'Textbook of Disturbances of Mental Life' by Heinroth (1818)

A selection from Textbook of Disturbances of Mental Life, or Disturbances of the Soul and Their Treatment by Heinroth, 1818.

The authors of A History of Medical Psychology (1946) credit Heinroth as one of the founding fathers of modern psychiatry:
He used the word 'soul,' merely because there was no other word in the German language of the time to denote that complex phenomenon called 'human mind' or our present day 'sense of guilt.' This was a definite step toward a general psychopathology, because it went beyond the purely formal considerations of the patient's mode of reasoning.

Alexander and Selsnick in their The History of Psychiatry: An Evaluation of Psychiatric Thought and Practice from Prehistoric Times to the Present (1966) also credit Heinroth as a "forefunner of psychoanalysis." They write:
He expresses in religious-moralistic terminology the central concept of modern psychiatry, that of inner conflict. If Heinroth would have used the modern expression, 'sense of guilt' for sin, he would have been more readily recognized as a forerunner of psychoanalysis... . Stated in modern terms, the source of mental disturbances is the conflict between the unacceptable impulses (the id) and the conscience (the superego).

Heinroth regarded insanity as the effluence of personal guilt, which is "the source of all evil as well as of all psychic disturbances."

"The psyche and evil are united just as the sexes are universally united: through love. The psyche's love for evil is called its propensity for evil."

"Men may say what they will, but apart from total denial of God there is no psychic disorder. It follows that an evil spirit dwells in those who suffer from psychic disorders; they are truly possessed."

Melancholia attonita resulted from an experience that made a profound impression on a mind incapable of offering effective resistance "since the individual had failed during his lifetime to make the necessary preparation". When external influences like shock, anger and grief bring about mental disorders, "this is proof positive that such individuals are anything but mentally sound, that they are indeed morally corrupt."

Eknoia maniaca: "From this hell there is no salvation other than through a miracle. Only through the most hideous forms of debasement, through the vilest excesses, and through the worst crimes can a man in this condition achieve complete psychic catharsis."

Religious Melancholia: "A dissolute life that has sapped his strength, wanton surrender to every passion, a serious crime or a series of offences- this is the boggy pond whose dregs foam to the surface following a violent disturbance of its depths. A shattered psyche in a shattered body- this is the basis for religious melancholia."

Excesses and negligence- can this "be the sign of a well-ordered psychic life? Or it is not rather an indication that the organization of the psyche is defective? Gross negligence, thoughtlessness, rashness, violence- in short, all types of aberrent behaviour associated with mental disorders- can hardly be accounted for if we assume that its organization is perfect."

Repressed Hemorrhoids: "Do they result from a wholesome pattern of living? From a good physical and mental regimen? ... no such disorders occur in the absence of dissipation, laxity, imprudence, etc. Gluttony, intemperance, dissolute living- all this finally forces nature to resort to extreme measures in an attempt to effect a cure. This hardly redounds to the credit of mankind!"

"All passion, is truly a state of human disease. ... Passions form a very complex tissue in the human soul. For they are as varied as the object of desire and fear and the forms of existence and possession can be. But all have in common that they rob the soul which panders to them of peace and freedom. [...] Anyone imprisoned by passion is unfree and unhappy."

"The man who is fettered by passion deceives himself about external objects and about himself... .This illusion, and the consequent error, is called madness. Madness is a disease of the reason... [which] originated from the passions within the soul. [...] In madness the spirit is fettered and man, just as in passion (both being indissolubly linked), is unfree and unhappy."

"It [the stimulus to evil] strides through countries, it clings to objects and mutual relationships in the form of ideas which, when honestly but blindly believed in, were called spirits or demons and were said to possess the power of mischief, which is perfectly true. It is no mere image, and even less hyperbole, to say that these spirits have usurped control over the earth and that all those who are mentally disturbed have become so through their power. They all have a common starting point, a main principle to which they are subordinated: selfishness. This most evil of all evil ideas is present in the most remote and in the closest human relations; it is absorbed with the mother's milk and finds a fertile soil in the human heart. Selfishness ... appears in a variety of guises to merge with the nature of man. The ideas of money, power, possession, pleasure, etc. are such guises and are subservient spirits of this great Beelzebub. They are all struggling against the good spirit."

"People work, speculate, and earn money, for the sake of their bodies; and when we speak of life, we mean the body, whole the soul, that is, the calculating intellect, is the servant of the body. Those who think in this way see no sense of considering human life from the point of view of good and evil; and our description of the nature of mental disturbances as originating form the Spirit of Evil will not be understood by these people and will be mocked by them; but it is nevertheless true, and it will be recognized when its day comes."

"If we assume [he is here talking about what he calls the "concept of the doctor of the psyche"] that it is at all possible to cure mental disturbances... there arises the following question. Since it is the degenerate mental life which must be led back to normal, since it is the humanly healthy condition which must be restored, would this be the task of a doctor? or perhaps of a cleric? or of a philosopher? or of an educator? There are arguments which speak in favor of each of these four viewpoints, and each of these professions is at least apparantly entitled to take possession of this curative task."

"We must inquire to which of these professions (or perhaps to none of them), in their conventional and customary meaning, we are to entrust this branch of medical art and science."

"Since we are speaking of medical art and science, we should think that nobody but a doctor should have a right to make mental disturbance the object of his studies and treatment."

"The doctor of the soul (or psyche), is a true man of reason. He has overcome selfish interests and treats for purely humanitarian reasons. He considers his patients only as sufferers and not in relation to his own personality."
"From the very outset he ['the doctor of the psyche'] influences the patient by virtue of his, one may be permitted to say, holy presence, by the sheer strength of his being, his glance, and his will."

"What is needed in such cases [he is speaking here about patients for whom there is still hope of recovery], is constraint, which is in no way cruelty or inhumanity, but is necessary for the reeducation of such patients to the norm of reason. [...] It is those least deserving of freedom, namely maniaci, who love freedom best; and as long as they are left to themselves and to their perverted activity, even if only in an Autenrieth chamber [?], no recovery is thinkable. [...] For as long as such and similar patients have their will, nothing can be done with them."

Heinroth talks about a device used for 'treating' patients, known as 'the box': a "device that resembles the casing of a grandfather clock, such as may still be found in the halls or rooms of old families. It is as tall as a man, and it has an empty space in the place of the clock face. The patient is put inside, and his face is then displayed in the place of the dial. The patient is thus rendered ridiculous, which is the purpose of the device."

"rules" "first, be master of the situation; second, be master of the patient."

"... no special treatment should be attempted unless the physician can control the external surroundings, relationships, and influences on the patient. [...] The third rule is: the physician must not apply any specific treatment unless he is master of the patient, and this he can only become if he is spiritually superior to him. Unless this superiority is established, all treatment will be in vain."

"Since the physican of the psyche, appears to the patient as helper and savior, as father and benefactor, as a sympathetic friend, as friendly teacher, but also as a judge who weighs the evidence, passes judgment, and executes the sentence, and at the same time seems to be the visible God to the patient, it follows that the component parts of the procedure he adopts must be, according to conditions, mildness and friendliness, gentleness, calmness, patience, consideration, sympathy, and a measure of condescension, but also earnestness, firmness, impressive though restrained authority, and the exercise of a just, consistent, firm discipline."

"Like the monarch, the physician does not do all this directly by himself. He must accordingly find suitable assistants... faithful, honest, humane, hard-working, skillful individuals, such as may be found among the servant class."

"It is the duty of the state to care for mentally disturbed persons whenever they are a burden to the community or present a public danger; and the accomodation, cure, and care of such individuals is the duty of the police."

"Since the purpose of the lunatic asylum is evident from the name itself, it follows that it would be contrary to its purpose to connect it in any form or manner with any other kinds of institutions, such as prisons, institutions for the care of the infirm, juvenile disciplinary institutions. [...] While all efforst must be made to have perfect security, all impression of a prison must be avoided."

"A special building must be set aside for the physical treatment of the mentally disturbed. ... It must also have a special correction and punishment room with all the necessary equipment, including a Cox swing (or, better, rotating machine), Reils's fly-wheel, pulleys, punishment chair, Langermann's cell, etc."

"[T]he most important teacher and master is the physician. [...] His instructions are binding on everyone. He is the life and soul of the lunatic asylum."