Pathology of the Brain and Nervous Stock (1667 AD)
Soul of Brutes (1672 AD)
Thomas Willis

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"The primary object is naturally curative... discipline, threats, fetters and blows are needed as much as medical treatment...Truly nothing is more necessary and more effective for the recovery of these people than forcing them to respect and fear intimidation. By this method, the mind, held back by restraint, is induced to give up its arrogance and wild ideas and it soon becomes meek and orderly. This is why maniacs often recover much sooner if they are treated with torture and torments in a hovel instead of with medicaments."

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Introduction:

  1. In 1667 AD, Thomas Willis clearly understood that madness was a spiritual problem to be cured with torture. His statement says it all: "Wherefore, Furious Mad-men are sooner, and more certainly cured by punishments, and hard usage, in a strait room, than by Physick or Medicines." If insanity was really a chemical imbalance, these "moral treatments" would have no effect: "Therefore let the diet be slender and not delicate, their clothing course, their beds hard, and their handling severe and rigid. ... The first Indication, viz. Curatory, requires threatening, bonds, or strokes, as well as Physick. For the Mad-man being placed in a House for the business, must be so handled both by the Physician, and also by the Servants that are prudent, that he may be in some manner kept in, either by warnings, chiding, or punishments inflicted on him, to his duty, or his behaviour, or manners. And indeed for the curing of Mad people, there is nothing more effectual or necessary than their reverence or standing in awe of such as they think their Tormentors. For by this means, the Corporeal Soul being in some measure depressed and restrained, is compell'd to remit its pride and fierceness; and so afterwards by degrees grows more mild, and returns in order : Wherefore, Furious Mad-men are sooner, and more certainly cured by punishments, and hard usage, in a strait room, than by Physick or Medicines." Willis is one of the earliest doctors connected with Bedlam, to recommend torture as a cure for insanity. Willis saw the main cause of madness as being rooted in the mind not the body and his cures reflected that view: "Therefore, for the healing of the Spirits, first of all it is to be procured that the Soul should be withdrawn from all troublesome and restraining passion, viz. from mad Love, Jealousy, Sorrow, Pity, Hatred, Fear, and the like, and composed to cheerfulness or joy: pleasant talk, or jesting, Singing, Music, Pictures, Dancing, Hunting, Fishing and other pleasant Exercises are to be used. They who are not for Sports or Pleasures (for to some Melancholicks they are always ungrateful) are to be roused up by employing them in more light business; sometimes Mathematical or Chemical Studies, also Travelling, do very much help; moreover, it is often expedient to change the places of habitation, in their native soil. Those who will still stay at home, are to be warned, that they take care of their Household affairs" However, Willis one of the first to understand the nervous system. He therefore believed that moral choices could have an effect upon the nervous system, which in turn caused insanity. The idea that the mind could make the body sick and induce madness was not a new idea. But his etiology of madness rooted in the nervous system was new. His theory that bad moral choices caused bad nerves in the brain became the dominant view in the Bedlam mental hospital in England. 100 years later, William Battie, for example, induced vomiting in the insane in order to physically shock the nerves as a cure! Today we know Willis and Battie were quacks, since that nerves and brain tissue of schizophrenics are in perfect working order. Today, chemical psychiatrists still cling to a vestigial root of Willis' quacky ideas. It is seen in the modern mythical concept that chemical imbalances in the brain cause mental illness. Today, it appears very scientific to suggest insanity is caused by chemical imbalances, but like Willis' bad nerves, there is no scientific proof of either! While Willis correctly rejected the common idea of his day, that a woman's uterus caused hysteria, he made the mistake of blaming the brain instead! Interesting that Willis diagnosed both men and women with "hysteria" the same way men are diagnosed with postpartum depression today. Its all pure junk science! "Having weighed these, and other Reasons, we doubt not to assert, the Passions commonly called Hysterical, to arise most often, from that the animal spirits, possessing the beginning of the Nerves within the head, are infected with some taint." (Pathology of the Brain and Nervous Stock, Soul of Brutes, Thomas Willis, 1667 AD)
  2. "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)
  3. "Willis, one of the great figures of seventeenth century medicine, made extensive studies in neuroanatomy and neurophysiology by dissection and experiment so that he was styled 'the first inventor of the nervous system' (Freind, 1727). His classic Cerebri anatome, 1664 for which Richard Lower made model dissections and Sir Christopher Wren drew plates, advanced knowledge of the brain far more than is conveyed by the eponym 'circle of Willis' for the arterial anastomoses at the base of the brain described in it. He also attempted to localise nervous diseases by correlating clinical signs with postmortem examination of the brain. These achievements made him the founder of `Neurologie a term of his own coining which in the later nineteenth century was applied to the specialty built up on the knowledge accumulated by the approaches he pioneered. He also turned his attention to Tsycheology', the study of the `Nature and essence . . . parts, powers, and affections' of the 'Corporeal Soul' or mind (as Tsychologia' this term had been used since the end of the sixteenth century in theological works on the soul). In the course of his work Willis made a number of contributions to psychiatry proper. First, he convincingly vindicated the uterus and the humours from causing hysteria, which incidentally he likened to hypochondriasis in men. Instead he placed its pathology squarely in 'the Brain and Nervous Stock', so that today the sufferer from 'nerves' is indebted to Willis for having given his troubles a habitation and a name. He considered the important feature of hysteria the 'fit' or episodic disturbance of sensation, motion and consciousness short only of 'universal Convulsions' or epileptic grand mal, and accordingly classified it under 'Convulsive Diseases'. Today however many of the symptoms he called 'hysterical' are recognised as belonging to the epilepsies as those arising in abnormalities of the temporal lobes. Yet by Willis's great authority fits continued for more than another 200 years to be considered the essential feature of hysteria and it remained linked with epilepsy as in Charcot's hybrid 'hystero-epilepsy'. Even today many textbooks give hysteria as the main differential diagnosis of fits. Secondly, Willis gave one of the most extensive accounts of the whole field of mental illness which had appeared up to that time. He attributed 'melancholy' or affective psychosis to 'passions of the heart'; and 'madness' or psychosis accompanied by thought disorder, delusions or hallucinations that is schizophrenia to 'vice or fault of the Brain'. He recognised the difference between the symptoms of gross brain disease and those of mental illness in which he accounted for the absence of pathological findings by postulating a disturbance of the brain and nerves in terms of disordered 'Animal Spirits'. For this reason he is often credited with having first equated mind disease with brain disease. Derived from anima, the soul, the animal spirits were thought to be distilled from the blood in the brain as in a gland, their circulation accounting for nervous action. In advance of his contemporaries who thought of an actual fluid flowing to and from the brain in hollow tubes, Willis realised that nerves were solid and the spirits merely conducting agents. Intermediaries between mind and body, he assumed their action could be disordered by either. Hence his treatment of mental illness was partly through the mind and partly physical. Low spirited, depressed or melancholic patients needed stimulating and invigorating; high spirited, obstreperous cases of 'raving madness' lowering, depleting and repressing treatments. These principles were of course nothing new but the poles between which psychiatric therapeutics have moved since the inception of the 'humours', based on the naive idea of 'too much or too little'. This traditional view survived although couched in many 'new' terms as time went by. As the theory of tension and relaxation in the nervous system it reached its acme in the eighteenth century in the Brunonian system of `asthenic' and `sthenic' states and in the nineteenth century in Francis Willis's (1823) low and high' states with corresponding treatments by stimulation or sedation and in our own time by pep-pills or tranquillizers. Thirdly, Willis described patients with dementia in association with paralysis and tremor with fatal termination, which possibly represent the first cases of general paralysis of the insane, a disease not established as a clinico-pathological entity until the third decade of the nineteenth century. It is perhaps pertinent that Willis also noted the beneficial effect of mercury by inunction in some cases of what he called Palsie ... not very fixed' which of course became part of the standard treatment of syphilitic brain disease." (300 years of Psychiatry, Richard Hunter, 1963, p187)

 

(Pathology of the Brain and Nervous Stock, Soul of Brutes, Thomas Willis, 1667 AD)

Pathology of the Brain and Nervous Stock, Soul of Brutes, Thomas Willis, 1667 AD

Thomas Willis (1621-1675)

M D Oxon, F R C P, F R S, physician of Oxford and London; Sedleian professor of natural philosophy, Oxford University

Pathologite cerebri, et nervosi generis specimen. In quo agitur de morbis convulsivis, 1667 Translated as An essay of the pathology of the brain and nervous stock: in which convulsive diseases are treated of . . . by S. P[ordage]. In: The remaining medical works of that famous and renowned physician Dr. Thomas Willis London, Dring et al., 1681 pp. 76-8

De anima brutorum . . . exercitationes duce. Prior physiologica . . . altera pathologica, 1672 Translated as Two discourses concerning the soul of brutes . . . The first is physiological . . . The other is pathological . . . by S. Pordage, Student in Physick London, Dring et al., 1683 pp. 188, 192-4, 201, 206-8

HYSTERIA AND THE NERVOUS STOCK

The hysterical passion is of so ill fame, among the Diseases belonging to women, that like one half damn'd, it bears the faults of many other Distempers : For when at any time, a sickness happens in a womans body, of an unusual manner, or more occult original, so that its Cause lies hid, and the Curatory Indication is altogether uncertain, presently we accuse the evil influence of the womb, (which for the most part is innocent) and in every unusual Symptom, we declare it to be something hysterical, and so to this Scope, which oftentimes is only the subterfuge of Ignorance, and medical Intentions, and use of Remedies are directed.

The Passions, which are wont to be referred to this sense or order, are found to be various and manifold; which rarely happen in diverse women, or which come wholly after the same manner : The most Common, and which commonly are said to constitute the formal Reason of the hysterical distemper, are these, viz. A motion in the bottom of the belly, and an ascention of the same, as it were a certain round thing, then a belching, or a striving to vomit, a distention, and murmur of the hyponchondria, with a breaking forth of blasts of winde, an unequall breathing, and very much hindred, a choaking in the throat, a vertigo, an inversion, or rolling about of the eyes, oftentimes laughing, or weeping, absurd talking, sometimes want of speech, and motionless, with an obscure or no pulse, and deadish aspect, sometimes Convulsive motions, in the face and Limbs, and sometimes in the whole body, are excited: But universal Convulsions rarely happen, and not unless this disease be in the very worst state: Because, for the most part, the Tragedy of the Fit is acted without Contraction of the members, only in the inferior belly, Thorax, and head, to wit, in some of them, or successively in all: women of every age, and Condition, are obnoxious to these kinde of Distempers, to wit, Rich and poor, Virgins, wives, and widdows : I have observed those Symptoms in maids before ripe age, also in old women after their flowers have left them; yea, sometimes the same kinde of Passions infest men, as plainly appeared by the example already shewed.

As to the causes of those symptoms, most ancient, and indeed Modern Physitians, refer them to the ascent of the womb, and vapours elevated from it : The former opinion, although it plead antiquity, seems the less probable, for that the body of the womb is of so small bulk, in virgins, and widdows, and is so strictly tyed by the neighbouring parts round about, that it cannot of it self be moved, or ascend from its place, nor could its motion be felt, if there were any : as to that vulgar opinion, or Reason taken from the vapours, we have often rejected it as wholly vain, and light, for just reasons elsewhere .. .

We are at length perswaded . . . that the distemper named from the womb, is chiefly and primarily convulsive, and chiefly depends on the brain and the nervous stock being affected, and whatever inordination, or irregularity from thence happens . . . is only secondary . .. Having weighed these, and other Reasons, we doubt not to assert, the Passions commonly called Hysterical, to arise most often, from that the animal spirits, possessing the beginning of the Nerves within the head, are infected with some taint.

OF MELANCHOLY

Melancholy . . . is a complicated Distemper of the Brain and Heart : For as Melancholick people talk idly, it proceeds from the vice or fault of the Brain, and the inordination of the Animal Spirits dwelling in it; but as they become very sad and fearful, this is deservedly attributed to the Passion of the Heart. But we cannot here yield to what some Physicians asfirm, that Melancholy doth arise from a Melancholick humor . . . This Distemper suddenly excited, from a solitary evident cause, as a vehement Passion, is far safer than by leasure invading, after a long Procatarxis or foregoing cause . . . Melancholy being a long time pretracted, passes oftentimes into Stupidity, or Foolishness, and sometimes also into Madness . . . Further, there is scarce any better thing to be expected from them, who lying sick with only imaginary Diseases, take all Remedies, and require still more, and of diverse kinds, to be given them . . . the Evident Cause of this Disease, if any noted thing went before, should be inquired into; and if it may be, either presently removed, or else its removal to be in some sort feigned. Further, the affections of the mind being vehement, and stirred up from thence, are either to be appeased, or subdued by others opposite . . .

Therefore, for the healing of the Spirits, first of all it is to be procured that the Soul should be withdrawn from all troublesome and restraining passion, viz. from mad Love, Jealousy, Sorrow, Pity, Hatred, Fear, and the like, and composed to cheerfulness or joy: pleasant talk, or jesting, Singing, Music, Pictures, Dancing, Hunting, Fishing and other pleasant Exercises are to be used. They who are not for Sports or Pleasures (for to some Melancholicks they are always ungrateful) are to be roused up by employing them in more light business; sometimes Mathematical or Chemical Studies, also Travelling, do very much help; moreover, it is often expedient to change the places of habitation, in their native soil. Those who will still stay at home, are to be warned, that they take care of their Household affairs . . . if the sick be seduced with phantastical illusions, and imagine some prodigious things of themselves, and firmly believe them; their mind is to be drawn from them, by artificial inventions; very many causes and examples of this sort of Cure are to be found in Books, and a discreet Physician may institute the like as occasion serves.

OF MADNESS

After Melancholy, Madness is next to be treated of, both which are so much akin, that these Distempers often change, and pass from one into the other . . . And indeed, if in Melancholy the Brain and Animal Spirits are said to be darkned with fume, and a thick obscurity; In Madness, they seem to be all as it were of an open burning or flame . . . three things are almost common to all: viz. First, That their Phantasies or Imaginations are perpetually busied with a storm of impetuous thoughts . . . Secondly, That their Notions or conceptions are either incongruous, or represented to them under a false or erroneous image. Thirdly, To their Delirium is most often joyned Audaciousness and Fury.

The Curatory Indication

The first Indication, viz. Curatory, requires threatnings, bonds, or strokes, as well as Physick. For the Mad-man being placed in a House for the business, must be so handled both by the Physician, and also by the Servants that are prudent, that he may be in some manner kept in, either by warnings, chiding, or punishments inflicted on him, to his duty, or his behaviour, or manners. And indeed for the curing of Mad people, there is nothing more effectual or necessary than their reverence or standing in awe of such as they think their Tormentors. For by this means, the Corporeal Soul being in some measure depressed and restrained, is compell'd to remit its pride and fierceness; and so afterwards by degrees grows more mild, and returns in order : Wherefore, Furious Mad-men are sooner, and more certainly cured by punishments, and hard usage, in a strait room, than by Physick or Medicines.

But yet a course of Physick ought to be instituted besides, which may suppress or cast down Elation of the Corporeal Soul. Wherefore in this Disease, Bloodletting, Vomits, or very strong Purges, and boldly and rashly given, are most often convenient; which indeed appears manifest, because Empiricks only with this kind of Physick, together with a more severe government and discipline do not seldom most happily cure Mad folks . . . Further there are to be used Specisick Remedies, so called, of which is famous, a Decoction of Pimpernel with the purple slower, also the tops of Hyperican or St. Johns-Wort, and other Decoctions, Opiates, and Powders of Antilyssi are frequently noted among all the famous Empericks . . . Moreover, from Chirurgical Remedies, besides, opening a Vein, many other helps are wont to be had for the curing of this Disease. Cupping-glasses with Scarisication, often help. Blisterings, Cauteries both actual and potential are praised of many. Others commend cutting an Artery, others Trepaning, or opening the Skull, others Salivation . . .

The vital Indication institutes how mad people ought to be handled, concerning their government, diet, and sleep. In this Disease there is no need of keeping up the flesh, as in most other Diseases : For the spirits ought not to be refreshed with Cordials, nor strength to be restored with Medicines; but on the contrary, both being too raging of themselves, things are to be administer'd as it were for the suppression or extinction of a flame raging above measure. Therefore let the diet be slender and not delicate, their clothing course, their beds hard, and their handling severe and rigid. But sleep, for that it is very necessary, ought to be caused sometimes by Anodynes; for which end, Hypnotick Remedies or Medicines above prescribed for Melancholy, are also convenient in this Disease. In inveterate and habitual Madness, the sick seldom submit to any Medical Cure; but such being placed in Bedlam, or an Hospital for Mad people, by the ordinary discipline of the place, either at length return to themselves, or else they are kept from doing hurt, either to themselves or to others . . . Thus much concerning the cure of continual Madness. The intermitting, either has perfect lucid intervals, in which the Sick return to themselves, or the fury only ceases, the Delirium being still left, insomuch that the distemper'd become gentle and tractable, yet still they continue amiss, as to their imagination and judgment, and speak and do many absurd or incongruous things, and afterwards sometimes again become furious.

 

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