The other side of the subject may be briefly disposed of. We occasionally, though rarely, meet with people who grieve over good fortune when it comes to them; these have the pain of pleasure. I do not think that any psychologist has dwelt on them, and it seems to me useless to make a study of these cases. Though in form the reverse of the pleasure of pain, it fundamentally resembles it. This disposition of mind, found in certain pessimists, is rightly called eccentric or bizarre—_i.e._, general opinion instinctively looks on it as a deviation, an anomaly. This, moreover, is only a special instance of a general state of mind—morbid or pathologic sadness—which we are about to study. I have remarked above that, as pain and sadness always involve a morbid element, the expression _abnormal_ would be more accurate and less open to criticism.
In order to affirm that a physical or moral pain is outside the usual law, and may be described as abnormal, we shall have recourse to the three distinctive marks given at the opening of this chapter, and we can take, as our one type, that of melancholia in the medical sense. It presents the required characteristics: the long duration, disproportion between the cause and effect experienced, and excessive or insufficient reaction.
It is needless to give a description of the melancholic state; it may be found in all treatises on mental disease. This affection assumes many clinical forms, varying from _melancholia attonita_, which simulates a stupid apathy, to the agitated form accompanied by incessant groans, from the slight to the profound and incurable forms. It will be sufficient to enumerate the most general features. In comparing melancholy with ordinary sadness, we may follow the cumulative method, because the morbid state is nothing but the normal condition thrown into high relief.
1. We know that the physiological characteristics of normal sadness are reducible to a single formula: lowering of the vital functions. The same is the case with melancholia, where, however, the organic depression is much more accentuated. Constriction of the vaso-motor nerves, resulting in a diminished calibre of the arteries, anæmia, and lowered temperature of the extremities; lowering of the cardiac pressure, which may descend from an average of 800 grammes to 650 and even 600 grammes; a progressive slackening of nutrition, with various resultant manifestations, such as digestive troubles, checked secretions, etc.; slow and rare movements; a dislike of all muscular effort, all work, all physical exercise, unless there are (as sometimes happens in cases of agitated melancholia) moments of disordered reflex movements and attacks of fury. Such is the general condition. It is obvious that this represents pain carried to an extreme degree, and that we find, here too, as well as in normal melancholy, passive and active pains.
2. The psychic characteristics consist, in the first place, of an emotional state varying from apathetic resignation to despair; some patients are so crushed as to think themselves dead. It has been noted that, in general, persons of a gloomy disposition are inclined to melancholia, while those of a cheerful one rather tend towards mania. In both cases there is an exaggeration of the normal condition. The intellectual disposition consists in the slackening of the association of ideas, in indolence of the mind. Ordinarily, a fixed idea predominates, excluding from the consciousness all that has no relation to it; thus the hypochondriac thinks only of his health; the nostalgic, of his country; the religious melancholiac, of his salvation. Voluntary activity is almost _nil_; aboulia, “the consciousness of not willing, is the very essence of this disease” (Schüle). Sometimes there are violent and unexpected reflex impulses, which are a new proof of the annihilation of the will. To sum up: while normal sadness has its moments of intermission, the melancholiac is shut up in his grief as if by an impenetrable wall, without the slightest fissure through which a ray of joy might reach him.
Here arises a question we cannot neglect, because it is connected with one of the principal theses of this work, the fundamental part played by the feelings. Passive melancholia, being taken as the type of the painful state under its extreme and permanent form, what is its origin? There are two possible answers. We may admit that a physical pain, or a certain representation, engenders a melancholic disposition, and poisons the affective life. Or we may admit that a vague and general state of depression and disorganisation becomes concrete and fixes itself in an idea. On the first supposition the intellectual state is primary, and the affective state resultant. On the second the affective state is the first moment, and the intellectual state results from it.
This problem, rather psychical than practical, has only occupied a very small number of alienists. Schüle admits the twofold origin.[50] Sometimes the patient, suffering from a painful and causeless depression, which he cannot shake off, inquires no further; but, most frequently, he connects the painful feeling with some incident in his previous or present life. Sometimes, _much more rarely_, the haunting idea is the first to appear, and forms the pivot of the melancholic state and its consequences. Dr. Dumas,[51] who has devoted a special work to this question, founded on his own observation, comes to the same conclusions as Schüle. One of his patients attributed her incurable sadness, in turn, and without sufficient reason, to her husband, to her son, to expected loss of work. In others, the melancholy is of intellectual origin: the loss of fortune, the idea of irrevocable damnation, etc. He is thus led to admit that a melancholia of organic origin is the most frequent, one of intellectual origin the rarest.
Footnote 50:
Schüle, _Traité clinique des maladies mentales_, Art. “Mélancolie” (French edition), pp. 21, 28.
Footnote 51:
G. Dumas, _Les états intellectuels dans la mélancolie_, where may be found several detailed observations.
Can we trace back these two modes of manifestation to a common and deeper cause? This is Krafft-Ebing’s[52] solution: “We must consider psychic pain and the arrest of ideas as co-ordinate phenomena; and there is reason to think of a common cause, of a nutritive trouble of the brain (anæmia?), leading to a diminished expenditure of nervous activity. Taken comprehensively, melancholia may be considered as a morbid condition of the psychic organism founded on nutritive troubles, and characterised on the one hand by the feeling of pain and a particular mode of reaction on the part of the whole consciousness (psychic neuralgia), on the other by the difficulty of psychic movements (instinct, ideas), and finally, by their arrest.”
Footnote 52:
Krafft-Ebing, _op. cit._, vol. ii., sec. 1, chap. i.
I am unwilling to incur the reproach of inferring more from facts than they contain, and of insisting on unity at any price; but it follows from the preceding that if the element of feeling is not everywhere and always primary, at least it is so in the majority of cases. Besides, it is closely connected with fundamental trophic troubles, so that we arrive at the same conclusion by another road. Dumas (_op. cit._, pp. 133 _et seq._) has insisted on the depressing influences of marshy soil, on the stagnation, the physical and moral apathy of the inhabitants of Sologne, the Dombes, the Maremma, and other regions infested by _malaria_, a condition which may be summed up in two words, sadness and resignation. These facts are quite in favour of the organic origin of melancholia.
The special study of the anomalies of pleasure and pain is not important for itself alone. The formula generally admitted since Aristotle, which couples pleasure with utility, pain with what is injurious, admits of many exceptions in practice. Perhaps the constitution of a pathological group in the study of pleasure and pain may permit us to solve some difficulties, to prevent the rule and the exceptions being placed on the same plane, and unduly assimilated to one another. We shall see that this is so in one of the following chapters.
