EPILEPTIC INSANITY. By R. H.
Firth, F.R.C.S., Eng.,
Surgeon, Army Medical Staff, Amritsar. In the English papers lately has appeared the report of the trial of a man named Patrick, who, with great violence and, apparently, from inadequate motive, and without secrecy murdered This case attracted considerable his mistress. attention in English medical circles at the time, owing to the condemnation of the prisoner to death when there were strong grounds for presuming that the unfortunate man was an epileptic. Subsequent investigation having beeu made, the sentence was commuted to penal servitude. It is notorious that the general public, and also a number of medical men do not sufficiently understand the often peculiar homicidal phenomena displayed by persons at times who are the subject of epileptic seizures. Psychologists have long recognised a special group of symptoms, which may be termed Epileptic Insanity. Personal experience as a clinical assistant in Bethlehem Hospital, London, gave me many opportunities of observing several such It is an uncases who were in that asylum. doubted fact that epilepsy sometimes produces
mental derangement
On account of its character, this is forms of insanity.
of a most furious kind. violent and destructive one of the .most dangerous The excitement or mania
EPILEPTIC INSANITY.
April, 1886.]
Ill
may last ti few minutes, a few hours, or a few days; it then subsides, and the person coming to himself again appears as sane and rational as ever. During the intervals between these maniacal paroxysms the individual is calm and sensible. This disease is met in varying degrees of severity. With the first few seizures there may be mental derangement, but later, when disease has lasted somewhile loss of memory or mental weakness occurs, then gradually passing on, in the worst cases, to actual dementia. One may group epileptics into three classes: (a) Those in whom the fits are well masked, and followed by maniacal excitement. (b) Those in whom the epilepsy is masked, and in whom a passing mental aberration occurs in place of the usual convulsive seizure. (c) Those in whom the homicidal mania occurs before the fit or convulsive seizure conies on. The first class is, I believe, the common one. In the second class instead of the morbid action affecting the lower or motor centres (convulsions), it seizes the higher or mental centres (mania), the phenomena being really an epilepsy of mind. In the third class we find that before the onset of a fit, a notable change takes place in the demeanInstead of being amiable our of the individual. and gentle, he is sullen, suspicious, and irritable. One sees this class commonly in asylums. With this moral perversion, all kinds of hallucinaIn due course the convultions are associated. sion occurs, then the mental cloud passes off, and the patient resumes his usual manner until the next moral change comes on, as the harbinA point to be borne in mind ger of another fit. is this, that epileptic insanity, marked by irritability, moroseness, and moral perversion may occur in periodical attacks, months or years beIt is in such fore a true fit may declare itself. conditions of mind too that murders have been committed, and the criminal never suspected to The mental symphave been an epileptic. toms in epilepsy are worthy of some consideration. They may be placed under four heads: or pre-runners. Prodromata (2) Mental (1) symptoms of epileptic vertigo or "petit mal." (3) Violent symptoms, regular convulsions or "grand mal. " (4) Mental decay and epileptic dementia. In the group of prodromata we meet with moroseness,irritability, dulness, enfeebled memory, and confusion of ideas; whilst in some cases Ave find gaiety ,loquacity, &c., which contrast strongly with their normal apathy. In some cases the same ideas, hallucinations,and recollections recur before the attack. These varying mental symptoms would seem to be at times really part of the attack (and not prodromata), and would indicate that the higher centres (mental) are disturbed before the lower ones (motor), and are similar to the "auraj" so graphi-
incomplete epilepsy.
In the second division
Insanity, April
cally described sometimes by we
some
epileptics.
have the abortive
or
In these cases no convulsion occurs, and no complete unconsciousness takes place. A mere momentary terror, a confusion of ideas, or a passing muscular spasm may be the only symptom. When in this peculiar state, the person often speaks and acts as though he were really in his normal state, and not until the attack has passed off and he really is recovered, are we able to tell by the total absence of recollection of all that has gone before, that the patient was not in his normal state of reason. This apparently normal state of reason in which the individual answers questions, makes remarks, and acts, may last for hours or days.* The epileptic in this condition is like the somnambulist, who perceives objects only in so far as they are connected with the ideas in his mind at the moment. This peculiar state of consciousness and yet unconsciousness is important in its bearing on responsibility for actions done. An individual in this anomalous state of mind does deeds of which he has no recollection when in his normal state of mind. For these he can hardly be held responsible. The true " petit, mal " is a confusion of ideas, often accompanied by a remarkable impulse to commit violence. These unfortunates are usually sad and distressed, irritable, suffer from loss of memory, and cannot fix their thoughts, and are impelled to violent deeds by a power which they cannot resist. The state of these unfortunates is truly terrible. We sane ones cannot thoroughly realise this peculiar mental state. Our best effort to do so is when we recall our state when dreaming some awful dream. These poor epileptics vainly endeavour to escape from the painful ideas which dwell in, and prey upon their minds day after day. Incapable of even the hope of relief, how narrow the gulf which separates them or keeps The third divithem from murder or suicide. sion or epileptic mania is a mania of a most furious nature. It differs from all other forms by the suddenness of its onset. It has none or If any, they are headfew warning symptoms. ache, brilliancy of the eyes, change of voice, slight tremors, sadness, irritability or exciteOne attack resembles another in its ment. The fury of these patients is warnings. and such patients are the terror of an extreme, asylum. The mania is usually short in duration, and generally leaves no recollection of what has taken place. In the fourth group we have the effects This impairs and of long-continued epilepsy. weakens the mind, then comes failing memory, The foregoing are and finally actual dementia. the common symptoms of epileptic insanity, but *
Echeverria
on Violence of 1873.
Epileptics
in Journal of
THE INDIAN MEDICAL GAZETTE.
112
only ones : others of varying with, more particularly exaggerated religious sentiment, by which visions are seen, and announcements from 011 high heard. It is important to remember how epilepsy by
means
110
degree
are
the
met
in persons for a long time medical men. Attacks of often so slight as to be put down to faintness, &c., &c. It is probable that many cases of so-called transitory mania are really due to epilepsy in some form or other. The deductions to be drawn from consideration of these points is that in cases of epileptic or automatic homicide, we must not insist that in every case actual convulsions occurred : for it may be a case of masked epilepsy. One cannot by special features identify an epileptic homicide 011 every occasion, but strong presumptive evidence of its being so will be absence of intelligible motive, absence of premeditation, ferocity in execution, an absence of secrecy, or concealment, absence of remorse, and incomplete remembrance of all the circummay
be overlooked
by experienced epileptic vertigo are
even
stances.
Transitory mania is often accompanied by Given homicidal and destructive tendencies. a sufficient exciting cause, and transitory mania will occur in those of the insane neurosis, just as with cause, epileptic mania will occur in those of the epileptic neurosis. No doubt can exist as to the irresponsibility of a person who commits a crime when labouring under an attack of epileptic mania, provided satisfactory evidence exists as to the actual of the attack. If the paroxysm be occurrence short, then difficulty arises ; coming on and passing off rapidly, it might be overlooked. However, in conclusion, if in presence of sufficient exciting cause acting on one who has not either the insane or epileptic neurosis, or head injury 011 one in whom there has been no sufficient to affect the mind, or 011 one in whom no previous history of insanity exists, then I hold that the bringing forward of an allegation of transitory mania as an excuse for crime is .not admissible, and must not be entertained ; whilst, 011 the other hand, cases of true epileptic transitory mania demand our closest scrutiny, sympathy, and support, particularly when the subject of judicial investigation. There is only too much cause to fear that many a criminal has been hurried to his last sleep for deeds done, when he was really irresponsible for his actions. It is to the medical profession alone that the public can look for guidance in these difficult cases, and for justice to be done to the unfortunate criminals, for whom the rigidity of the law allows so little loophole of escape.
[April,
1886.
Firth, F.R.C.S., Eng.,
Surgeon, Army Medical Staff, Amritsar. In the English papers lately has appeared the report of the trial of a man named Patrick, who, with great violence and, apparently, from inadequate motive, and without secrecy murdered This case attracted considerable his mistress. attention in English medical circles at the time, owing to the condemnation of the prisoner to death when there were strong grounds for presuming that the unfortunate man was an epileptic. Subsequent investigation having beeu made, the sentence was commuted to penal servitude. It is notorious that the general public, and also a number of medical men do not sufficiently understand the often peculiar homicidal phenomena displayed by persons at times who are the subject of epileptic seizures. Psychologists have long recognised a special group of symptoms, which may be termed Epileptic Insanity. Personal experience as a clinical assistant in Bethlehem Hospital, London, gave me many opportunities of observing several such It is an uncases who were in that asylum. doubted fact that epilepsy sometimes produces
mental derangement
On account of its character, this is forms of insanity.
of a most furious kind. violent and destructive one of the .most dangerous The excitement or mania
EPILEPTIC INSANITY.
April, 1886.]
Ill
may last ti few minutes, a few hours, or a few days; it then subsides, and the person coming to himself again appears as sane and rational as ever. During the intervals between these maniacal paroxysms the individual is calm and sensible. This disease is met in varying degrees of severity. With the first few seizures there may be mental derangement, but later, when disease has lasted somewhile loss of memory or mental weakness occurs, then gradually passing on, in the worst cases, to actual dementia. One may group epileptics into three classes: (a) Those in whom the fits are well masked, and followed by maniacal excitement. (b) Those in whom the epilepsy is masked, and in whom a passing mental aberration occurs in place of the usual convulsive seizure. (c) Those in whom the homicidal mania occurs before the fit or convulsive seizure conies on. The first class is, I believe, the common one. In the second class instead of the morbid action affecting the lower or motor centres (convulsions), it seizes the higher or mental centres (mania), the phenomena being really an epilepsy of mind. In the third class we find that before the onset of a fit, a notable change takes place in the demeanInstead of being amiable our of the individual. and gentle, he is sullen, suspicious, and irritable. One sees this class commonly in asylums. With this moral perversion, all kinds of hallucinaIn due course the convultions are associated. sion occurs, then the mental cloud passes off, and the patient resumes his usual manner until the next moral change comes on, as the harbinA point to be borne in mind ger of another fit. is this, that epileptic insanity, marked by irritability, moroseness, and moral perversion may occur in periodical attacks, months or years beIt is in such fore a true fit may declare itself. conditions of mind too that murders have been committed, and the criminal never suspected to The mental symphave been an epileptic. toms in epilepsy are worthy of some consideration. They may be placed under four heads: or pre-runners. Prodromata (2) Mental (1) symptoms of epileptic vertigo or "petit mal." (3) Violent symptoms, regular convulsions or "grand mal. " (4) Mental decay and epileptic dementia. In the group of prodromata we meet with moroseness,irritability, dulness, enfeebled memory, and confusion of ideas; whilst in some cases Ave find gaiety ,loquacity, &c., which contrast strongly with their normal apathy. In some cases the same ideas, hallucinations,and recollections recur before the attack. These varying mental symptoms would seem to be at times really part of the attack (and not prodromata), and would indicate that the higher centres (mental) are disturbed before the lower ones (motor), and are similar to the "auraj" so graphi-
incomplete epilepsy.
In the second division
Insanity, April
cally described sometimes by we
some
epileptics.
have the abortive
or
In these cases no convulsion occurs, and no complete unconsciousness takes place. A mere momentary terror, a confusion of ideas, or a passing muscular spasm may be the only symptom. When in this peculiar state, the person often speaks and acts as though he were really in his normal state, and not until the attack has passed off and he really is recovered, are we able to tell by the total absence of recollection of all that has gone before, that the patient was not in his normal state of reason. This apparently normal state of reason in which the individual answers questions, makes remarks, and acts, may last for hours or days.* The epileptic in this condition is like the somnambulist, who perceives objects only in so far as they are connected with the ideas in his mind at the moment. This peculiar state of consciousness and yet unconsciousness is important in its bearing on responsibility for actions done. An individual in this anomalous state of mind does deeds of which he has no recollection when in his normal state of mind. For these he can hardly be held responsible. The true " petit, mal " is a confusion of ideas, often accompanied by a remarkable impulse to commit violence. These unfortunates are usually sad and distressed, irritable, suffer from loss of memory, and cannot fix their thoughts, and are impelled to violent deeds by a power which they cannot resist. The state of these unfortunates is truly terrible. We sane ones cannot thoroughly realise this peculiar mental state. Our best effort to do so is when we recall our state when dreaming some awful dream. These poor epileptics vainly endeavour to escape from the painful ideas which dwell in, and prey upon their minds day after day. Incapable of even the hope of relief, how narrow the gulf which separates them or keeps The third divithem from murder or suicide. sion or epileptic mania is a mania of a most furious nature. It differs from all other forms by the suddenness of its onset. It has none or If any, they are headfew warning symptoms. ache, brilliancy of the eyes, change of voice, slight tremors, sadness, irritability or exciteOne attack resembles another in its ment. The fury of these patients is warnings. and such patients are the terror of an extreme, asylum. The mania is usually short in duration, and generally leaves no recollection of what has taken place. In the fourth group we have the effects This impairs and of long-continued epilepsy. weakens the mind, then comes failing memory, The foregoing are and finally actual dementia. the common symptoms of epileptic insanity, but *
Echeverria
on Violence of 1873.
Epileptics
in Journal of
THE INDIAN MEDICAL GAZETTE.
112
only ones : others of varying with, more particularly exaggerated religious sentiment, by which visions are seen, and announcements from 011 high heard. It is important to remember how epilepsy by
means
110
degree
are
the
met
in persons for a long time medical men. Attacks of often so slight as to be put down to faintness, &c., &c. It is probable that many cases of so-called transitory mania are really due to epilepsy in some form or other. The deductions to be drawn from consideration of these points is that in cases of epileptic or automatic homicide, we must not insist that in every case actual convulsions occurred : for it may be a case of masked epilepsy. One cannot by special features identify an epileptic homicide 011 every occasion, but strong presumptive evidence of its being so will be absence of intelligible motive, absence of premeditation, ferocity in execution, an absence of secrecy, or concealment, absence of remorse, and incomplete remembrance of all the circummay
be overlooked
by experienced epileptic vertigo are
even
stances.
Transitory mania is often accompanied by Given homicidal and destructive tendencies. a sufficient exciting cause, and transitory mania will occur in those of the insane neurosis, just as with cause, epileptic mania will occur in those of the epileptic neurosis. No doubt can exist as to the irresponsibility of a person who commits a crime when labouring under an attack of epileptic mania, provided satisfactory evidence exists as to the actual of the attack. If the paroxysm be occurrence short, then difficulty arises ; coming on and passing off rapidly, it might be overlooked. However, in conclusion, if in presence of sufficient exciting cause acting on one who has not either the insane or epileptic neurosis, or head injury 011 one in whom there has been no sufficient to affect the mind, or 011 one in whom no previous history of insanity exists, then I hold that the bringing forward of an allegation of transitory mania as an excuse for crime is .not admissible, and must not be entertained ; whilst, 011 the other hand, cases of true epileptic transitory mania demand our closest scrutiny, sympathy, and support, particularly when the subject of judicial investigation. There is only too much cause to fear that many a criminal has been hurried to his last sleep for deeds done, when he was really irresponsible for his actions. It is to the medical profession alone that the public can look for guidance in these difficult cases, and for justice to be done to the unfortunate criminals, for whom the rigidity of the law allows so little loophole of escape.
[April,
1886.
