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2. The Moral Philosophers
Francis Bacon was born in London on 22 January 1561. He was educated at Trinity College, Cambridge, and later studied law at Gray's Inn. In 1603 he was knighted, became King's Counsel in 1604, Solicitor-General in 1607, Attorney-General in 1612, Privy Councillor in 1616. The following year he was appointed Lord Chancellor and raised to the peerage. He was charged with bribery in 1621 and in 1622 was barred from sitting in Parliament. He was pardoned in 1624 but devoted his time thereafter to literature, dying in 1626. He divided human learning into three parts: History, which answers to memory; Poesy, which answers to imagination; and Philosophy which answers to reason. The part of his work which concerns mental illness was contained in the Human sub-division of Philosophy. The problems of the people who were adjudged to be mad were that many, if not most, of the practitioners of the day had determined that mental illness was either the result of organic disease or the punishment of God. Bacon prompted research and he wrote in Book Two of his Advancement of Learning that there should be a study of the mental faculties, in order that one might find their origins in the brain, how they were affected and their relationship to the body. He believed that an indepth study of the individual cases was essential but his views in this respect were not followed to any great extent until the end of the eighteenth century. Bacon encouraged a study of anatomy (post mortem) so that findings could be related to the original symptoms where possible. Quite strikingly, in addition to these very forward looking steps, he suggested something even more avant-garde for his time, what now is referred to as social psychiatry, the understanding of the relationship between the individual and the society in which he lived. Sir Kenelm Digby was a Fellow of the first Council of the Royal Society, a gentleman scientist who died in 1665. He dealt with all categories of natural phenomena, and in amongst his writings on these are recorded medical and psychological topics. Two of the most interesting of these was his understanding of conditioning and folie à deux. His work on conditioning stemmed from an interest in antipathy, or aversion. He showed that animals which as adults would normally attack another species instinctively could be conditioned against this by being brought up together with one of the other species from birth. He transferred this idea into helping those whose lives were affected by fantasies or delusions by dint of using suggestibility as a means of converting their aversion. His consideration of folie à deux where one person's actions or beliefs are transmitted to another by the power or the force of the originator’s personality was stimulated by his knowledge of a particular woman who had lost her husband and was in a deep sadness as a consequence. She
had four or five women with her as servants or relatives, and her mood was transmitted to them. He caused these women to be removed from the situation and they all recovered. This type of reaction is seen today in a variety of situations, not least in that of the religious sects where a leader is sufficiently charismatic that he can persuade many followers of his beliefs and thereby convince them of the righteousness of particular actions which otherwise they would not contemplate. This may extend to such activities as crime and sexual deviation. It appears that there was as much a need for psychotherapy four hundred years ago as there is today. These early believers in the need for those who could cure the illnesses of the mind indicated a situation that has not reduced over the intervening time. Descartes [1596-1650] the French philosopher, in searching for an understanding of the mind and soul of man, the fundamental differing factor which he and others believed separated man from the animals, gave the seat of the soul a location in the pineal gland. This was turned to again in the twentieth century when this gland began to utilise for extractions from it in the treatment of schizophrenia. If used in children it causes sexual precocity and a cessation of normal growth throughout the body. Richard Sibbs [1577-1635], who was almost a contemporary of Descartes, believed that the conflict between good and evil created ‘the soules disquiet’ and caused ‘the whole man’ to become ‘distempered’. He also believed that fantastic imaginations could, in some persons, have the same effect as if they were true. It was only a small step for him then to offer the explanation that a wicked man will always have a troubled soul, and that this would lead to maladies within the body and insanity of the mind. Thomas Hobbes another philosopher of the same period studied the connections between man's senses, imagination, speech, reason passions and virtues. In other words his intellectual attributes. Later these ideas were developed by John Locke and David Hume. Still later Freud discovered in free association a means of tracing the workings of the unconscious mind and its connections with conscious thought and action. Ralph Cudworth an intellectual was concerned that the improvements in scientific knowledge that were being made during his time might make his God somewhat redundant. As an adjunct to this thesis (1678) he set out to show that mental activity was not a part of 'express consciousness', and continued for instance during sleep. He also was at pains to point out that the vital activities of the body carried on without any input from consciousness and were entirely involuntary. [It wasn't until 1751 that there was an understanding of autonomic systems and reflex action; and almost another hundred years' later that unconscious cerebral activity was demystified.]
Robert Hooke, a scientist, became involved in early psychiatry in two very different ways. He designed the new Bethlem Hospital which opened in Moorfields in 1676, and which remained in use there until 1815. He also investigated the concept of how we understand the notion of time. His interest was not in the states of mind — he had a more dynamic involvement, and he showed that our sense of time comes from memory which is built up from the significant associations between our involvements and ideas. From his understanding that memory can be destroyed by diseases he concluded that memory must be located in a particular part of the brain. Hooke was also one of the first western scientists to draw attention to the properties of Indian hemp or marihuana which he found, ‘seemeth to put man into a dream’. He thought it might be of use for lunatics but this suggestion was not taken up. Later it was used during WW II, for dealing with neurasthenia (battle shock), for the purposes of a drug induced abreaction. The philosophers who were thinkers rather than practitioners contributed much to the reasoned approach to mental illness. One of these was Thomas Tryon who wrote, A Treatise of Dreams and Visions in 1689, followed by a second edition in 1695. This contained a sensible and advanced psychological explanation of what might now be called the breakdown of ego function. Tryon was very critical of the physical treatments that were used on the mentally ill patients of his day such as the techniques of blood-letting, and the 'stupefactive medicines'. His contention was that, ‘madness and frenzie arise from the extreme passions such as: love, hate, grief, covetousness, despair, all of which destroy the senses of the soul; so that it loses its distinguishing and imaginative property, becoming unconfined of the grosser senses, even as in dreams’. In other words there is loss of judgement and the cortical control is to some extent lost. There had been established at Bethlem Hospital a routine of raising money by the admission of the general public for ‘sight-seeing’ trips. This was denounced by Tryon, despite the fact that it brought substantial revenue to the hospital. John Locke who is known mainly as a philosopher was also a physician as well as a diplomatist. In 1690 he published his work, An essay concerning humane understanding. Two of the more important areas covered by this work were concerning the distinction between 'idiots and madmen' and ideas about psychological complexes. Locke understood the ‘natural’ defects that separated fools from the acquired unreality of the madmen. The fools he saw as lacking reason, whilst the madmen who, not having lost reason, put together ideas in a mistaken logic accepting their fantasies as truths. They put wrong ideas
together to make false propositions, whilst the idiots made few if any propositions and rarely reasoned at all. Locke came to the view that an emotional reaction could be developed without the person knowing how this had come about. He separated out the reactions that come from reasoning from those that come involuntarily. He made the important suggestion that children should be carefully watched during their formative years to ensure that their ideas and understanding were matched to reality and morality. He pointed to the maladjustment of children brought about by the effects of adults who caused them to follow activities of body or mind that would later bring them pain and misunderstanding Whilst all of us are probably familiar with Robert Boyle and his laws of physics, many will not realize that he was also a natural philosopher who wrote a great deal on medical matters. He turned his mind to the curiosities of medicine, and the unusual methods of treating them. He pointed to incidents where shock brought about conditions such as a stroke; and others where, rather than harm, improvement or cure was the outcome. He was also careful to advise that particular conditions did not always produce the same signs in different people, and likewise the same signs did not always point to the same condition. Thus he tried to move people away from negative thoughts that might contribute to hypochondriasis. A further attempt to help people was to advise them against self-medication when they did not understand the potions they were using. This tendency was of course consistently rife right up to the onset of the NHS and even beyond. Some drugs have been specifics for insanity and nervous diseases for centuries. None of these lasted longer than camphor which was in use for over a thousand years. Even then its action (in large doses) which produced epileptiform convulsions was simulated through the use of metrazol and later still electric shock treatment. Another philosopher who contributed developmental approaches to psychiatry was David Hartley, one time of Newark, Bury St Edmunds, London and Bath. In his Observations on man, his frame, his duty, and his expectations, published in 1749 he put forward a theory of mental organisation and behaviour patterns which took in some aspects of Locke's association of ideas with Newton's thoughts on the flow of nervous impulses in a movement akin to fluidity. He seemed to understand that the flow of impulses went through what we now know as neural circuits, and that this applied regardless of whether the brain was normal or changed by disease or affection. His view was that the mentally ill differed from normal because they misunderstood past or future facts of a common nature in a way that separated from others in similar situations. This he noted affected their happiness, memory and discourse; and the connective consciousness was impaired. He suspected that the poor judgement of children and
idiots, the dotage of old people, drunkenness, deliriums, reoccurrence of ideas, violent passions, melancholy and madness were all connected to an imperfection of reasoning. He considered madness to be due to either physical cause (i.e. bodily) or mental. The former he determined was due to disproportionate passion or affection; the latter to the intervention of some process at a point when the bodily systems were lowered or attenuated by disease. Thus he tried to convince that cures for madness need attend to both the body and the mind. John Wesley the founder of Methodism and the promoter of spiritual welfare of the people was considerably interested and concerned for their physical well-being. He published Primitive Physick in 1747, The desideratum: or electricity plain and useful in 1760, and The Family Physician in 1769. In 1756 he had obtained an electrical treatment machine and propounded that some found it an immediate cure and others a more gradual one. He was quite remarkably forward in his thinking by suggesting that the pains and aches of the body may be caused by psychological factors. Despite the input to the science from the philosophers psychiatry is still probably as far behind the other branches of medicine as it was in the mid-eighteenth century. This despite the contributions of people like Thomas Reid, professor of philosophy at the University of Aberdeen, and later professor of moral philosophy at the University of Glasgow. In 1764 he published An inquiry into the human mind, on the principles of common sense. Prior to this, theoretical philosophy was directed towards the 'soul' and how it behaved, together with the senses of motion; imagination, reason and memory, together with an understanding of the relationship between passions and ideas. Reid pursued a different course which was more akin to that followed later by Bentham which we now know as dynamic psychology. His theory was gained from an understanding of how he perceived that his own mind worked. This structured analysis brought him to realize that the mind had an anatomy, as he saw it, 'as indispensable as that of the body'. A proper understanding of this required, in his view, 'a distinct and full history of all that hath passed in the mind of a child from the beginning of life and sensation'. It was probably not until Freud's time that such a clear understanding of this aspect of mental illness was again attained. Reid's understanding clarified certain aspects of inheritance and culture. It was already recognized that man had certain powers and courses of action that were not dissimilar to lesser species, but he drew attention to the advantage that man has in being able to nurture ideas and ideals. He pointed to the inherent difficulties that were present in the presentation of new ideas because as he wrote of the need to use, ‘new
words and phrases ... giving different meaning to those that are received ... which create prejudice and misconstruction, and which must wait the sanction of time to authorize ... Innovations in language ... are always suspected and disliked by the many, till use hath made them familiar, and prescription hath given them title’. A cousin of Reid, John Gregory, who was both a professor of philosophy and of physic as well as being physician to the King in Scotland, combined both the psychological and the medical approach to dealing with the affections of the mind. He advised that both these sciences should be combined and was very much against the theorisers. He attempted to bring about a more rational approach by the use of comparative psychological studies in order to gain a better understanding of human behaviour. This led much later to the introduction of the behaviouristic schools of psychology and the development of the idea that behaviour could be modified by conditioning probably first introduced by Sir Kenelm Digby in 1644. Gregory was also concerned about the ethical side of medical practice particularly that which involved those who were vulnerable because of mental illness. He drew attention to the 'physicians treating these complaints with the most barbarous neglect, or mortifying ridicule, when the patients can ill afford to fee them'. At the other end of the scale he commented on the way in which the well-off patients were treated, ‘...they foster them with the utmost care and apparent sympathy; there being no diseases in the stile of the trade so lucrative as those of the nervous kind’. Gregory overrode the idea that instinct was the prerogative of lesser species than man. Some had thought that mankind had been given the power of reason in order to negate what was seen as the lower power of instinct. Gregory underlined his belief that not only was this not the case but that instinct was or could be; ‘a sure and infallible guide; tho’ the depraved and unnatural state into which mankind is plunged often stifles its voice or makes it impossible to distinguish it from other impulses which are accidental or foreign to our nature’. Indeed he went further and suggested that reason was a weak principle in man compared to instinct, ‘and generally is a more unsafe guide’. He was quick to point out though that instinct should be carefully separated from 'those cravings which bad habits have occasioned'. He reflected on the way that medicine had fiddled with theories over the centuries, and prevailed upon his fellow practitioners to follow his edict. ‘...To cure the disease of the mind there is required that intimate knowledge of the human heart which must be drawn from life itself and which books never teach. Of the various disguises under which vice recommends herself to the imagination, the artful association of ideas which she forms there, the many nameless circumstances that soften the heart and render it accessible, the arts of insinuation and persuasion, the
art of breaking false association of ideas or introducing counter associations, and employing one passion against another; and when such knowledge is acquired the successful application of it to practice depends in a considerable degree on powers which no extent of understanding can confer.’ Another writer on instinct and a contemporary of Gregory was James Vere, a London merchant and a governor of Bethlem Hospital. His proposition was that the intellectual instincts of man can and should prevail over those basic instincts which man shares with the animals. However this potentially overriding power can be undone by what he called, ‘self-love and partiality’. He found that despite the ‘good order that providence has established’, man could be seduced by his affections so that the moral order was overcome which, ‘divides man against himself, and hence a large share of disquiet and restlessness will be the unavoidable consequence’. The diversionary conflicts were, according to Vere, ‘appetite or desire, and aversion or dislike’. When these are activated, ‘certain sensations will arise which are usually distinguished by the name of passions’. Thus anger, fear and grief may well be substituted for contentment. His belief was that whatever action man undertook there must come into play some contribution from the base instincts and he must therefore be aware of the need to temper any immodest intrusion with the full force of his conscience.