# Popular Science Monthly/Volume 46/April 1895/Communicated Insanity

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* COMMUNICATED INSANITY.
By CHARLES W. PILGRIM, M. D.
FOR several weeks past it has been scarcely possible to take up a paper without seeing such startling headlines as "Triplets, and all Crazy," "Three Daughters become Maniacs," etc. In fact, so much publicity has been given to the rather unusual number of cases of communicated insanity that have recently occurred in New York, Buffalo, and Philadelphia that the subject has become one of general interest and one upon which accurate information should be given.
The fact that an insane person can, under certain conditions, produce the same form of insanity in another previously sane, or infect him as it were, is indisputable. The French were the first to recognize this fact, and several cases have been reported in L'Encéphale, and other journals, under the term folie à deux. It has also been called folie simultanée by Régis, and folie imposée by Falret.
Although folie à deux is not an unusual occurrence, folie à trois is quite uncommon, and still rarer, although not unknown, is the evolution of insanity with like symptoms in whole families. Dr. Cramer, in the Allgemeine Zeitschrift für Psychiatrie, reports a most interesting example of the latter kind where a mother and daughter becoming insane, and possessed with delusions of persecution, impressed the same delusions upon the father and five grown-up children. Thus the same form of insanity was imposed upon a family of eight.
Dr. Ireland, in his interesting book The Blot upon the Brain, shows how powerful an influence the insane mind has had upon the sane in the history of religious imposture. He calls attention to the fact that there are people still living who remember Joanna Southcott, who claimed that when sixty years of age she would give birth to the Messiah, and who succeeded in making nearly a hundred thousand people in England believe in her statements.
Brothers, of whose insanity there is no doubt, infected many, and even some among the educated, with his claims to inspiration; and John Thoms, of Canterbury, as late as 1838 collected quite a number of followers whose faith was great enough to make them believe that they would be invulnerable against the attacks of the militia. As a result, Thoms and nine of his credulous followers fell victims to the bullets of the soldiers. But even then all faith was not lost, for many believed that he would rise again within a month. Such psychical epidemics, Kirchhoff believes, are gradually evolved by a sort of "waking suggestion" like the process of suggestion during hypnosis. ​An interesting discussion upon the subject of communicated insanity was brought out at the meeting of the Association of Asylum Superintendents in 1887 by the reading of the history of the Pocasset letter-carrier. Freeman, who, with the consent of his wife, who had become possessed of his same fanatical ideas, offered up their son as a sacrifice, in the manner of Abraham. The insanity of the mother was not detected at the time, but in a month she became manifestly insane. As will be seen, this case can not be considered a typical one of communicated insanity, for the remorse and grief which necessarily followed the participation in her husband's fanatical act were sufficient to account for her insanity aside from any influence which he might have had over her. The discussion, however, brought out the interesting fact that several of the superintendents present had had experience with cases which would appear to justify the use of the term "communicated insanity," although others objected to its adoption. One particularly interesting instance was related by Dr. Fletcher, of Indiana, where two brothers and a sister, living on a farm isolated from the rest of the community, became, one after the other, controlled by the same insane delusion. They were Germans, industrious and thrifty, but uneducated and superstitious. The elder brother conceived the idea that the devil had taken possession of their farm and was secreted under a certain bowlder in the barnyard. He imagined that no good crops could be raised until his Satanic majesty had been unearthed. He began searching, and worked for several days rolling up great bowlders until the younger brother, and finally the sister also, became possessed of the same idea, and lent their assistance. They all worked for about six weeks, making an excavation about twenty feet square and fifteen feet deep. They worked so hard and became so emaciated that the neighbors interfered and had them sent to an asylum, where, happily, under the influence of treatment, change of surroundings, and good diet, they ultimately recovered.
Within the past year two sisters have come under my observation whose histories support more fully than any cases with which my reading or observation have made me acquainted the theory that under certain conditions the insane mind may mold the sane mind just as is common with those that are working normally. These two sisters were aged respectively forty-three and thirty; both were unmarried, and, unlike the cases reported by Dr. Fletcher, they were quite well educated and possessed of some literary taste, and were more than ordinarily accomplished in music, both instrumental and vocal. The elder was large, somewhat masculine in appearance, rather aggressive, and possessed of considerable personality. The younger, on the contrary, was ​quiet, retiring, and more inclined to follow than to lead. Their father was nervous and eccentric, but had never been declared insane. The mother, while living, with the assistance of the sons, maintained a comfortable home, but after her death the home was broken up and it became necessary for the sisters to earn their own livelihood. The younger was particularly fond of music and was ambitious to obtain a musical education. In order to accomplish her desire they decided to go to Boston, where they hoped by sewing and dressmaking to earn sufficient to support themselves, and also enough to give the younger an opportunity to pursue her musical studies. The result was, of course, disappointing, and they were at last obliged to return to the town which they had left, and there begin what proved to be the bitterest struggle of all. Having previously lived in comparative comfort, their surroundings were altogether different when they found themselves alone, struggling to earn their bread by the use of the needle in their native town. It was difficult to obtain the necessary work, and the elder sister after a time began to think that their lack of success must be due to the work of enemies. From this idea systematic delusions of persecution were gradually evolved which influenced her to such an extent that she could not go into the street without thinking she was being followed, watched, and annoyed. These ideas she communicated to the younger sister, who for some time endeavored to persuade her of their falsity. About this time the elder sister developed the delusion that all her acts were due to the influence of the Holy Spirit, and that she and her sister were to be henceforth inseparable, and that they were to act together under all circumstances and in regard to all things. This idea she also communicated to the younger sister, and at last the oft-repeated delusions had their effect and the passive subject became as clay in the potter's hands. The subjectivity of the younger sister was from that time complete, and soon she developed delusions of exactly the same character and of equal strength, until finally neither could go outside the house with any feeling of safety. They became so suspicious that the most ordinary acts on the part of friends or strangers were misinterpreted, and the finding of an ordinary red necktie which had once belonged to one of the brothers led them to believe that he had become an anarchist. From this suggestion the elder sister conceived the idea that three red stars had been placed on the front door to indicate that it was under the anarchistic ban, and in that way warn and drive away any one who might desire to enter for the purpose of offering them work. This idea was, of course, imparted to the younger sister, and immediately the stars appeared as a reality to her. Thus the active agent not only communicated her delusions to the passive subject but actually ​transferred her visual hallucinations. From this state it was easy to get into a condition where anything red exerted a very disturbing influence over them. As the insanity progressed aural disturbances manifested themselves, and they were made still more unhappy by hearing noises in the rooms above, which convinced them that their enemies were not content to annoy them only when they went into the street, but that they had actually taken possession of the house in order to keep up their torment. One night the elder sister awakened the younger saying that she heard some one walking in the room above them, and that she was sure that it was some one who had come to do them injury. The younger listened and became convinced that they were in great danger, and both claimed that they could feel the presence of the stranger, although they could not see him, and they both smelled the kerosene oil with which he was to burn the house. Believing that they were in great danger, they began throwing furniture out of the house, deeming that the best way of attracting the attention of the police. While in the act of throwing the furniture out they both screamed: "We can not help it. We are not to blame!" They were, of course, taken in charge, and the next day they came under my care. They were separated at once and placed upon different wards in the hospital. In about four months from the time of admission the younger sister had given up all her delusions and had reached her normal condition. The course of the disease in the elder sister was not so satisfactory, however, and, though much improved, she is still influenced by the ideas which controlled her before admission. From frequent conversations with the younger sister after her recovery the fact was made plain that for several weeks she realized that her sister was insane and fought hard to remain uninfluenced herself. At last, however, the sane mind succumbed to the overpowering influence of the insane one, and she became her sister's second self in word, thought, and act. Of course, this would not have occurred had the condition of things been reversed and had the younger sister been the first to become insane. Neither would it have followed had it not been for the neurotic tendencies of the passive subject coupled with the debilitation due to worry, overwork, and ​insufficient food. The close association of the two and the solitary life which they led were also important factors in the case.
I would not for a moment subscribe to the doctrine that insanity is contagious and communicated from one to another, as, for instance, smallpox is, and I altogether repudiate the common idea that it is easy to become a lunatic when compelled to associate with and listen constantly to the ravings of madmen. The immunity of doctors and nurses who live among the insane and associate with them constantly is sufficient proof that under ordinary circumstances, when there is neither hereditary tendency nor neurotic temperament, there is but little danger of being affected by association with the insane. Of course, no medical superintendent would knowingly engage as a nurse one who was ignorant and superstitious, or one who was unduly nervous or inclined to insanity from hereditary influences, and that is probably the chief reason why so few cases of mental trouble occur among those whose lives are passed in the midst of the melancholy wrecks of human minds. This brings to mind the popular fallacy that an insane person is apt to be made worse by being sent to an asylum where he must associate with others who are insane. Experience proves this belief to be entirely unfounded, for as a general thing the insane, being occupied entirely by their delusions, take little notice of their surroundings, and hence the appropriateness of the French term aliené—a stranger to the world in which he lives. Of course, when recovery begins, the situation is different, but even then the associations are not generally injurious, for the convalescing patient often takes an interest in his less fortunate fellow, which does much to promote his recovery, as well as to make him realize that he himself has been insane.
But, notwithstanding my lack of belief in the contagiousness of insanity, I believe, as stated at the beginning of this article, that under certain conditions insanity may be communicated or developed by association, and this paper is written with the hope that some practical hints may be gathered from the observation of cases similar to the ones I have described. It is obvious that when insanity exists in a family it is highly injudicious to subject other members of the family, especially those who are neurotic, to the influence of the insane member. The danger is much greater when the delusions are of a persecutory character, and women are much more liable to be affected than men. Acute mania or dementia are not likely to communicate themselves, but not infrequently a mental breakdown occurs in other members of the family, due to the loss of sleep, confinement, and irregular habits which the home care of such cases involves. When insanity has spread, or communicated itself to another, as it were, the course is plain. Separation must take place at once, and it is not at all ​unlikely that under new surroundings and appropriate treatment the passive subject will soon be restored to the normal state. But even admitting that under ordinary circumstances the danger of communicating insanity from the insane to the sane is slight, I shall think that this paper has fulfilled its purpose if it does aught to encourage the early treatment of the insane in hospitals especially designed for the care of such cases. Only those who are familiar with the fact appreciate the danger from delayed treatment, and realize how the chances for recovery diminish as the months pass by without hospital aid. From a careful analysis of the cases with which I have had to do during the last decade, the incontrovertible fact is shown that from six to eight persons recover when placed under treatment within the first three months from the beginning of the attack, where only one recovers when hospital treatment is delayed a year. This fact alone suggests in no uncertain tone the early removal of the patient from the influence of home and friends, even though "communicated insanity" should be considered merely a figment of the alienist's brain.