The bodies of the insane held a particular fascination for the 19th-century asylum doctor. Actions might betray a person’s psychological state in the most striking ways, with bodies subjected to tics and spasms, and facial expressions revealing the deepest thoughts and feelings.
The late 1800s was a climate in which the relationship between body and mind was being ever more meticulously refined. In the 1890s, for example, Charles Sherrington discovered a feedback mechanism in muscles that was important for the regulation of posture and movement. Sherrington’s work suggested that bodily attitudes – such as seated posture, or how a person ‘carried’ themselves – could indicate inner psychology.
This was an idea that had obvious application within the asylum. At admission, patients were physically assessed, a process that often included testing of the reflexes and bodily strength using contraptions such as the dynamometer (to measure the grasping power of the hands). Thus, a doctor might note something like this: ‘Patellar tendon reflex absent in each limb, no cremasteric reflex. Tactile sensibility of lower limb is diminished.’ For this patient, his mental state was also found wanting; he showed ‘great obtuseness in understanding what [was] said to him’ and was characterised throughout his case notes as dull, unresponsive, and generally ‘diminished’. In a seamless melding of body and mind, both were in a state of decline. It was the body that succeeded in speaking for the patient, his appearance compensating for his difficulties with verbal communication (his articulation was ‘thick and indistinct’).
Apart from indicating a general deterioration in a patient’s condition, the state of muscles and reflexes might also indicate the seat of a problem with surprising specificity. David Ferrier noted that the knee jerk was a crucial indicator of disease – it was absent in cases of tabes dorsalis, for example. (Tabes dorsalis is a neurosyphilitic condition characterised by nerve degeneration.) The importance of the muscular sense in health and disease was clear in many physiological and psychiatric tracts. ‘That the muscles possess a sensibility of their own’, wrote Ferrier in The Functions of the Brain, ‘…is proved beyond all doubt by their nervous supply and by physiological and clinical research’. He described a hierarchically-organised community of muscles, varying in strength, ‘thus the powerful extensors of the back, and muscles of the thighs keep the body arched backwards and the legs rigid’. Guillaume Benjamin Amand Duchenne de Boulogne (phew!) had also credited the muscular system with an independent intelligence, reasoning that coordination required a harmonious relationship between different muscle groups. The use of the term ‘muscular sense’ by many physiologists gave muscular tissue an almost anthropomorphic character – muscles were independent entities capable of action and reaction in response to external influences.
It was up to the patient, then, to keep their muscles in check. The will, an elusive but enduring concept in alienist science, was most forcefully expressed – or most notably absent – in the movements of the body. The view that only the will stood between order and chaos, as Roger Smith tells us, ‘translated easily to physiological descriptions of the economy and hierarchical arrangement of the nervous system’. Loss of control over bodily movements was viewed as a ‘de-education’, or erasure of learned automaticity, seen for example, in the tottery but energetic gait of tabes dorsalis patients.
The central explanations for such loss of control, by emphasising the co-existence of reflex action and the will, allowed mental science to move closer towards natural, biological science without discarding that essence of being human that marked men apart from other animals. Thus, as Stephen Jacyna points out, bodily actions could be explained in a mechanistic way, but also as a consequence of manipulation by the soul. If a person lost their powers of control, the body could descend into a state of chaos. In this way, the patient’s movements and attitudes frequently served as a diagnostic tool in the asylum, particularly if the patient’s own verbal testimony was unreliable or impossible.
W.F. Bynum and F. Clifford Rose (eds.), Historical Aspects of the Neurosciences: A Festschrift for Macdonald Critchley (New York: Raven Press, 1982)
David Ferrier, The Functions of the Brain (London: Smith, Elder & Co., 1876)
L.S. Jacyna, ‘Somatic theories of mind and the interests of medicine in Britain, 1850–1879’, Medical History 26 (1982).
Roger Smith, Inhibition: History and Meaning in the Sciences of Mind and Brain (London: Free Association Books, 1992).
– Jennifer Wallis