CHAPTER XVI.

CONCEALED INSANITY.

§ 267. It sometimes happens, that when maniacs have learned what notions of theirs are accounted insane by others, and have understanding enough left to appreciate the consequen'ces of their mental condition, they endeavor to conceal it, for the purpose of avoiding the effect of those measures which the law prescribes. If the address and ingenuity which they then manifest have occasionally succeeded in baffling the scrutiny of the most practised experts, it is not strange that common observers should have been frequently deceived, and that some of the medical profession even, with a knowledge of this fact before their eyes, should have been outwitted by their manoeuvres. When it is considered, that the insanity of many consists in a few insane notions, which do not to all appearance affect their general conduct and conversation, the difficulty of concealing it, by professing to have renounced their belief in these notions, is perhaps not greater than that which attends the accomplishment of most of their designs. Their task too is materially lessened, it is to be recollected, by the prevalent error, that madness is inseparable from boisterous behavior and complete disorder of the ideas. At the commencement of the French Revolution, when the mob broke into the lunatic hospitals, for the purpose of liberating those among their inmates whom they supposed to be unjustly confined, many recounted their wrongs so clearly and connectedly, that they were deemed at once to be victims of oppression, and ordered to be released. Their conduct, on being set free, soon convinced these enlightened champions of their race, that those who had put them in confinement, had, what they themselves had not, some reason for their measures. Lord Eldon once related that after repeated conferences and much conversation with a lunatic, he was persuaded of the soundness of his understanding, and prevailed on Lord Thurlow to supersede the commission. The lunatic, calling immediately afterwards on his counsel to thank him for his exertions, convinced him in five minutes, that the worst thing he could have done for his client, was to get rid of the commission.1 In another place (§ 21), will be found a case which well illustrates the adroitness and perseverance, with which maniacs will sometimes conceal their mental derangement.

§ 268. In England and in this country, the choice of the means for establishing the existence of insanity when concealed, is left to individual sagacity. This, no doubt, is sufficient, where great practical acquaintance with insanity readily suggests the course best adapted to each particular case, but the greaf majority of medical men will feel the need of some system or order of proceeding, that will simplify their inquiries and render them more efficient. The French arrange their means into three general divisions or classes, which are made use of, each in succession, when the preceding class has failed of its object. They are called the interrogatory, the continued observation, and the inquest, and as no better arrangement has ever been offered, it may be well to describe it; and it may be added in passing, that it would materially conduce to our success in inquiries of this kind, if they were always pursued in the course here indicated.

§ 269. Interrogatory.—The interrogatory embraces only those means of information, which are applicable in a personal interview with the patient. After learning generally his moral and intellectual character, his education and habits of living, the duration and nature of his mental delusion (if it can be ascertained from his acquaintances), and the state of his relations to others, and after observing the expression of his countenance, his demeanor and general appearance, we may proceed to a direct examination of his case. In the first place, it is necessary to lull his suspicions and remove his distrust, as far as possible, by a free and courteous deportment, and an air of kindness and unaffected interest in his welfare. He should then be engaged in conversation, which should lead him by easy and imperceptible transitions to the particular subject on which his mind is deranged; and the manner in which he treats it should be carefully observed, for if he is really insane on that point, he will probably avow it; while if he is not so, he will take the opportunity to declare his disbelief in the notions imputed to him, and bring forward various considerations to support the truth of his assertions. He should be led to speak of his relatives and friends, especially if they have taken any part in provoking his interdiction, or otherwise interfered in his affairs, and here he will need all his self-control to restrain himself from the angry and revengeful feelings which he entertains towards them. When confined in hospitals or other lunatic establishments, we should not fail to ask how they like their situation, and what they think of their companions; for Georget observes that many even of those the least deranged, are such poor observers, or have so little penetration, that they are ignorant of the nature of their abode, and the character of those around them. When the mental disorder is that of imbecility or dementia, we must not confine our questions to the simple topics of their present condition or feelings, for they may be able to answer them clearly and rationally, when subjects requiring a little more reflection or exertion of memory, may be far beyond their comprehension. It not unfrequently happens that the mental deficiency affects the faculties of the mind unequally, degrading some to the scale of idiocy and leaving others in a state of tolerable strength and developement. When, therefore, the capacity of the mind is in question, whether for interdiction or any other purpose, we must not fail to test the soundness of all the faculties, by inquiries relative to the objects with which they are respectively concerned, since, if satisfied with a partial examination, we may grossly deceive ourselves and injure the interests of others. True, this requires a knowledge of the mental constitution not possessed by every one charged with this kind of investigation ; but the deficiency, common as it is, proves nothing against the importance of this knowledge.

§ 270. The importance of the above suggestions is strikingly shown by the case of a young man,

B , noticed by Dr. Abercrombie,1 and Dr.

Combe,2 which occasioned much trouble and litigation ta the parties concerned. This person was educated for the church, and had made such proficiency in the study of Latin and Greek, that, for several years, he acted as a tutor in these languages. He also displayed great keenness and adroitness in driving a bargain. When, however, his mind was directed to those studies and topics, which require the exercise of the higher powers of the intellect, he was found so deficient that he utterly failed in his second examination before the presbytery, in which his reasoning powers were tasked, though the first, which was in the languages, he passed successfully and creditably. It was found, too, that he was incapable of comprehending the relations of business, or even performing the ordinary duties of life. Accordingly, it appeared in the course of the law-proceedings, that those witnesses who knew him only as a linguist or a purchaser, did not hesitate to pronounce him an able, clever man; while those who had business transactions with him that called his reflective powers into action, had no doubt whatever of his imbecility.