Part 5

This excitement of the depressing and exhilarating passions alternately, is the most striking characteristic of the insane. It is true, that both these states or stages of the disease, if long continued and not well managed, are necessarily followed by a third state of exhaustion. The systems of body and mind are wholly worn out by exertion, and require rest to recruit and manifest their renewed power, but changes from one state to another is only a partial exhaustion; another class of feelings become active, while the former are suspended, so that the melancholy and “high state” are for the most part, states of mind or changes in the direction of its energies, and not that the melancholy have less than the furiously malignant or joyous maniac, of that power which is equally necessary to mental activity of every description.

For instance, I have known the same person sent at one time as patient under the influence of religious melancholy, originating in erroneous extreme Calvinistic views; and at another period in the most joyous state of religious excitement, from having come under the influence of extreme Arminian views. On the same principle, I have by the most laborious process of argumentation and the statement of what I conceive right views, produced a counter-impression, given another character and form to the disease, and in some cases, on this principle, effected a cure. {18}

As these cases are much more common, and these views of much more importance than mankind, or even medical men imagine; and as many who possess a susceptible constitution of mind, similar to those whose cases I have described, are living in the world in this fearful and continual state of mental excitation, and of course, may be on the verge of the same precipice, it is right they should be warned of the danger to which they expose themselves.

It need scarcely be mentioned, that the present constitution of society is not in a healthy state. It is not bound together by that order and sympathy which should exist, but on the contrary, discord and disseverment prevail to an extent which seem to threaten its decomposition and destruction. But too many individuals are intoxicated with the fury of their various passions and inordinate desires, and mad with the endless anxieties and reverses they produce. One part of society, as well as one part of the mind, is at war with another. I wish it, however, to be particularly observed, because I shall have to revert to the fact hereafter, that it is not so much these exciting causes, or even the sad effects of these feverish and wasting passions, that are in themselves so dreadful and fatal, as they are when accompanied or followed by the conflicts and condemnations of conscience. Wherever there is the endeavour to overturn and sacrifice some confirmed and good principle, that which is lowest is encouraged to struggle for pre-eminence, and the mind suffers extreme misery and distraction.

It is in this way that we often find minds that have much that is amiable about them, are soonest overthrown; but in all cases when (as in this and what is in fatality next to this, perpetual domestic discord) the fire of our spirits, which should give life, health, and support to our exertions, is not united and clothed with that wisdom which ought to diffuse itself in every useful direction; it is in an altered and dangerous state, producing, according to this alteration of state, disordered function, acrid secretions, and if long continued, disease; and when disease is established, its state is further altered, so as literally to “eat up the flesh,” and in one form or another burns, scathes, withers, and consumes us, {20} but I need not now enter into all the various evils, miseries, and conflicts in which the mind is involved, and the dangers to which it is exposed, nor the corresponding physical effects, nor show that even were these extremes exclusive and improper, activity does not exist, but where the understanding seems most completely called forth; still we have reason to fear that we pursue the important duties of civil life, whether it be the weighty matters of legislation, or the scarcely less responsible exercise of the learned professions, or what ought to be the binding and sweet influence of faithful dealings in trade, and our common intercourse with each other, in an improper spirit, and from improper motives, and not with that singleness and simplicity of heart for each other’s good, which alone is useful and safe; which we could not fail to do, were we sufficiently aware, that in as far as we depart from this purity of spirit, our views of truth must be perverted, and our healthy vital energies changed, causing fever, paralysis, or some morbid state, and all our sympathies poisoned and deranged. But I might find enough of matter for illustration without detailing the effects of over-excitation, arising from our mad desires after wealth, fame, and distinction, or even the consequent distracting and overwhelming miseries of misfortune, poverty, and starvation, in the modes and amusements of fashionable life, to which sensitive persons, and especially those who have made themselves morbidly sensitive, become, as in the case last stated, the victims.

Excitable and cheerful persons often fall into states of depression, purely because they have drawn too largely and exclusively on their exhilirating passions; whereas, had they drawn equally on the depressing passions, they would have tempered and balanced each other, and kept the mind in its right state; and such is the constitution of the world we live in, that our duties require that both should have their relative and appropriate share of exercise.

Persons, often, in company, think it necessary exclusively to exercise the exhilirating passions, and they return home not only with these feelings exhausted, but with the depression passions assuming in their turn an over-active state, and in this state they perhaps encourage a spirit of discontent, and peevishness, making sad havoc of domestic peace, and producing an unhealthy state of mind, an alteration in the state of the nervous energy, generating an acrid and morbific matter in the system, and ultimately disease, both in themselves and others. {22}

It is too well known that many who are all life and energy in company, sink on returning home, into this state of apathetic melancholy. This is especially the case with those persons who are betrayed by their buoyant spirits and powers of pleasing into extremes, exciting themselves by stimulus and other excesses; and as they are often minds originally of the most amiable constitution, they afterwards, when left to sober reflection, are overwhelmed with self-condemnation; and should they, to raise their sinking spirits, have again recourse to stimulus, the evil is increased, and the effects are terrific. It is to these painful and conscientious conflicts, as much, and perhaps more, than the mere physical effect of their excess, that the disorder and destruction of their minds are to be attributed.

I mention these simple and common forms of irregular and discordant excitation, to shew that from such causes the susceptible mind gets into the habit which may terminate in the more fixed and serious form of alternate states of irresistible excitement of the exhilirating and depressing passions, constituting insane cases, just as we find those of the alternate over-excitement of the kindly and benevolent affections; or, of the angry and malevolent passions terminate in corresponding states.

How many persons live in this baneful domestic atmosphere of perpetual storm and sunshine? And hence, when the mind of one of these becomes morbid, and the malevolent passions assume the exclusive sway, they are said to hate those they formerly loved, which is simply the more permanent state of their former fits of anger; in fact, every form of incipient insanity may be traced with more or less ease, to these corresponding causes. This may not be popular doctrine, but it is the truth.

Many married persons get into this destructive habit of indulging in these extremes of anger and affection; and where they are known to have existed in no common measure, they propagate this their state of mind in their children, and which is afterwards most effectually and successfully educated by their conduct and example; and hence such domestic circles are fruitful soils in producing insane cases. I could state some fearful examples of the truth of these observations, but I would gladly throw a veil over these melancholy pictures of human nature. The sword may slay its thousands, but the demon of domestic strife is much more destructive to man’s life, health, and peace.

I mention all these matters, to show that such are exactly, in their incipient form, the cases which require the most delicate, intellectual, and laborious attention. The delusions which occur in an after stage, arise out of these habits, and until they appear without disguise, it is difficult for strangers to pronounce them insane; and yet these are causes which produce the worst and most incurable consequences; and if cure is to be effected, it can only be by a system of management, which by calming and tranquillising the mind, will best allow the physical effects to subside. But when this painful and irritable state of mind has been of long duration, and some chronic and inflammatory state of insiduous, slow, and gradual growth, is the consequence; then a longer time will be required before cure can be brought about. I may here remark, that it is absurd to suppose we can expect this, by moral or medical means singly,—they must always co-operate, and never be separated in the mind of him whose object is cure: and it is a most important and fearful consideration, that on their treatment depends the increase or diminution of their disease.

To show there is the greatest difficulty, delicacy, and anxiety required to be exercised in the management of these cases, it is only necessary to mention, that they are precisely those, who, as I have already said, though they are either in reality, or ultimately prove the worst and most dangerous cases, can nevertheless, in the incipient stage of the disease, and more especially immediately after being placed under moral restraint and medical care, exert their remaining power of self-control over their delusions and extravagances, so as to appear, for some considerable time, perfectly sane. Indeed, it may be considered as a general fact, that where the insane person preserves his individuality of character, and his alarming state is chiefly indicated by his having his prominent peculiarities in the natural constitution of his mind in a highly exaggerated and caricatured state, (which is always a most unfavourable prognostic, and more particularly if this exaggeration be grounded in self-love,) the incipient stage assumes this delusive appearance.

It is to such cases, in their incipient stage, that I have hitherto devoted myself, and which I have had for the last fourteen years constantly about me.

In devoting ourselves to such cases, we are doing no more than we conceive to be our duty, nor do I conceive this explanation makes, in all cases, our own house superior to others. In some cases, the reverse is the fact. This explanation is intended to show the necessity of classification, and division of labour. In many cases, so far from giving a preference to ourselves, I would give a preference to the surgeon, matron, and attendants at the other houses. In many cases, they become attached to them, and prefer remaining with them. Besides, a mere change is sometimes useful, and often operates as a powerful check;—they are in their favourite house,—they behave ill, and a threat of removal restrains them. All this requires attention, and is assisted by the arrangements described.

To show this is no new and fallacious view, manufactured and brought forward for the mere purpose of my own defence, I beg leave to quote from an explanation of the drawings and plans of the houses and grounds, which were, according to the Act of Parliament, sent to the Quarter Sessions at Chelmsford, now many years ago.—Speaking of Leopard’s Hill establishment, I said—

“At present there are no very violent cases, and some that were so are convalescent, and when patients become convalescent, they are often removed to my own house at Fair Mead, in order to relieve them from painful associations; by contributing in every way to their comfort and their happiness, and by devoting ourselves more particularly to them, we secure and expedite their cure; this removal is often most expedient and useful, but it sometimes happens, {27} that they prefer remaining amongst those to whom they have become attached; and they are then removed out of the galleries, and have apartments in the front and family part of the house.”

“Fair Mead House, I wish it to be distinctly understood, is an additional house in the same grounds, but at a sufficient distance to serve the purpose I have just stated,—the purpose of humane classification, according to their state. In fact, agreeable to these views, it may be considered as a necessary appendage to the others. It enables us the better to discharge a most important and delicate duty, that of more closely watching, and more directly and personally attending to patients during the incipient and critical stage of convalescence; a period when, wanting such attention, they are driven by a revulsion of feeling into their old state, or sink from exhaustion, and die.”

“Again, by having three houses separated in this way, and for these purposes, it not only enables us to divide the males from the females, but also to devote ourselves to those to whom a more delicate and intellectual attention may be useful, in this critical period of convalescence, and it also enables us to select such, whether old or recent cases, as are capable of participating in, and not deranging very much the enjoyments of the domestic and social circle. All which will include convalescents; some incipient cases; some that are melancholy; others that are imbecile; some that may be permanently deranged, but very full of good nature, and not troublesome; and some that are hopeless upon some specific point, but pretty correct on all others.”

Another consideration of greater moment is, that persons necessarily attach an importance to the house in which we more generally reside, and even some recent slight cases feel none of that painful repugnance in coming to us, that is usually felt on the bare mention of a place of confinement, {28} and many come not only without reluctance, but with voluntary pleasure. In my tables, sent to Lord Lyndhurst three years ago, I there show that more than one-third of the patients then received, had been so brought, and “that I had always held forth to them the promise that they were coming as visitors,” saying, “as long as you behave as such, you shall be treated as such.” When they forfeit this, they are deprived of their privileges, and, in some cases, they may be sent to Leopard’s Hill establishment; and in others, a threat of their being removed from this to Fair Mead, answers the same purpose.

I consider it a point of the very first importance, that truth should never be violated; we must, therefore, on no account, at any time, deceive them, and more especially in the first instance. If we begin by destroying confidence, we destroy the basis on which alone all moral good can be effected. Without truth there can be no confidence. It is quite a mistake to suppose a system of deceit is necessary for the purpose of more quietly accomplishing their removal from home. I can conscientiously assert that my own experience proves the contrary, and that I have not found in a tithe of the cases which I have had to manage, any very great difficulty in persuading them willingly to accompany me, more especially if I had sufficient time given me to ingratiate myself into their good opinion and confidence, which I do, by fully explaining the object of their removal, the treatment I intend to adopt, and the means to be used to make them as happy as possible in the new circumstances in which they are about to be placed. Whenever this was done, and I found them in a state to understand it, which is the case in a greater number of instances than most persons imagine, they have then almost invariably been persuaded to come willingly, without using any arts of deception.

I delicately, but candidly tell them, that they are considered to be insane, that the disease has produced some change in their usual mode of feeling and thinking, that the object of the proposed visit is their good, and that if they will only go willingly along with me, I pledge myself they shall be treated as visitors, unless their own conduct should oblige me to act otherwise towards them. If after all the pains I take, (and no pains can be too great to accomplish my object in this faithful way,) they still refuse, I then tell them, that their going is a matter quite settled, and cannot possibly be altered; that they may as well make a merit of necessity, and like rational beings, go at once with cheerfulness, and good-will, in order that they may still receive the good which I have promised them.

If after such explanations they do consent to go willingly, or even without much force, a grand point is accomplished; for in this case, suppose after their arrival they grossly commit themselves, and justly forfeit their claim to the treatment I have promised them, and I am obliged to abridge them of the liberty they had really given them, they then feel and often acknowledge the justice of any change in their treatment, which is the result of their gross misconduct, and they exert themselves with the hope of regaining the liberal privileges they have forfeited, and thus from their desire to be considered and treated as visitors, they put forth into operation what is of the greatest importance, the valuable principle of self-control.

In most cases, while nothing is more consoling to their afflicted spirits than friendship, and the society of those they love, nothing is more grievous to them than its loss. To form such a feeling, is very difficult; but by beginning and proceeding on these principles, showing them that truth and justice and kindness are the basis of our actions, we establish a wonderful moral influence over them.

It will often happen, however, in stating to them that their minds are not considered in a right state, they will stoutly deny it. I then assure them, I shall be very glad to find they are right, and hope they will not force upon me by their conduct, a different conviction. Stating to them very gravely, what I understand has led to this conclusion, saying, if we judge by the acknowledged rules of the world, they must confess there is something very unusual and strange in their words and actions; but at the same time, I trust they will not in future commit or lose themselves, as it appears they must have done. In which case I promise them I will myself befriend them, and endeavour to replace them as soon as possible, in the confidence of their friends, but which I can only do when their conduct will enable me to transfer to their friends the confidence it has given me. Many, of course, assert, that what others call insanity, they know to be correct and proper; then I say, we must have time to examine it at leisure, that it is too weighty a matter to determine in haste. Where the person cannot be made to comprehend all this reasoning, of course other methods must be adopted, according to the nature, exigencies, and the state of each patient. In fact, it is impossible to state all that is, or ought to be done on these occasions; we can only hint at the spirit of the procedure, for every separate case requires its own appropriate plan of procedure.

To show the propriety and advantages in this method of proceeding, I shall state the important fact, that some few have at once been cured, without removal from home, by the powerful influence of its candour and honesty.—And in all cases, when, after all this labour and delicacy, they are removed, and are, subsequently, on the same principles, and in the same spirit, treated with every possible indulgence, and the greatest degree of forbearance, even overlooking many lesser faults, and waiting, until, as we say, “they break out and commit themselves,” in some very decided manner, so as to furnish us (even in their own estimation) with a very palpable plea to abridge them of their indulgencies, they have then forced upon them the conviction of their error, and are obliged to acknowledge the justice of any change that is made.

It is singular, that many have on this plan been speedily cured by the self-restraint this system conspired with other things to give them; and many others have recovered without ever feeling or considering themselves as having been treated as insane patients; and most of them do not consider themselves as under any confinement whatever. Not more than about 3 p. cent. suffer any personal restraint, and not one for years under any constant personal coercion, and we have, at times, been for months together with not more than one patient whom we were afraid of trusting in the grounds alone.

I must more particularly advert to this most powerful argument in favour of this plan, which is, that it conduces to form the habit of self-control, which is the habit above all others which ought ever be our aim to form. It ought to be the primary object in every moral plan of cure. But I shall have some further observations to make on this principle, and the various means which tend to form and increase it, in another place. I only hint at these things at this time, for the purpose of showing that all these delicate, modified, conditional, and encouraging plans of superintendance are assisted by the arrangements I have described.