it is a qualitative option: a phenomenology of melancholic experience.
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Some seventy years later, animal spirits lost their scientific prestige. Now it was from the body's liquid and solid elements that the secret of disease was sought. The Medical Dictionary which Robert James published in England in 1743 proposes, under Mania, a comparative etiology of that disease and of melancholia: "It is evident that the brain is the seat ... of all diseases of this nature. ... It is there that the Creator has fixed, although in a manner which is inconceivable, the lodging of the soul, the mind, genius, imagination, memory, and all sensations. . . . All these noble functions will be changed, depraved, diminished, and totally destroyed, if the blood and the humors corrupted in quality and quantity are no longer carried to the brain in a uniform and temperate manner, but instead circulate there with violence and impetuosity, or move about slowly, with difficulty or with languor." It is this languishing flow, these choked vessels, this heavy, clogged blood that the heart labors to distribute throughout the organism, and which has difficulty penetrating into the very fine arterioles of the brain, where the circulation ought to be very rapid in order to maintain the movement of thought—it is all this distressing obstruction which explains melancholia. Heaviness, encumbrance—here again the primitive qualities guide analysis. The explanation becomes a transfer to the organism of qualities perceived in the condition, the conduct, the words of the sick person. We move from qualitative apprehension to supposed explanation. But it is this apprehension that continues to prevail and always wins out over theoretical coherence. Anne-Charles Lorry juxtaposes the two main forms of medical explanation—by solids and by fluids—and ultimately causes them to intersect, thus distinguishing two kinds of melancholia. The one whose origin is in solids is nervous melancholia: a particularly strong sensation agitates the fibers which receive it; as a result, tension increases in the other fibers, which become more rigid and at the
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same time susceptible to further vibration. But should the sensation become even stronger, then the tension increases to such a degree in the other fibers that they become incapable of vibrating; the state of rigidity is such that the flow of blood is stopped and the animal spirits immobilized. Melancholia has set in. In the other form of disease, the "liquid form," the humors are impregnated with black bile;
they become thicker; clogged with these humors, the blood thickens and stagnates in the meninges until it compresses the principal organs of the nervous system. Then we find again the rigidity of the fibers, but in this case it is no more than a consequence of a humoral phenomenon. Lorry distinguishes two melancholias: actually it is the same group of qualities, affording melancholia its real unity, that he employs successively in two explanatory systems. Only the theoretical edifice has been doubled. The qualitative basis in experience remains the same.
A symbolic unity formed by the languor of the fluids, by the darkening of the animal spirits and the shadowy twilight they spread over the images of things, by the viscosity of the blood that laboriously trickles through the vessels, by the thickening of vapors that have become blackish, deleterious, and acrid, by visceral functions that have become slow and somehow slimy—this unity, more a product of sensibility than of thought or theory, gives melancholia its characteristic stamp.
It is this undertaking, more than faithful observation, which reorganizes melancholia's symptoms and mode of appearance. The theme of a partial delirium increasingly disappears as a major symptom of melancholics in favor of qualitative data like sadness, bitterness, a preference for solitude, immobility. At the end of the eighteenth century, all forms of madness without delirium, but characterized by inertia, by despair, by a sort of dull stupor, would be readily classified as melancholia.8 And as early as James's
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Dictionary, an apoplectic melancholia is discussed, in which the sufferers "refuse to rise from their beds . . . ; once on their feet, they will not walk unless they are forced by their friends or attendants; they in no way avoid others, but they seem to pay no attention to what is said to them;
they make no answer." If, in this case, immobility and silence prevail and determine the diagnosis of melancholia, there are cases in which one observes only bitterness, languor, and a preference for isolation; their very agitation must not deceive the observer nor authorize a hasty diagnosis of mania; these patients are definitely suffering from melancholia, for "they avoid company, prefer solitary places, and wander without knowing where they are going;
they have a yellowish color, a dry tongue as in a person suffering from great thirst, and their eyes are dry, hollow, never moistened with tears; their entire body is dry and burning hot, their face dark, and expressing only horror and sadness."9
The analyses of mania and their evolution during the classical period obey the same principles of coherence.
Willis opposes mania to melancholia. The mind of the melancholic is entirely occupied by reflection, so that his imagination remains at leisure and in repose; the maniac's imagination, on the contrary, is occupied by a perpetual flux of impetuous thoughts. While the melancholic's mind is fixed on a single object, imposing unreasonable proportions upon it, but upon it alone, mania deforms all concepts and ideas; either they lose their congruence, or their representative value is falsified; in any case, the totality of thought is disturbed in its essential relation to truth. Melancholia, finally, is always accompanied by sadness and fear;
on the contrary, in the maniac we find audacity and fury. Whether it is a question of mania or melancholia, the cause of the disease is always in the movement of the animal
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spirits. But this movement is quite particular in mania: it is continuous, violent, always capable of piercing new pores in the cerebral matter, and it creates, as the material basis of incoherent thoughts, explosive gestures, continuous words which betray mania. Is not such pernicious mobility that of an infernal water, sulfurous liquid, those aquae stygiae, ex nitro, vitriolo, antimonio, arsenico, et similibus exstillatae: its particles are in perpetual movement; they are capable of provoking new pores and new channels in any substance;
and they have strength enough to spread themselves far, exactly as the maniacal spirits are capable of spreading agitation through all the parts of the body. An infernal water gathers in the secrecy of its movements all the images in which mania takes its concrete form. It constitutes, in an indissociable way, both its chemical myth and its dynamic truth.
In the course of the eighteenth century, the image, with all its mechanical and metaphysical implications, of animal spirits in the channels of the nerves, was frequently replaced by the image, more strictly physical but of an even more symbolic value, of a tension to which nerves, vessels, and the entire system of organic fibers were subject. Mania was thus a tension of the fibers carried to its paroxysm, the maniac a sort of instrument whose strings, by the effect of an exaggerated traction, began to vibrate at the remotest and faintest stimulus. Maniacal delirium consisted of a continual vibration of the sensibility. Through this image, the differences from melancholia became precise and were organized into a rigorous antithesis: the melancholic can no longer enter into a resonance with the external world, because his fibers are relaxed or because they have been immobilized by too great a tension (we see how the mechanics of tension explains melancholic immobility as well as maniacal agitation): only a few fibers vibrate in the melancholic, those which correspond to the precise point of his
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delirium. On the contrary, the maniac vibrates to any and every stimulus; his delirium is universal; stimuli do not vanish into the density of his immobility, as in the melancholic's case; when his organism returns them, they have been multiplied, as if the maniac had accumulated a supplementary energy in the tension of his fibers. It is this very fact, moreover, that makes the maniac, in his turn, insensible, not with the somnolent insensibility of
the melancholic, but with an insensibility taut with interior vibrations; this is doubtless why maniacs "fear neither heat nor cold, tear off their clothes, sleep naked in the dead of winter without feeling the cold." It is also why they substitute for the real world, which nonetheless continues to solicit them, the unreal and chimerical world of their delirium:
"The essential symptoms of mania result from the fact that objects do not present themselves to the sufferers as they are in reality."10 The delirium of maniacs is not determined by a particular error of judgment; it constitutes a defect in the transmission of sense impressions to the brain, a flaw in communication. In the psychology of madness, the old idea of truth as "the conformity of thought to things" is transposed in the metaphor of a resonance, a kind of musical fidelity of the fibers to the sensations which make them vibrate.
This theme of manic tension develops, beyond a medicine of solids, into intuitions that are still more qualitative. The rigidity of fibers in a maniac always belongs to a dry landscape; mania is regularly accompanied by a wasting of the humors, and by a general aridity in the entire organism. The essence of mania is desertic, sandy. Theophile Bonet, in his Sepulchretum anatomicum, declares that the brains of maniacs, insofar as he had been able to observe them, always seemed to be in a state of dryness, of hardness, and of friability. Later, Albrecht von Haller also found that the maniac's brain was hard, dry, and brittle. Menuret repeats
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an observation of Forestier's that clearly shows how an excessive loss of a humor, by drying out the vessels and fibers, may provoke a state of mania; this was the case of a young man who "having married his wife in the summer-time, became maniacal as a result of the excessive intercourse he had with her."
What some imagined or supposed, what others saw in a quasi-perception, Dufour proved, numbered, named. During an autopsy, he removed part of the medullary substance from the brain of a subject who had died in a state of mania; he cut out "a cube six lines in each direction" the weight of which was 3 j.g. Ill, while the same volume taken from an ordinary brain weighed 3 j.g. V: "this inequality in weight, which seems at first of little consequence, is no longer so slight if we consider the fact that the specific difference between the total mass of the brain of a madman and that of a normal man is around 7 gros less in the adult, in whom the brain's entire mass ordinarily weighs three livres." Mania's dessication and lightness show even on the scale.
Were not this internal dryness and this heat further proved by the ease with which maniacs endured great cold? It was an established fact that they had been seen walking naked in the snow, that there was no need to warm them when they were confined in the asylum, that they could even be cured by cold. Since Jean-Baptiste van Helmont, the immersion of maniacs in ice water had been widely practiced, and Menuret states that he knew a maniac who, having escaped from the prison where he was kept, "walked several leagues in a violent rain without a hat and almost without clothing, and who by this means recovered perfect health." Montchau, who cured a maniac by "pouring ice water upon him, from as high above as possible," was not astonished by so favorable a result; to explain it he united all the themes of organic calefaction that
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had succeeded and intersected each other since the seventeenth century: "One need not be surprised that ice water produces such a prompt and perfect cure precisely when boiling blood, furious bile, and mutinous liquors carried disturbance and irritation everywhere"; by the impression of coldness, "the vessels contracted more violently and freed themselves of the liquors that crammed them; the irritation of the solid parts caused by the extreme heat of the liquors they contained ceased, and when the nerves relaxed, the course of the spirits that had proceeded irregularly from one side to the other was re-established in its natural state." The world of melancholia was humid, heavy, and cold;
that of mania was parched, dry, compounded of violence and fragility; a world which heat—unfelt but everywhere manifested—made arid, friable, and always ready to relax under the effect of a moist coolness. In the development of all these qualitative simplifications, mania attained both its full scope and its unity. It has doubtless remained what it was at the beginning of the seventeenth century, "fury without fever," but beyond these two characteristics, which were still only descriptive, there developed a perceptual theme which was the real organizer of the clinical picture. Once the explanatory myths disappeared, and humors, spirits, solids, fluids no longer had any currency, there would remain only the schema of coherent qualities which would no longer even be named, and what this dynamics of heat and movement slowly formed into a constellation characteristic of mania would now be observed as a natural complex, as an immediate truth of psychological observation. What had been perceived as heat, imagined as agitation of spirits, conceived as fibrous tension, would henceforth be recognized in the neutralized transparency of psychological notions: exaggerated vivacity of internal impressions, rapidity in the association of ideas, inattention
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to the external world. De la Rive's description already has this limpidity: "External objects do not produce upon the mind of a sufferer the same impression as upon the mind of a healthy man; these impressions are weak, and the sufferer rarely heeds them; his mind is almost entirely absorbed by the action of the ideas produced by the deranged state of his brain. These ideas have such a degree of vivacity that the sufferer believes they represent real objects, and judges accordingly." But we must not forget that this psychological structure of mania, as it appeared and was stabilized at the end of the eighteenth century, is only the superficial sketch of an entire profound organization, which itself would capsize and which had developed according to the half-perceptual, half-iconographic laws of a qualitative world.
No doubt this entire universe of heat and cold, of humidity and dryness, reminded medical thought, about to accede to positivism, of the circumstances of its own origin. But this blazon of images was not simply reminiscence; it was also an undertaking. In order to form the practical experience of mania or melancholia, this gravitation, against a background of images, of qualities attracted to each other by a whole system of sensuous and affective affinities was essential. If mania, if melancholia henceforth assumed the aspects our science knows them by, it is not because in the course of centuries we have learned to "open our eyes" to real symptoms; it is not because we have purified our perception to the point of transparency; it is because in the experience of madness, these concepts were organized around certain qualitative themes that lent them their unity, gave them their significant coherence, made them finally perceptible. We have passed from a simple notional description (fury without fever, delirious idee fixe) to a qualitative realm, apparently less organized, simpler, less precisely limited, but which alone was able to constitute
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recognizable, palpable units really present in the total experience of madness. The field of observation of these diseases was partitioned into landscapes that obscurely gave them their style and their structure. On the one hand, a sodden, almost diluvian world, where man remained deaf, blind, and numb to all that was not his one terror: a world simplified in the extreme, and immoderately enlarged in a single one of its details. On the other, a parched and desertic world, a panic world where all was flight, disorder, instantaneous gesture. It was the rigor of these themes in their cosmic form—not the approximations of an observing caution—which organized the experience (already almost our own experience) of mania and melancholia.
It is Willis, with his spirit of observation, the purity of his medical perception, whom we honor as the "discoverer" of the mania-melancholia alternation. Certainly Willis's methods are of great interest, chiefly in this particular: the transition from one affection to the other is seen not as a phenomenon of observation for which it was then a matter of discovering the explanation, but rather as the consequence of a profound natural affinity which was of the order of the
ir secret nature. Willis does not cite a single case of alternation which he had occasion to observe; what he first discovered was an internal relation which engendered strange metamorphoses: "After melancholia, we must consider mania, with which it has so many affinities that these complaints often change into one another": it happens, in fact, that the melancholic predisposition, if aggravated, becomes frenzy; frenzy, on the contrary, when it decreases and loses its force, finally grows calm and turns to melancholic diathesis. A rigorous empiricism would see two related diseases here, or even two successive symptoms of the same disease. However, Willis does not pose the
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problem in terms of symptoms nor in terms of disease; he merely seeks the link connecting two states in the dynamics of animal spirits. In the melancholic, we remember, the spirits were somber and dim; they cast their shadows over the images of things and formed a kind of dark tide; in the maniac, on the contrary, the spirits seethed in a perpetual ferment; they were carried by an irregular movement, constantly repeated; a movement that eroded and consumed, and even without fever, sent out its heat. Between mania and melancholia, the affinity is evident: not the affinity of symptoms linked in experience, but the affinity—more powerful and so much more evident in the landscapes of the imagination—that unites in the same fire both smoke and flame. "If we can say that in melancholia, the brain and the animal spirits are obscured by smoke and a dense vapor, mania seems to ignite a kind of conflagration hitherto muffled by them." The flame in its rapid movement dissipates the smoke; but the smoke, when it falls back, smothers the flame and extinguishes its brightness. The combination of mania and melancholy is not, for Willis, a disease; it is a secret fire in which flame and smoke are in conflict; it is the vehicle of that light and that shadow.
Madness and Civilzation ( A History of Madness) Page 14