Mania





Under the term 'mania' are included all those forms of mental

unsoundness in which there is undue excitement. It is divided into

general, intellectual, and moral, and each of the two latter classes

again into general and partial.



=General Mania= affects the intellect as well as the passions and

emotions. Mania is usually preceded by an incubative period in which the

patient's general health is affected. The duration of this period may

vary from a few days to fifteen or twenty years. When the disease is

established, the patient has paroxysms of violence directed against

himself as well as others. He tears his clothes to pieces, either

abstains from food and drink or eats voraciously, and sustains immense

muscular exertion without apparent fatigue. The face becomes flushed,

the eye wild and sparkling; there is pain, weight, and giddiness in the

head, with restlessness.



=General Intellectual Mania=, attacking the intellect alone, is rare;

but some one emotion or passion, as pride, vanity, or love of gain, may

obtain ascendancy, and fill the mind with intellectual delusions.



A delusion may be defined as a perversion of the judgment, a



chimerical thought; an illusion, an incorrect impression of the

senses, counterfeit appearances; hence we speak of a delusion of the

mind, an illusion of the senses. Lawyers lay great stress on the

presence of delusions as indicative of insanity. An hallucination is a

sensation which is supposed by the patient to be produced by external

impressions, although no material object acts upon his senses at the

time.



=Partial Intellectual Mania=, or =Monomania=, also called =Melancholia=,

is a form of the disease in which the patient becomes possessed of some

single notion, contradictory alike to common-sense and his own

experience.



=General Moral Mania.=--This is a morbid perversion of the natural

feelings, affections, inclinations, temper, habits, moral dispositions,

and natural impulses, without any remarkable disorder or defect of the

intellect, or knowing and reasoning faculties, and particularly without

any insane illusion or hallucination. It is often difficult to

distinguish this form of mania from the moral depravity which we

associate with the criminal classes.



=Partial Moral Mania--Paranoia--Delusional Insanity.=--In this form one

or two only of the moral powers are perverted. Delusions are always

present, and very frequently are those of persecution. The patient's

conduct is dominated by his delusion; thus murder and suicide may be

committed. There are several forms:



Kleptomania, a propensity to theft; common in women in easy

circumstances. Dipsomania, or Oinomania, an insatiable desire for

drink. Morphinomania, a craving for morphine or its preparations.

Erotomania, or amorous madness. When occurring in women this is also

called Nymphomania, and in men Satyriasis. It consists in an

uncontrollable desire for sexual intercourse. Pyromania, an insane

impulse to set fire to everything. Homicidal mania, a propensity to

murder. Suicidal mania, a propensity to self-destruction. Some

consider suicide as always a manifestation of insanity.



=Insanity of Pregnancy.=--This may show itself after the third month of

pregnancy in the form of melancholia. It is not recovered from until

after delivery.



=Puerperal Mania.=--This form of mania attacks women soon after

childbirth. There is in many cases a strong homicidal tendency against

the child.



=Insanity of Lactation= comes on four to eight months after parturition,

either as mania or melancholia. The mother may repeatedly attempt

suicide.



=Mania with Lucid Intervals.=--In many cases mania is intermittent or

recurrent in its nature, the patient in the interval being in his right

mind. The question of the presence or absence of a lucid interval

frequently occurs where attempts are made to set aside wills made by

persons having property. In these cases the law, from the reasonableness

of the provisions of the will, may assume the existence of the lucid

interval. A will made during a lucid interval is valid. When an attempt

is made to set aside the provisions of a will on the ground of insanity

in a person not previously judged insane, the plaintiff must show that

the testator was mad; when the provisions of the will of a lunatic are

attempted to be upheld, the plaintiff must show that the will was made

during a lucid interval.



A testator is capable of making a valid will when he has (1) a knowledge

of his property and of his kindred; (2) memory sufficient to recognize

his proper relations to those about him; (3) freedom from delusions

affecting his property and his friends; and (4) sufficient physical and

mental power to resist undue influence. The fact of a man being subject

to delusions may not affect his testamentary capacity. He may believe

himself to be a tea-kettle, and yet be sufficiently sound mentally to

make a valid will.



=Undue Influence.=--Persons of weak mind or those suffering from senile

dementia are often said to have been unduly influenced in making their

wills, and subsequently their dispositions are disputed in court. Before

witnessing the will made by such a person, the medical man should

satisfy himself that the testator is of a 'sound disposing mind.' This

he will do by questioning, and his knowledge of the home-life of the

patient will either confirm or set aside the idea of influence.



A person who is aphasic may be competent to make a will. He may not be

able to speak, but may understand what is said to him, and may be able

to indicate his wishes by nods and shakes of the head. Ask him if he

wishes to make a will, then inquire if he has £10,000 to leave, then if

he has £100, and in this way arrive approximately at the sum. Then ask

him if he wishes to leave it all to one person. If he nods assent, ask

if it be to his wife or some other likely person. If he wishes to divide

it, ascertain his intention by definite questions, and, having

ascertained his views, commit them to writing, read the document over to

him, and ask if it expresses his intentions. That being settled, a mark

which he acknowledges in the presence of two witnesses, preferably men

of standing, will constitute a valid document.



In certain forms of neurasthenia, the 'phobias' are common, but must not

be regarded as evidence of insanity. 'Agoraphobia' is the fear of

crossing an open space, 'batophobia' is the fear that high things will

fall, 'siderophobia' is the fear of thunder and lightning, 'pathophobia'

is the fear of disease, whilst 'pantophobia' is the fear of everything

and everybody.



=Epilepsy in Relation to Insanity.=--The subjects of this disease are

often subject to sudden fits of uncontrollable passion; their conduct is

sometimes brutal, ferocious, and often very immoral. As the fits

increase in number, the intellect deteriorates and chronic dementia or

delusional insanity may supervene. (1) Before a fit the patient may

develop paroxysms of rage with brutal impulses (preparoxysmal

insanity), and may commit crimes such as rape or murder. (2) Instead of

the usual epileptic fit, the patient may have a violent maniacal attack

(masked epilepsy, epileptic equivalent, psychic form of epilepsy).

(3) After the fit the patient may perform various automatic actions

(post-epileptic automatism) of which he has no subsequent

recollection. Thus the patient may urinate or undress in a public place,

and may be arrested for indecent exposure. Epileptics who suffer from

both petit and grand mal attacks are specially liable to maniacal

attacks. Such insanity differs from ordinary insanity in its sudden

onset, intensity of symptoms, short duration and abrupt ending. To

establish a plea of epilepsy in cases of crime, one must show that the

individual really did suffer from true epilepsy, and that the crime was

committed at a period having a definite relation to the epileptic

seizure.



=Alcoholic Insanity.=--This may occur in three forms:



1. Acute Alcoholic Delirium (mania a potu), due to excessive amount

of alcohol consumed.



2. Delirium Tremens, due to long-continued over-drinking. The patient

suffers from horrible dreams, illusions, and suspicions, which may lead

him to attack people or commit suicide.



3. Chronic Alcoholic Insanity. Loss of memory is the chief symptom,

with paralysis of motion, hallucinations and delusions of persecution.



=Responsibility for Criminal Acts.=--To establish a defence on the

ground of insanity, it must be proved that the prisoner at the time when

the crime was committed did not know the nature and quality of the act

he was committing, and did not know that it was wrong. At the present

time, however, the power of controlling his actions is usually made

the test.



The plea of insanity is brought forward, as a rule, only in capital

charges, so that the prisoner, if found guilty, will escape hanging. If

proved 'guilty, but insane,' the person is sentenced to be kept in a

criminal lunatic asylum 'during His Majesty's pleasure.'





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