Monomania of Pride
...a female aged 38, the daughter of an officer in the Customs. The
cause of her illness is not known, but it appears to have been of long
standing. Six years before her admission, she met some soldiers, who, she
said, attempted to create a disturbance, and who appear to have frightened
her. for some years before her admission, she was in the habit of coming
from Devonport to Exeter, whenever the assizes were held at the latter
place, in order that she might maintain her rights as Her Majesty's Person.
On these occasions, a benevolent magistrate, to whom she had made herself
known, used to send her home. At last, on one of these occasions, she was
thought decidedly unsafe, and was sent to the asylum. Her delusion is,
that she is Her Majesty's Person--she is not Her Majesty, but Her Person--
a distinction on which she lays great stress, but which we have never been
able to understand. She is proud, and dignified in her demeanor. Out of
the commonest materials of dress she contrives to make a distinguished
appearance. She fastens the skirt of her dress low, so as to form a sort
of train; and, with arms folded, the head with its coronal ornaments thrown
proudly back, she would if permitted, maintain an erect and regal position
from morning till night. As she has dilated and irritable heart it would
be dangerous to permit her to indulge this fancy; and hence arise some
differences of opinion between her and those who have the care of her health.
The intense pride expressed in the turn of head and eye, and in the firm
compressed lips, cannot be mistaken. It is the physiognomy
of one exaggerated emotion, transmuted into one delusive idea [Bucknill
and Tuke, 1858/1968,507].
Primary
Dementia
...The patient, now aged forty, had a severe attack of typhus fever
when nineteen years of age, after which, her husband says that 'her jaw
dropped, and she has never been perfectly right since.' This did not prevent
her, however, being married to a shoemaker, and bearing five children,
the last of whom, six months old, she suckled to the date of her admission,
affording an example of one means by which insanity is propagated. She
was admitted in a state of extreme filth and personal neglect, in the same
mental state in which she still remains, namely, a void of sensation, emotion,
and thought. On her blank physignomy there are no traces of passion telling
of former storms of mania, there is not even the slight effort of
attention which corrugates the brow of the idiot. She never laughs or weeps,
or indicates any want or any annoyance. She knows none of the attendants
or patients by name; says she was never married; remembers her maiden name,
but appears to have forgotten her married name. If she were accidentally
hurt, she would feel but little pain; if she were not fed like an infant,
she would die of starvation with little suffereing. She is very fat, has
a good color in her cheeks, and her physical functions are performed well.
The catamenia are suppressed. She seldom moves, feeling no motive to do
so. When told to move, she progresses with a short, quick trot, like a
young child. She eats revenously, and would choke herself if her food were
not carefully minced. She affords a good example of the extent to which
physical health may be retained when the activity of the cerebral functions
is reduced to its lowest ebb [Bucknill & Tuke, 1858/1968, 510].
Since ...insanity is, by common consent, acknowledged
to betray itself by the facial expression, it becomes necessary to inquire
what are its true physiognomical symptoms. ... It's importance ...cannot
be easily overrated; but the art of physiognomy cannot be taught in dissertations
or treatises. A few principles may... be laid down...The expression of
the physiognomy in a sane person is compounded of intellectual, emotional,
and propensive expression.... The student of the physiognomy of the insane
must, ...endeavor to separate and distinguish the three elements of expression...and
estimate the degree in which they severally exist. Having done this, he
must bend all his powers of perception and discrimination to the
character which prevailing emotion has stamped on the physiognomy....Insanity
anticipates the effect of years, and prematurely impresses upon the human
face the strong characteristics of habitual emotion. In the youthful insane,
the facial lines of anger and pride, sorrow and fear, are more deeply cut
than in sane persons of advanced years; and in a mature or aged lunatic,
they are often displayed in an exaggerated degree rarely observed in persons
of sound mind. ...In a great... number of cases... a remarkable peculiarity
is observable in the physiognomy of the insane; this exists in a want of
accord in the expression of the different features. This ...reminds one
of these children's toys, in which the upper and lower halves of painted
figures are separable, and capable of being joined in fantastic reunion.
...The expression of the mouth often gives the lie to that of the eye and
brow... This is ...the most characteristic
peculiarity of insane physiognomy, because it is only observed among
the insane. ...Another peculiarity of the physiognomical expression of
the insane, is the apparently causeless and motiveless play of feature
which is frequently remarked in them. ...it occasions the state of facial
expression upon which the popular idea of a madman' looks is founded. These
changes, although apparently causeless and motiveless, are not so in reality;
they are, indeed, a reflection of those rapid changes in the emotional
state which often exist mania [Bucknill and Tuke, 1858/1968, pp. 285-88]
Secondary
Dementia
...A woman, aged forty-nine, the subject of secondary dementia. She
has been insane two years and a half. The cause was attributed to religious
excitement, and the fear of death from disease of the knee joint. The form
of insanity which first presented itself, was that of acute maniac excitement,
with delusions of a religious type, and suicidal desire. The thought that
her soul was separated from her body, and that it was forever lost. She
attempted to strangle herself, and also to beat her brains out by running
against walls. After admission, this violence subsided, and she passed
into a state of chronic excitement, which was gradually decreasing mental
powers, has continued to the present time. She sleeps badly, and believes
that she is visited at night by an old lover, towards whom she uses very
bad language, and whose supposed attempts to get into bed she reissts vigorously.
Although quiet enough during the day, she is often, in consequence of this
delusion very noisy at night. During the day, she holds quiet conversations
with this lover, and with persons whom she has known in early life. She
not only hears but sees these people, and this hallucination has impressed
that earnest inquiring look, so faithfully given in the portrait. Her memory
of early years is much stronger than that of events which have just passed.
She connot tell our name, or the names of the nurses, or of any of her
fellow-patients; but she can remember the names and residences of the people
who lived in the neighborhood of her home. She takes her food well; but
her attention is so feeble, that without great care, she would lapse into
dirty habits. The catamenia are gegular. The general expression of the
face is that of mindlessness, combined with the deep lines of emotional
excitement. From the presence of the latter, her physiognomy presents a
great contrast with that of ...of primary
dementia... The face also presents a striking instance of that want
of harmony between the expression of the different features, which
is so often so characteristic a trait of insane physiognomy. The upper
part of the face, viewed alone might be taken to belong to a person in
a state of acute mania; the lower part, viewed alone, might be mistaken
for utter fatuity or idoicy [Bucknill & Tuke, 1859/1968, 510-11].