Part 19

The out-of-door games of the insane are very much regulated by the extent of ground attached to the asylum. Where this is ample, as at Colney Hatch, cricket is the favourite summer recreation; a skittle-alley, a bowling-green, and a fives-court, are found in most county asylums. In America, where women adopt more masculine habits than in England, female lunatics play matches on the bowling-green; and in France gymnastic exercises are employed for the exercise of both sexes, and may, we think, be introduced into the English asylums with advantage. The idiotic patients and those who are incapable of much exertion may be seen in the airing courts enjoying the monotonous swinging motion of the machine known in domestic life under the name of "the nursery yacht," being nothing more than a rocking-horse with the horse left out by particular desire. In addition to these means of diverting the minds of the patients, walking parties, under the superintendence of officers of the establishment, are made up two or three times a week. During the haymaking season it is customary to allow the inmates of asylums to which farms are attached to go forth into the fields to assist with the rake and the pitchfork. This permission is always looked upon as a great treat, and its effect upon the patients is of the happiest kind, especially _if the scene of their temporary labour admits no sight of the asylum and its wearisome walls_. Here for a few hours they seem to realize the liberty and delight of younger days. The physician on such occasions may read in their "grateful eyes" that we are at present arrived only half way on the road of non-restraint. Individual patients, again, are suffered to leave the public asylums on a day's visit to their friends, under the care of a nurse; and some who are nearly convalescent are permitted to go and return of their own accord. It is the custom of Colney Hatch and Hanwell, and we believe of most asylums in England, to grant the patients a certain period of probation among their friends, in order to test their fitness to be discharged as cured; to give them, in short, mental tickets-of-leave. This is an admirable plan, inasmuch as it secures to the patient the full enjoyment of liberty, at the same time that it enables him to keep himself well in hand, knowing that, as he is not unconditionally released, an immediate recall to the asylum would follow any sign of returning irrationality.

The dietary in public asylums is ample, and the quality excellent. Hanwell may, perhaps, be considered the model establishment in this respect. It is the joke of the other asylums, that one man has been regaled there daily for years with chicken and wine. Even the fancies of the patients are now and then gratified at some expense. There is an old lady in Hanwell who believes that the whole establishment is her private property; and, on one occasion, she complained to the medical superintendent that, notwithstanding all the expense she was at to keep up the grounds and forcing-houses, she never could get any grapes. The next day she was presented with a bunch, which had been purchased to appease her repinings. This humouring method of treatment, as it is called in other asylums, is much patronized by the matron, a person who seems to enjoy as much power as the medical officers. In her report for 1856 she thus speaks of a patient who died in the course of last year:--

"She had been employed many years in the laundry, and always imagined she was to be removed elsewhere--that on Monday morning a waggon would call at the gate for herself and her property. Accordingly, every Monday morning throughout the year, at 10 o'clock, she was accompanied to the gate, dressed with a coloured handkerchief pinned fancifully over her cap instead of a bonnet, and carrying a small parcel (_her property_) of the most heterogeneous contents--thimbles, ends of tape, polished bones, pebbles, pieces of smooth coal, &c. The waggon was never found to be in waiting, and Mary, without evincing any disappointment, walked cheerfully back to the laundry, telling the superintendent that 'The waggon would be sure to come next Monday, but that she need not lose time, so she would work all this week.'"

In many asylums this method of treatment is thought calculated to feed the original delusion; but here, again, the judgment of the physician ought alone to determine the course to be taken in each individual case. In patients labouring under violent excitement, to oppose an hallucination, however absurd, would add fuel to the fire. Again, in a chronic case like that of the laundry-maid, the harmless fancy of the poor creature might not only be indulged in with impunity, but served to renew week by week her stock of cheerfulness.

The lunatic colony of Gheel, situated twelve miles south of Turnhont, in Belgium, amid a vast uncultivated plateau consisting of heath and sand, called the Campine, affords an extraordinary example of the pre-eminent advantages of the present mode of managing lunatics. Until the era of railroads this spot was so out of the ordinary track of the world, that but few persons even of those who were interested in the treatment of the insane were aware of its existence. Here we discover, like a fly in amber, a state of things which has lasted with little change for twelve hundred years. Here we see the last remnants of the priestly treatment of insanity, coupled with a system of non-restraint which certainly existed long before the term was ever heard of in England and France. Gheel owes its origin to a miracle. Saint Dympna, the daughter of an Irish king, suffered martyrdom in this place from the hand of her father in the sixth century. So great was her fame as the patron saint of lunatics, that her shrine, erected in the church dedicated to her, speedily became the resort of pilgrims, who journeyed hither in the hope of being cured of their madness or of preventing its advent. Her elegantly-sculptured tomb contains among other bassi-relievi one in which the devil is observed issuing from the head of a female lunatic, while prayers are being offered up by some priests and nuns, and close at hand another chained maniac seems anxiously awaiting his turn to be delivered from the demon. The idea carefully inculcated by the priests, that lunacy meant nothing more than a possession by the devil, has long been banished from other lands. Here, however, it has flourished for many centuries, and the ceremony of crawling beneath the tomb has existed so long, that the hands and knees of the devotees have worn away the pavement. The act is still occasionally performed amid a scene in which superstition and terror are combined in a manner calculated to cure any lunatic, if deep mental impressions were alone required to purge away his malady. But what is far more interesting and astonishing to those accustomed to the bolts and bars, the locks, wards, and high walls of crowded European asylums, is the almost entire liberty accorded to the lunatics resident in the town of Gheel and its neighbouring hamlets, to the number of 800, or one-tenth of the whole district. No palatial building, such as we encounter in nearly every county in England, is to be seen. The little army of pauper and other patients gathered from the whole superficies of Belgium, instead of being stowed away in one gigantic establishment, in which all ideas of life are merged in the iron routine of an enormous workhouse, are distributed over five hundred different dwellings, three hundred of which are cottages, or small farmhouses, in which the more violent and poorer classes are dispersed, and the remaining two hundred are situated in the town of Gheel, and are appropriated to quieter lunatics and those who are able to pay more liberally for their treatment. In these habitations the sufferers are placed under the care of the host and hostess; more than three persons never being domiciled under one roof, and generally not more than one. The lunatic shares in the usual life of the family; his occupations and employment are theirs, his little cares and enjoyments are the same as theirs. He goes forth to the fields to labour as in ordinary life; no stern walls perpetually imprison him, and make him desire to overleap them, as Rasselas desired to escape even from the Happy Valley. If it is not thought fit for him to labour with plough or spade, he remains at home, and takes care of the children, prunes the trees in the garden, and attends to the potage on the fire; or if a female, busies herself in the ordinary domestic duties of the house. The lunatics, as may be supposed, are not left to the discretionary mercies of the host and hostess. A strict system of supervision prevails, somewhat analogous to that of the lunacy commissioners and the visiting justices of England. The entire country is divided into four districts, each having a head guardian and a physician, to whom is entrusted the medical care of every inmate belonging to that section. There are, in addition, one consulting surgeon and one inspecting physician for the whole community. The general government of the colony is vested in the hands of eight persons, who dispense a code of laws especially devised for it. The burgomaster of Gheel presides over this managing committee, whose duties are to distribute the patients among the different dwellings, to watch over their treatment, and to admit or discharge them. A visiting commissioner is annually appointed, who inspects the dwellings of the different hosts, and sees that the patients are properly cared for. The oversight of the lunatics falls almost wholly upon the hostess, the man rarely interfering, unless called upon to control a disorderly patient. The people of Gheel, from having been engaged for ages in the treatment of the insane, are said to have acquired extraordinary tact in their management, which, Dr. Webster remarks, may be considered to exhibit a most judicious mixture of "mildness and force." Although instruments of restraint, such as the strait-waistcoat, and the long leathern thong below the leg, to prevent patients from running away, are occasionally resorted to, the sectional physician must be instantly informed of their imposition, and their use cannot be continued without his sanction. So little are they required, that Dr. Webster found less restraint in this colony, unconfined by walls, than in the asylum at Mareville, in France, containing a similar number of lunatics. Yet there were fewer escapes than from the strictly-guarded restraint-abounding prison, only eleven persons having fled from Gheel in the course of last year, and nineteen from Mareville. Here also, it will be observed, there is no separation of the sexes. The lunatics live the life of the other inhabitants, and males and females associate in the same household. If we compare the effects of this simple treatment with that of the most expensive of our own asylums, we are compelled to admit that the balance is in favour of Gheel, where, notwithstanding the free admission of chronic cases, upwards of twenty-two per cent. of cures takes place annually, while at Hanwell and Colney Hatch the cures never exceed fifteen per cent. No fair comparison can be instituted between the expense per head at Gheel and in our English establishments, inasmuch as living is much cheaper in Belgium; but we may state, that the average cost of board and lodging for each pauper in the colony is 10_l._ per annum, or exactly the sum charged for lodging alone in our county asylums.[17]

A plan, towards which we have been slowly advancing during the last half-century, will speedily, we hope, be more closely followed. A trial is already, to some extent, being made of it in the neighbourhood of existing asylums, and might supplant, with immense advantage, the prevailing custom of building new wings, and over-populating old wards. The present system of enormous buildings, which destroys the individuality of the inmates, and suppresses all their old habits and modes of life, is evidently disapproved by the commissioners, as appears from the language they hold in their tenth annual report:--

"We have the best reason for believing that the patients derive a direct benefit, in many ways, from residing in cheerful, airy apartments detached from the main building, and associated with officials engaged in conducting industrial pursuits. A consciousness that he is useful, and thought worthy of confidence, is necessarily induced in the mind of every patient, by removal from the ordinary wards where certain restrictions are enforced, into a department where he enjoys a comparative degree of freedom; and this necessarily promotes self-respect and self-control, and proves highly salutary in forwarding the patient's restoration. As a means of treatment, we consider this species of separate residence of the utmost importance, constituting in fact a probationary system for patients who are convalescing; giving them greater liberty of action, extended exercise, with facilities for occupation; and thus generating self-confidence, and becoming not only excellent tests of the sanity of the patient, but operating powerfully to promote a satisfactory cure. The want of such an intermediate place of residence is always much felt; and it often happens that a patient just recovered from an attack of insanity, and sent into the world direct from a large asylum, is found so unprepared to meet the trials he has to undergo, by any previous use of his mental faculties, that he soon relapses, and is under the necessity of being again returned within its walls. Commodious rooms contiguous to the farm-buildings are now in the course of construction at the Somerset County Asylum; and there is every reason to believe that the patients will derive benefit by residing in these apartments, which at once possess a domestic character, and afford every facility to carry on agricultural pursuits."

It strikes us forcibly that the commissioners have tended to create the evil they deprecate in not protesting against the erection of gigantic asylums; but it is cheering to find that the idea of supplemental buildings possessing a "domestic character" has taken possession of their minds, and that they are now enforcing it on the minds of others with their well-known zeal and ability. The Devon Asylum, among others, has adopted the plan; and its accomplished physician, Dr. Bucknill, the editor of the _Asylum Journal_, bears important testimony to the great advantages to be derived from it.

"I have recommended the erection of an inexpensive building, detached from, but within the grounds of the present asylum, in preference to an extension of the asylum itself. My reasons for this recommendation are, that such a building will afford a useful and important change for patients for whom a change from the wards is desirable. The system of placing patients in detached buildings, resembling in their construction and arrangements an ordinary English house, has been found to afford beneficial results in the so-called cottages which this institution at present possesses. _These cottages are much preferred to the wards by the patients themselves, and permission to reside in them is much coveted._ I am also convinced that such auxiliary buildings can be erected at much less expense than would be incurred by the enlargement and alteration of the asylum itself. I propose that in the new building the patients shall cook and wash for themselves."

"These cottages are much preferred to the wards by the patients themselves, and permission to reside in them is much coveted." In these few lines we read the condemnation of huge structures like Colney Hatch, built externally on the model of a palace, and internally on that of a workhouse, in which the poor lunatic but rarely finds any object of human interest, where his free-will is reduced to the level of that of a convict, and the very air of heaven necessary to his health is doled out at intervals, when, with infinite lockings and unlockings, the attendants order a batch of persons into the stagnant and tiresome airing courts. Infinitely better for the lunatics would be the freedom and homeliness of the smallest cottage to the formal monotony of cheerless wards; better far that they should, as Dr. Bucknill suggests, cook and wash for themselves, than that the offices should be performed wholesale in the steam-laundry and the steam-kitchen. A patient would undoubtedly feel a far greater interest in peeling his own potatoes for the pot, and in cooking his own bit of bacon, than in receiving them ready cooked. It is the duty of the physician to interest the patient in his daily work, and no more effectual method of accomplishing this could be suggested than in putting him to work for himself.

Wherever large asylums are already erected, no better plan could perhaps be suggested than the building of satellite cottages, which would form a kind of supplementary Gheel to the central establishment; but we should like to see the experiment tried, in some new district, of reproducing in its integrity the Belgian system. The colony of Gheel was once a desert like the country which surrounds it; it is now, through the happy application of pauper lunatic labour, one of the most productive districts of the Low Countries. Have we no unoccupied Dartmoors on which we could erect cottages, and train the cottagers to receive the insane as members of the family? The performance of domestic offices, the society of the goodwife and goodman, and the influence of the children, would do far more to restore the disordered brain of the lunatic--pauper or otherwise--than all the organization of the asylum, with its daily routine, proceeding with the inexorable monotonous motion of a machine, and treating its inmates rather as senseless atoms than as sentient beings, capable, though mad, of taking an interest in things around them, and especially awake to the pleasure of being dealt with as individuals rather than as undistinguishable parts of a crowd. The children are of particular moment. Lunatics are singularly gentle to them, and are interested in all their actions. At Gheel it is customary to send the bairns into the fields to conduct the patients home from their labour in the evening; and we learn from Dr. Webster that a violent madman, who would not stir upon the command of his host, will suffer himself to be led, without a murmur, by an urchin scarcely higher than his knee. The presence of the young in the ward of an asylum seems to light it up like a sunbeam. The love of children does indeed lie at the very foundation of the human heart, and we cannot estimate too highly their beneficial influence upon the brain which is recovering from the horrors of insanity.