Part 5

One great art in this management was that of Mrs. Allen’s making her useful as her deputy in every thing in the house, either in matters of a household nature, or in attending upon others. And notwithstanding her own miserable state, no one was ever more qualified for a nurse, or better understood every thing connected with the arrangements of the table; and her very perfection in all these matters, had, before Mrs. Allen came, been the cause of an increase rather than a relief to her misery, for she became the object of great jealousy and dislike to my housekeepers and matrons, on this score: but now it became a source of employment, amusement, and diversion. Though she long continued to possess, for the most part, this disposition to fall into the same miserable state, yet it never afterwards degenerated into that dreadful agony and distraction I have described. At times it ceased altogether, and her more happy state supervened, when she was full of hope and self-esteem, of life and activity, the very antipodes of her former state. But it is altogether astonishing how both these states were lessened and kept in check by Mrs. Allen’s manners, combining the most inflexible firmness with admirable tact and good nature. When all her almost exhaustless fund of sympathy failed, it was always found a sufficient check, and at once to call forth our patient’s powers of self-control, for Mrs. Allen to say that she really could not bear the association of her miserable state any longer, and that they must separate; and it was very seldom necessary to hold out the threat, that she must be removed into the gallery and back part of the house.

Perseverance in this system of unwearied and perhaps unequalled kindness, gradually mitigated and diminished these alternate states of excitement and depression; thus shewing to demonstration, that in this way, with the aid of medical treatment, the excitement of the depressing and the exhilirating passions may be checked and restrained, so that in time they may regain their due equilibrium;—that instead of these cases degenerating, as they have almost always done, into hopeless cases of mania or melancholia, and often terminating in complete dementia, they, by this system, might in process of time regain the due equipoise, or the relative and appropriate share of the exercise of the different functions of mind, and be brought, as in the case just described, to repossess the greatest of blessings, the healthy action of the feelings and faculties in the discharge of those duties which constitute alike the object, the usefulness, and the happiness of her present existence.

I mention such cases, because I shall hereafter do all I can to draw attention to similar mental states, as the common causes of insanity. That almost all cases _begin in this way_, but that they are disguised or kept from our view, with those who possess self control, until (unless the tendency be cured by such efforts to disguise it) they at last burst forth into some form of insanity; and indeed insanity itself may be defined generally, the uncontrolled over-excitement, imbecility, suspended or paralysed state of one or more of the mental functions, arising from some previous faulty state of action. I shall have to show hereafter how all these cases might in their incipient and curable stage have their specific modes of moral and medical treatment applied in order to counteract and cure them; and by this method incurable cases would be almost unknown.

At the same time let it be observed, that such treatment requires much more delicate and intellectual attention than is in the power of those who for the most part live amongst the insane, and, have the direct and important management of them; and that, in justice to ourselves, I have a right to assert, that where such treatment has existed, and does exist, it is not a matter which money can remunerate, and that in this case there was no pecuniary reward. It was no such inducement that had any influence in regulating the conduct which we pursued with such unwearied diligence; and not merely was there no pecuniary reward, but even gratitude was wanting for a time; for this attention was so delicate, that she was always made to feel she was the person conferring rather than receiving favours; so that when she was relieved from her depressed state, and it was superseded by the excitement of the exhilirating passions, her self esteem dwelt only on the favours she imagined she had been conferring. _She was useful_, but her usefulness was more for her own good than for ours. Indeed, we paid the price of patient endurance to a degree and extent which can never be conceived or known, still less was she in a state to perceive or appreciate our motives, therefore she conceived, and was confirmed in the impression that she was actually the person to whom obligation and gratitude were due. This impression was the last remains of her disease, or of that over-excitement of the exhilirating passions, which with the longer-continued paroxysms of the over-excitement of the depressing passions, constituted the character of her case; and she left us, not merely before the “high state” had solely subsided, but at the very time when we felt it to be our duty to restrain and subdue it, and of course when she felt most mortified, and was least able to perceive and appreciate our motives, but which she has since done to our entire satisfaction.

She has now been upwards of three years in the world, engaged in useful and active duties, and though she may be liable to extremes, and be too susceptible of the action of exciting causes, yet I have every reason to believe, that experience has taught her the necessity of counteracting and restraining their baneful influence. I am told by her friends, that now collision with the world having smoothed down the peculiarities which her long seclusion had contracted, her character appears much improved.

I might detail many such cases, and prove that cures have apparently been effected by this intellectual and delicate attention, and more especially in some slight and incipient cases. But I may also state, that many cases of the most serious kind have been so treated, and have recovered. I particularly have in view, two cases of the most determined suicidal melancholy, that were so delicately treated and watched, that they were not themselves aware for months, they were even in a place of confinement, or they had an eye of anxiety constantly watching over them. To this watchfulness and constant exertion to amuse and divert them, I principally attribute the gradual diminution of their melancholy, and ultimately their recovery. These cases, No. 412, and 373, have each returned three or four times of their own accord, and have each time, under this system, gradually recovered.

Is it not then of importance that we should do every thing possible to lessen the present feelings of horror associated with such places? then might we expect to find them come of their own accord, have confidence in their medical friend, concur and co-operate in the plan marked out for their cure, and the consequence would be, that we should find them generally recover.

_No._ 373 _came of his own choice_,

And was a most distressing case of hypochondria, which had from various causes been increasing upon him for about twenty years; and when he so came, he was in the most depressed and melancholy state possible. His whole mucous membrane had long suffered from chronic inflammation, and was in a state of the greatest irritability. He was, in less than nine months, altogether another being; his habits were altered, and his health greatly re-established; and this person was one whose cure was partly to be attributed to my mode of amusing him. I do not mean to enter into his particular history, or his medical treatment, for it would itself make a volume; but I introduce a brief notice of his cure, for the sake of illustrating the foregoing principles of Classification, and to show that a variety of methods are necessary to accomplish the object we ought ever to have in view, and that it would never answer to apply indiscriminately the same medical or moral treatment to any two cases.

A plan was proposed to spend an hour at least with him every evening, and this hour I devoted to that of detailing to him a history of my own life, always contriving, in the style of the Arabian Nights Entertainments, to break off suddenly at some point of interest; and these conversations, had they been committed to writing, would have formed some very amusing volumes. The great art and merit of the plan consisted not merely in making them amusing, but in contriving to introduce, without appearing intentionally to do so, (that I might not in his over sensitive state offend him), facts and views calculated to counteract the errors and bad habits into which he had fallen.

In all cases it is necessary to know every extreme view and error to which the human mind is liable, and where these exist, as inmost cases of insanity, to endeavour to counteract them by clear and beautiful views of the truth.

What is of the greatest consequence, is that it is still more necessary to know the best mode of making truth admissible and effectual; for it ought never to be forgotten, that in all cases where error and delusion exist, even if we know those views which are best calculated to counteract and remove them, still more depends on the manner, circumstances, and spirit in which we present and apply them. I am anxious to draw attention to this truth, because it appears to me the world at present has no adequate conception of this great and necessary art in its propagation: still less does it appear that mankind, nor even many medical men, have formed any proper estimate of the vast importance of such a system in the treatment of the insane: a system, however, which requires that we should be fully acquainted with the history of man, and be able to perceive the causes and effects of false and perverted views of philosophy, morals, and religion, and above all that we should possess a knowledge of the constitution of the human mind, with all the specific differences of every individual case.

I mention this case with others, to show that there are many instances where something more than common attention is required, and that to such patients we devote ourselves, and have them at our own house for this purpose. These are precisely those who are over excitable. They form a large proportion of the insane, and in their incipient stage, their minds are rather in a state of perversion, than absolutely lost or deranged; whose cure depends on correcting this perversion, and restoring the relative and appropriate share of activity and energy to each function, in the exact measure, proper place, and according to the order of their right distribution.

If then, these houses serve these various purposes, who is best able to judge when such purposes can be best served? The exact moment lost can never be regained! a wrong word, or even look, may unhinge, and bring on a relapse! It is a species of discipline like that of a nursery;—children commit some fault, and are removed from the objects of their affection as their punishment; and no punishment is greater or more effectual. Some of our circle break out into passion, or give way to some strong propensity; they are told it won’t do, and are removed: they soon promise to behave better, and return. The causes are sudden and unexpected, and sometimes trivial; and this mild medicine, instantly administered, has a wonderful influence. Sometimes the attendants will be better suited for some specific cases at one house than at the other; and it may be injustice to other patients to change them, but great justice to change the patient on their account.

When I state to patients’ friends these matters, and the difference of these houses, I say decidedly, that in those cases to whom our attention, and the comforts of the domestic circle may be useful,—those friends should, if they possess the means, prove, by a corresponding remuneration, that they duly estimate such delicate attention; particularly as they do generally acknowledge that it is not in the power of money to compensate for the expenditure of so much feeling, and being subjected to so much annoyance. In all cases where it appears this attention and placing them in our domestic circle, will contribute to their comfort or their cure, we, as a matter of feeling and of duty, treat them with equal kindness and attention, always giving considerations of comfort and of cure, the first place.

Besides, most cases are improved by association with those of a different character. I have seen many old torpid cases, and a still greater number of recent cases of suspension of mind, cured by being placed occasionally among those who were in a more lively state, and this after every other means had failed.—And it is reasonable, for nothing can exceed the comic effect of the strange and laughable speeches and manners of some among this class of patients; and, in the case, the treatment of which was altogether mistaken or mis-represented, there was surely nothing incredible or unreasonable in saying I preferred, that this lady should have the chance of being roused out of her torpid state, by remaining at Leopard’s Hill Lodge, where of course, she might have these means occasionally put in force; for all the females were then at that house, and at the same time, she did possess the advantage of every possible delicacy of attention from Mrs. Allen, who was, with her children and an additional number of servants, then living altogether at that house.

The case No. 335, was, as I have already mentioned, always soonest roused out of her melancholy condition, by being placed for a short time in the midst of such association. It would be contrary to the economy of providence, as exemplified by the constitution of society, to place all the melancholy in one class, and all the lively in another. The truth of this argument receives additional confirmation, when we consider, which I am prepared to prove, that insanity in many cases, is produced by, and consists of, an aggravation of the original peculiarity of character, and therefore it is evident, that such collision, like collision in the world, is making one extreme tend to correct another, though of course, the worst and most dangerous cases of every description, are not in their treatment included in this principle.

Many instances are recorded, of two opposite cases, by being thrown together, neutralizing, like an acid and alkali, each other; that is, the melancholy have been roused by the lively, and the lively depressed by the melancholy, and thus both have been brought into a better state.

Sometimes the insane have been cured by witnessing their own case caricatured in that of another. For instance, two proud men, the victims of their gradual and progressive false estimate of themselves, assume in their insane state, the same crown and kingdom, and by witnessing each other’s delusion, have been forced to feel that one must be in the wrong; and thus, one or both were brought to reflection, and ultimately to a more sound and sober state of mind.

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.”