The great difficulty in her 
case, has been to divert her of the idea that she was an 
invalid, and of the fascination of being pitied and waited 
upon. She was not altogether a fraud. She had been 
made to believe by injudicious friends and medical 
advisers, that her complaints were real. In her case, as 
in many similar ones, there has been a vein of moral 
perversity, a disposition to exaggerate and give a false 
coloring to everything done for her. 
While she appears amiable and lovely, and expresses 
the highest regard for her attendants, she would write to 
her mother that she was neglected and abused, inventing 
some ridiculous incident to show it. Becoming inspired 
with the prospect of marriage,’ her progress to complete 
recovery has been rapid. This lady is a type of many 
similar cases that have come under my observation, some of 
whom have been regarded as martyrs of great suffering 
by sympathizing friends.