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a state of healthy activity, is turned to other portions of the system. The blood-supply of these parts, which is also essential to the discharge of the usual amount of physiological functions, has become greatly lessened. In short, the same law holds true in reference to elements and areas of the brain which pertains to those of any other portion of the system, viz., that when an organ or element ceases to functionate, or largely diminishes its usual amount of function, it speedily tends to become weaker, and after a longer or shorter time becomes incapable of use.

In seeking to restore the mind to its normal action, it will, therefore, be of the first importance to improve the circulation in the regions of these associated fibres and tracts of the brain, and also to increase the nerve energy to a normal standard. Now one of the most effectual means of securing this is by bringing into increased activity the various muscles of the trunk and extremities. Exercise of almost any portion of the muscular system is attended with an increase of heart action, and consequent movement of blood, not only toward the parts more immediately concerned in the special action, but also toward the brain centres. The increased blood supply tends to enrich these nerve elements and restore the flow of nervous energy to them, and thus the two primary conditions for improvement are supplied.

Moreover, exercise in the way of muscular movement in various directions tends to interest and engage the attention, though the patient may not fully realize this himself. Indeed, it will often prove quite impracticable for one to remain in a class of six or ten persons, and observe the various movements of the bodies and extremities, which should always be timed to the music of some instrument, and not have the attention roused and the curiosity excited. In the majority of the class of patients now under consideration, the brain centres have not become so insensible to external stimuli that they will not respond. When witnessing almost any kind of symmetrical movement accompanying the sound of music, there exists in nearly all persons a strong tendency to join in the movement, and they find it difficult not to beat time automatically with foot or hand when merely listening to music.

Now I suggest that this tendency which exists in nearly every one to join in the movements of time and music be made use of with the class of patients I have been considering, as one of the most effectual means of rousing the brain centres to a larger measure of healthy activity. A few movements for a short time at first, and slowly increased as to variety and length of time, will soon increase the power of attention, which is the most essential point. This gained, other and more diversified forms of activity will lead to further increase of mental power.

These suggestions are in accordance with what has been found to be true of the brains of many of the chronic insane, which have remained in a semi-dormant condition for a long time. By means of associated labor they have been enabled to hold the attention for longer periods upon work, and mental operations have been improved. Practically there will be found almost no difficulty in influencing a large per cent. of chronic patients to join with others in any form of work they may be capable of doing, simply by placing them in the company of others who are so engaged.

The patient who will continuously and persistently refuse to join with others when engaged in some form of physical exercise or occupation, and at the same time remain with several others so employed, and with whom he is accustomed to associate, is the exception.



DELUSIONS. Beliefs Dependent upon Education-Definition of Insane Delusion—Ætiology -Diminution or Excess of Nerve Energy-Thought Elements of Ireams - The Character of Delusions Dependent on-Cases—May be either Expansive or Depressive in Character - May be Transient and Imperfectly Organized or Enduring and Quite Fully Organized—Illustrative CasesOther Elements of Insanity-Excitement—Depression-Incoherence-Excess and Defect in Inhibition—Impairment of Memory and Will Power.

Delusions are False Beliefs. Hallucinations are false perceptions. The first pertain to and grow out of the psychical functions of the brain ; the second depend upon the sensorial and psychical ; both may, and sometimes do, exist in cases of sanity. Additional descriptive elements of definition therefore become necessary in order to properly differentiate an insane delusion.

First, it is important to distinguish between merely superstitious beliefs and insane delusions. There are few beliefs so absurd that they may not find lodgment in the brains of the ignorant, especially if they are regarded as having a religious character. Multitudes are yearly found who readily embrace ideas and beliefs which appear to be unsupported by evidence to ordinary minds, and evince the sincerity of their convictions by renouncing former modes of life, leaving family and friends for new homes and untried experiences. An announcement is made that an angel has been seen by a child in some locality, and thousands flock together from long distances to see the place where the heavenly vision is said to have appeared.

The mother in India believes it to be her duty to throw her newly-born babe into the Ganges, that she may perform a service acceptable to the gods which she worships. During the 16th and 17th centuries the belief in witches was very prevalent throughout Europe and to some extent in America. It is probable that many thousands were put to death in consequence of this belief, which had little other basis than a disordered motor activity in some cases and ignorance in others, and yet those in authority thought they were doing God service.

As the character of beliefs depends largely upon the state of civilization and the quality of education existing in any society, it would be difficult to name one which would, under all conditions, be distinctly an insane delusion, or an act growing out of such belief which would in all cases be regarded as an insane act. In determining whether false beliefs are insane delusions, therefore, it is essential to consider them in their relation to the antecedents of the individual professing them, the conditions of society in which he lives, and the degree of civilization with which he has been surrounded. A delusion, or an act growing out of it, might be an almost certain indication of insanity in one person, while in another it would have no such decisive indication.

Again, beliefs in a state of health, whether delusions or not, usually arise from impressions acting upon the brain from without; on the other hand, an insane delusion always arises from within, that is, from the operation of disordered brain centres. Persons are rarely argued into insane delusions, or out of them; they arise in consequence of a deranged psychical activity, and cease to exist only when this becomes changed or passes into a normal condition.

The peculiarity, absurdity, or falsity of any belief, therefore, is not necessarily a test of its nature. This must be determined by a careful study of, first, the person's past mental character and those influences which have been in operation to affect it, and, second, the method of its formation and advent.

Definition 1: Insane delusion may be defined as a belief in that which has no foundation in fact, is at variance with the person's past mental history, and of the falsity of which he cannot be permanently convinced by any kind of evidence.

Definition 2: “Insane delusion is a belief in something that would be incredible to sane people of the same class, education, or race as the person who expresses it, this resulting from diseased working of the brain convolutions." (Clouston.)

Many persons have delusions who are not insane, and conversely, some insane persons do not have delusions. Nevertheless, it is true that the majority of the insane have delusions during some period of the disease. So generally is this the case that they become one of the most important elements of insanity.

Still, it should be borne in mind that delusions do not constitute insanity, nor, vice versa, is insanity delusion.

Any special delusion which may arise in the brain hemispheres constitutes simply an evidence, so far as it goes, of a disordered process of cerebration.

This disordered process may or may not ultimately eventuate in numerous delusions, or in some or all of the other mental processes to which allusion has been made on previous pages as constituting elements of insanity. The essential fact to be realized is that the brain is disordered in its process of functionating, and that the delusion may be merely a symptom of this fact.

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