2nd.—The different Divisions, into which I divide the Insane.
3rd.—Their General and Specific Character.
4th.—The Correspondence between Causes and Effects.
5th.—That the Study of Mind will evolve the Principle of Universal
Generalization.
6th.—Their Moral and Medical Treatment.
7th.—A Selection of Cases in Illustration.
By this I shall be able to give a more full and perfect understanding of
the peculiar character and proper treatment of this particular case; and
by which will be seen, though imperfectly, something of those principles,
and of that spirit which has pervaded the whole of our conduct to all
those entrusted to our care.
“To do all this, in connexion with the above case, would not be right,
were I influenced by any improper spirit; but as my conviction is
confirmed by experience, that these unjust persecutions, provided we use
them rightly, are for our good, I feel in no danger of indulging in any
spirit, but a spirit of gratitude and forgiveness.”
From all this, (whatever variation I may make in the plan as I proceed)
as well as from what I say in my first work on Insanity, where the same
principle and mode of procedure is adopted, it will be seen that my task
is not a slight one. In the preface to that work, I say,
“Many subjects, not usually included in works of this kind, will be
introduced; but as my reasons for doing so will best explain
themselves in due course, and as one subject will be introductory to
another, it is unnecessary to mention them now, particularly as it
might excite critical objections, which I would rather wish to disarm
than pretend to brave.
“Without presuming on the experience, knowledge, or the materials I
may possess, of this I am confident, that so long as I am conscious
that the love of truth is my pole-star, so long will my faith
continue firm in this, that with patience and perseverance, and the
love of truth for our guide, scarcely any man’s powers are so limited
but he may hope to acquire some clearer views, or perhaps make some
discoveries in the matters he has undertaken to investigate.
“The objects of my enquiries are very numerous, and involve so many
either undiscovered or unadmitted truths, which are so closely
connected with subjects of inquiry the most interesting, that I have
adopted this slow and humble plan of proceeding for the present, and
have suspended, for a while, my first purpose of publishing a
systematic treatise on insanity.”
It is intended that each publication shall contain one subject, at least,
in some measure complete, so that each part may have its distinctive
title, and be had separately.
The study of mental philosophy, of which insanity is a very important
part, is, of all studies, provided we are on the road where truth is the
guide, the most useful to our moral state. This belief was the first
motive which induced me, now more than thirty years ago, to direct my
medical attention to this most radically-important, though
hitherto-neglected branch of the profession, as well as to whatever
seemed best calculated to make me understand the sources of all erroneous
and extreme views, and which a series of painful circumstances through
life have excited and continually strengthened; but it is not necessary
to state them: I may, however, mention that, as early as 1807, I visited
lunatic asylums _con __amoré_, and that in 1816, 1817, 1818, and 1819, I
was engaged in lecturing on Mind and its Diseases. Before this time, I
had no conception that I should ever be exclusively devoted to this
department of the profession, which _circumstances_ at that period forced
upon me. I trust, however, that I have endeavoured to profit by the
opportunities which this new situation afforded me of more fully
comprehending the nature of mind, its connection with life and
organization, its diseased manifestations, and of ascertaining the best
modes of co-operating with nature in the removal of them; and, at any
rate, it is certain that, for the purpose of lessening the miseries and
increasing the comforts of those under my care, I, for the most part,
have sacrificed every personal consideration.
From 1819 to 1824, I continued medical resident and superintendant of
York Asylum; and on leaving it, it was voted unanimously, “That I
deserved the thanks of the Governors, for my constant and successful
efforts in establishing and perfecting the mild system of treatment
there.” I was again engaged in lecturing, at the request of several
institutions, on Mind and its Diseases; soon afterwards, in 1825, I fixed
on this situation, as the best adapted of any part of the country about
London which I saw, (and I spent several weeks in the examination; nor
have I since that time seen any I like better) to carry into effect my
views of the treatment of the insane, either as respects the recovery or
the comfort of recent or confirmed cases; for here, together with
domestic comfort, diversity of occupations and amusements suited to their
various states, the retirement, pure air, and sweet scenery around,
afford ample scope for walks, without annoyance, and apparently without
restraint; which, with judicious moral and medical management, combine
many acknowledged requisites to assist the disturbed and diseased mind to
regain its tranquillity, and in many cases to resume its healthy tone of
action.
I shall only add, that all these views have been amply justified by the
beneficial results on those entrusted to my care; so much so, that these
results and my success have greatly exceeded my most sanguine
anticipations.
I here gladly close these personal remarks, which have been forced from
me, for self is a subject which it is seldom wise and always dangerous to
introduce.
It only remains to notice another peculiarity in this essay, which is,
that of having introduced some animadversions on legislators whose minds
are not sufficiently pure or comprehensive to enable them to avoid the
common error of overlooking general principles, and not to presume to
judge and draw conclusions from the hasty, partial, and erroneous views
they have acquired on the subject on which they legislate. This has
often led to, or been combined with, that great selfish view of making
themselves and their property the chief good, not considering the real
objects of legislative care, nor “that life is more than meat, and the
body more than raiment.” This it is which has corrupted all our laws,
especially our criminal code, which was a system of legal murder, not
justice, and a perfect scandal to the nation.
The same faults are visible in all they have done for the poor insane.
They have given an undue and exclusive consideration to property and to
the few extreme and violent cases; treating them and _all who have the
care of them as criminals_. To live amongst them, appears to be deemed a
crime, for which neither goodness nor talent can atone. All which must,
in various ways, have an injurious influence. To banish these errors is
to better the treatment of the insane. This conviction is my excuse for
introducing the subject, and which makes me anxious to prove, from
experience, that such extreme cases hardly have any existence at all
under a proper system of treatment; and, that at all events, this liberal
treatment materially lessens the horror and danger usually conceived to
attend these places.
Insanity is, no doubt, a terrible visitation; but why should we allow a
false and unreasonable horror to increase it? and why should we thus
sever our sympathy from a disease which more than any other requires it?
The medicinal virtues of the fruits of charity are best proved amongst
them. Grant that the disease arises from some remote or proximate
ill-directed mental states. Why should we have more horror of insanity,
than many other consequences of ill-regulated minds? To me, the foul
ward of some large public Hospital, is incomparably more horrible and
loathsome. Such direct consequences of wickedness present the object
before us in an aspect that makes it difficult for us to exercise any
feelings of commiseration towards them. Not so the insane. But these
are views, however, into the consideration of which I shall not enter in
this place; but I mention or rather hint at the diseases of other organs,
for the purpose of asserting that the reality and appearance of the
miserable state of the insane is not so shocking as people imagine; but
that still I allow it is an awful visitation.
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, ch’entrate;” {xiii}
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 and act just as if all the insane were in a similar condition.
It would seem that these prejudices and horrors of the insane exist in a
much greater degree in this part of the kingdom than they do in
Yorkshire. There I was in the constant habit of taking convalescent
patients with me into family parties of the first respectability; and
members of these families were also in the constant habit of visiting
them as friends and acquaintances, and of inviting them to tea and to
spend the evening at their own homes; and this practice, in most
instances, had a very pleasing and beneficial influence. This was the
case with other institutions; but I have not found, neither have some
others found, any such faith in, and sympathy for, the insane in this
part of the kingdom, but quite otherwise; and yet I am certain, it is an
example they cannot too soon imitate—its beneficial influence will bring
satisfaction to themselves, will remove their prejudices, destroy their
painful fears, and lessen the chances of the calamity invading
themselves. There is a protection around those who are striving to
alleviate the distresses of others.
This difference, which I and others have experienced, makes me more
anxious “to impress these views on others, and especially on those around
me, in order that I may not be obliged, from too great a deference to the
fears and prejudices of those I most anxiously wish to conciliate, to
abridge the exercise and lessen the happy effects of a system which
theory and feeling have suggested and compelled me to pursue; and which
nearly twenty years’ experience and increased knowledge have confirmed
and justified.” {xv}
So important have I considered just views of the insane, that I have
added an Appendix for the express purpose of exhibiting a fair average of
the general appearance of the insane. With the same view, I have given a
few portraits of such of these cases as are now, either themselves, or
their friends, dead, or little known. I had the same principle in view
in my first publication, which induced me to give cases in regular
rotation, “rather,” as I there say, “than the common mode of making a
selection of extreme ones, that I might not give a distorted picture of
the insane, nor add to the unreasonable horrors and false impressions on
their state, as this has, I am convinced, been one cause of an improper
spirit and conduct towards them.”
It is scarcely necessary, after what I have already said in the Appendix,
again to guard the reader against the mistake of supposing that the cases
and treatment described in that Appendix form any data or criterion for
judging of the kind of cases and treatment in my own private
establishment. The medical swing, for instance, is stated as having been
useful, in some violent cases of mania; but this was even then soon laid
aside as objectionable; but it would be worse than useless now, because,
under a system which does not cultivate the habitual exercise of the
vindictive passions, cases in which it was of use, no longer exist. In
fact, to have recourse to any means which operates so much on the fears,
whatever medical virtues it may appear to possess, is adopting a
principal which philosophy and Christianity equally condemn. It ought
ever to be the aim of all persons IN POWER to call in no principle but
that of the OMNIPOTENCE of SYMPATHY and BENEVOLENCE; and this PRINCIPLE
is not to be excluded even from those whose spirits are imprisoned in
bodily evils and diseases.