In most public hospitals, the first attack of diseases is seldom to be observed; and it might naturally be supposed, that there existed in Bethlem, similar impediments to an accurate knowledge of incipient madness. It is true, that all who are admitted into it, have been a greater, or less time afflicted with the disorder; yet from the occasional relapses to which insane persons are subject, we have frequent and sufficient opportunities of observing the beginning, and tracing the progress of this disease.
Among the incurables, there are some, who have intervals of perfect soundness of mind; but who are subject to relapses, which would render it improper, and even dangerous, to trust them at large in society: and with those, who are upon the curable establishment, a recurrence of the malady very frequently takes place. Upon these occasions, there is an ample scope for observing the first attack of the disease.
On the approach of mania, they first become uneasy,[5] are incapable of confining their attention, and neglect any employment to which they have been accustomed; they get but little sleep, they are loquacious, and disposed to harangue, and decide promptly, and positively upon every subject that may be started. Soon after, they are divested of all restraint in the declaration of their opinions of those, with whom they are acquainted. Their friendships are expressed with fervency and extravagance; their enmities with intolerance and disgust. They now become impatient of contradiction, and scorn reproof. For supposed injuries, they are inclined to quarrel and fight with those about them. They have all the appearance of persons inebriated, and those who are unacquainted with the symptoms of approaching mania, generally suppose them to be in a state of intoxication. At length suspicion creeps in upon the mind, they are aware of plots, which had never been contrived, and detect motives that were never entertained. At last the succession of ideas is too rapid to be examined;[6] the mind becomes crouded with thoughts, and confusion ensues.
Those under the influence of the depressing passions, will exhibit a different train of symptoms. The countenance wears an anxious and gloomy aspect, and they are little disposed to speak. They retire from the company of those with whom they had formerly associated, seclude themselves in obscure places, or lie in bed the greatest part of their time. Frequently they will keep their eyes fixed to some object for hours together, or continue them an equal time "bent on vacuity." They next become fearful, and conceive a thousand fancies: often recur to some immoral act which they have committed, or imagine themselves guilty of crimes which they never perpetrated: believe that God has abandoned them, and, with trembling, await his punishment. Frequently they become desperate, and endeavour by their own hands to terminate an existence, which appears to be an afflicting and hateful incumbrance.