Medical Inquiries and Observations upon the Diseases of the Mind

Benjamin Rush

6 ideas

1. Madness originates in diseased brain blood vessels

   Rush argued that the primary seat of insanity is the blood vessels of the brain, whose morbid excitement and irregular action produce disordered thought. This relocated madness from the soul, demonic possession or moral failing to a physical organ, making it a disease of the body subject to medical treatment.

2. Depletion therapy to reduce vascular excitement

   If insanity is overexcited circulation in the brain, treatment should lower that excitement by removing fluid and stimulation: copious bloodletting, purging, low diet and cold applications. The therapy follows directly from the causal model, so a wrong theory of mechanism produced treatments that were systematically harmful yet internally coherent.

3. The tranquilizer chair immobilizes the patient

   Rush designed a chair that strapped down the patient's arms, legs and torso and enclosed the head in a box, holding the patient motionless for hours. He claimed it lowered the pulse and reduced blood flow to the brain while calming the patient without blows or chains. It shows how a physiological theory can justify a new form of restraint as a humane medical instrument.

4. Reframing madness as illness to reduce cruelty

   By treating the insane as sick rather than wicked or bestial, Rush argued they deserved medical care, cleaner conditions and freedom from public ridicule and beatings. Recasting a stigmatized condition as a disease changes how society is permitted to treat the sufferer, even when the specific cures offered are harmful.

5. Moral derangement as a disease of will

   Rush proposed that the moral faculty could be diseased independently of the intellect, so a person might reason normally yet be driven compulsively to lying, theft or vice. This made certain wrongdoing a matter for physicians instead of only for moralists and courts, anticipating later ideas of impulse disorders and diminished responsibility.

6. Social and political events cause mental illness

   Rush held that intense passions and social upheaval, including revolution, financial speculation, grief, intemperance and religious excess, excite the brain's circulation and produce insanity. On this view individual madness is linked to the surrounding political and economic climate, and the environment is part of the cause of mental disease.

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