COMMON EUKOKS: 
Theoretical and Practical, Relating to Insanity. 
By ORPHEUS EVERTS, M. D., 
Medical Superintendent of the Cincinnati Sanitarium. 
Late Superintendent of the Indiana Hospital for the Insane; late President of the 
Association of Medical Superintendents of American Institutions 
for the Insane, etc., etc. 
[From the American Journal of Insanity, for October, 1886 ] 
REVISED BY THE AUTHOR. COMMON ERRORS: 
Theoretical and Practical, Relating to Insanity. 
Read before the Association of Medical Superintendents of American Institu- 
tions for the Insane, at Lexington, Ky., Tuesday, May 18, 1886. 
By ORPHEUS EVERTS, M. D., 
Medical Superintendent oj the Cincinnati Sanitarium. 
President of the Association. 
It has been said that mistaken notions respecting 
human destiny have been the greatest obstacles to 
human progress. That notions at variance with all 
facts and inferences, as now recognized by the learned, 
respecting all phenomena, have been at all times enter- 
tained by a large majority of mankind, will not be 
denied. Notions so deeply rooted, so firmly fixed, so 
widespread and overshadowing, as to resist all encroach- 
ment, save that of growth — the irresistible expansion 
of capabilities and knowledges. 
Whether such notions have been really obstructive, 
or only faithful expressions of concurrent ignorance 
and incapability, awaiting the advance of intelligence, 
may be questionable. (1.) But if the onward move- 
ment of the races has ever been so obstructed it must 
(1.) The notions entertained by any given people at any given period are 
necessarily, in accordance with the capabilities and knowledges of such people. 
Such notions do not obstruct progress, but indicate attainment. The notions of 
infancy are displaced by the beliefs of maturity. Beliefs of the ancients have 
been displaced by modern recognitions, as imperceptibly as childhood glides 
into youth. 2 
be so still, to an extent measurable by the influence of 
such notions over the common teachings of the time. 
To the medical profession of to-day—as representing 
a wider range of knowledges, and greater freedom and 
courage of investigation, than any other — the world 
looks for instruction respecting all natural phenomena— 
the phenomena of living matter more especially—yet 
not all of us of this profession par excellence, have out- 
grown many of the mistaken notions of our ancestors, 
nor opened our eyes fully to the light of present 
knowledges. 
Our Medical Schools have been, and still are, behind 
the advance of science in the instruction given by them 
respecting the constitution and conduct of living beings 
— teaching still, with some notable exceptions, super- 
ficial anatomy, and elementary physiology — with the 
apparent indifference of infallibility toward all that is 
new, or recently asserted, in Biologic science. 
But the special features of this address forbid further 
general remarks. 
The first, and most important, Common Error of 
theory respecting insanity is an ascription of the 
phenomena of mental disorder to an immaterial, hence 
hypothetical, personality called “The Mind.” 
That this is an error may be known from the facts 
that all mental manifestations are phenomenal, and all 
phenomena of which we have any knowledge are sequen- 
tial to antecedent changes in the conditions of material 
structures. Also from the fact that all pathological 
conditions of which we have any knowledge—which we 
have been compelled to recognize as necessarily antece- 
dent to the manifestations of insanity — pertain to 
material beings, whose structural characteristics are 
highly developed organs called Brains. 3 
This error, which is a survival from the mythopoeic 
concepts of primitive peoples, born of efforts to solve 
the riddles of the universe without the capability of 
mature growth, or the knowledge of facts acquired by 
experience, has been modified by the pressure of com- 
pulsory recognitions of physiological facts, to such an 
extent that most physicians of any pretension to educa- 
tion now ascribe insanity to an intimate association of 
“the Mind” still regarded as an immaterial, seperable, 
spiritual being, with the material body of man which 
alone is subject to dissolution, hence disease. 
This modification, while it retains the substance of the 
original error, marks a decided advance in the recogni- 
tions of the profession, which in time will occupy still 
higher grounds commanding broader views of an ever- 
widening horizon. 
It may be asked, and will be, in consideration of the 
assertion that all mental manifestation is phenomenal— 
the natural, inevitable, sequence of antecedent condi- 
tions of material structures—-“What then becomes of 
the long list of recognized ‘ moral causes ’ of insanity ; 
or the much-talked-of ‘ Influence of the Mind upon the 
Body?’” 
The answer is simple. Substitute “ Brain ” for 
“Mind”, and the problem is solved. 
What! brains think? matter imagine? convolutions 
reason ? 
Why not ? 
Is it really more incredible, to one accustomed to 
thinking, that brain matter should become sensitive, 
conscious, self-conscious, and capable of thinking, than 
that matter of any kind should become brains — by 
virtue of inherent qualities, and the influence of 
environments ? 4 
Are the brain functions of retaining presentations, 
(memory) reproducing presentations in the order of 
their reception, (remembering) or in variations of order, 
combining parts of various presentations in new rela- 
tions, (imagining,) or even the more complex function of 
reasoning; (all of which represent but different states or 
degrees of complexity of consciousness,) more wonder- 
ful or incredible than are the co-relative, and necessarily 
antecedent, brain functions of feeling, seeing, hearing, 
tasting, smelling, etc.? 
Is it more difficult to comprehend the apparent fact 
that matter, under certain conditions, is capable of per- 
ceiving light, than that matter, under .certain other 
always necessary conditions, becomes capable of mani- 
festing light? 
Why degrade living material beings, of which we have 
some knowledge, by denying apparent capabilities; while 
we ascribe to imaginary beings of whom we have no 
knowledge, capabilities, and the performance of func- 
tions, that can not be traced by any rational method 
to such beings ? 
Is it because we would not presume to question the 
wisdom of our ancestors, or impeach the integrity of 
history, venerable because of its antiquity ? 
What is human wisdom but an aggregation of pre- 
sentations to human consciousness, measureable by 
the capabilities and knowledges of individuals or races 
at any given time, and liable to impeachment by any 
considerable expansion of capabilities and knowledges 
effected by human growth, individual or racial? 
What is history but a reflection of contemporaneous 
recognitions, however limited and ignorant, and liable 
to be discredited, at any time, by any considerable 
additional information ? 5 
Or, is it because our bodies perish, dissolve, and 
lose their individuality in the great mass of living 
matter to which as elements they return ? “Aye, 
there’s the rub.” 
Were our bodies to awake from the unconscious- 
ness of death as they do from the unconsciousness 
of sleep, and we did know it, the bugbear of “material- 
ism” would no longer alarm the timid philosopher; nor 
should we have further need of a hypothetical being, 
soul, or spirit, dwelling uneasily within our bodies, 
helplessly restrained, and subject to manifold indigni- 
ties, (for what purpose, punitory or purgatorial, no one 
knows,) to account for the physiological phenomena of 
consciousness. 
And yet, admitting the existence of spiritual beings, 
should we have any evidence of their greater stability as 
individuals than characterizes material beings? Inas- 
much as that which is known is the basis of all rational 
supposition, and furnishes the elements of all imagina- 
tions, how can we predicate perpetuity as a quality of 
spiritual individuals, so as to satisfy the demands of 
reasonable enquiry ? 
Judging by what we know of the “ becoming,” growth, 
and dissolution, of material beings, must it not be true 
that spiritual beings, in order to dwell within, animate, 
and characterize material individuals, must themselves 
be specializations from a common spiritual substance, 
etfected at times, and in a manner, corresponding to the 
specialization of such beings of material substances as 
they are destined to so animate and represent? And, 
if so, is it not logical to infer that they are alike subject 
to dissolution, and return to the source from which they 
were derived ? Does it not appear, indeed, to our 
senses, that they begin, and cease to be, simultaneously ? 6 
—both disappearing and reappearing in endless alterna- 
tions. “Individuals perish—the race is (maybe) im- 
mortal.” 
Were it not so; if all substance, material and spir- 
itual, (all substance is both material and spiritual, one 
and inseperable,) capable of specialization, were subject 
to no further change after once becoming individual; 
the limits of specialization having been reached, there 
would be no further activity possible; all phenomena 
would cease; and the world, the universe, would be a 
vast assemblage of purposeless, motionless, individuals 
—immortal! but incapable of any of the functions or 
enjoyments of living beings. 
But science can be pursued only within the domain 
of facts ; and they who are earnest in pursuit are more 
interested in accumulating facts, and so harmonizing 
them as to deduce laws, or principles, therefrom, than in 
jmrely intellectual speculations, or vain attempts to 
“reconcile ” mistaken notions, however long or generally 
entertained, with such laws or principles. 
In substituting the word “brain11 for the word 
“mind” (when preceded by the definite article), and 
affirming the proposition that living matter is capable 
of becoming, under definite and essential circumstances, 
conscious—of receiving and differentiating presentations 
from environments—of retention, of reproduction, and 
recombinations of such presentations; in other words, 
capable of feeling, remembering, imagining, reasoning, 
and willing ; it need not be denied that other functions 
of the body are variously affectible by the manner in 
which these mental functions are performed, or neg- 
lected. It may be affirmed however, in explication of the 
influence supposed to be exerted by “the mind’1 over 
the body, that it is not “the will” acting as an indepen- 7 
clent being, with design, that enables a man under 
certain circumstances to resist and retard disease; but 
it is the whole organic act of willing. Nor is it “ the 
imagination ” acting as still another person, in conjunc- 
tion with “the will”, or with a will of its own, that so 
affects bodily conditions that a timid man maybe killed 
by an imaginary hemorrhage; ora superstitious woman 
may be raised from a bed of chronic illness by faith in 
prayer; or a believer in homeopathy maybe benefited 
by pretented medication; but it is the complicated and 
comprehensive physiological act of imagining. 
Neither is it to be denied that insanity is sometimes, 
if not often, caused by conditions of brain induced by 
presentations from environments primarily affecting 
states of consciousness; the so-called “moral causes” 
of insanity. 
Consider the phenomena as related to antecedent 
conditions of what is called “mental shock.” Brain 
shock, as now recognized. There are certain materials 
and conditions necessarily precedent to such phe- 
nomena, viz: 
(a.) Certain masses of living matter called brains, 
that from a precedent condition of inherent sensitive- 
ness, through a long process of adaptation and heredity, 
have become capable of complex states of conscious- 
ness, and responsive to the excitations of environments, 
by which physical and chemical changes are affected, 
followed by corresponding brain-phenomena; feeling, 
memory, imagination, &c. 
(b.) Certain appendages structurally continuous with 
such masses of brain-matter, called “organs of sense,” 
terminating in contact with environments. 
(c.) A continuous supply of a peculiar liquid called 
“blood,” floating a burden of living matter, qualified 8 
and ready to take the place of matter' disintegrated by 
action, exhausted by use, and no longer capable of aiding 
in the performance of brain-function, (to be carried away 
byreturning currents of this same liquid) — together 
with all the organs and conditions implied for the 
preparation and distribution of this blood. 
(d.) An exciting cause, capable of reaching the 
brain by way of the organs of sense; and of stimulat- 
ing it to sudden and unusual activity, through its own 
qualities of sensibility and consciousness. 
These conditions admitted—what then? 
A woman and a mother sees her son crushed to death 
by a locomotive engine; or hears a messenger relate the 
shocking circumstance; and sinks, or falls, insensible; 
or, it may be, stands dumb, motionless, like Niobe 
in marble; to regain consciousness by and bv — not as 
her former self—but as a raving maniac; a gibbering 
imbecile ; or a fantastic fool. 
What has happened ? Enquire within. Some injury 
has been done to this woman’s—mind? 0, no; this 
woman’s brain. 
How? By what? 
By its own exertion under sudden and extraordinary 
stimulation. Some tense string broken by its own 
vibration. Some bent spring fractured by its own 
recoil. (2.) 
Another etiological error, is that of ascribing insanity 
to a single cause — such as intemperance, overwork, 
religion, spiritualism, remorse, and the like; while the 
fact is that nearly every case of insanity not effected by 
(2.) A group of muscles may contract so violently under stimulation as to 
remain for a time paralyzed, and manifest when recovering various degrees of 
impairment. So, too, brain-structures may be injured by their own activities. 9 
mechanical or chemical violence, is the result of a con- 
spiracy of causes more or less complicated. 
In this conspiracy, it is probable that the most 
uniformly present and influential agent is “heredity,” 
or an inherited structural peculiarity, or biological 
tendency, constituting a “potentiality of insanity” in 
individuals, that is not common to the race. 
This fact may not be recognized generally, nor 
accepted as true, by many otherwise well-informed 
persons whose biological studies have been limited, and 
whose views of the great facts of evolution and heredity 
are neither comprehensive nor clear. 
That this “potentiality” is an important factor in the 
causation of insanity, and yet an exceptional condition 
of human beings, may be inferred from the fact that 
while like causes may be expected to produce like effects 
under like conditions, but few persons, of a given num- 
ber exposed to all of the causes and subject to all of 
the conditions regarded as sufficient to produce insanity, 
except this, become insane. 
How many men are overworked, or underfed, or 
intemperate, or have lost property, friends, or fame, 
and are yet neither insane nor in danger of becoming so ? 
How many women grieve, or fret, or suffer the pangs 
of despised love, or the sublime martyrdom of matern- 
ity, and yet do not “go crazy.” All men and women, 
who live long enough, pass through the “perilous 
periods” of puberty, and “change of life,” and many 
indulge sexually to excess, or practice self-abuse, yet 
how few are made lunatic thereby! 
That this “potentiality” is a matter of inheritance 
rather than of acquisition, may be inferred from the 
facts, that it must be physiological — pertaining to 
organization — and is indicative of such a departure 10 
from typical racial conditions as is not likely to be 
effected by the growth of an individual, or the vicis- 
situdes affecting a single generation. This inference is 
sustained, also, by the fact that insanity is developed, 
almost exclusively, in persons whose ancestors have 
been for a longer or shorter period subject to environ- 
ments peculiar to civilization ; in which the mixing of 
races, and artificial vicissitudes of being, are well 
calculated to influence organization and effect such a 
departure. 
In estimating the value of this factor in the problem 
of insanity, it should never be forgotten that it is not, 
itself, a disease ; nor an exciting cause of disease. It is 
probably, only a specialized condition of brain matter, 
—effected by various influences, and fixed, more or less 
permanently, by heredity — that one may inherit and 
carry through a long lifetime, without becoming insane; 
or because of which one may be subject to insanity, 
although the immediate ancestor through whom the 
condition was transmitted may not have shown any 
recognized indication of its existence. 
As to other conspiring causes: inasmuch as all influ- 
ences capable of exciting and continuing brain activity 
— and all agents capable of vitiating the quality, or 
interfering with the diffusion, of living matter essential 
to the maintenance of brain-action and brain-integrity— 
are efficient causes of insanity, it will be seen at a glance 
that possible combinations of such causes are innumer- 
able. A hint in this direction should be sufficient for 
all practical purposes. 
Another common error is that of mistaking symptoms, 
or manifestations of insanity, for causes of disorder. 
The most prominent feature of insanity in a given case 
may be, as indicated by speech and action, of a religious 11 
character. Cause assigned, “religious excitement,” or 
simply, “ religion.” Another insane person, with audit- 
ory hallucinations, holds conversations with invisible 
beings, and has his insanity charged to “spiritualism.” 
A third, melancholy person, accuses himself of crimes 
— the unpardonable sin, perhaps — and has “remorse” 
scored opposite his name, as the cause of his infirmity. 
Such assignments of causes may all be erroneous. 
Such manifestations are, more frequently than otherwise, 
phenomenal sequences of diseased activities effected by 
other, and very different, causes. When a man is drunk 
and talks religious nonsense, one does not attribute his 
intoxication to religion. It need not be f denied that 
intent and protracted contemplation of religious sub- 
jects involving problems too profound for human 
capabilities, by persons incapable of ordinary reasoning 
—believing at the same time that eternal doom awaits 
the verdict—or that the terrifying denunciations, threats 
and appeals of “hot-gospelers,” addressed to the ignor- 
ant and superstitious, may, by undue excitations of 
brain activities, arrest nutrition, suspend appetite, and 
“murder sleep,” and thus become causes of insanity. 
Nor is it to be denied that an overwhelming demon- 
stration (as estimated by the party interested) of the 
actual presence of disembodied spirits of long lost 
loved ones returned from unimaginable wanderings — 
bringing with them airs from “summer lands,” and 
comforting assurances of life and happiness beyond the 
grave, (but half believed before)—might strain with 
dangerous tension some of the finer fibers of conscious 
mechanisms — nor that genuine remorse can become a 
co-conspirator in the causation of insanity. It does not 
follow as a necessary sequence, however, that insanities 
so caused, are characterized by religious, spiritualistic, 12 
or remorseful, expressions; nor is such even frequently 
the case. 
The time may come — is coming — when the more 
skilful will be enabled to analyze the phenomena of 
mind with great accuracy and minuteness; so as, 
possibly, to refer even delicate shades of difference to 
exact conditions of organs manifesting them; and to 
retrace the evolution of a mental concept to the primary 
sensations from which it descended. But we can not 
do so now. 
Of Diagnosis.— Errors of diagnosis in cases of alleged 
insanity, are comparatively infrequent. Medical prac- 
titioners are seldom called upon to differentiate insane 
from sane conditions in doubtful or obscure cases. Of 
the multitude of persons committed to public and 
private asylums, as insane, every year, rarely one is 
found to be not insane. 
There are persons, however, in every community, who 
by their speech and actions subject themselves to sus- 
picion of being insane, but respecting whose conditions, 
if brought to a test, there would be diverse opinions. 
It is when such persons are brought to bar, accused of 
crime, or incompetency, that the qualifications of medical 
witnesses are fully illustrated—not always to the credit 
of the profession whose livery they wear. 
The only province of the diagnostician, in such cases, 
being to determine whether certain phenomena charac- 
teristic of the accused are sequential to natural, or to 
pathological, conditions ; the most common error is that 
of ascribing to pathological conditions phenomena that 
are natural to the individual accused when in a state of 
perfect health—because of the possible resemblance of 
such phenomena, of both speech and action, to well- 13 
recognized insanities in others when impaired by 
disease. 
Errors of this kind have been committed, and are 
likely to be repeated — will he repeated — as long as 
medical men accept a quasi-physiological psychology as 
scientific; and listen to the teaching of authors, who, in 
contempt of their own knowledge, are more intent, 
sometimes, on establishing a prejudiced opinion of their 
own, or discrediting that of another, than they are upon 
promoting science. It is to be regretted that really 
great men do not see all objects periscopically at all 
times. 
It may be claimed that such errors are not important, 
inasmuch as conditions so similar as to make it difficult 
to determine the difference by their phenomenal 
expression — although one may be called natural 
depravity, and the other disease—are practically the 
same. 
But this claim is not well founded. There is as much 
practical difference between conditions indicated by 
natural depravity of character, and insanities, as there 
is between conditions manifested by the exalted tem- 
perature of physiological activity, and the heat of 
fever. As much difference as there is between the 
false beliefs of the ignorant, and the delusions of the 
distempered. 
Another, and kindred error, is that of mistaking 
rational beliefs for insane delusions. 
Beliefs that may appear to many persons irrational, 
and absurd, may be, as entertained by others, perfectly 
rational. 
Any belief that is in accordance with all such 
testimony as is presented to, and comprehended by, the 
believer, respecting any given subject, is rational; — 14 
provided such testimony is alike convincing to others 
of similar capabilities and information. 
A common belief that the Earth was created before 
the Sun was, and became a fixed object around which 
the Sun was made to move, for the sole benefit of the 
Earth’s inhabitants, was a rational belief when enter- 
tained by every body, whatever we may think of it. 
Beliefs in the divinity of kings, and the infallibility 
of popes, once unquestioned, were rational. Centuries 
of human growth were required to more than partially 
discredit them. 
Belief in witches, and witchcraft, once universal, 
unaccountable as it may seem to us who are not haunted 
by recognitions of personal devils, papal or Miltonic, 
was, and is, when contemplated in the light of the 
testimony by which it was justified, a rational belief. 
Insane delusions are mental concepts of impaired 
organs, responsive to excitations from within: hence not 
amenable to facts or arguments, and out of harmony 
with the general recognitions of the class or race to 
which the person entertaining them belongs. (3.) 
Rational beliefs are mental concepts of healthy organs, 
responsive to excitation from without — hence amenable 
to facts and arguments, and in harmony with concur- 
rent recognitions of the class or race to which the 
persons entertaining them belong. 
(3.) “The essential characteristics of insanity, that which distinguishes it 
as a morbid state, consists chiefly in the fact that certain states of the brain— 
certain dispositions, feelings, emotions, opinions, determinations—proceed from 
within outward, owing to disease of the organ of mind; while, in the healthy 
state, our emotions, opinions, determinations, originate only upon sufficient 
external motives, and on that account stand in a certain harmonious relation to 
the external world.”—(Griesinger, Ment. Dis. page 60.) 15 
Of Prognosis. — Nothing is more difficult than to 
prognosticate accurately the result of any given case 
of insanity. The most common error of prognosis is 
that of recovery. 
But few insane persons ever recover fully their 
original states of mental capability. Not to exceed 
forty per cent of the whole number of persons now 
insane in the United States, will so far recover, under 
the most favorable circumstances, as to pass currently 
for persons of sound minds. The patient, prolonged, 
intelligent and conscientious labors of Dr. Pliny Earle, 
exhausting all present sources of knowledge on the 
subject, force upon us the conviction that even forty per 
cent is a higher ratio of expectation than facts would 
justify, for this country or for Europe. (4.) Yet with 
nearly every insane patient admitted to our hospitals 
for treatment comes the prognosis of the family physi- 
cian, “speedy recovery.” Such errors can only be 
accounted for by presumptions of ignorance, or in- 
sincerity, on the part of the physicians making them; 
equally unworthy of the profession. 
Of Treatment. — Errors of treatment of the insane 
are, undoubtedly, common and many. Such at least is 
a justifiable inference to be drawn from recognitions of 
our own ignorance respecting the more occult phenom- 
ena of living matter, and still greater ignorance, if 
possible, of the real relation of drug-influences to 
physiological and pathological conditions. To point out 
such errors specifically, and define them, would be more 
difficult than to infer, and admit their existence. 
It is probable, however, that the greatest thera- 
peutical error of practice, is that of administering too 
(4.) See American Journal of Insanity, October, 1885. 16 
much medicine. That there are medicines which, when 
skilfully administered, contribute somewhat to the com- 
fort, and therefore, or so far, to the cure, of the insane, 
can not be denied. But as related to the whole number 
of drugs prescribed, they are neither many, nor potent. 
This criticism need not be limited to the use of drugs 
in the treatment of the insane. It is as applicable to 
other specialties of practice as to this. With a rapidly 
increasing accumulation of knowledge, to which the 
medical profession has contributed, and had access, a 
growing conversatism in the use of drugs has character- 
ized modern practice, and marked its progress. The 
middle of the present century will be forever memorable 
in the history of medicine as the period of transition 
from “old” to “young” physic, and a genuine reforma- 
tion of theories and practice effected by human growth. 
The topic of “Treatment” having been thus disposed 
of, there is but one other to which attention is requested 
in this connection. 
Of Classification. — It is an aphorism of philosophy 
that perceptions of imperfection imply perfection as 
an inferential quality. Perceptions of imperfections, 
however, do not necessarily imply personal knowledge 
of that which is perfect. All classifications, or schemes 
for the classification, of insanities, have, thus far, proved 
to be exceedingly imperfect and unsatisfactory. The 
fact is that neither our psychological nor pathological 
knowledge is sufficiently accurate and comprehensive to 
justify a pretense of scientific classification of insanities 
upon either as a basis. 
True science is severely exacting. Classification, 
however, such as we are capable of constructing at the 
present time, is of but little importance to the student 
or practitioner of psychiatry. The least complicated is 17 
the best, however arbitrary. Nor is it worth while to 
attempt more, until we are enabled by a large increase 
of knowledge to recognize physiological and pathologi- 
cal conditions of all or any organs implicated, by 
mental phenomena expressive of such conditions. Im- 
portant errors have already been suggested, or perpet- 
uated, by the terms adopted by various authors in their 
endeavors to construct a better classification than that 
in use, without the requisite increase of knowledge. 
An error already alluded to—that of accepting as 
sufficient a single alleged cause of insanity in explica- 
tion of variable and complicated phenomena, in any 
given case, Is illustrated, and perpetuated, by the terms 
adopted for the classification of insanities upon a plan 
descriptive of both psychical and pathological features 
—such as: “ Paralytic Dementia,” “ Puerperjal Mania,” 
&c., &c. Still greater, or more important errors, how- 
ever, are suggested and perpetuated by terms used in a 
metaphysical scheme — such as “Moral Insanity,” 
“Intellectual Insanity,” “Emotional Insanity,” “Affec- 
tive Insanity,” &c., &c., with such subordinate terms 
as “Kleptomania,” “Pyromania,” “Dipsomania,” 
“Aboulomania,” “Reasoning Mania,” and the like — 
representing mistaken notions respecting the genesis 
of mind, and the relation of phenomena to antecedent 
conditions; and leading to recognitions of certain 
“states of feeling and modes of thinking,” characteristic 
of, and habitual to, individuals, and classes of men, 
whose conditions are, and may have ever been, strictly 
physiological, as manifestations of disease. 
Than which — if precedent, or concomitant, impair- 
ment of the organs of mind by disease is essential to 
insanity--nothing could be more erroneous. Than 
which — if insanity is to be regarded as “an uncondi- 18 
tional excuse for crime,” nothing could be more 
pernicious. 
The doctrine of Moral Insanity is indeed a prolific 
mother of errors — requiring for its maintainance the 
false assumption, that there is a genetic distinction of 
different degrees of general intelligence. (5.) In 
other words that moral concepts so far differ from 
other mental concepts as to imply an independent 
origin, as distinct from the sources of other ideas as 
one man is distinct from another. And that such 
different sources of mental concepts may, or may not, 
co-exist in a single man; and that co-existing, one may 
be impaired, or obliterated, without in the least affect- 
ing the capability or integrity of the other. 
That such substantiation of the doctrine of “ Moral 
Insanity" is impracticable may be inferred from the 
following propositions, if true : 
(a.) Mental capabilities are developed step by step, 
yet continuously, with the structural development of 
living matter in the form of brains—as is amply 
illustrated by the growth of individual human beings 
from infancy to manhood; and of progressive races of 
mankind from infantile conditions to higher attain- 
ments. 
(b.) The order of development of mental capa- 
bilities is from simpler to more complex states of 
consciousness—characterized by increasing ability to 
recognize, differentiate, combine, and generalize prin- 
ciples from, observable facts. 
(5.) “All mental acts take place within the intelligence, * * * and all 
the various mental acts which were formerly designated separate faculties 
(imagination, judgment, will, &c.,) are only different relations of the understand- 
ing with sensation and movement—or the result of conflicts of ideas with them- 
selves.”—(Griesinger, Ment. Dis., page 26.) 19 
(c.) Growth of structure and capabilities may be 
arrested at any point attained—but there can be no 
hiatus between points, or degrees, or groups of degrees, 
of attainment; nor any transposition of groups of 
capabilities once attained, out of the order of their 
development. (6.) 
(d ) Mental concepts of a moral character—ethical 
inductions from recognitions of facts—correspond in 
complexity and comprehensiveness to the general 
intelligence of individuals and races—high moral per- 
ceptions belonging to, and characterizing, exclusively, 
the more progressive races of mankind, and modern 
periods of history. (7.) 
(e.) The “order of disorder”—if the phrase is 
admissible—or the order of retrogression, to which, in 
accordance with the inherent cyclicity of living matter, 
all structures are obedient—as uniform in successions 
of condition and phenomena as is the order of progres- 
sion — corroborates the inference that high moral 
recognitions pertain to the* higher, and later, if not 
final, developments of intellectual capabilities. (8.) 
(6.) A man may be capable of recognizing objects, and of remembering 
something of their qualities—but incapable, because of arrest of development— 
of imagining, or reasoning, to any considerable degree. He can not be capable 
of imagining or reasoning to any extent without the precedent capability of 
perceiving and remembering, developed and intact. 
(7.) Ethnical observations as well as scientific inferences, establish the fact 
that the undeveloped, savage races of mankind, are of different degrees of 
intelligence, with corresponding moral deficiencies. The vicious classes of civil- 
ized societies—“the savages of civilization”—are, as classes, conspicuously 
undeveloped, and below par intellectually. 
(8.) The first general symptom of impairment effected by alcohol, (which 
may be presumed to affect the brain generally through its systemic circulation,) 
as manifested by mental characteristics, is a loss of moral tone, beginning with 20 
(f) Inasmuch as all great moral precepts—original 
teachings—have been formulated and promulgated by 
men of extraordinary general intelligence—exception- 
ally developed—looked upon by undeveloped multi- 
tudes as “inspired”—it may be safely affirmed that 
until the existence of an idiot with high moral percep- 
tions can be demonstrated ; the existence of a philoso- 
pher without moral perceptions, or capability to perceive 
—is equally problematical. Hence total incapacity to 
recognize moral principles, in any given case, justifies 
the inference of undeveloped or defective intellectual 
capabilities. (9.) 
the highest register, veracity. The final attributes of humanity being the first 
to suffer diminution, or destruction, with the first movements of a retrogressive 
order—objectless lying, by persons before trustworthy, is frequently the prelude 
to subsequent diapasons of insanity. 
(9.) That phase of human consciousness, commonly called “ conscience,” or 
“ conscientiousness,” is regarded by many as proof of independent moral capa- 
bilities. 
“Conscientiousness,” says Dr. Clouston, (Ment Dis., page 256,) “ the sense of 
right and wrong, is to a large extent an innate brain-quality. We see this in 
children from the earliest age. Some have it strongly without teaching or ex- 
ample; others have it sparingly, and need the mo3t assiduous care to develop it." 
Inasmuch as the sense of right and wrong does not imply a knowledge of that 
which is right, as distinguished from that which is wrong—but a recognition of 
difference between that which gives pain and that which gives pleasure—a sense 
which brain-matter becomes capable of at an early period of development—Dr. 
Clouston’s major proposition, may be, almost admitted. But that children from 
the earliest age, or at any age, without training or example, have intuitive per- 
ceptions of that which is right, is unprovable and improbable. Unschooled per- 
sons, acting from a “ sense of right and wrong,” are as liable to do wrong as to 
do right—if not under the direction of authority. Sagacious animals can be 
trained by rewards and punishments—recognizing the relation of conduct to 
pleasure and pain—to do right and refrain from doing wrong—within certain 21 
It is easy to answer arguments based upon such 
propositions by recitations of clinical histories of 
exceptional cases, so far as observed and comprehended, 
and the conclusive declaration that “Moral Insanity is 
not a question of theory, but of fact.” (10.) 
limitations of capability. We do not speak of such animals, however, as being 
moral or conscientious, but as more than ordinarily intelligent. 
■ Moral conduct on the part of the greater number of men whose conduct can 
be so characterized, is in consequence of habit, enforced originally by authority ; 
and in accordance with instruction, or dictation—not because of the intuitions 
of “ conscience.” 
The common morals of even the most enlightened peoples, are not original 
intuitions, but precepts formulated—not by children, nor women—but by the 
most highly developed, and generally intellectual, men of all the ages. 
Has Dr. Clouston ever seen a child that had this sense of right and wrong 
“ strongly ” developed, from “ earliest age” in which other senses were defective, 
or wanting? He describes a boy of ten years—(Ment. Dis page 256) “that 
was not an idiot not an imbecile, and quick intellectually, who could not be 
taught morality.” But if the " moral faculties ” are independent, or in any way 
differ from the faculties manifested by general intelligence, should we not have 
conscientious idiots ? 
That the defect in this boy, as described by Dr. C., can not be differentiated 
from intellectual incapacity will be seen from the following paragraphs. “ He 
(the boy) really seemed incapable of knowing the difference between a lie and 
the truth, or at all events he never could be got to avoid the one or tell the other. 
He lied without any temptation, and with no object to be gained. He stole. He 
had little proper affection for his brothers and sisters and parents; he was inca- 
pable of the sense of shame,” etc. 
(10.) “The question is,” says Dr. Clouston, (Ment. Dis. page 225) “have we 
any examples, where from disease, a man who up to that time had been moral 
and conscientious, and obeyed in his conduct the laws and social observances 
had lost his moral sense while he retained his intelligence and reasoning power, 
having no mental exaltation or depression, and in consequence of that diseased 
condition spoke and acted immorally? Further comes the question—can he, 
when the diseased condition is cured and recovered from, regain his former 
morality in feeling and conduct? 
“ I have no hesitation in answering both questions affirmatively, because I have 22 
It is quite as easy, and much more impressive, to 
sketch, biographically, the prominent features of some 
notorious criminal—call it a picture of a variety of 
moral insanity, recognized by distinguished observers, 
though never before so well portrayed—and offer it in 
evidence as conclusive. (ii.) 
seen such cases. It is not a question of theory (moral insanity) but of fact.” 
Such disposal of the subject may satisfy many less sincere and appreciative 
admirers of Dr. Clouston than is the writer of this note. But in consideration 
of the fact that there are so many possible gradations of intellectual capability 
between the extremes of infantile and mature attainment; between the intelli- 
gence of the multitude, and the exceptionally great; one wonders if the persons 
referred to really retained all of their previously developed intellectual capa- 
bilities—or if they might not have suffered some deterioration of the higher and 
finer qualities, the last in order of evolution, and the first in order of dissolution 
—enough to account for manifestations, without the presumption of a distinct 
or independent moral faculty ? The late Dr. George Beard said—(N. Y. Jour. 
Men. and Ner. Dis., Jan., 1882.) 11 In all insanity there is moral impairment.” 
11 Insanity without moral decline is not insanity.” “ The essence of insanity 
is immorality.” “ While the immoral are not usually insane, the insane are 
always immoral.” 
All of which, conservatively considered, is true. Inasmuch as all insanity is 
expressive of disease of mental organs, and consequently of retrogressive activi- 
ties, which begin with the culmination of progressive activities, and impair or 
destroy first that which was last developed. 
(11.) Dr. W. A. Hammond, (Surgeon General, U. S. A., retired list,) read a 
paper before the N. Y. Medico-Legal Society, March 1, 1882, in which, after 
crediting the Pinels, Esquirol, Morel, Dagonet, and others, with dim recognitions 
and imperfect descriptions of a variety of moral insanity, called “ reasoning 
mania”—draws the following sketch, and presents it to the Society as a picture 
of the disease so named, fortunately now, never more to be mistaken or gain- 
said. 
“ The most prominent characteristic of the disease is an overbearing egotism 
which shows itself on all, even the most unimportant occasions. The individual 
without social position, without wealth, and without political influence conceives 
that he has only to make his wishes known to those in authority to have them 23 
But such answers do not shake the broad foundation 
of facts upon which truth stands—nor cause us to 
forget that it is more reasonable to suppose that indi- 
vidual observers of exceptional phenomena may be 
mistaken as to facts, or appearances, than that nature 
is erratic, or than that truth is incongruous. 
granted. He does not hesitate to push himself forward as an applicant for high 
office, and this when he has no one qualification fitting him for the position he 
seeks. Refusals do not dismay him, the most pointed rebuffs do not abash him. 
. . . The intense egotism of these persons makes them utterly regard- 
less of the feelings and rights of others, . . . and sometimes they 
display positive cruelty in their treatment of persons who come in contact with 
them. This tendency is especially seen in their relation with lower animals. 
The egotism of these people is unmarked by the least trace 
of modesty in obtruding themselves and their assumed good qualities on the 
public at every opportunity. They boast of their genius, their righteousness, 
their goodness of heart, their high sense of honor, their learning, and other 
qualities and acquirements, and this when they are perfectly aware that they 
are common-place, irreligibus, cruel, and vindictive, utterly devoid of every 
chivalrous feeling and saturated with ignorance.” 
Can any one who read the newspapers from July 2, 1881, to the date of this 
delivery, March 1, 1882, fail to recognize the then living model?