A New System of the Spleen
Vapours and Hypochondriack Melancholy
Wherein all the Decays of the Nerves
and Lownesses of the Spirits are mechanically Accounted for
Nicholas Robinson
(doctor and governor of Bedlam)
1729 AD
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Introduction:

  1. 1729 AD, Nicholas Robinson, doctor and governor of Bedlam the same time James Monro, believed insanity was caused by life choices, sin and thinking too hard, over excitement of emotion, so as to break the nerves of the brain, "all the Decays of the Nerves and Lownesses of the Spirits are mechanically accounted for" ... "Fits had so weakened the Fibres of the Optic Nerves." Its like trying to put too much current through an electrical wire and it either melts or blows a fuse! Robinson does take a biologic view of the etiology of mental illness, but he believes it is a case of the choices, thoughts and emotions of the mind that is ultimately responsible for the damage. He notes how damaged nerves can be caused by sin and guilt: "Hence arise their Difference, Scruples, and Fears, concerning the Sincerity of their Faith and Repentance, as also the Certainty of their Election or Reprobation; which several Points, from the preaching of some hot-headed Gospel-Ministers, are so strongly fix'd on the Minds of silly, weak, unhappy People, as to work them into a State of Despondency. THEN their Sins fly glaringly in their Faces, and are so infinitely great, that no Satisfaction can compensate; then they think of nothing but the fearful Wrath of God just ready to be pour'd out upon them; that the Sentence of Condemnation is already pass'd, and that they certainly shall be damn'd to all Eternity." A few years later the doctors of Bedlam like John Monro, dropped the idea that sin, emotion and life choice and circumstance caused insanity, and focused on correcting the physical problems with treatments that amounted torture. Robinson shows how an atheist is driven to madness through his rejection of God: "take a view of the Atheist ... What Hope, what Refuge ... the Mind was in Despair through Doubt ... Where can he rest his hopeless Hope! where seek for Mercy, when Conscience, Horror, Despair, and all the dismal Scenes of Woe, that can afflict the most obdurate Heart, fly glaringly in his Face, and sting his tortur'd Soul, with Pain and Grief unsufferable to human Nature! Hence spring those frequent Suicides, to which these harden'd Miscreants have Recourse, to rid them of a Life most loathed, wretched, and miserable to endure. So that no Scene of Horror can be more dreadful, than to view an Atheist on his Bed of Sickness, just reviving to a Sense of his being forsaken of God, and all Hopes of his Mercy." Nicholas Robinson believed that mental illness was caused by feelings of sin, hopelessness and condemnation which in turn damaged the brain nerves. In a page out of modern chemcial psychiatry, Robinson believes drugs are the cure: "But of all Medicines in the Spleen, I know none equal or fit to compare with that truly noble Drug we call Opium. It's our Refuge in all Distresses; it gives Ease and Relief in the most torturing Pains, and when all other remedies fail; ... for by relaxing the Fibres of the Brain and Nerves". Gotta love the idea of giving heroin to the insane! It would be much easier if they simply repent Dr. Robinson! (A New System of the Spleen, Nicholas Robinson, 1729 AD)
  2. "Nicholas Robinson (1697-1775) A New System of the Spleen, Vapours and Hypochondriack Melancholy, Wherein all the Decays of the Nerves, and Lownesses of the Spirits are mechanically Accounted for ... (1729), A: pp. 222-25, B: pp. 234-40, C: pp. 241-47. Robinson was one of the most energetic and enthusiastic of the writers and practitioners of the early part of the eighteenth century. He trained in medicine at Rheims but practised and taught in London, where he was a governor of Bethlem. His adoption of a rigorously 'mechanical' view of mental illness shows the powerful influence of Willis, whose 'Animal Spirits' become in Robinson the `Alachinulae' of the fibres of the brain in their relation to the nervous system and to the entire animal economy. This dynamic view of madness has two important consequences. The first is that, unlike many of his contemporaries, Robinson takes madness seriously. That is, he does not explain the experiences and sufferings of the mad as delusions, products of a disordered imagination. They are real for the simple reason that they are bodily in origin. This makes him astonishingly sympathetic in his attitudes towards patients, and in his accounts of 'religious melancholy Madness' and 'Lunacy and Enthusiastick Madness', given below as extracts B and C, he is able to enter wholeheartedly into the beliefs and sensations described. The second consequence, however, is the ferocity of some of his recommended treatments. Because mental illness is somatic in origin, only cures applied to the body will have any chance of success. For Robinson, you may as soon attempt to counsel a man out of the most violent Fever, as endeavour to work any Alteration in their Faculties by the Impressions of Sound, tho' never so eloquently apply'd'. Rather, 'the most violent Vomits, the strongest purging Medicines, and large Bleeding, are to be often repeated'. Like many medical men of the period, Robinson was also interested in the differences between male and female manifestations of mental illness, and the first extract given is an account of 'A most remarkable History of Hysterick Fits' in a young woman, though ironically the case is one in which he is not called upon to prescribe at all." (Patterns of Madness in the Eighteenth Century, A Reader, Allan Ingram, 1998 AD, p76)
  3. "The idea that insanity is due to "nervous exhaustion," a fatigue of the brain or nervous system, best treated by rest, has a long history." (Coercion as Cure, Thomas Szasz, 2007 AD, p 105)

 

A New System of the Spleen
Wherein all the Decays of the Nerves
and Lownesses of the Spirits are mechanically Accounted for
Nicholas Robinson
1729 AD

A. Of the Symptoms of VAPOURS and HYSTERICK FITS in Women.

[note: this woman probably had epilepsy or a brain tumor]

THE following Relation is the Case of a young Lady I visited, attended with the most Surprizing Symptoms of Vapours and Hysterick Fits I ever beheld in my Life. She was of a thin, pale Complexion, of a tall, slender Habit; and subject to a sharp, acute Pain of her Head, that was greatly exasperated at certain Seasons.

UPON the Access of the Fit, she fell violently on the Floor, and all her Body was agitated, shaken, and distorted in a most cruel Manner. Her Head was violently convuls'd divers Ways, her Eyes were contracted inwardly in their Orbits, with their Whites turn'd up and fix'd. To these Symptoms follow'd a light, murmuring Noise in the Bowels, which was succeeded with a great Distention of the left Hypochonder, that terminated in a round Globe, swell'd prodigiously above the Surface of her Belly; presently after she smil'd, and mimick'd a laughing Countenance, then cry'd, sigh'd, and groan'd, after which she lay still. In about five Minutes Time, the Convulsions return'd in the most furious Manner; upon which, to my great Surprize, she was suddenly flung off the Bed, with a prodigious Impulse; the whole Body being darted, as it were, from a Spring, her Abdomen gave the greatest Signs of the impulsive Motion; immediately after this I observ'd the round Globe that form'd the Swelling on the left Hypochonder vanish'd, though the Convulsions continued, and notwithstanding there were half a Dozen in the Room, yet much ado had they all to lift her on the Bed again, so strong was the Fit, above all the natural Powers of her Body.

ALL her Limbs, Hands, Head, and Feet were agitated with divers Bendings, Motions, and Contractions; all the immoveable Muscles of her Body stretch'd as on a Rack, and the Spume of Foam that work'd from her Mouth was mix'd with Streaks of Blood. At length the Rigour of the Fits abated, or at least seem'd to abate, and she lay still, which was follow'd with an unusual murmuring Noise from within, that greatly surprized the Bystanders. Some superstitious People, there present, endeavour'd to impose a Sense on these inarticulate Sounds; tho' I am sure her Lips never moved: The Noise was not unlike the Crying of an Infant, which was frequent and sudden.

THUS she lay for near three Hours, and then the muscular Fibrillae began to relax, and she, by Degrees, to come to herself; but notwithstanding it was high Noon-Day, and not above twelve of the Clock, yet could she not discover the least Glimmerings of Light for above five Hours, the Severity of her Fits had so weaken'd the Fibres of the Optick Nerves. She complain'd of a great Dizziness of her Head, a Numbness and Stiffness in all her Limbs, and her Bones were so exceedingly sore, that she scarce would believe, but that somebody had been drubbing her: As soon as she was perfectly restor'd to the Use of her Senses, she declar'd that she could not remember the least Transaction, that happen'd during all this Uproar and Disorder.

B Of the SYMPTOMS of SPLEEN, VAPOURS, and HYPOCHONDRIACK

MELANCHOLY, when they degenerate into the natural, or religious melancholy Madness.

I AM now come into the most gloomy Scene of Nature, that Mankind can possibly encounter, where nothing but Horror reigns; where the noble Endowments of the reasonable Soul are often disconcerted to a surprizing Degree, and this lordly Creature Man almost debas'd below the brutal Species of the animated Creation.

MELANCHOLY Madness is a Complication of continual and unintermitting Horrors, that spares neither Body nor Mind. When this Affection is far advanc'd into the Habit, the Patient appears to all that see him a moving Piece of Ruin, and wears his Soul in his Countenance, which is mark'd with all the Characters of Woe, Gloom, and Desperation. He is lost to himself, his Friends, his Country, and Relations; he is dark and benighted in the full Glare of Day, and trembles to behold the Face of the Sun, from an Apprehension, that it insults his Misery. He flies to his Couch, in hopes to bury his Cares, and lull his Soul into sweet Slumbers: His Couch! miserable as he is, denies to him that sweet Ease and pleasing Consolation, and perplexes his Mind with Phantoms of Furies just ready to devour him.

WHEN the Symptoms arise to this surprizing Height, which they seldom fail of, if not timely remedied, the Body then scarce feels the severest Usage you can give it; the Reason of which is, that all, or most of the Nerves that afford the natural Sensations to the several Organs of the Parts are let down beneath their natural Standard, not unlike, tho' not so much, as in palsical Affections. However, the immediate Intercourse between the Mind and Body, is by some Means or other greatly disconcerted; and this is the Reason, why those finest Sensations that arise from the several Appetites of Hunger, Thirst, and Venery, are diminish'd, to a Degree scarce able to create an Attention to those Cravings of Nature; and hence it happens, that they are able to endure Hunger, Thirst, and Watchings, to a Time almost incredible, to Persons not acquainted with such Cases; all which several Phaenomena shall be accounted for, when we come to treat of the Causes of those Disorders.

SOMETIMES this natural melancholy Madness is improv'd upon the Constitution, by a Set of religious Objects, and then it comes under the Denomination of religious Melancholy; in this Case, the Patient is either too much oppress'd with Fear, or over-presuming; the latter most properly is call'd Enthusiasm; for these Objects of Fear or Presumption are vary'd, exalted, or depress'd, according to the different Constitution or Temperature they reside in. If the Habit be naturally of a phlegmatick Make or Disposition, then all the Ideas will be despairing. Hence arise their Difference, Scruples, and Fears, concerning the Sincerity of their Faith and Repentance, as also the Certainty of their Election or Reprobation; which several Points, from the preaching of some hot-headed Gospel-Ministers, are so strongly fix'd on the Minds of silly, weak, unhappy People, as to work them into a State of Despondency.

THEN their Sins fly glaringly in their Faces, and are so infinitely great, that no Satisfaction can compensate; then they think of nothing but the fearful Wrath of God just ready to be pour'd out upon them; that the Sentence of Condemnation is already pass'd, and that they certainly shall be damn'd to all Eternity.

THUS, these unhappy Wretches go on to encrease their Woes, before bad enough, now made worse from the Objects of Despair. But thus much I must observe in Defence of Religion, that these Disorders are no way the Effects of religious Duties, nor is Religion any way justly chargeable with their Consequences; they are owing to the Temperature of the Body, which, whenever it starts from its natural Standard, obliges the Mind to revolve upon those Ideas, that were most familiar to it while it was in Health. And if the Patient was intent upon religious Duties in Health, he will certainly revolve most upon those under this Disease; and as Fear, Sadness, and Sorrow, are the Pathogonomicks of phlegmatic Melancholy, he will naturally take religious Objects by the left Hand, and multiply the Duties of Religion above the Powers of human Nature to perform, and then quarrel with himself, for not doing what was above his Power to do, and what neither God nor his Laws exacted at his Hands.

THUS, this unhappy Wretch goes on from bad to worse, always fighting, groaning, and desponding of Mercy, from a God infinitely merciful: In vain shall you tell him of the Satisfaction of his Saviour for his Sins; his Sins are so foul and enormous, that they are above all Satisfaction: No Blood can wash out the Stains of his Sins, nor blot out the black Catalogue of his Transgressions.

AND this is the Circle of Ideas, that the most religious Persons will naturally run through, while the Symptoms of natural Melancholy continue to oppress them; for Fear and Sadness, being relative Terms, have no Foundation or Meaning, when they are not referr'd to some Objects: It therefore naturally follows, that whoever fears, must have some Grounds for those Fears, either real or imaginary; if they be real Fears, then they must arise from some Cause that struck the Object of Fear upon the Mind.

BUT if this be the Fate of religious Persons under this Disease, let us change the Scene, and take a view of the Atheist or Libertine under the same Affliction. What Hope, what Refuge can he expect from a gracious God, whose Providence he has so often blasphem'd, ridicul'd and deny'd? Under the Symptoms of religious Melancholy, the Mind was in Despair through Doubt; but here, even that Doubt would be the highest Pleasure: He now perceives God's heavy Wrath ready to be executed upon him, and thinks he is already in Hell; himself is Hell, and suffers all the Pains of the Damn'd; he howls, he roars, and, in the Height of his outrageous Frenzy, blasphemes God and his Religion: Where can he rest his hopeless Hope! where seek for Mercy, when Conscience, Horror, Despair, and all the dismal Scenes of Woe, that can afflict the most obdurate Heart, fly glaringly in his Face, and sting his tortur'd Soul, with Pain and Grief unsufferable to human Nature! Hence spring those frequent Suicides, to which these harden'd Miscreants have Recourse, to rid them of a Life most loathed, wretched, and miserable to endure. So that no Scene of Horror can be more dreadful, than to view an Atheist on his Bed of Sickness, just reviving to a Sense of his being forsaken of God, and all Hopes of his Mercy.

C Of the SYMPTOMS of SPLEEN, VAPOURS, and HYPOCHONDRIACK

MELANCHOLY, when they degenerate into Lunacy and Enthusiastick Madness.

THE Mania, or what we call Lunacy or the raging Madness, is only the foregoing Melancholy improv'd in a hot, biliose, sanguine Constitution; whereupon all the Impulses are strongly struck on the Seat of the common Sensorium, and the rational Soul divested of all its noble and distinguishing Endowments.

THIS Madness presents the Reader with a most dreadful Scene of Horror and Distraction; the Patient appears with a fierce, grim, and rough Aspect, his Reason is disturb'd, his Judgment confus'd, and the Exercise of his Intellectuals is lost and bewilder'd in a bottomless Gulph of most absurd Cogitations.

SOMETIMES the Fits of Lunacy arise beyond all the Bounds of Nature, and the Patients acquire a preter-natural Strength, greatly above the Power of the strongest Man to oppose: They will break the strongest Bars of Iron with a single Impulse, throw off their Bonds, Chains, and Shackles, to the Wonder and Surprize of all that see them; nor are they scarce ever tired, tho' they exercise their Bodies whole Days and Nights, and are almost continually without Sleep. They will endure the severest Usage, with a steady and equal Mind; nor shall you perceive them at all scarce affected with the Extremes of Cold, Fasting, and Stripes, that are enough to sink the Spirits of the most intrepid Mortals.

OTHERS, again, acquire a Swiftness of Foot, greatly superior to the swiftest Man. I myself knew a young Woman, that in the Height of her Lunacy, broke from her Keepers, and run so fast, for near two Miles, that neither Man nor Horse could overtake her, got into a River, and was drowned, before any could come to her Relief.

WHEN once the Disease is suffer'd to arise to this Height, they are bold, impudent, and of a most revengeful Disposition; apt to quarrel, and think, and speak, and dream, if perchance they slumber or sleep, of nothing but Battles, Combats, and their Manhood; they are furious and impatient in Discourse; stiff, irrefragable, and prodigious in their Actions; and, if provok'd, most violent, outrageous, and ready to kill themselves, and all others, that come in their Way.

THEY sleep but little; their Urine is of a fiery, flameous Colour, and but little in Quantity; their Pulse is quick, low, and very unequal, which certainly indicates, that the Fever is lodg'd upon the Nerves and Spirits, contrary to the Antients, that averr'd, that this Disease might be without a Fever; their Stools are white, hard, and but little in Quantity; their respiration varies, but generally is slow, and scarce perceivable.

PERSONS, of the greatest natural Parts, of the finest Genius's, and most elevated Imaginations, are often observ'd, in their Flights, to start into Madness; for being naturally of warm, biliose Constitutions, it necessarily follows, that (while the aspiring Soul is pursuing some lofty Thought, soaring to an uncommon Height, and teeming with the grand Discovery) the Impulses prove too strong for the feeble Brain to support, the Intenseness of Thought disconcerts the tender Fibres, and the whole Magazine of most beautiful Ideas are shatter'd, and jumbled into the greatest and most irregular Confusion, by the Force of the labouring Imagination.

WHEN once these finest Fibres of the Brain, that immediately support the regular Exercise of our Thoughts, have suffered such a fatal Shock; no Operation of the Mind, that is regular, sedate, and uniform, can ever after be expected; but all his Actions will be express'd by sudden Fits and Catches; and shew themselves in all the Diversity of Characters, according to the prevailing Passions that struck the Impulse. Thus the gay and merry, the fond and loving, the angry, revengeful, or Scholastick Characters, succeed each other, by sudden Starts and Sallies, according to the natural Passion he was subject to, before the Invasion of the Disease.

IF the Patient was proud, ambitious, haughty, or imperious, in his natural Temper, then, upon the Access of the Lunacy, he will imagine himself metamorphos'd into a King, a Prince, or Viceroy; and demand suitable Attendance to the regal Power, princely Dignity, or noble Character, he ought to bear in the World, in case he was the very Person he takes himself to be: Those of a fierce, savage, and cruel Nature, imagine themselves transform'd into Wolves, Bears, or Tigers, and fancy they retain all the Ferocity of those savage Animals.

SOMETIMES this raging Lunacy is improv'd upon the Habit of warm, biliose Constitutions, from a set of religious Objects, and then it arises to Enthusiasm; a Species of Madness quite different from religious Melancholy, and which produces different Effects: For whereas the Patient under the Symptoms of religious Melancholy, was greatly oppress'd with Fear, Sadness, and Despair; these, on the contrary, from an over-weening Opinion of their own Sanctity or Holiness, are elevated to the highest Degree of Familiarity with their Maker: They are his Viceroys, chosen Saints and Servants, sent on especial Errands, to reclaim the unbelieving World.

WHEN the Brain is once well-warm'd, then every groundless Opinion, or silly Fancy, that strongly settles itself on their Minds, is an Illumination from the Spirit of God, and of divine Authority; and then every Impulse that drives them on to any odd and ridiculous Action, is immediately a divine Call from Heaven; it's a Commission from Above, and must be obey'd. If you tell them of Mistakes, Errors, the Delusions of their Senses, or Suggestions of Satan, they will answer you, that they see the Light infus'd, hear the Call, feel the Impulse, and cannot be mistaken; it's clear and visible to them, as the Sun at Noon-Day, and consequently needs no other Proof than its own Evidence: They feel the Hand of God moving them within, and the Impulses of his Holy Spirit directing them in all their Enthusiastick Thoughts, Words, and Actions.

But of all Medicines in the Spleen, I know none equal or fit to compare with that truly noble Drug we call Opium. It's our Refuge in all Distresses; it gives Ease and Relief in the most torturing Pains, and when all other remedies fail; ... for by relaxing the Fibres of the Brain and Nerves, it sets their illachinulae at such a Distance from each other, as either totally destroys their Sensations, or at least greatly impairs them; whereupon it comes to pass, that the Perceptions are intercepted for a while, and a pleasing Stupefaction brought upon all the Organs, that serve the several Senses, which Phaenomenon we call Sleep.

 

 

 

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