The President's Address to the Association of Medical Officers of Asylums and Hospitals for the Insane, on Thursday, July 5th, 1860

Extract

The new position in which you have done me the honour this day to place me, entails upon me the duty of passing in review the varied interests and difficult problems of social and medical science, which are necessarily involved in promoting that which is the primary object of this Association, the welfare of the insane. The welfare of the insane! What a world of interests does not this small phrase include; what questions of individual happiness or misery; what questions of the prosperity or ruin of families; what questions of morality and law, of religion and politics; in fine, does it not ‘inferentially include the welfare of the human race. From time when Nebuchadnezzar ate grass, the happiness of the human race has often been at the mercy of the not metaphorical insanity of its rulers; and how often does not madness in lower stations imperil all that is precious. A mad orator on the floor of the house, or in the pulpit, may do comparatively little mischief, for opinion breaks no bones; but madness in a man of action, in an admiral for instance who commits suicide in the heat of an engagement, or an engineer in charge of a railway train; to what fearful disasters may it not give rise? In the world there is nothing great but man, in man there is nothing great but mind, says Hamilton. How vast, how wonderful a subject of study, therefore, is mind, whether in its integrity, or its decadence and ruin, in its health or its disease! Mental physicians, are we pledged to devote ourselves to the contemplation, and, as far as may be, to the full appreciation of this great subject, that we may oppose decay, and relieve disease ? Would it were possible to prevent it! Mental hygiene is, indeed, a subject vast as that of human progress. The highest and lowest stages of human development, those of the savage and the practical philosopher, are, perhaps, almost equally free from this direst scourge of human pride; the one with passions undeveloped, the other with passions under subjection. But the line of progress from one to the other of these termini, is strewn with those who have fallen in their weakness to linger and to die. Madness, the Nemesis of that ill-directed, ill-regulated development that we call civilization, what if it were to increase until the tendencies to mental disease overweighed in the community the conservative powers of health! There have been communities and times in which physical disease has threatened, or actually put an end to a race of men; and there have been communities and times in which folly and passion and delusion have been so widely endemic, that the fabric of society has been torn down, and even its very foundations shaken; and were it not for the resiliency of nature, the benign law of adjustment, by which deviations from law are a check upon further deviation, it is possible to conceive that the tendencies to mental infirmity and disease should increase; that passionate selfishness and insane folly should have continually augmenting power to reproduce themselves until acquired, and hereditary tendencies to madness should overbalance the forces of self-control and sanity, so that an observer, neither cynical nor metaphorical, might justly exclaim upon the “mad world,” and races, like families, become impotent for all except mischief and disaster, until time, the great physician, brought the only cure in extinction. Such speculations as these are not without their use, impossible as their realization may appear; they at least serve to make us value rightly the blessings we enjoy, blessings which from their commonness we are too apt to over look. We have no earthquakes in this country, and we calculate upon the stability of our buildings; we have no dead calms, and that world without motion, whose stagnant putridity has been painted by Byron and Coleridge, is to us a dread but impossible imagining. But the stability of our dwelling-place, and the restless agitation of the elements, although among those simple elementary conditions upon which our being depends, are also conditions which it is most easy to conceive might have been otherwise.