Part 4

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.

In fact, so important have I considered this plan of Classification, that when I first came to Leopard’s Hill Lodge, I contrived the best way I could, with my means, to have a family and front part of the house, independent of the galleries; and should I be called upon to extend my plan to meet my increasing success, and should my life be spared, and time and health permit me to follow out my views and to build an Asylum upon a larger scale, I should keep these principles of Classification, as well as many others, in view, in the plan I should adopt, for I am more and more confirmed that they are extremely important; and I may mention as proofs, that at all the houses we have had parties in the front part, who would, in their conduct and pursuits, and social enjoyments, put to shame many families who are reckoned perfectly sane. We have visiting parties from house to house, with the usual amusements of cards, chess, billiards, cricket, &c. For some months we published a weekly newspaper of considerable interest. Nor is it unworthy of notice, that some articles of a very superior kind in our critical Journals have been written in this place; all which gives it more an air of social enjoyment and comfort, than the coldness and repulsiveness usually attendant on the loss of liberty, and forms within ourselves a little world of interest, better suited, I believe, to the state of the inhabitants than the real world could be to them. It is, in fact, a System of Classification, originating, if not in the most enlightened, at any rate in the most humane considerations of the various states and maladies of mental aberration, and which enables us to exercise a powerful influence over those under our care. It is in agreement with our conviction of the importance of that which may be laid down as a maxim, that, if the mind be maintained in a state of tranquillity, the affections are more likely to be brought into a right state, the effects of functional disorder, or even disease, to subside; the mists of delusion to clear away; and the light of the understanding to resume its province.

The last and most important consideration is, that this plan has induced several (especially before the letter and spirit of the law were opposed thereto) to return voluntarily on their perceiving symptoms of their returning malady.

I could give, were it not that motives of delicacy forbid me, some very striking and interesting cases, illustrative of these facts and these principles, and the beneficial results which arise out of them.

One of these cases, illustrative of this necessity of more delicate and intellectual treatment in certain states of mental aberration, I am advocating, I may mention. It is that of a lady who had been, upwards of seventeen years, in alternate states of excitement and depression, and in confinement all this time, whose recovery I attribute, combined with medical means, principally to such attention.

_No._ 335 _was first admitted of her own accord_, _March_ 5_th_, 1826, _aged_ 56; _discharged May the_ 4_th_, 1826; _again returned of her own accord_, _June_ 30_th_, 1826 {36}

This case was a most striking sample of a great number of a similar description, who are the subjects and victims of this perverse and irregular mental excitation, which become, without proper management, more confirmed cases of mania and melancholia, which continuance in this state for a sufficient time, produces disease, and disorganization of the brain, and ultimately terminates in incurable dementia, either of a partial or more general character.

She was a person of a highly sanguine temperament, possessing by nature great capabilities, but her intellectual powers had not, by education or circumstances in life, been so much developed and increased as her energetic feelings, which were most excitable, strong, and active. If her education had equalled her natural endowments, her understanding would have assumed no common pre-eminence, and in which case her feelings would probably have been brought under due subordination. It was not, however, so much even the defects of her education, as the circumstances of her life, and especially those connected with her religious associations, which were incomparably more calculated to increase the strength and activity of her feelings, than to call forth and cultivate her intellectual powers; indeed, instead of any such cultivation in any proportionate degree, there is every reason to believe, these associations had a paralysing influence; nor perhaps were any habits of self-control, or any mental restraint whatever, formed or acquired in this connection, except that which operated too exclusively on her religious and conscientious fears; and hence, without entering into the details of her history, the result was the formation of a character, such as is most common under the present artificial systems and circumstances in modern times, ill formed to withstand the effects of adverse or prosperous fortune.

It was her lot to pass through these extremes, and after suffering many reverses, mortifications, disappointments, bereavements, and some matters of a private and most afflictive nature, she had a rheumatic fever, when the explosion took place; then the weak and over-exercised parts of her mind displayed themselves in an irregular and increased degree. Her state was an exaggeration of her former energetic and acute nervous sensibility, operating alternately on the depressing, and exhilirating passions.

When she came to me, for she had been in various places previous to this period, she was in a state of religious melancholia. Her conscientious fears were dreadful, and her misery extreme. She conceived herself condemned to eternal punishment—she was already in torture. When in this terrible state, she had more power to engage one’s commiseration, than any patient I ever had. Her descriptions of her own state were extremely eloquent and affecting, and her appeals for sympathy were overpowering and irresistible, and I was absolutely worn out and overcome by the fatigue and misery I endured in my efforts to console and restore her. I shall always continue to feel the painful effects of my anxious exertions in this and several similar cases of melancholia; but no case and perhaps no number of cases, shook and overwhelmed my nervous system as this did, (unless it be one through whom I had a nervous fever); not merely because of her extreme agony, but my own health and spirits were then in a very depressed state, having been for years a martyr to chronic enteritis and gastritis. I mention this to account for the obligation I felt myself under, to dissever my sympathies from this overwhelming influence, and to transfer her to the kind care of Mrs. Allen, to whose lively and cheerful disposition, uniform and judicious kindness, combined with great firmness and gentleness, soothed and softened her melancholy state, and, in time, tempered the extremes to which she had been subject, and kept her spirits in a better direction.