Moral Insanity: a Medical Theory of the Corruption of Human Nature

2 Moral Insanity: A Medical Theory of the Corruption of Human Nature Although the term “anthropology” derives from antiquity, it was only in the latter half of the eighteenth century that it came into common usage. Immanuel Kant (1724-1804), Ernst Platner (1744-1818), a doctor of philosophy as well as medicine, and other Germans employed it to refer to combined research into the body, the mind, and their interrelations. 1 Prichard’s Edinburgh education had familiarized him with a similar approach towards the phenomena of mind and body, although it was not until the 1830s that he adopted Continental terminology, talking about matters “anthropological” and “ethnological”. Prichard’s medical occupations and his interest in the natural history of mankind mutually informed each other so that his deliberations on the workings of the mind went hand in hand with his anthropological ideas. In this chapter we shall examine to what extent he, in his capacity as a “mad-doctor”, considered a certain kind of insanity as forming part of what may be called the anthropological condition, and how far his understanding of this condition depended on religious beliefs. His was an attempt to conceptualize madness, its physical manifestations, its material and moral causes, without compromising those parts of the human mind that, in his view, belonged to the realm of the immaterial soul rather than to the sphere of base corporality. The role of the brain in madness stood at the centre of Prichard’s deliberations: while he was convinced that madness had something to do with the conformation of the brain, he yet repudiated all those theories which overemphasized its role at the expense of the immaterial or transcendental which Prichard regarded as a reality in its own right. He turned from a steadfast follower of the Lockean definition of mental derangement with its emphasis on human rationality into a philosopher attempting to account for feelings of existential alienation and despair. 2 In the following pages we shall probe the strategies he chose to support his changing opinions between the 1820s and the 1830s. Prichard’s mature theories of madness drew on three different approaches: first, the 25 Moral Insanity writings of the doctor Thomas Hancock who dealt with the notion of human instincts; second, the doctrines by France’s most famous alienists, Philippe Pinel and J. E. D. Esquirol; and third, German notions of madness, in particular those of the so-called somatists. But before these issues can be discussed, we must juxtapose Prichard’s early notions of madness against his 1830s concept of “moral insanity” which was to gain him lasting fame. The Limits of Locke’s Rational “Delusion”: Diseases of the Passions In Britain in the second half of the eighteenth century, insanity was widely explained within the Lockean philosophical framework of enlightened rationality: delusions or illusions led human reason into error.3 By the beginning of the nineteenth century, in the wake of the French Revolution and in the midst of the transformations which the industrial revolution was bringing about, new theories of insanity emerged. First developed on the Continent, they soon made their way to Britain. Prichard was one of those who attempted to rechart the traditional understanding of madness. This appeared necessary to him because his observations of mental unsoundness seemed incompatible with older nosological descriptions. Madness had become as unfathomable as the epoch itself appeared to many. Increasingly, cases of insanity came to attention in which patients did not seem to dwell in some delusive state. Rather they displayed deep sullenness, unmitigated fury, or utter shamelessness, a propensity to theft, or pyromania, seemingly without either purpose or motivation. One of the constructs used to explain the evidence was Prichard’s new concept of moral insanity. On the surface it accounted for a changed perception of insanity; on a deeper level, however, moral insanity was expressive of Prichard’s religious views as well as his ideas about the human constitution, and it was his response to the problems inherent in the rise of capitalist society. Moral insanity referred to a derangement of those mental faculties which presided over man’s emotive framework as well as his moral faculty. Prichard first put the notion forward in 1833, in an article in The Cyclopaedia of Practical Medicine .4 In his Treatise on Insanity, a survey published in 1835 and dedicated to Esquirol whom he had visited in 1831 at his hospital at Ivry near Paris, he gave an account of the state of medical thinking on madness, inscribing moral insanity into nosology and embedding the doctrine in his medical philosophy. 5 As a doctor to St Peter’s Hospital, part of which served as lunatic asylum, Prichard had had ample opportunity to 26.

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