Saturday, 19 October 2013

1845, The Principles of Medical Psychology, Ernst von Feuchtersleben.


To an over-excited will, we oppose removal of the object [i.e., that excite the will]..., repose, solitude, especially in combination with darkness and silence; and in the higher degrees, restraint. This restraint, whether it be purely psychical , by inspiring awe, or whether it be effected by corporeal means, as by fetters, &c., is a necessary condition in psychical cures. [...] Every insane patient must be treated, according to circumstances, at the commencement of his disorder with uncompromising firmness. The commands should be short and decisive, but such only as can be carried into effect. Corporeal restraint must be carefully adapted to circumstances. There lies a peculiar controlling power, especially in men of great vital energy, in the eye; we know that this power, which Neumann attributes to a light actually emanating from the optic nerves, is applied even to animals, as, for instance, in shoeing horses. The English call it "to catch or meet the eye," and Esquirol frequently mentions that he looks steadfastly at his patients. Here, again, it must be borne in mind that the physician who would exercise this kind of magnetism ought to be sure of his success, or he will make himself ridiculous.

The psychical influence is effected by an individuality of the physician, to which that of the patient (for the most part females) becomes subject or passive, so that the spontaneity of the latter is, as it were, merged in that of the former. In cases of great susceptibility on one part, and of great energy on the other, this rapport is often produced by the mere look, often too without intentional influence.

The remedial dietetics of the mind (as the prophylactics of psychopathies), are those among the psychical remedies which are applicable to a still healthy personality. [...] That strength of mind is partly a prophylactic against the psychosis is evident from this circumstance, that the energies of the functions and organs in general, and in this instance, therefore, those of the functions of thought and of the organs of the brain, help reciprocally to develop and heighten each other. Hence it follows that the individual concerned can not only contribute to the prophylaxis, but must himself have the chief share in it. Its basis is, therefore, self-knowledge...; its sum and substance, self-command. Here, then, we are at the limits of our medical domain, actually on the confines of ethics; and, in fact, as Schiller, in a physiological view, so Esquirol, led by psychiatrical observation in a pathological view, recognises virtue as the moral aegis of physical health. That the diffident man should not wholly rely upon himself, but, where his own judgement is not sufficient (as in choosing a profession, in contracting marriage, in various other affairs, &c.), should seek the advice of a qualified psychological physician, ought to be understood as a matter of course.

The first problem of mental-dietetics, is to make ourselves objective; that is, to acquire self-knowledge. After understanding our psychical relations, the second problem is to harmonise them; that is, to do away with the preponderance of one tendency over another. Above all, it is requisite for our purpose that fancy should be restrained and kept in subordination. [...] IT is very necessary that we should in particular excercise ourselves in recognising and internally balancing these ever-fluctuating extremes of life-- joy and sorrow, in order that... the equilibrium may be restored. Lastly, let a genuine religious state of min, "the free relation of man to a superior power," that aegis against everything mean, morbid, and destructive, in faith and moral conduct be preserved, and we shall be able to look from within with tranquility on the threatening terrors of insanity.
All this must be effected and enforced by the physician, as a psychagogue or instructor of the mind, where the individual himself in not equal to it.
Langermann, if not the first, was, at all events, the foremost to compare the treatment of mental disorders to education, and to advise mental development and cultivation with a therapeutical view. As a prophylatic, it is fully adequate to its object... . Children and lunatics are said to have this in common, that "they speak the truth;" they have many other and more important resemblences.... . Moreover, that self-command is possible, even in a state of mental disease, and consequently offers a means of cure, is proved by the cunning of lunatics, by which they are often able for a long time to conceal their insanity.

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