Part 11

When the understanding is enlightened, or the higher feelings cultivated, the impulses of our inferior feelings will assume a better character, and be less liable to abuse. In asylums, whatever mischief and malignity, are, by improper treatment produced, the attendants place the whole to the account of their insanity; very readily, and without any self-accusation, blaming, and perhaps, severely punishing effects which they themselves have either been the sole cause of, or which they might have prevented. Nor can we wonder that such evils have existed, if we consider how very difficult it is, to find combined kindness, understanding, and practical usefulness in those who can be procured to attend upon them. Yet all this should exist in the character and conduct of those who undertake their management.

The grand principle of treatment is, to avoid even the appearance of unnecessary restraint, and to treat them with apparent confidence: such a plan of procedure will almost invariably excite their secret but proudest endeavours to preserve and retain this confidence. There is a secret power which holds the helm of the mind, and by its controlling and moral influence guides it more effectually than any rude restraints applied to the bones and muscles of the human frame.

There is no influence so powerful as the sphere of a moral influence.

It is painful to reflect on their former treatment; caged in iron-gratings and exhibited for money! Treated as wild beasts, they necessarily became like them, or worse! Devils in revenge and evil, Satans in deceit and delusion! Or if any portion of the man remained, think of the spirit writhing in agony, or sinking with despair within them! All this, and worse, in some despotic countries, even now exists; and in how many places are they not still made to drink the bitter cup of neglect and coldness, contempt and cruelty. Where do they receive, as they ought, judiciously and constantly, the cordial of sympathy and friendship? Where is every appearance of confinement and injurious association carefully avoided, and every thing studied to make them feel at home, and all this combined with medical attendance? Say not all this is unnecessary; for if life, under any circumstances, cannot be said to exist without some association of sympathy, it is certain there are among the insane, cases of misery and wretchedness which absolutely require for their cure, as well as their comfort, all the moral kindness and medical attention we can possibly give them.

It has been an universal complaint, that there is nothing certain or fixed in the treatment of Insanity, and that it is presumed it is not yet fully understood. I am of opinion that no medical treatment in any case can be fixed as certain or judicious unless we understood the origin and nature of disease; and I have therefore devoted a considerable portion of this Essay to the consideration of the correspondence which exists between the causes and effects produced; and this I only consider as preliminary to a more full and adequate investigation of causes than I am aware has hitherto been made; but still, as preliminary to this important subject, I shall, in my next Essay, first give a general explanation of the origin and cause of disease, and this in agreement with a principle which I conceive to be of universal application.

APPENDIX TO THE ESSAY ON CLASSIFICATION.

INTRODUCTORY OBSERVATIONS.

As in the foregoing Essay on Classification, I have several times stated my objections against writers on Insanity selecting only extreme cases, by which, I conceive, impressions of horror against the Insane are increased to their prejudice; I shall, therefore, for the express purpose of exhibiting a fair specimen of the general character of the insane collectively, in their worst and most revolting state, add, in an Appendix to this Essay, about twenty of the oldest in age as well as in the duration of the disease, and of course of the most incurable cases, taken in regular rotation from the Register Book of the oldest Asylum in the kingdom, excepting Bedlam; containing, at the time the living characters were described, about one hundred of the same class. Now though these are taken from among those who had suffered all the brutalizing influence of the old and neglected system of treatment, yet they do not, as a whole, exhibit so shocking a picture as previous popular prejudice would imagine. Notwithstanding this truth, it is proper to state, that they are incomparably a worse picture, than the same number would make, taken with equal fidelity and correctness, from among my own patients, admitted within the period of my own exclusive superintendance,—this would, therefore, be much better calculated to correct this injurious prejudice than that which I now give for this purpose: but they are too recent to be so introduced; yet as this would be a very striking contrast illustrating the effects of different treatment, I shall be prepared, should I live long enough for time to throw his dark veil over their memory, with the same number of cases, taken and described on the same principle.

I am the more anxious to do this at present, and fulfil this my future intention, because it may perhaps be laid to my charge, that in adducing cases illustrative of the principles contained in this Essay on Classification, as well as those which, from similar reasons, I may have hereafter to introduce, that I have been guilty, and may be guilty of the same error of selecting peculiar and extreme cases for my purpose; but I have been led into this, from the feeling that circumstances had forced upon me, however contrary to my previous intentions, something of a defensive attitude.

These are the reasons which have been my inducements in adding this Appendix; at the same time, to make the cases, in this naked form, as interesting and as useful as possible, I have not only drawn them with the most minute attention to truth, but to each I have appended some appropriate and useful observation.

Previous, then, to my entering upon the important subject mentioned at the end of this Essay, I shall now introduce these cases as a faithful portraiture of the Insane.

No. 1.—Admitted 1782; aged 76.

THERE is nothing recorded of this case, from which any correct information of the causes of the malady, or of its nature, when admitted, or of its progress since that period, can be drawn. Some of his relations are insane, and many of them exceedingly eccentric. His friends accuse some nurse of an improper application for the itch; yet, notwithstanding this accusation, the disease was gradual in its approach. He was gay when at Cambridge, and lost considerable sums at the gaming table. There is reason to believe that he had always been eccentric; and I have been told, that in his youth, he was proverbially called the proud and polite man. {114a} Whether this be correct or not, it is certain, that even now, though so little mind remains, he is soonest roused and offended, though otherwise very good-natured, by whatever questions his own importance.

Though, like many old men, he is fond of dozing away his time in bed, he has, notwithstanding, seasons of greater animation, when he seems more busily occupied with his own thoughts, often talking to himself; repeating very correctly passages committed to memory, probably forty years ago. {114b}

At these periods, unless teased or vexed in the way already stated, he is very good-natured and polite; and from his general manners, and particularly in the modulation of his voice, he still appears, in spite of the coarseness of his dress, {114c} the remains of a perfect gentleman. At these times, he is, for the most part, very happy, laughing and playing like a little child; and his very mischievous tricks—throwing stones, writing on the walls, tearing his clothes in order to make some little fanciful change and decoration of his dress, seem to be done rather as resources for regular employment or amusement, than from any malicious design or delight to be mischievous.

OBSERVATION I.

The slight changes or states of excitement described in this case, are in my opinion, the mere fluctuation of his animal spirits. I shall hereafter make further remarks (see ob. 5) on this subject; and therefore, in the mean time, (to obviate the objections which may be brought against this view,) I shall only observe that when we consider the defective and uncontrolled state of mind, {115} in these old and incurable cases of insanity, any change or increase of their animal spirits must, though perhaps depending on causes which equally affect the sane, display itself in them, in a very different manner.

No. 2.—Admitted 1785; aged 67.

There is no statement of this case on record, from which any satisfactory information can be derived; nor have I been able to obtain any account of his former life, or the nature or treatment of his case. There has been nothing of late years to distinguish his case from many old ones, whose minds have sunk into the torpid state, except it be, which is scarcely worthy of notice, that he has sometimes stood on his head to say his prayers; sometimes spit in his pocket; and, when provoked, used indecent language; otherwise his state of mind has not, for many years, exhibited any observable alteration. {116} He will be best known when I say, that he is singled out from the rest, as a little, timid, old-looking man, uniformly sitting in a moping, creeping posture.

OBSERVATION II.

This man is not more of an idiot than the one just described, yet there is much less appearance of mind about him; but his mental powers had not formerly been so much evolved and improved by education; and the mind, like the soil we tread on, once properly broken up and cultivated, will, in defiance of neglect, long retain traces of its former improved state. Besides his want of early culture, being one of the middle class of patients, he was wholly left without mental food or exercise. There was, under the old system, a complete sacrifice of the lowest, utter neglect of the middle, for the sake of the higher class of patients; so that there was, with the middle class, for the most part, no intellectual interest excited by social converse and attention; nor, on the other hand, were the malignant passions kept alive by brutal treatment: and hence we now find amongst this class, the greatest proportion {117} of those whose minds have sunk into torpid inactivity; and not so much because they are lost, but because, from their want of excitement, they have too long continued in this motionless state. It is true, that their minds may, by the first attack, have undergone some great shock, to derange or paralyse the more perfect performance of its functions; but it is certain, that afterwards, no means were used to resuscitate or feed the powers of the mind into renewed vigour and activity. Few, even in the perfect possession of their faculties, could bear to be excluded from the air and sunshine of social life, and mingle only with beings in this melancholy state, without feeling its effects upon them. We are not to wonder, then, that those whose spirits have thus been prematurely entombed within them, should have become almost as dead to themselves and the world, as if the soul had already left them. To prevent these consequences, I shall state all that I think ought to be done, in another number of this work; which I conceive is the most interesting part in the treatment of insanity.

No. 3.—Admitted 1787.

There is nothing on record about this case, nor have I been able to obtain any information of his previous history.

His mind is not in so defective or deranged a state, as strangers and superficial observers are, from appearances, apt to imagine. It is true, he seems stupid and churlish, always silent unless spoken to, and then he answers with abruptness and impatience, in a murmuring, grumbling, and almost unintelligible manner, putting his words oddly together, like a child, or one unused, or too lazy, to articulate, and not that his answers are absolutely irrational.

He plays well at draughts and whist, but his doing so appears to depend more on old habits, {119a} than on the present exercise of his faculties; which, though, as already observed, they are not wholly lost, yet, from his torpor, age, and the natural obstinacy of his disposition, he is disinclined to exert himself out of his usual course: and though his constant habits of employment and amusement in the house, make up for him a considerable stock of felicity, and aid in procuring the degree of health and spirits he enjoys, and the degree of mind he still possesses; yet he is so extremely obstinate and tenacious of his own mode of procedure, that any attempts to oppose him, will arouse his temper into fits of angry passion. {119b}

OBSERVATION III.

There is nothing particular to observe here, unless it be the obvious remark, that from his age and confinement for such a number of years, among beings who, for the most part, have no commerce with right feelings and thoughts, it is wonderful that any thing like powers of mind should still remain; or that he should, excluded from the excitement and collision of the world, possess any inclination to exercise them; but this is most probably owing to the amusements and employments already stated; and for the sake of drawing attention to this fact, have I been induced to make any observation on this case.

No. 4.—Admitted 1787.