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Chapter 5 Diagnosing the Mad 58 GHOSTS IN THE MACHINE: PATIENTS’ METAPHYSICAL SIGNS AND SYMPTOMS The Speech of the Mad Monro’s case book allows us, as one might hope, to obtain a relatively good idea of what both the mad-doctor and contemporary families considered to be the signs and symptoms of madness. The text reveals Monro to be someone who displayed considerable deliberation and a willingness to suspend judgment when diagnosing cases until more information had clarified matters. Generally, however, Monro’s diagnostic concern is directed to the mental processes that appear to be suggested by patients’ language and behavior, and it is notable that he attends very much to the form of their symptoms while not worrying very much about their content.1 Speech was predictably regarded as an especially firm indicator of mental state, verbal communications being often the first and most important point of experiential contact between doctor and patient and lying at the very crux of the consultative encounter. It was often and fundamentally on the basis of patients’ spoken (or reported) language that the physician arrived at and evolved his diagnosis and his very means of proceeding. Patients who talked excessively “loudly,” “incessantly,” or too much, such as Mrs. Edge and Mrs. Holford; who were “full of talk” or prone to “ramble,” such as Mrs. Elder; who “talk’d very insensibly,” incoherently, inconsistently, nonsensically, or “without rhime or reason ,” such as Mrs. Holford, Mrs. Stone, Miss Hume, Mrs. Duncan, Mrs. Edge, and Mrs. Moreati; or who talked too vehemently or passionately, such as Mr. Sergison, presented vivid signs of mental disorder.2 Patients who spoke too little or hardly at all were similarly marked out as disordered , their lack of words tending to distinguish them as idiotic, dull, melancholic, low spirited, and depressed, in contradistinction to the furious and the lunatic. Some patients were so resistant to the mad-doctor ’s probings that they can have given him little clue to their conditions, as when Monro complained of Mrs. Hobbes that “I could get very little more from her than that she wanted to get up & take a walk.”3 For those, on the other hand, such as Miss Anther, who talked “pretty sensibly,” or Miss Lovell and Mr. Whitby, who talked “very sensibly” or “very well” and were “able to give a good account of” themselves, speech might be a contraindicator.4 In the case of others, such as Miss Campden, Miss Compton, and Miss Cutter, who not only talked to Monro “very rationally, & coolly” but “seem’d sensible” or “conscious” to some extent that they were “not well” and of the nature of their complaints, there were the clear suggestions of a better prognosis .5 Such cases contrast with some of the “worst” patients Monro saw, including the attempted regicide Margaret Nicholson, “who did not seem sensible of having committed any crime.”6 The definitive association in this era between madness and various degrees of insensibility naturally led the mad-doctor to attend constantly to positive and negative evidence of sensibility in patients’ words, deeds, and looks. The larger the remnants of sensibility that the mad-doctor could discern, the better the prognosis: just as Captain MacDonald was “in some manner sensible that he is not well,” so Miss Compton was “at times conscious that she is not well & seems sensible what her complaint is.”7 The alert reader may already have observed something else about this attention to patients’ conversation: it is noticeable, as the balance of examples given above indicate, that disorders of speech seem to be much more commonly recorded for female than for male patients, perhaps implying a bias on Monro’s part, or on the part of contemporary families , against women talking out of turn. It would be easy to suggest that other signs of a gendered evaluation of patients’ behavior can possibly be discerned in the description of patients as “flighty,” “full of gayety,” “flurried,” in a “high state/way,” or “too full of spirits.”8 Such language is, after all, highly suggestive of prevailing expectations that women should conduct themselves quietly, demurely, and decorously. Yet matters are not so simple, for on closer inspection, it turns out that language of this sort is employed in the case book no more often to describe women than to describe men. If evidence of the mad-doctor’s gendering of speech seems ambivalent, Monro’s often dismissive attitude to such speech is certainly not. Disdainful terms such as “nonsense...

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