On the Haschisch
or Cannabis Indica
John Bell, M.D.
The Boston Medical and Surgical Journal
16 April 1857 & 23 April 1857
The various periodicals of this country have abounded, during the last few
years, with accounts of the Haschisch; every experimenter giving the
history of the effects it has had upon himself. In most cases this has been
mingled with much fanciful and irrelevant matter. These notices have been
confined almost exclusively to the various popular literary journals, but
it has not received the attention it merits in those exclusively devoted to
medicine. Under these circumstances, the following
résumé of what has been written on the subject, seen
through the medium of personal experience, may not be destitute of
interest.
Among the nations professing Mahometanism, there are not a few substances
used as substitutes for the alcoholic liquors interdicted by the author of
that religion. They are everywhere the most inveterate users of tobacco,
opium, coffee, and a variety of other narcotics less generally known.
Among these latter, no one has recently attracted so much attention as the
Haschisch, Cannabis Indica, or Indian Hemp. It is only within a few
years, comparatively, that a knowledge of it has come to us, but it has
been in general use for many centuries at the East, and reference is even
thought to have been made to it by the ancient classic authors. The novelty
of its effects and its apparent harmlessness have induced travellers in
Egypt and Asia to experiment upon themselves, and a knowledge of it has
thus found its way to the nations of the West. The defective pharmaceutic
process employed by the inhabitants of its native countries, render its
preparations of very different strength, and admixtures of various foreign
substances make its effects uncertain. A specimen obtained from Damascus
contained about twenty-five percent of opium, a considerable quantity of
camphor and spices, and nearly half was a mixture of rancid butter and
extract of hemp. The substance widely known in this country under the
Arabic name of Haschisch, is obtained by boiling the leaves and
flowers of the plant with butter, and, when pure and carefully prepared, is
a very active preparation. The extracts prepared in this country from the
Indian plant, contain all the properties of the Haschisch, and are
every way preferable to it. The common hemp, though believed by botanists
to be a variety of the same species as its Indian congener, is entirely
destitute of the property which distinguishes the latter. This difference
alone, if found to be permanent, would be sufficient to cause them to be
regarded as distinct species.
The action of the drug is not confined to any single part of the system. It
is an efficient but slow cathartic, an active diuretic and sudorific, and a
most irresistible hypnotic in the latter stages of its action. But it is
better known for its effect upon the nervous system; it is for this object
that it is extensively employed in the East, and it is in this connection
that it possesses its greatest interest. Abundant personal experience of it
leads me to think that its peculiar effects upon the nervous system are
only a secondary result of its action upon the mucous membrane throughout
the whole track of the alimentary canal. The slowness of its action, not
commencing in less than two hours after the dose is taken; the sensation of
dryness, and afterward the abundant secretion in the throat and mouth; the
heat throughout the abdomen; and the soreness which persists for several
days; and, finally, the absence of any symptoms of nervous debility, when
the immediate effects are gone; all point to this as its modus
operandi. It would seem as though it were absorbed, and that in this
process of being thrown off, it occasioned those phantasies which have
caused it to be used as an intoxicating agent. In the dose usually
recommended, of from one to three grains, it is absolutely inert: five
grains is the smallest quantity from which any perceptible effects are to
be expected, and generally more will be required. Few persons, perhaps, who
have read the brilliant “Confessions of an English Opium Eater,” have been
without a fancy to experience the wonderful effects
there described: all who have yielded to the desire, have been
disappointed. If any one supposes the intoxication of Haschisch to
be of the same nature, a few grains of the drug will most efficiently purge
him of the idea. On the first trial, one is generally frightened at the
intensity and violence of its action, and few will be disposed to carry the
dose beyond ten grains. Indeed, most will be amply satisfied with having
once experienced it. The following were the results of a moderately large
dose of Tilden & Co.’s extract.
It was taken with coffee, which increases the effects of the hemp, and at
the same time diminishes its duration, perhaps merely by promoting a more
rapid absorption. For two hours no results at all were experienced. At this
time a dryness seemed to commence at a particular spot in the throat, and a
feeling of warmth throughout the abdomen. These were not the results of
disordered sensation, for a clammy mucus soon began to be secreted, though
the huskiness of the throat still remained. Up to this time, there was not
the slightest excitement or confusion of thought. Suddenly, however, an
idea having no connection with the train of thought passing in the mind at
the time, appeared, as though suggested by another person, and then was
gone again as suddenly as it came, leaving upon the mind much the same
feeling as when one escapes from a dream or a deep reverie. The same thing
was repeated two or three times, at intervals rapidly diminishing in
length. Even now I can hardly believe but it was the result of strained
attention to my physical sensations, for the gentle warmth of the abdomen
was rapidly becoming a burning heat — still, however, not by any means
unpleasant — and the dryness of the throat had extended to the tongue.
I had taken the drug with great scepticism as to its reputed action, or at
any rate with the opinion that it was grossly exaggerated, and I
accordingly made up my mind not to be “caught napping” in this way again,
and to keep a careful watch over my thoughts. But while enforcing this
resolution, as I supposed, I found myself, to my own astonishment, waking
from a reverie longer and more profound than any previous. From scepticism,
to the fullest belief of all I had read on the subject, was but a step. Its
effects so far surpassed anything which words can convey, that I began to
think I was on the verge of narcotic poisoning; yet, strange to say, there
was not the slightest feeling of inquietude on that account. I resolved to
walk into the street. While rising from the chair, another lucid interval
showed that another dream had come and gone. While passing through the
door, I was aware of having wandered again, but how or when I had permitted
myself to fall into the reverie I was perfectly unconscious, and knew only
that it seemed to have lasted an interminable length of time.
These singular attacks of mental disturbance recurred oftener, and lasted
longer, till the lucid interval between was reduced to a mere instant’s
conscious duration of thought. This condition came on so rapidly, that in
less than fifteen minutes from the time of my being aware of the first
mental disturbance, the power of controlling the thoughts was almost
completely lost. All ideas of time and space were especially bewildered,
and I realized completely for the first time the ideas of some
metaphysicians, that time, properly speaking, has no existence except in
connection with a succession of mental operations or sensations. The most
trivial circumstance, the slighest noise, gave rise to trains of thought,
which went bounding from subject to subject, completely emancipated from
the rules which ordinarily govern the mental operations, till suddenly some
other circumstance would give an entirely new direction to them, and the
last series of imaginations would seem to have lasted from eternity, even
while the eye was fixed upon the clock, the hand of which had not
perceptibly moved.
Now, a phenomenon still more singular began to exhibit itself. I felt that,
in spite of all exertions, I was beginning to receive the suggestions of
disordered fancy for real objective facts. Intellectually, I knew that the
spinal column could not be a barometer, in which mercury had usurped the
place of the spinal cord. Yet in another sense, over which the operations
of the intellect were completely powerless, I felt that it was a barometer.
An unpleasant sensation in the lumbar region suggested the idea of a heavy
column of mercury pressing upon it, and at the time, and under the
circumstances, the transition to the idea of the barometer was easy and
natural. There was no balancing of arguments in the arrival at this
conclusion; there was no half-way period of doubt and uncertainty, to
emerge into full credence. At the instant the idea occurred at all, it
commanded the assent, with the same fulness as when in perfect mental
health does the idea of our own existence. The thought certainly occurred
that it was a delusion, but it made no more impression than the suggestion
would, that the sense of sight was a figment of the brain, and objects seen
had no existence except in the imagination. This belief was not a transient
one; it was the first hallucination to appear, and continued with varying
degrees of intensity, as the thoughts were more or less occupied with other
subjects, till all others had disappeared. The belief in the reality of the
delusion was never for an instant absent; it pervaded the whole being, and
was often the point on which the thoughts turned seemingly for a long time.
The painful attempt to regulate these disturbed states of consciousness,
was soon given up, and, half voluntarily, half by a species of moral
compulsion, the whole psychical nature surrendered itself, without further
struggle, to the fullest and most complete belief in the actual existence
of a thousand hallucinations. During this time the thoughts were becoming
more and more disordered; ideas, between which, apparently, there was not
the slightest connection, thrust themselves in, till finally their rapid
recurrence, and the loss of that sense of governing the mind which we
ordinarily possess, induced the belief that I was the victim of diabolical
agency — that some terrible demon had taken possession of my whole
intellectual being, and identified himself with every thought, in the same
way that a man might direct the physical movements of a child. The feeling
of utter powerlessness to check the wild current of thought was complete,
and there was a sensation as though, if there had been the ability, the
will could not be exercised.
The firmest intentions were forgotten in an instant. There seemed to be no
difference between the idea and the expression of it in words. A moment was
long enough to forget whether it had been expressed or not. The sound of
persons whispering in the room, brought with it the belief that they were
laying some plot. It was not a vague suspicion that they were intending
some injury, such as whispers and glances might excite in any one; but
everything they had said — the particulars of the whole plot — were
present, with the same vividness and overpowering conviction as they always
are in true hallucinations.
The fantasia had now arrived at its height. It was an hour and a
half since the first sensations of excitement and wandering commenced.
About the same time passed before it had completely subsided. The mental
phenomena in this stage were as remarkable as while the effects were coming
on. One after another the delusions disappeared as rapidly as they came;
not by any exercise of the gradually returning regularity of thought, but
suddenly — with a bound — so that it was surprising to have believed, a
moment before, what now appeared so absurd.
The whole time during which there is any perceptible difference from the
normal state, is from three to five hours, according to the dose taken. The
hemp resembles in its action some other medicines which are erroneously
called cumulative. That is, a dose may be taken without producing any
perceptible action; and on another occasion, a dose only a grain larger
will act violently. Indeed, the effects of this agent seem to be of such a
nature, that there is no resting place between its full action and none at
all. A delusion, of the truth of which we are only half convinced, would be
no delusion at all. Unlike opium, alcohol, and other narcotics of the order
Solanaceae, it leaves behind it no mental confusion, headache, or other
signs of a direct and powerful action upon the nervous system. The
secretions of the alimentary canal, however, remain in an unnatural state
for several days, and there is a slight oppression felt in the abdomen, if
the dose has been at all large. During all the time of its action, there is
a tendency to laugh, in spite of the delusions, which are almost uniformly
of an unpleasant character. The feeling of buoyancy of spirits is somewhat
the same as is caused by a slight dose of alcoholic stimulant.
Amid all the strange vagaries of the Haschisch, the mind preserves
the power of taking cognizance of its condition, and to a certain extent of
analyzing its operations. The memory of everything said and done is nearly
perfect; but of the multitude of thoughts, only those making a more than
commonly distinct impression are preserved.
Can this singular substance be put to any useful purpose, to illustrate any
of the varied mental phenomena of health and disease? Is it worthy a place
in the medical armamentum, from its action alone upon the mind?
The great advances made in the philosophy of medicine during the last half
century, have been due almost entirely to the devotion with which pathology
has been pursued. Instead of the ill-arranged and ill-understood assemblage
of symptoms observed with scrupulous care, which went to make up the idea
of a disease, we now direct our aim to strip it of everything fortuitous
and to fix in the mind the type of the malady — those essential features
which are uniformly the same under every variety of circumstances, and
about which the more obvious symptoms cluster, like the drapery about a
statue. In diseases of the mind, this has not been done: their seat and
nature are too deep to be reached by the knife of the morbid anatomist.
Esquirol, after a whole life devoted to the study of this subject, and
after the most ample opportunities that have ever fallen to the lot of any
individual, says, that “Pathological anatomy is yet silent as to the seat
of madness; it has not yet demonstrated what is the precise alteration in
the encephalon which gives rise to this disease.” Nor has greater success
obtained in the attempt to explain the relations and analogies of the
various forms of insanity. The cause of the latter failure is sufficiently
obvious. Theory has taken the place of fact. No competent individual who
has experienced insanity in his own person, has written upon the disease.
The insane themselves can rarely give a consistent account of their
disease, even if they were qualified, by previous study and observation, to
take the best advantage of their own mental state. Even our own observation
of the disease is rarely complete: the minor degrees do not come under the
care of the physician, and it is only when the more severe cases are
evident to all, that friends will acknowledge its existence and submit the
unfortunate patient to examination. How imperfect would be our ideas of
grief, anger, or pain, if we could only observe their outward
manifestations, or listen to a description of them by one who had suffered
them! And yet this is all, and more than all that we can know of the
intimate nature of insanity, of its connections and analogies, unless we
have suffered it in our own persons. If we had never felt any of the
passions, our diagnosis of them might perhaps be as perfect, and the
empirical treatment as successful, as now; but a vagueness would
necessarily pervade our mind as to their nature, and we should be liable to
continual error in reasoning upon them. Southwood Smith well observes, that
the symptom of fever termed febrile restlessness cannot be
understood by any one who has not experienced it in person.
The most superficial observation of a case of mania, will not fail to show
many and strong points of resemblance to that of a person under the
influence of a powerful dose of Cannabis Indica. In both there is the same
excitement and abruptness of manner, the same rapidity and incoherence of
thought, the same false convictions and lesions of the affective faculties.
The following description, by Prichard, of an ordinary case of chronic
mania, such as composes the greater number in the wards of every hospital,
might apply, without the change of a word, to the condition of a person
under the influence of the Haschisch. “It is, however, a state of
great intellectual weakness, in which none of the operations of the mind
are performed with energy or effect. The memory, the judgment, the powers
of attention and combination, are so much impaired, that the individual is
wholly inadequate to the duties of society, and incapable of any continued
conversation; his actions and conduct are without steadiness and
consistency, his thoughts are deficient in concentration and coherence.”
There is no really important point in which these manifestations differ
from the condition produced by the Haschisch. There is no error of
judgment, no delusion or lesion of the will or moral faculties, which is
seen in the former state, but what might take its rise in the latter. In
this question, the difference of cause of the mental disturbance might at
first sight appear an insuperable objection to reasoning from one condition
to the other. But is insanity always produced by the same cause? On the
contrary, there is no disease to which the human frame is subject, that
acknowledges such a variety. There is hardly a physical or functional
lesion of any tissue or organ, but may produce it by its reaction on the
nervous system, and it is difficult to say whether the best or worst
proclivities of our nature are oftenest regarded as the productive agents
of the same mental disease. If opium and tobacco and alcohol may produce,
by long use, without any apparent disease, a mental state which deserves
the name of insanity, why may not the fantasia of hemp receive the
same name! What reason, then, is there why we may not rely upon its
revelations as so many views of the hidden workings of the spirit, in that
gravest of all diseases! If this be allowed, the Haschisch may in a
degree serve as a key to unlock some at least of the mysteries of mental
pathology. Why may we not thus possess a means of studying the disease in
question, better than we have of most others! We can apply to it the
principles of experimental philosophy, and test it by the best of means
upon the best of subjects. The idea of this application of the medicine
originated with Dr. Moreau (de Tours), of Paris, a physician of large
experience in his specialty, and whose
work[1] on the subject possesses the
highest interest, as presenting many views of insanity and kindred
subjects, different from those commonly received.
In the study of insanity by this means, if there is any one fact impressed
upon the mind more strongly than another, it is that of the essential unity
of the whole psychical nature. It is impossible not to recognize the truth
that the ordinary language of metaphysics is applicable to the explanation
of morbid mental phenomena. The popular division into the intellect, the
will, the instincts and the moral faculties, though having a show of
precision, and absolutely necessary in common language, conveys too much.
Such divisions are too distinct and disconnected to be true to nature.
The minute organological divisions and hasty generalizations of the
phrenologists are only the results of the same principle carried to a
greater extent.
A few words upon each of the kinds of psychical disturbance caused by the
Haschisch will conduce to the better understanding of its action,
and of its relations with the analogous, or precisely similar phenomena of
insanity.
Throughout the whole period of its effects, there is a sense of pleasurable
excitement. By the French authors who have experimented and written on the
subject, this feeling is regarded as one of the most marked phenomena of
the drug. Doubtless this was the case with them: with myself, it has never
been so great as is generally represented.
It is true there is a strong tendency to laugh, but it is a laugh in which
the feelings participate to a very slight degree. It is the same to
whatever subject the thoughts are directed. In delusions of an agreeable
or disagreeable character, there is the same smile. It is different
entirely from that state of mental excitement, attended with pleasurable
emotions, which is met with in the first stages of many cases of insanity.
In such instances the sentiments of a pleasure are caused by the most
sanguine anticipations of success in every wild project. It is a feeling
which would be very proper, did not its cause show too plainly the
intellectual disturbance which pervades it. There is nothing like this in
the effects of the Haschisch. The face does not as ordinarily prove
a true index to the mind. While the thoughts do not pause long enough upon
any subject for the feelings to be touched, the face is covered with
smiles. Disagreeable anticipations and a joyful expression of countenance
do not seem at all incongruous. It seems to be all on the surface, leaving
the depths below unmoved. The condition is much the same as in dreams, when
we are often surprised at our own callousness to all impressions of
pleasure and pain: when good and bad fortune alike pass over us without
exciting happiness or sorrow. Perhaps upon different temperaments, the
action of the drug may be essentially different. My own experience of it
has been sufficient to convince me that this sentiment of happiness may be
completely lost in the crowd of other phenomena. It would have been hardly
worth while to notice so slight a peculiarity, were it not that one of the
most interesting of its proposed therapeutic uses is in connection with
this property.
It has been proposed by M. Moreau to
take advantage of this reputed action, to combat certain varieties of
insanity connected with melancholy and depressing delusions. If a series of
hallucinations of a pleasing character, or a state of pleasurable
excitement, could be produced and kept up for a length of time, the change
might become permanent. The morbid chain of thought might be broken, and
the mind resume its healthy action upon the withdrawal of the medicine.
Used in this way, the drug would seem to hold a middle place between
medical agents as ordinarily used, and the moral discipline which is
principally relied on at present. This proposed application is original
with M. Moreau, but the idea of
superseding melancholy by exciting pleasurable emotions, is certainly as
old as the time of David, whose harp succeeded in driving the evil spirit
out of Saul. Such means, in cases of true insanity, have in practice fallen
into utter contempt. Music, per se, never has cured an insane
patient in our times, or, as a late writer says, “music never cures
insanity, except such cases as appear in the comic opera.” Music may be,
and unquestionably is, of value as one among the diversions and employments
which take off the tedium of hospital life, and pro tanto occupy the
space in the disordered mind, which would otherwise be absorbed in diseased
acts and reflections. M. Moreau
reports several instances of doubtful cures effected by the medicine, but
confesses that his experience of its use is limited. The following cases
from his work will illustrate its effects upon the variety of insanity in
question. “Two patients suffering under melancholia, after five or six
hours experienced a lively excitement, with all the characters of gaiety
and sprightliness which we have observed. One especially, tormented by
terrors of imagination and melancholy delusions, who had not spoken ten
words a day for more than nine months, did not cease to chat and laugh and
joke during the whole evening. I rarely found in his words any connection
with the ideas which habitually occupied his attention. However, the
excitment over, both fell again into their previous condition.”
The use of the Haschisch, with this view, has not been extensive in
this country — not so extensive as it deserves to be. It has been tried,
however, in several of the insane hospitals, but the results have not been
encouraging. Indeed, in most cases they have been completely null, so that
the suspicion has been engendered that it does not possess the
physiological action attributed to it. Nothing could be more unfounded;
there is no article in the whole materia medica which, according to
my observation, is more to be depended upon to induce its peculiar effects.
But it must be given in doses much larger than those usually employed, that
any effects may be experienced from it. We could hardly expect that cases
having their origin in extensive physical disease, can be benefited in this
manner, but in functional diseases of the brain, it certainly gives promise
of possessing powers more directly useful than any other specific drug of
the materia medica.
Every one is aware how much our ideas of time depend upon the rapidity of
thought, and the degree of attention we give to passing events. While the
mind is busily engaged in conversation or reading, we seem to lose all
notion of the succession of events; we live in a world of ideas, retaining,
however, an intimate sensation of the fact that we are only thinking. In
this state we take no note of the passage of time; an hour is compressed
into a minute. In dreaming, the mind is just as busily engaged, and yet we
may magnify an instant into any conceivable limits. In the state of
reverie, the same thing occurs, though to a less marked degree. The fact is
familiar to every one that we may be awakened by some noise, and in the
interval between sound sleep and complete wakefulness, we may pass through
a long imaginary conversation, or an extended series of events, ending with
some explosion or catastrophe, which on being completely awake, we are
aware is only the noise which has awakened us. Our ideas of time, then, do
not depend exclusively upon the succession of mental pictures. They are
much more closely connected with the degree to which we identify ourselves
with our thoughts. Just in proportion to their vividness and the extent to
which they overcome our attention to the fact that we are thinking — not
acting, just in such proportion does time correspond to what it would be,
were the subject of our thoughts real objective facts. This sensation of
the excessive duration of time, is perhaps the most remarkable and obvious
of the effects of hemp, and the extent to which it is experienced may be
regarded as the best means of regulating the dose. It is never absent,
throughout the whole duration of the mental disturbance, and the deception
is so complete and so disagreeable, that no one who has taken it need ever
be in the slightest doubt as to whether he is experiencing its effects or
not. In the higher degrees of its action all definite ideas of time are
lost. Past, present and future exist no longer. The whole existence is
concentrated in the train of thought we are engaged in. In dreaming, this
change in the ideas of time is not unpleasant, for we cannot observe the
discrepancy between our present and former sensations. The following case
of insanity, where all proper notions of time were lost, is abridged from
Moreau. “A young lady, during the first
few days of an attack of maniacal excitement, believed that she had no
longer any age. She imagined herself to have lived at every historic epoch
to which memory carried her. Those about her were reproached with having
stolen her measure of time. Her mother was acknowledged as such no longer,
for the reason that she could not have a mother younger than herself.”
Another believed himself to be God, because he had existed from eternity.
Under the influence of Haschisch, the ideas of time may be regulated
by the intellect, and consequently one is never led astray, except when the
attention is directed to another subject; while this is the case, the
sensation of immense duration of time is continually and intimately
present. Without having experienced it, no one can form the slightest idea
of its vividness and reality.
The errors in regard to space are dependent for their existence upon those
of time, and are of much the same nature. During the existence of the
fantasia, an object does not appear more distant than under ordinary
circumstances. But while the hand is stretched forth to take it, and we
are conscious that the movement is executed with ordinary rapidity, such a
length of time has passed away, that only the exercise of reflection and
the direct evidence of the sense of sight, can convince us that the hand
has not moved through a space corresponding to the time it seems to have
been in motion.
The deception is never so complete as that in regard to time; a glance of
the eye corrects it, but it rules again as soon as the head is turned. It
is in this circumstance that insanity differs from the delirium of an
ordinary dose of hemp. In the former, and in cases of large doses of the
latter, the sense of sight does not correct the delusion. The sensations
coming from the eye are overruled by the reality of those having their
origin in the imagination. It is only during the occasional lucid moments
of Haschisch that the judgment can be exercised, or the eye directed
to an object to appreciate its circumstances. Not that the muscles are
paralyzed, but the will does not put them in motion. As in an ordinary
reverie, the vacant stare shows that the mind does not take cognizance of
the objects towards which the eyes are directed.
The first effects of it upon the intellectual faculties, are a gradual loss
of power to direct the thoughts. The sense which is ever present in mental
health, that we are responsible for what passes in our minds, is lost. This
loss is never partial as to any single thought. We do not perceive this
power to be gradually slipping away so that we can mark each step of its
departure, but suddenly, like lightning, it occurs to us that, the moment
before, some thought came into the mind by a channel very different from
ordinary. To use a well-understood manner of speaking, we have nothing to
do with its presence — it came there of itself. In small doses, its
effects are limited to this degree of mental disturbance. If the quantity
taken has been larger, these attacks recur oftener and oftener, the
experimenter losing and regaining the consciousness of directing the course
of thought many times in a minute. When under the highest degree of its
action, the glimpses of the fact that our thoughts are not our own, are few
in number and momentary in duration. In this state of veritable mania,
ideas come and go with a rapidity completely inconceivable in ordinary
mental conditions. Some glide through the mind without seeming to make any
impression at all; others become realities as perfect as though admitted
through the senses. Yet in all this overthrow of the governing power, there
is a certain degree of connection in the succession of ideas. But the
attention is so slightly concentrated upon even the most vivid of them,
that the slightest occurrence, the movement of a hand or a word addressed
to us, sweeps them away in an instant. We live in the thought that is
uppermost at the time; those which are past are as nothing, and we take no
thought of what the future are to be. Intentions formed the moment before,
are lost. If we wish to say anything, the chances are equal that it will be
forgotten — buried by the succeeding idea. Let one in this state attempt
to write, and he will produce a composition similar to what is often seen
by those practically acquainted with hospitals for the care of the insane.
Broken phrases, words without the least connection, with occasionally a few
sentences having some obviously connected ideas at bottom, make a compound
highly characteristic.
The conversation is more connected than the writing, for it is better able
to keep up with the thoughts. In both there is some connection in the mind
of the individual; while one word or part of a sentence is being written, a
multitude are gone, and when the pen comes to a stop, it goes on again with
the train of thought which is present at the instant, without endeavoring
to go back and take up the thread which is lost. In talking, one feels
compelled to finish the sentence without an instant’s hesitation; if the
word which expresses the meaning does not occur, another is substituted for
it without reference to its signification. If we hesitate, the train of
thought is overwhelmed by the rushing tide of ideas, which never waits for
utterance. The connection between successive conceptions, however, is not
always perceptible to the individual, even in the slight degree referred to
above. A large portion seem to be mere isolated pictures, drawn alike from
memory, from imagination and from incidents which happen to be taking place
at the time, but all strangely confused and equally transient in the
impression they make. This mental state is so similar to many cases of
insanity, that it would be difficult, if not impossible, to distinguish
them without having recourse to their duration and the causes which
produced them. The extreme rapidity and vividness of thought are absolutely
identical with the most observable phenomena of that disease.
Mania is by far the most hopeful species of insanity, in respect to its
prognosis, while dementia is the most hopeless. It has been thought that
in cases of mental disease, tending to fall into the latter state, the
powerful stimulation of the hemp might perhaps arrest the downward course,
and place the patient in a state more amenable to treatment, and
consequently more hopeful, as regards chances of ultimate cure. With these
ideas in view, it has been administered in very heroic doses in all stages
of hebetude. But the mind in this condition seems to have completely lost
its wonted resiliency: it responds no longer to what were once powerful
stimuli. In this state the hemp produces no perceptible effects, in the
more advanced stages, and only the slightest change in any. All hopes of
benefit resulting from its administration in these cases, have been
abandoned by the author, himself, of the proposition — a sure proof of its
utter want of any probability of value.
But the most interesting of the effects of the hemp are in connection with
the subject of delusions. It is in reference to these that it can be put to
the best use in assisting to understand the workings of disease. There are
very few cases of insanity but exhibit delusions at some period of their
course, and there are not a few persons, ordinarily reputed sane, who are
subject to them. A clear understanding of them will conduce, more than
anything else, to a full understanding of those mental states which are
spoken of under the collective term insanity. Their importance will justify
a closer examination than any of the other morbid mental manifestations,
caused by the drug of which we are speaking.
Before the time of Esquirol, all the mistakes of madness were included
under one term. He saw reason to divide them into two classes — illusions
and hallucinations; the first taking their origin chiefly in a disordered
condition of the senses, the latter depending exclusively upon intellectual
disturbance. These distinctions of the great master have been adopted by
most succeeding authors who have written upon the subject. Whether these
divisions are founded in nature, and show evidence enough to demand
adoption, we shall presently examine. In the mean time, a few words on the
origin of hallucinations in addition to what has been said before. They
have the same relation to disorders of the intellect that ordinary states
of consciousness do to healthy manifestations of that function. There is no
word which gives any better idea of the process by which these figments of
the brain come to be regarded as facts, than there is of the way in which
we come to believe so strongly in our own existence, or the existence of
the objects we feel or see. There is certainly not the slightest similarity
between hallucinations and ordinary mistakes in regard to the existence of
facts. One pre-supposes the exercise of the memory; the other acts without
it and even defies it. The circumstances under which they have their origin
are as varied as the hallucinations themselves. Many seem to be purely
intellectual, at least the chain which connects them with the external
world is too long and complicated to be followed. Some idea, disconnected
perhaps, or having a very loose connection with those preceding it, assumes
the attributes of reality, and for the future it is an idea no longer, but
becomes a fact, and is reasoned and acted upon as such. The great majority
of the hallucinations of the insane have this origin. Their fears and
suspicions, their strange actions, their pride and humility, are often
founded upon some belief which they act upon but do not disclose. Perhaps
in many instances it is too vague to be put into words. A thought suggested
by another may be adopted in the same way and become a thought and finally
a belief of our own. Some sensation of pain or uneasiness in a particular
part of the body turns the thoughts in that direction, and forthwith a
delusion is established. This is peculiarly apt to be the case in
hypochondria, where the stomach being in most cases the peccant organ, is
believed to be the abode of some reptile. Esquirol relates cases of a woman
suffering under chronic peritonitis, who believed the Pope was holding a
council in her belly; of a military officer who had rheumatism in the knee,
and believed there was a robber confined in it. These last, however, he
gives as instances of his variety of illusions, though in this he is not
followed by other writers, who confine themselves exclusively to the five
senses.
The idea of illusions is perhaps too stongly fixed, by the ability and
influence of writers who have acknowledged their existence, to be easily
refuted. There are certainly no such phenomena among all the varieties of
psychical disturbance caused by taking the hemp, though there are delusions
which if observed in another and judged by the rules laid down by writers
on mental pathology, would be considered as striking instances of them.
There is never the slightest lesion of the sentient extremities of the
nerves, so far as I have experienced. The senses are as perfect as ever,
and the information given to the mind is as correct as though the latter
were in its natural condition. It is in the disordered state of the
psychical system that we must look for the origin of all insane delusions,
whether having reference to objects of sense or not. There is no ground for
the distinction that has been made between hallucinations and delusions. On
this subject Ray[2] says, “that the
functions of the senses are sometimes
greater perverted, there can be no question; but it needs more evidence
than we yet have to prove that such perversions have much if any part in
producing these illusions.” The principal arguments for the existence of
sensory illusions are of this kind: a person may have continually before
him some vision, as long as his eyes are open, but upon shutting them the
delusion disappears. Or it may last during the day and disappear at night,
or vice versa. It is inferred from such cases, which are
sufficiently numerous, that the whole difficulty is in the sentient
extremities of the sensory nerves, and that as soon as these cease to act,
the object seen disappears. The true explanation of these and similar
cases seems to be this. The mere contact of light with the retina gives
rise to ideas, perhaps immediately, perhaps through a crowd of others
preceding them, which are taken for verities. And all this, while the
objects within view are seen as well as ever. But the sensations caused by
sight are too feeble and receive too little attention to compete with the
vividness of those supplied by the perverted intellect. The facility with
which the evidence of the former is passed by, and credence given to the
latter, is astonishing and inexplicable to one who has not experienced it
in his own person. Esquirol mentions the case of an individual who, under
the influence of such a delusion, took a window for a door, walked through
it and was precipitated from the third story to the ground. If there had
been the slightest doubt in the mind of this person, the uncertainty would
have saved him. He must have seen what was before him, but pre-occupied
with the notion of the door, the evidence of the eyes made no impression.
The hearing is passed by in the same way, but still oftener, for sounds are
rarely so continuous as objects of sight. A person under the influence of
hemp may carry on a tolerably well-connected conversation, till suddenly he
makes some remark which shows that it is made in reference to his own
thoughts, rather than to anything which has been said before. He confounds
what is passing in his own imagination with the thoughts of others, and
consequently attributes to them motives and intentions which they do not
possess. His memories of the past and anticipations of the future are drawn
from the same inexhaustible fountain. Add to these false premises, false
reasoning, warped affections and a disordered will, and the picture of
insanity is complete.
Any one who, under the influence of Cannabis Indica, has seen what the
human mind is capable of becoming, cannot but feel a lively interest in
those who are suffering under mental alientation; he cannot but look with
hope to it, as a means of more fully comprehending what is the most
distressing of finite calamities, and he cannot but think that a substance,
the action of which is so powerful and unique, will be found, when fully
understood, to possess valuable therapeutic virtues. But this point can
only be set at rest by a series of experiments more careful and extended
than has yet been made.
Footnotes:
- 1.
Du Haschisch, et de l’aliénation mentale.
- 2.
Medical Jurisprudence of Insanity
|