Part 2

“Without presuming on the experience, knowledge, or the materials I may possess, of this I am confident, that so long as I am conscious that the love of truth is my pole-star, so long will my faith continue firm in this, that with patience and perseverance, and the love of truth for our guide, scarcely any man’s powers are so limited but he may hope to acquire some clearer views, or perhaps make some discoveries in the matters he has undertaken to investigate.

“The objects of my enquiries are very numerous, and involve so many either undiscovered or unadmitted truths, which are so closely connected with subjects of inquiry the most interesting, that I have adopted this slow and humble plan of proceeding for the present, and have suspended, for a while, my first purpose of publishing a systematic treatise on insanity.”

It is intended that each publication shall contain one subject, at least, in some measure complete, so that each part may have its distinctive title, and be had separately.

The study of mental philosophy, of which insanity is a very important part, is, of all studies, provided we are on the road where truth is the guide, the most useful to our moral state. This belief was the first motive which induced me, now more than thirty years ago, to direct my medical attention to this most radically-important, though hitherto-neglected branch of the profession, as well as to whatever seemed best calculated to make me understand the sources of all erroneous and extreme views, and which a series of painful circumstances through life have excited and continually strengthened; but it is not necessary to state them: I may, however, mention that, as early as 1807, I visited lunatic asylums con amoré, and that in 1816, 1817, 1818, and 1819, I was engaged in lecturing on Mind and its Diseases. Before this time, I had no conception that I should ever be exclusively devoted to this department of the profession, which circumstances at that period forced upon me. I trust, however, that I have endeavoured to profit by the opportunities which this new situation afforded me of more fully comprehending the nature of mind, its connection with life and organization, its diseased manifestations, and of ascertaining the best modes of co-operating with nature in the removal of them; and, at any rate, it is certain that, for the purpose of lessening the miseries and increasing the comforts of those under my care, I, for the most part, have sacrificed every personal consideration.

From 1819 to 1824, I continued medical resident and superintendant of York Asylum; and on leaving it, it was voted unanimously, “That I deserved the thanks of the Governors, for my constant and successful efforts in establishing and perfecting the mild system of treatment there.” I was again engaged in lecturing, at the request of several institutions, on Mind and its Diseases; soon afterwards, in 1825, I fixed on this situation, as the best adapted of any part of the country about London which I saw, (and I spent several weeks in the examination; nor have I since that time seen any I like better) to carry into effect my views of the treatment of the insane, either as respects the recovery or the comfort of recent or confirmed cases; for here, together with domestic comfort, diversity of occupations and amusements suited to their various states, the retirement, pure air, and sweet scenery around, afford ample scope for walks, without annoyance, and apparently without restraint; which, with judicious moral and medical management, combine many acknowledged requisites to assist the disturbed and diseased mind to regain its tranquillity, and in many cases to resume its healthy tone of action.

I shall only add, that all these views have been amply justified by the beneficial results on those entrusted to my care; so much so, that these results and my success have greatly exceeded my most sanguine anticipations.

I here gladly close these personal remarks, which have been forced from me, for self is a subject which it is seldom wise and always dangerous to introduce.

It only remains to notice another peculiarity in this essay, which is, that of having introduced some animadversions on legislators whose minds are not sufficiently pure or comprehensive to enable them to avoid the common error of overlooking general principles, and not to presume to judge and draw conclusions from the hasty, partial, and erroneous views they have acquired on the subject on which they legislate. This has often led to, or been combined with, that great selfish view of making themselves and their property the chief good, not considering the real objects of legislative care, nor “that life is more than meat, and the body more than raiment.” This it is which has corrupted all our laws, especially our criminal code, which was a system of legal murder, not justice, and a perfect scandal to the nation.

The same faults are visible in all they have done for the poor insane. They have given an undue and exclusive consideration to property and to the few extreme and violent cases; treating them and all who have the care of them as criminals. To live amongst them, appears to be deemed a crime, for which neither goodness nor talent can atone. All which must, in various ways, have an injurious influence. To banish these errors is to better the treatment of the insane. This conviction is my excuse for introducing the subject, and which makes me anxious to prove, from experience, that such extreme cases hardly have any existence at all under a proper system of treatment; and, that at all events, this liberal treatment materially lessens the horror and danger usually conceived to attend these places.

Insanity is, no doubt, a terrible visitation; but why should we allow a false and unreasonable horror to increase it? and why should we thus sever our sympathy from a disease which more than any other requires it? The medicinal virtues of the fruits of charity are best proved amongst them. Grant that the disease arises from some remote or proximate ill-directed mental states. Why should we have more horror of insanity, than many other consequences of ill-regulated minds? To me, the foul ward of some large public Hospital, is incomparably more horrible and loathsome. Such direct consequences of wickedness present the object before us in an aspect that makes it difficult for us to exercise any feelings of commiseration towards them. Not so the insane. But these are views, however, into the consideration of which I shall not enter in this place; but I mention or rather hint at the diseases of other organs, for the purpose of asserting that the reality and appearance of the miserable state of the insane is not so shocking as people imagine; but that still I allow it is an awful visitation.

When the gloom and horror at present thrown around establishments for the insane shall be cleared away, Dante’s inscription over the gates of Hell, will be no longer applicable to them,

“Lasciate ogni speranza, voi, ch’entrate;” {xiii}

this, or perhaps another passage from Euripides, has been imitated by our Milton,

“Here hope never comes, which comes to all.”

They will be considered houses of cure, or hospitals for the insane.

The erroneous and false impressions concerning the character and state of the insane, will be corrected. The popular impression, that they are all violent and vociferous, destructive and dangerous, will be removed. Hitherto medical writers, by selecting the most striking cases, have contributed their share to this popular error. They have been led to do this, partly because they are cases, which more naturally arrest their own observation; but chiefly, because they are more easily described, make a more interesting picture, and are the most curable. A statement of the recovery of such patients, though it may serve to exalt the writer in public estimation, is wrong in itself, and very injurious in its influence; for it increases the unreasonable horrors and false impressions entertained about the insane, and propagates and perpetuates the evils of which the public and legislature complain. They receive impressions from extreme cases, which average about five per cent. then speak and act just as if all the insane were in a similar condition.

It would seem that these prejudices and horrors of the insane exist in a much greater degree in this part of the kingdom than they do in Yorkshire. There I was in the constant habit of taking convalescent patients with me into family parties of the first respectability; and members of these families were also in the constant habit of visiting them as friends and acquaintances, and of inviting them to tea and to spend the evening at their own homes; and this practice, in most instances, had a very pleasing and beneficial influence. This was the case with other institutions; but I have not found, neither have some others found, any such faith in, and sympathy for, the insane in this part of the kingdom, but quite otherwise; and yet I am certain, it is an example they cannot too soon imitate—its beneficial influence will bring satisfaction to themselves, will remove their prejudices, destroy their painful fears, and lessen the chances of the calamity invading themselves. There is a protection around those who are striving to alleviate the distresses of others.

This difference, which I and others have experienced, makes me more anxious “to impress these views on others, and especially on those around me, in order that I may not be obliged, from too great a deference to the fears and prejudices of those I most anxiously wish to conciliate, to abridge the exercise and lessen the happy effects of a system which theory and feeling have suggested and compelled me to pursue; and which nearly twenty years’ experience and increased knowledge have confirmed and justified.” {xv}

So important have I considered just views of the insane, that I have added an Appendix for the express purpose of exhibiting a fair average of the general appearance of the insane. With the same view, I have given a few portraits of such of these cases as are now, either themselves, or their friends, dead, or little known. I had the same principle in view in my first publication, which induced me to give cases in regular rotation, “rather,” as I there say, “than the common mode of making a selection of extreme ones, that I might not give a distorted picture of the insane, nor add to the unreasonable horrors and false impressions on their state, as this has, I am convinced, been one cause of an improper spirit and conduct towards them.”

It is scarcely necessary, after what I have already said in the Appendix, again to guard the reader against the mistake of supposing that the cases and treatment described in that Appendix form any data or criterion for judging of the kind of cases and treatment in my own private establishment. The medical swing, for instance, is stated as having been useful, in some violent cases of mania; but this was even then soon laid aside as objectionable; but it would be worse than useless now, because, under a system which does not cultivate the habitual exercise of the vindictive passions, cases in which it was of use, no longer exist. In fact, to have recourse to any means which operates so much on the fears, whatever medical virtues it may appear to possess, is adopting a principal which philosophy and Christianity equally condemn. It ought ever to be the aim of all persons IN POWER to call in no principle but that of the OMNIPOTENCE of SYMPATHY and BENEVOLENCE; and this PRINCIPLE is not to be excluded even from those whose spirits are imprisoned in bodily evils and diseases.

CONTENTS.

Page On the buildings, grounds, situation, and system, necessary 1 for all purposes of an efficient classification Illustrated by an interesting case of recovery, No. 106. 5 Do. do. do. No. 195. 12 On the common division of Insanity into Mania and 15 Melancholia, not necessarily being separate classes of cases, but generally, merely variable states of the same case, requiring corresponding changes and modes of moral treatment This view of these cases is confirmed, and their danger 18 forewarned, by an examination of the natural constitution of mind and previous habits of those subject to these states The delicate treatment which such cases often require, 25 renders a separate house, where the medical proprietor and superintendant and family reside, of great importance, as well for them as for milder and convalescent cases That cases under this system, are induced, when they know 28 it from experience, or have it faithfully explained to them, to come and return without fear or reluctance The great importance of this first step; and of making 29 truth the basis. The manner of doing this explained, and its beneficial influence stated Illustrated by an interesting case of recovery, No. 335. 36 Ditto do. do. No. 373. 45 Further observations on such cases and the above principles 47 That suitable classification and association is better than 49 entire seclusion Illustrated by cases, No. 425 and No. 429 51 On the beneficial influence of their being accustomed to 53 the usual habits, manners, and privileges of civilized life On the propriety of diminishing the prejudices which exist 59 against the mere residence at an Asylum, if for the purpose of restoration The evils of considering diseases of the brain as a greater 61 disgrace, and as an indication of greater criminality than other diseases That our aim in all our moral treatment should be, to call 65 forth self-control, and all the better principles and feelings of the human mind; and that this important subject will be resumed Illustrated by a case, No. 372. 69 Do. do. No. 395. 71 That often we have only a choice of evils, and must choose 73 the least Illustrated by a case, No. 421. 75 Do. do. No. 396. 77 On the use of exercise, and a retired situation for the 78 purpose An account of a system of cure, by being made to work, 81 related by Dr. Gregory Regular work always useful, when willingly undertaken, but 82 not otherwise; easily managed with the labouring, but as difficult with a higher, class of patients The danger of irritation, illustrated by a case 83 The contrary system of soothing, illustrated by a case 84 Further remarks and quotations on this subject 86 The talents and sacrifices all this requires, and their 89 influence, Notwithstanding all this apparent extra trouble, it is, 100 when done from right motives, the safest and easiest in the end That these views are based on the firm ground of Christian 108 philosophy CONTENTS OF APPENDIX. EXPLANATION of the object of this Appendix; which is, by 111 giving a correct description of the state and character of a fair average number of old insane cases, to counteract the usual misconceptions and prejudices existing against them Case No. 1.—His eccentricity, and exaggeration of his 113 natural character and that of his family. Has seasons of excitement Observation 1st.—That the fluctuations of the animal 115 spirits of the old insane often depend on causes which equally act on the sane; but, that from differences of state and circumstances, the effects are very different Case No. 2.—Though in a very torpid state, yet he has (as 116 every case has) his distinguishing peculiarities Illustrated by a Portrait 116 Observation 2nd.—That mind is a garden which we must 116 cultivate—a fire which requires stirring and feeding Case No. 3.—An example, which indeed every one is, more or 118 less, of the correspondence, as far as the remnants of mind exist, between his present and original character and organization. His habits of employment, and its happy influence Illustrated by a Portrait 118 Observation 3rd.—On the use of employment, and its easy 119 application Case No. 4.—That of an idiot. Odd displays of an increase 120 of animation Illustrated by a Portrait 120 Case No. 5.—Torpid lethargy. His natural character amiable 121 Case No. 6.—Though in a very singularly deranged state, 122 evinced by the most extravagant fancies and exploits, which he delights to detail to every one, yet he is constantly employed, useful, and happy Illustrated by a Portrait 122 Observation 4th.—The explanation of the peculiarity of his 124 character, proves that, in all cases, truth should never be violated in our conduct towards them Case No. 7.—A very singular case of periodical violence and 125 sleep. His habit of gyration described Observation 5th.—His habit of gyration explained. How far 127 the generally alternate states of excitement and depression of the insane is the return of their primary disease, or for the most part, merely the habits acquired of irregularly expending their nervous energy, which fluctuations are further increased by the usual atmospheric causes of excitement and depression The influence of temperature, moisture, climate, seasons, 129 diurnal periods, atmospheric changes, and different years, on our health and spirits, and the type of our diseases, (and that this subject will be resumed), and how all this is modified by the states, habits, and circumstances of the insane Why they are less subject to the prevailing diseases 133 The mental condition must, in all diseases, be considered 134 Illustrated by cases 135 How the state of mind and circumstances of the insane must 136 modify these physical influences Why this is differently exhibited by the insane, than it is 137 by those who retain the power over their own spirits That this view is proved to be correct, by the fact that 139 these causes produce different effects by their being under different modes of treatment That the various character of insanity is but the same 143 excitement of the vital energies operating on different parts of the mind, according to previous or present habits and states Hence, the insane are often caracatures of their own, as 146 well as of family habits and character The truth of this reasoning proved by the fact, that the 147 greatest number of insane cases occur when mental conflicts and worldly struggles are greatest, and among those whose minds are ill regulated or miserably circumstanced; but still it does not necessarily and always follow that those whose minds are most wicked are soonest overthrown, but sometimes the reverse The practical object of these observations 150 Case No. 8.—One of the extreme cases of furious mania, with 151 a leprous eruption of the skin Observation 6th.—Whether cutaneous disorders are common to 153 the insane? The treatment of this case Case No. 9.—One proof, out of many, which proves, that the 154 last strongest impression of their sane state continues prominent, even when their minds seem for ever lost to themselves and all passing objects around them Case No. 10.—In which an injury on the head produced 155 symptoms in correspondence with the phrenological office of the part injured Case No. 11.—Apparently perfect dementia, and yet he is 156 always employed Observation 7th.—An excellent illustration that there is 157 scarcely any insane person’s mind so much lost, but that still, provided labour has been their early common habit, they may with ease be brought into habits of useful employment, and which with such a class, should, both for their cure and comfort, be adopted, and arrangements made for the purpose Case No. 12.—A female instance of scolding and kindness by 158 turns Case No. 13.—Constantly talking to imaginary objects, but 159 still perseveres in his habits of usefulness Case No. 14.—A beautiful exhibition of female kindness and 159 love of children, as well as of many other symptoms which indicate that her former habits and general natural character and disposition have been amiable Illustrated by a Portrait 159 Case No. 15.—Like a passionate and proud man in a constant 161 state of inebriation Observation 8th.—A striking instance of the correspondence 162 between cause and effect Case No. 16.—Vanity turned into stone 163 Illustrated by a Portrait 116 Case No. 17.—An unmarried female, useful as a laundress, 163 and distinguished by her affection for cats and kittens Case No. 18.—An extreme instance of the most furious 164 excitement of the vindictive and destructive passions, and the habits and states to which his treatment had reduced him Observation 9th.—The mistake of calling those facts, which 166 are the effects of improper treatment, symptoms of insanity Case No. 19.—Constantly like one muttering in his dreams. 167 Very good-natured Observation 10th.—Perhaps his reason might have been 168 re-awakened by constant judicious treatment and attention Case No. 20.—An ideot, but employed 168 Illustrated by a Portrait 168 Case No. 21.—Was formerly in states of furious revenge, now 169 gradually diminished in frequency and degree, by kindness Observation 9th.—A happy illustration of the effects of 170 kindness Case No. 22.—Mind a perfect wreck—the effect of 170 disappointed love Case No. 23.—A very interesting caricature of political 171 mania of a person of family and title. He fancies himself constantly employed in making calculations and in doing many strange acts, all necessary parts of his mighty task of paying the national debt, which abstracts him from all external objects, and from all consciousness to his own bodily sensations Observation 12th.—That the correspondence between the 175 present and previous habits of mind, are, in most cases, and certainly in this, most striking On the effects of heat and cold, and the changes of 175 temperature in the insane That we are not to mistake, which is often done, the mind, 175 in a state of abstraction, being insensible to the external changes of temperature, for the physical system being unaffected by their action That the changes and unequal diffusion of heat correspond 176 with the general and particular state of the mind, and that in cases of pure intellectual abstraction, and in those excited by the bad passions, it is very different, and in cases of gradual decay of mind, it is altogether defective To discriminate those differences is necessary to regulate 179 our treatment according to the exigencies of the case Observation 13th.—On the effects of intense study and 180 general intemperance of the mind That when study is blamed, I have often found that the 180 intemperate feelings, wicked and irregular habits, were the real causes That proper mental exercise is as essential to the health 181 as bodily exercise That it is a great error to suppose such exercise injurious 182 or discountenanced by religion, provided always the mind is under the influence of right motives Case No. 25.—A dignified exhibition of all the mental 190 energies arranging and concentrating themselves under his self esteem Illustrated by a Portrait 190 Case No. 26.—A caricature of a masculine female 193 Case No. 27.—One of extreme torpor and debility 193 Observation 14th.—That the character of all hereditary 194 cases retains something of a family resemblance Case No. 28.—A caricature of Johanna Southcott’s followers 195 Illustrated by a Portrait 195 Case No. 29.—A most horrible object of demoniacal violence 197 suspended twice by a physical accident and disease Observation 18th. {26}—On the doctrine of demons, and that 198 the subject will be resumed in an after part of this work Case No. 30.—A very interesting demonstration of the misery 199 of ill-assorted marriages, and that the painful and powerful association of the original cause of the disease produced its frequent recurrence Observation 19th.—On the evils of such marriages, and that 202 the consideration of this important subject will be resumed in an after part of this work Case No. 31.—A singular and most interesting case of an 203 active, excitable, and overworked mind being overthrown by family afflictions, his power of personating various celebrated characters of different periods of the world, which he believes himself for the while to be. His splendid eloquence and conversations with imaginary beings, &c. Still, there were encouraging symptoms, that by proper and laborious methods of mental occupation, he might possibly have had the balance of his mind restored Illustrated by a Portrait 203 General explanation of the peculiar complexion of this 207 work, and of the Appendix in particular Concluding observations, that the object of this Essay, and 209 especially of the Appendix, has been to lessen the prejudices against and better the treatment of, the insane

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LIST OF DR. ALLEN’S PUBLICATIONS.

CASES OF INSANITY, with Medical, Moral, and Philosophical Observations and Essays upon them. 1 vol. 8vo. price 8s.

“Thou shalt not break the bruised reed.”—Isaiah.

“The care of the human mind is the most noble branch of Medicine,”—Grutius.

Extracts from the Reviews.