Part 7

Even the imbecile and idiot, are roused and improved by such associations, more than they had been, even with every endeavour to improve them, while they were in a state of seclusion. I have lately had two very remarkable instances of this kind.

No. 425 and 429.

Imbeciles, though they were from birth, they improved after their arrival; the scene was very different to the solitude in which they had been placed; the common scenes and circumstances of life, had not had sufficient power to rouse the dormant and torpid state of their mental functions, while scenes and circumstances, that are in themselves very painful, were better calculated to arouse in their moping minds, something like feeble efforts of reflection. I have seen them behold the strange antics of others, with intense wonder and interest.—Often they will catch the contagion of laughter; and thus if the understanding has no part in the matter, their spirits, at all events, partake of the merriment of the scene around them; and though insanity, considered in the abstract, is a melancholy thing, yet it is a truth, that there is much more of merriment than melancholy among the insane. I believe their average of happiness is greater than would be found among the same number in the world. Those who look with prejudice from impressions received from a few extreme cases, of course make out a different conclusion. Again, there is another consideration, which further proves that the happiness of these imbeciles and ideots may be increased by such association. They have still the blind affections craving for food, and they here find food for their gratification, better suited to their state than they could find it in the world. These affections without understanding, are to the world repulsive. It is strength of affection, guided by strength of understanding, that so powerfully attracts and binds society together. In this sphere they cannot revolve; here, eccentric as it is, they have one better suited to their state.

I daily see ideots and imbeciles taught to walk arm in arm; evidently pleased and gratified that they have objects for their blind affections to rest upon. Besides this, it is a very singular and remarkable fact, that this exercise of their affections, has contributed to the improvement of their physical state. Whatever increases innocent enjoyment, and contributes to happiness, are excellent medicines. Peace and purity of mind are better than physic. This exercise of their blind affections conduces alike to their felicity, and to the preservation of their health, by innocently keeping alive the regular and happy exercise of their animal spirits, by the only outlet they possess, that of their blind and instinctive affections; and hence, it is very remarkable, that in consequence of their animal spirits being no longer pent up, as was formerly the case, they are not now so liable to those sudden bursts and irregular displays of passion, to which they had been the victims; and what is still more remarkable, they are in better health, and not so liable to cramps and colics, which had been the corresponding physical effects of their irregular nervous distribution; so that even with them the truth is evident, that it is not good to be alone; the little world they live in is better suited to amuse and contribute to their happiness, than the quietude of civilized life, from which they could receive no enjoyment, and to which they could only give pain.

It is also worthy of remark, that some patients sink more rapidly into moping idiotcy when kept in a state of perfect seclusion, than they even do in the society of those who are insane like themselves.

I have seen patients who had not been accustomed to any association, who were, on their first arrival, in appearance, manners, behaviour, especially in their mode of eating, and their dirty habits, scarcely human; it was evident from all this, that they had long been unaccustomed to the common conveniences and decencies of life, as well as from the astonishment and delight they first exhibit, on these things being restored to them;—to see companions, and to find a table with the usual appendages of knives and forks, &c. evidently excited pleasing reminiscences and gave them additional life,—their improvement (externally, at any rate) was rapid, and, by continued attention, their restoration to habits of cleanliness complete.

To insure all these as well as many other advantages, and to make cure the primary object, requires not only that the proprietor should live amongst them, but also that he should be a medical man, and one who has experience, guided by upright principles and Christian feelings; for if medical men of talent and character could be induced to undertake this painful and anxious life, submitting cheerfully to all these sacrifices and inconveniences, much might be done to improve this neglected department of medicine, and augment the number of cures; at all events, most certainly increase the comforts of the incurable, and lessen the distressing apprehensions of those who fear the accession, or recurrence of mental aberration; yet notwithstanding the paramount importance of these things, so ignorant or so blinded by prejudice is the world on the subject, and so little aware of the talents and capabilities required for such a situation, that they consider the very name of a proprietor, and superintendant of an asylum, as absolutely sinking the character in public estimation; whereas no class of medical men, were they efficient, should be considered more honourable, because none can be more useful than those who devote themselves to the cure and comfort of persons in this most lamentable state.

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, ché ntrate;” {55}

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 just as if all the insane were in a similar condition.

Mr. Samuel Tuke says, “Many errors in the construction, as well as in the management, of asylums for the insane, appear to arise from excessive attention to safety; people in general have the most erroneous notions of the constantly outrageous behaviour, or malicious dispositions of deranged persons; and it has in many instances, been found convenient to encourage these sentiments, to apologize for the treatment of the unhappy sufferers, or admit the vicious neglect of their attendants.”

In the construction of such places, cure and comfort ought to be as much considered as security; and I have no hesitation in declaring, that a system which, by limiting the power of the attendant, obliges him not to neglect his duty, and makes it his interest to obtain the good opinion of those under his care, provides more effectually for the safety of the keeper, as well as of the patient, than all “the apparatus of chains, darkness, and anodynes.”

“The safety of those who attend upon the insane, is certainly an object of great importance; but it is worthy of enquiry whether it may not be attained, without materially interfering with another object, the recovery of the patient. It may also deserve enquiry, whether the extensive practice of coercion, which obtains in some institutions, does not arise from erroneous views of the character of insane persons; from indifference to their comfort, or from having rendered coercion necessary by previous unkind treatment.”

But there is another fact to be considered, not hitherto contemplated by any writer, and which is well expressed in a letter I received from a friend, in answer to one requesting his opinion in a case {57} wherein its importance has been shown to demonstration. He says, (and he is a man of great humanity,) “I am most solicitous that the distinction should be understood between those who cannot act and think or decide for themselves, and those who can, and who, sensible of their defective state, or of the approach even of absolute derangement, can of their own free will, place themselves in a situation, where they know that every medical and moral means will be used for their restoration. It is of the utmost importance, that the legislature should have it completely demonstrated to them, that there is a condition of the insane never contemplated by any legislator; the judicious management of which, is of the greatest consequence to them. Instead of the mental malady being allowed to proceed, until the sufferer is introduced into these retreats by force, its first approaches will be yielded to as soon as recognised, and the unhappy individual, whilst still in the possession of reason, will voluntarily or by gentle and affectionate solicitations, enter some refuge for mental distress, where, separated and secluded from the scenes and circumstances which were hurrying on intellectual destruction, he may, in a short period, in a condition of comparative happiness, escape the most tremendous calamity with which human nature can be assailed.”

I believe all the former evils connected with the management of the insane, have arisen from ignorance of their state; and therefore I am anxious to be perfectly understood, and labour most earnestly to correct this erroneous impression; and not only so, but I wish to prove the popular prejudice, that they are all ill treated, to be no where, as far as my knowledge extends, true or deserved; neither am I aware that this branch of medicine has been more abused than others; nor do I know in all my experience, of any unjust confinement for interest’s sake; there may be ignorance of the treatment required, but surely in these enlightened times, a medical man of any character can never lend himself to any thing so suicidal to his own fair character and prospects. I know, on the contrary, of evils arising from over caution in the other extreme. I am perfectly convinced that no insane person, should be without medical superintendance, and that to be placed singly in private houses, not medical, I know from experience to be sometimes most fatal and destructive; some few, it is true, are above all praise.

Sir Andrew Halliday after stating the number of insane, who are known and registered according to act of Parliament, says, “there is a number, if not equally great, at least nearly so, of whom the law takes no cognizance, and whose existence is known only to their relations and friends. These consist of individuals placed in solitary confinement, with persons who take only one patient. This is a state of things which ought not to be allowed to remain as it is, for a single hour, in this boasted land of liberty; I do not say, that it ever has taken place, though I have known one or two instances that might almost bear such a construction;—but I maintain that it may take place, for there is no law to prevent it; that individuals may have been sent into such seclusion, who never suffered from the pangs of madness; and it must be evident to every one who gives this subject the least consideration, that it only requires a faithful keeper, and that watchfulness, to retain such a person in prison for life. This number is said to have been prodigiously increased by the new Act.”

At the same time it must be allowed, that many incipient cases, requiring seclusion and separation from friends, would be aggravated by too sudden an introduction amongst masses of insane patients; and even by the very circumstance of arriving when there is the chance of exciting the usual horror and prejudice entertained against such places; but this ought not, and would not be the case, were the plans and systems of classification I have advocated, carried into practice. Every way and in every thing, we have imperfections and abuses; and it is much easier to condemn than to cure them; and they who at once believe abuses exist in proportion to the popular description that is given during some temporary excitement and prejudice, are not safe persons to have the important charge of removing them. I make these remarks, to show, that while a paternal government is justly, most anxious to protect the persons and property of those who can no longer protect and defend themselves, they should at the same time remember, that sanity of mind is still of much higher value; and that therefore concern about the property should not out weigh our concern for the cure.

I say nothing in the mean time, of the degrading suspicion and paralyzing interference, which the best and most conscientious man may under such system feel, in proceeding with the plans which, he from experience, knows to be essential to their restoration; but I contend, that the common error in legislation, of making property of more value than life, must here as well as wherever it is committed, have a baneful influence. In this instance, the acts or laws made under the influence of this very great and very selfish delusion, produce this very serious mischief, that they tend to increase the prejudice and aversion common to places of this description, some of which would otherwise be considered not merely unobjectionable places of residence, but places of seclusion, very agreeable in themselves, and most desirable as places of cure.

In many complaints, change of scene and association, are justly considered necessary to the restoration of health. It is not only the same in many cases of insanity but absolutely the first and most important step in every system which gives them a chance of restoration. Should then a bare residence in any place for the mere purpose of cure, be accompanied (in very many cases, it is unnecessary,) by an act which is considered as fixing the mark of degradation upon them, any more than it should in any other disease? This, instead of healing, is calculated to crush a heart already breaking; it is often fatal to their recovery! it is a principal cause of frequent relapses! They feel a stigma, thus fixed on their character, so confirming the prejudices of the world, and so encouraging that distressing and fatal look of suspicion towards them, that they are forced to feel that no one reposes any faith in them; and if this feeling does not ultimately destroy all comfort and confidence, all order and stability within them, it must very much weaken that concentration of energy so necessary to the successful exercise of all mental operations; and if their minds are weakened by previous attacks, and not well sustained by right principles, but on the contrary, like many others, merely regulated by worldly principles and considerations, then, they are not only deprived of the rock on which mind is based, but also of all the motives and objects which stimulate to mental action. In this state, what is mind but a sad wreck floating on the fathomless ocean of life, at the mercy of every wind and wave? To what else shall we compare its situation?—It is like a city broken down and without walls, any enemy may enter in, and overthrow it. Can we wonder then that persons whose minds are in this position, and whose prospects in life are thus blasted, should have a recurrence of the same awful visitation? or what is worse, that they should constantly feel their spirits paralyzed, and a melancholy gloom thus thrown over the remainder of their existence!

To make it necessary in all cases to have certificates, so far from being a security against abuse, is more likely to be a cloak for those who may wish to take advantage of the patient’s defenceless state; whereas in cases of voluntary seclusion, there can be no risk; for with such honourable confidence, we have at once, the proof and the security that it cannot and will not be abused. These, however, are not the most desirable inmates, as it regards the ease and comfort of the superintendant, and therefore no one can have any other motive in recommending this practice of voluntary seclusion, but that which arises from the conscientious consideration of its being more conducive to cure.

That all should have the sanction and concurrence of medical recommendation, is every way indispensable; but what I argue for is, that this should be done, in the manner best calculated to make it appear to the patient, that cure, and not mere confinement, is the object of the measure they are recommended to accede to without reluctance. That a great number will require certificates, and all the aid of authority, to make them submit to the measure, is certain; and in these cases, the law, so far from being a hardship, is a great convenience and advantage.

Again, violent and extreme cases may be said to certificate themselves, in these there can be no risk of making any mistake, and doing any injustice in the first instance; the injustice may be afterwards in improper treatment, and in over detention. But to prevent all such abuses, we must first make men perfect, and then we should have no diseases to cure. It is certain, that under a proper system, ameliorated by all these plans of procedure I have stated, it is astonishing how these violent and extreme cases would become less prominent. I believe they would not average five per cent. at any one time; and take the average of a number of years, and I suppose it would not be more than half that number. I am certain the proportion, during sixteen years of my experience, has been much less than even this; it is seven years since we had occasion to treat any one single case as a constantly furious and dangerous maniac; and even suppose, such cases, under the best management, were more frequent in occurrence, and continue in this state for some time, how easy it would be so to contrive an Establishment, that these violent cases should not annoy or disturb the rest; and when thus managed, so far from their influence being hurtful, they would become interesting and salutary objects of reflection and commiseration to those who are in a better state; and often, by example, would teach the greatest of all moral lessons, that which holds the primary place as a preventive, and is always a necessary adjunct in the business of restoration—self control.

In fact, every system of management that does not make this principle, of mildly calling forth and gently exercising this internal principle of self-control on matters that are least connected with the diseased parts of the brain, a constant and primary object of attention, is not merely defective, but exhibits very great ignorance of the attributes of mind, as well as of the causes and nature of its maladies; and it follows that, as a system, it must be without any clear principle to guide its physical and moral treatment. In all things, we ought to remember, and especially in a matter of such importance, that we can do good only so far as our knowledge extends; and even this knowledge is useless, unless we are zealously desirous and able to reduce it to practice. Whatever may be our proportion of knowledge, zeal, and ability, it cannot be arrogance, when called upon, to say, that I believe this principle is more brought into practice by the plans and arrangements I have described, than is the case with any system of treatment in any place that I have hitherto heard of or seen.

It is not known, as it ought to be, how powerful with the higher class of patients is the principle of honour; with many, a sense of religion; and with all, the fear of losing the approbation and friendship of those who are kind to them; as well as, from selfish motives, to secure the liberty and indulgences they have enjoyed. These means, and every principle which operates on human nature as checks on one part of the mind, and as encouragements to another, should be constantly and steadily kept in view, for the purpose of never losing an opportunity of instantly bringing them into useful, and of course successful, operation.

It is on this philosophical system of kindness, that every thing should be so contrived that the principle of internal self-control should be excited, and kept in exercise; and thus, being brought to depend somewhat on themselves, the depressing effects of the absolute restraint of fear, induced by harsh measures, and the tyranny into which a mere place of confinement with walls, and bolts and bars, must almost necessarily degenerate, is avoided.