from Faulks, Sebastian. Human Traces. London: Vintage Books, 2006. pp. 102-105.
". . . Next to Chiarugi, he placed a copy of Johann Reil's Rhapsodies of the Psychological Method of Cure in Mental Alienation [1803] , the first book, as far as he knew, to have stated that madness was not a supernatural visitation, but an affliction of the tissues of the brain, in a way that pneumonia is an ailment of the lung, no less physical for being invisible. Next to that he placed Traité medico-philosophique sur l'aliénation mentale [1801] by the Frenchman Philippe Pinel, who was known even to the dreamy undergraduates in Thomas's lectures as the man who 'struck the chains from the lunatics' at the Bicêtre hospital and I the Salpetrière in Paris. Thomas's professor had pointed out that Pinel had in fact replaced the chains with straitjackets and that his real contribution was to have believed that lunatics with periods of lucidity were curable.
In any event, there was something else Pinel had written that was of particular interest to Thomas because it seemed to have a bearing on the plight of Jacques's brother, Olivier. Pinel had noticed a particular group of symptoms that first afflicted young people, between puberty and adulthood; he seemed to have sensed, without stating it clearly, that this might be a distinct disease entity, and Thomas was convinced by what he had seen in the asylum that a large number of patients, particularly those demented and hearing voices, were suffering from what — for lack of any other term — he and Jacques had come to call 'Olivier's disease'.
On this point, Thomas was also excited by the writing of an English alienist, John Haslam, a medical officer at Bethlem. In Observations on Insanity [1810] , Haslam reported how he carried out post mortem inspections of twenty-nine Bethlem inmates and found that the lateral ventricles of the brain were noticeably larger than normal; he filled them with measured spoonfuls of water to prove it. If such physical phenomena could be shown by a teaspoon and a naked eye, Thomas thought, what might more advanced techniques not show? What, indeed, did Olivier's brain look like?
Had Sonia been able to see the care and respect with which Thomas shelved his small library, her anxieties for him might have been allayed. His own mind had been so inflamed by enthusiasm that he was almost immune to weariness; he felt the pity of what he saw about him in the asylum, but it did not touch him with despair; it inspired him: the slavering, the shouting and the shipwreck drove him on. Next to Haslam, he placed the three volumes of Des maladies mentales, published by Pinel's pupil, Jean-Etienne Esquirol, in 1838. Esquirol had become master of the asylum at Charenton, a place of cultivated gardens, billiards, dancing parties, tender nursing and something approaching douceur de vivre, from which patients had been sent home cured. Here, just outside Paris, the rising arc of enlightenment had seemed most exuberant.
Next to Esquirol, in the middle of the shelf, in a place of honour, Thomas placed Die Pathologie und Therapie der psychischen Krankheiten, the book most admired by the other alienists he had met. Its author, Wilhelm Griesinger, [1817-1868] was a physician who insisted that, since lunatics suffered from a disease of the body in nerve and brain, psychiatry must become part of medicine as a whole. The training he devised bore out his belief: one of his student psychiatrists was instructed, in mid-tuition, to intervene in a complicated labour causing concern in the obstetric ward next to the lecture hall. Thomas had read Griesinger in Heidelberg; even with dictionaries to hand, he found the prose extremely difficult to understand, but all the students he had met in Germany knew by heart Griesinger's battle cry that psychiatry must emerge from its hermetic life as a kind of guild and become an integral part of medicine. Thomas was considerably irritated to discover, on his return home, that the book had been translated into English more than a decade earlier.
These were his heroes, respectfully shelved; but now psychiatry was in need of a new one. While he sincerely believed that there was a rapid increase of knowledge and a growing consensus of the wise. it had to be admitted that there was an insidious and growing counter-movement. The setting-up of public asylums in France and Britain had brought welcome seclusion to many and had ended the use of chains and irons; but before long the huge buildings had come to falter under the mounting weight of numbers — from the jabbering multitude for ever at the gates. The trouble was that although the pioneering writers had humanely and beautifully described the problem, they had not found any cures. While Griesinger and the scholars scratched their heads, while they pored corpses on the slabs, observed their patients and puzzled at the wondrous meeting of thought with cell, there came into being an alternative philosophy whose main tenet was simple: in the absence of cures, there can only be management. Such a brutal belief naturally did not need volumes to articulate itself, Thomas thought, because it found its purest expression in McLeish's bookless shelves.
The last volume he put away epitomised the urgent need for rapid advance. The Physiology and Pathology of Mind [1867] by Henry Maudsley argued that lunacy was passed on from generation to generation; that characteristics not only inborn but acquired by a parent could be transmitted to a child and that the mentally ill were therefore part of a process called 'degeneration'. As such, they were to be viewed as a waste product of healthy evolution and were fit only for excretion. Maudsley doubted whether asylums helped to cure patients and pointed out that many became better only when they were released; he thought sedation by narcotics not much better than imprisonment by ball and chain, and concluded that psychiatrists were well advised merely to watch and learn until such time as they were in possession of more information about their subject.
Maudsley was right about the need for further observation. Thomas thought, the need to study the whole length of a disease from childhood to post-mortem; but such work needed time, and time was what a medical officer in a giant asylum never had. On the contrary, he had to rush and grasp at any evidence he could find in the rooms that opened off the reeking corridor. What laboratory conditions, Thomas thought. What carnival of delusion and inconsequence. What temptation to despair. A symptom that occurred in two people might be the central diagnostic point of the illness in one, and incidental in the other. Without time, though, how would he ever tell?
He relied on certain facts and insights provided by the authorities whose books he treasured and, to support them, he depended, to an extent he admitted was undesirable, on instinct. In the confusion and the headache, there were patterns, he was sure, and he could occasionally see them. There was, for a start, such a thing as Olivier's disease. He could predict how those afflicted by it would behave and report their symptoms; there were common, recurring factors that gave it a profound identity. A young German called Kahlbaum had also noticed the group of symptoms and called it 'hebephrenia', or young madness. How it was to be cured, though, he could not say.
Then, thought Thomas, there was the case of the warship inventor, whose wife was such a friend of Gladstone and who daily expected a letter from the Queen. These symptoms were also predictable, consistent and apparently separable from other kinds of madness; they formed a stage in the general paralysis of the insane, which had been noted by Haslam and Esquirol many years before; some thought the source of the illness appeared to lie in youthful debauchery and use of prostitutes, and that it might be related to physical symptoms of syphilis earlier in life; but how it entered the mind was impossible to describe . . . .”
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