The subject of moral insanity has already been considered from several points of view, but I think that when typical cases occur it is well to record them, so that, by a careful examination of published cases, more general information may be obtained concerning this malady. It may seem to the philosopher rather a mistaken way of considering the mind to divide it into intellectual and moral, but we in asylums have constantly to take notice of cases in which the moral side of the patient suffers very much more than the intellectual; and though I should not deem any person capable of being intellectually complete and yet morally defective, I would maintain that the defect on the intellectual side may be so little appreciated, or of so little importance in reference to the individual's relationships with the outer world, that it may be disregarded. In considering the cases at present under notice we shall have to point out that most of them have undoubtedly some defect or excess, if I may use the term, in their intellectual processes. When I say excess I refer to the presence of hallucinations and false perceptions that frequently occur in such cases. In attempting to define moral insanity it is easier to describe what it is not than to come to a comprehensive definition which will include all the cases falling into this group, and no others; and, by way of clearing up the condition, I would say that I look upon the moral relationships, so called, of the individual, as among the highest of his mental possessions, that long after the evolution of the mere organic lower parts, the moral side of man developed; that the recognition of property and of right in property developed with the appreciation of the value of human life, so that the control of one's passions, and of one's desires for possession, and of one's passion for power developed quite late in man, and, as might be expected, the last and highest acquisitions are those which are lost most readily. It is frequently noticed that in cases in which slow progressive nervous change takes place the moral relationships are the first, or among the first, to be affected; and in the same way after an intellectual storm it is no uncommon thing to see the intellect partly restored to its normal equilibrium, but still wanting the highest and most humane of its attributes—high moral control; so in the emotional states of acute mania, of general paralysis, or of chronic insanity we have corresponding defects in this highest intellectual control. From this point we shall have to notice moral insanity, it being in many cases a state or stage of mental disease, and not a fixed or permanent condition itself; so that in very many, if not in all, acute cases of insanity there is a period of moral perversion, just as in nearly all such cases there is a period of mental depression. I hardly think it worth my while to make very elaborate distinctions between the varieties of moral insanity. I would take it for granted that all admit what I have already said—that there is a condition in which the moral nature or the moral side of the character is affected greatly in excess of the intellectual side—and I will take the opportunity in this paper of discussing in detail a few of such cases, leaving for myself at another time, or for others, the consideration of cases bearing on the other parts of the subject. I should say that the cases of moral insanity are best considered under the heads of “primary” or “secondary,” and when speaking of “primary” I would refer to those cases which, from the first development, have some peculiarity or eccentricity of character exhibited purely on their social side. Such cases may be divided into the morally eccentric and the truly insane. The eccentric person who neglects his relationship to his fellow men and to the society and social position into which he was born must be looked upon as morally insane. Other cases seem from infancy prone to wickedness, and I would most emphatically state my belief that very many so-called spoiled children are nothing more nor less than children who are morally of unsound mind, and that the spoiled child owes quite as much to his inheritance as to his education. In many cases, doubtless, the parent who begets a nervous child is very likely to further spoil such child by bad or unsuitable education. In considering these latter cases—those that from childhood show some peculiarity of temper and character—it is all-important to remember that inheritance of neurosis plays a very prominent part indeed—that, in fact, the inheritance of neurosis may mean that the children are naturally unstable and unfitted to control their lower natures; that they come into the world unfitted to suit themselves to their surroundings; and, but for the conventional states of society, would soon lose their places and become exterminated. We shall, later, consider cases of this kind more in detail, but I would state before leaving the subject of primary moral insanity as seen in children, that I have seen a state of this kind occur in children of parents who have suffered from some febrile disease, or some constitutional disease like syphilis, before the begetting of the morally insane child, and I have no doubt that more will be discovered in time as to the relationship between the health of the parent at the time of the begetting and the moral state of the offspring.
An Histological, Study of the Thyroid Gland in Mental Disease, with Especial Relation to Chronic Thyroiditis
