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In the nineteenth century, the term insanity represented a broad spectrum of mental disorders as diverse as schizophrenia to the most severe of sociopathic disorders. What did nineteenth-century physicians think was at the heart of insanity?
Most antebellum physicians agreed that insanity was a disease of the brain and that examination of the brain tissues would reveal organic or functional abnormalities. Central State Hospital's (CSH) second medical superintendent, Richard Patterson, attested to this fact in his 1849 report to the State Commissioners:
mental derangement always depends upon either functional or organic diseases of the brain, and without such disease we see no derangement of the mind. The causes of this cerebral disease may be either physical or moral.
Accordingly, Dr. Patterson and his colleagues posited that "physical causes" of insanity were either direct afflictions, such as brain hemorrhaging or lesions, or indirect diseases, such as suppression of the menses or pulmonary disease, that, in time, damaged the central nervous system and eventually the brain.
But as Dr. Patterson noted, "moral causes" also contributed to the manifestation of insanity, and in an age when scientific medicine had not yet come to fruition, physicians naturally focused on the social and cultural forces causing insanity. Thus, CSH physicians typically attributed insanity to a host of social problems as diverse as domestic abuse to "Mexican War excitement" to millerism (a religious sect founded on the belief that God's wrath would descend upon the earth before the millennium).
Many physicians suggested that these social problems were a direct result of the social, economic, and political instability wrought by Jacksonian democracy, civil war, and industrialization. As historian Charles Rothman has compellingly argued, unprecedented social and economic fluidity in the mid-nineteenth century compelled Americans, poor and rich, to aspire for more, and many physicians interpreted this climbing of the proverbial ladder as excessive and pathological behavior. Physicians were equally disturbed by the new political and social freedom engendered by Jacksonian democracy. As CSH superintendent James Athon opined:
insanity increases in the same ratio with the advancement of improvements, the accumulation of the luxuries of life, and the general spread of all those fanatical, religious and political principles which characterize the age.
Fortunately, one of Dr. Patterson's predecessors, Dr. James Athon, required his medical staff to take detailed notes on the moral causes of each patient's mental illness, which appear in over fifty volumes of admission books and prescription books. These rich, detailed, and uncomfortably honest patient histories cast aspersions on many of the social, political, economic, and religious realities of nineteenth-century America.