IN the Annual Review of Medicine and Collateral Science for 1818, of the
London Medical Repository, the following notice is taken of these
Essays.—
“In the Philosophical Magazine the reader will find a series of
Essays by Mr. Allen; rich in ingenuity of argument, and abounding in
masterly views on the great subject of chemical agency, as affecting
changes in the modes of existing of physical matter. These essays
all go upon the principle, that in every change of existence that
matter is capable of undergoing, caloric is given out or absorbed in
the form of either electricity, of galvanism, of caloric, or of
light. Respecting the important question which has recently agitated
the philosophical world, and which has been proposed as a prize in
one of the Societies abroad; viz. In what does the difference consist
between galvanism and electricity? Mr. Allen observes, ‘In
electricity we contrive, by mechanical means, to collect the loose
and uncombined quantity from the earth and surrounding medium; and
this we do in circumstances in which it has nothing to act upon, as
free from moisture of any kind as possible; in fact, from every thing
readily soluble in heat or in this power. I would therefore, he
says, define electricity to be the object of science which treats of
the mechanical and natural means of separating this _grand agent_
from some of its combinations, and of ascertaining its actions in
this state.’ ‘In galvanism, on the other hand, this solvent power,
this electric fire, is produced in circumstances in which it has
_substances_ to act upon; substances which are most readily dissolved
in it; substances, in fact, which seem to form the grand medium
between this _power and passive substances_, and which are partially
dissolved in it. And hence I define galvanism as the electric fire,
or _grand agent_, only _partially_ separated from its combinations;
by which I refer principally to oxygen and hydrogen.’ After
illustrating this principle, by referring to the circumstances in
which the chemical agency of galvanism appears more conspicuous than
that of electricity, he adds, ‘thus we perceive, that when _the grand
agent of nature_ is _more perfectly_ separated from its combinations
it is ELECTRICITY; when partially separated, GALVANISM.’ Of these
views and principles we have a more ample illustration and defence as
the author proceeds in his investigation; and the whole inquiry is
conducted with much philosophical acumen. Hypothetical, of course,
part of it must be: but how different are the hypotheses of the
present from those of former times, when science was a sort of
poetry, and dealt in abstractions and inventions!”
* * * * *
ESSAY
ON CLASSIFICATION.
THE better to explain and illustrate my ideas and views on the important
subject of Classification, I shall, in the first instance, give a brief
description of the present plans, arrangement, and manner of proceeding,
in my own establishment.
Fair Mead House, Leopard’s Hill Lodge, and Springfield, with appendages
to each, constitute my present establishment at High Beach; and I wish to
have it most distinctly and most fully understood, that they are simply
for classification, of a more general or more specific nature; and
consequently, besides the advantages derived from having three houses, I
have (as far as I could) made arrangements in each for this purpose.
Leopard’s Hill Lodge, where I have more especially made arrangements for
the purpose of classification, consists of a front, or what may be called
the family portion of the house, and galleries behind, with appropriate
rooms for patients requiring more restraint.
To show that these houses are merely for the purposes of classification,
I may mention, that there is no sort of difference in the three houses,
excepting that in the one generally and latterly inhabited by ourselves,
we prefer having those to whom our individual and more immediate
attention may be useful. The same patients are even sometimes at one
house, and sometimes at another, according to their state; and sometimes
for the mere purpose of change. In fact, the greater part of our first
class of patients have been occasionally at Leopard’s Hill, and this with
the knowledge and approval of their friends.
As I have published some hints on this point, and addressed them to the
Commissioners in Lunacy, I may be permitted, in order to show I have long
entertained the same views, to quote two or three passages.
I there state, “that two establishments on the same grounds should be
allowed and encouraged for the purpose of Classification. My reason for
this alteration, in the Act relative to such places, is, that large and
crowded houses are decidedly objectionable, from the greater chance of
noise and disturbance, from their being less healthy, and from their
assuming more of a prison-like appearance, than of a family mansion.
With two, we can adopt a better and more complete method of
classification; and it is a consideration of very great importance, that
in one of them the proprietor and his family should reside, and devote
themselves to recent, partial, slight, or convalescent cases.”
As I conceive this plan of two establishments for the purposes of
classification, to be of the highest importance, and essential to the
moral regulation, as well as to the cure of the insane, so far from
avoiding any investigation of either the principle of their adoption, or
their mode of management, I wish the most exact knowledge to be obtained
of the one, and invite the fullest scrutiny of the other.
I would have not only two establishments in the same grounds, but these
sufficiently separated so as to prevent annoyance; and, not only this
separation, but I would have one to consist of a male and female part,
sufficiently separated from each other. This arrangement I have at my
own establishments, which consist of Fair Mead House, and of Leopard’s
Hill Lodge, for males, and Springfield for females, with appendages, and
separate cottages; and more especially, I would have each house divided
into a front and back part, and this front part so contrived, that in
appearance it should be sufficiently distinct from the other, so that
patients might feel, on recovery, that removal to this part withdrew them
from the more painful associations of their past state, and afforded them
solace and encouragement; thus might their recovery be expedited, and the
chances of relapse lessened. In the domestic part of the establishment,
the proprietor and his family should reside.
In many cases, an entirely separate house is required. I have known
cases, the cure of which would have been apparently blighted and blasted
for ever, if they could not have been wholly removed from, not merely the
real, but the apparent, association of former scenes and circumstances,
and this without any change in their servants and medical treatment and
attendance, which is also essential. Yet it is perfectly true, that in
other cases this association is not so injurious as most people would
imagine; the dawnings of the light of the understanding are, for the most
part, so gradual, and the mists of delusion so gently steal away, that
there would be a greater shock given by a sudden transfer to rational
scenes and real life, than by their continuance in the place where they
might be at the time.
I have often, with feelings of wonder and admiration, had occasion to
observe these occurrences. I have seen a convalescent patient very much
attracted by, and perfectly delighted with, the strange remarks,
speeches, and conduct of another inmate, sometimes fancying it was meant
purposely for his amusement and diversion; and on whom, refined wit would
have been lost, while the incongruous combinations of unguided thought,
which no wit or ingenuity can equal, appears, and is the very essence of
wit to him. Notwithstanding the truth of all this, there are other
cases,—cases of more sudden convalescence, where all this would shock and
horrify, and produce a revulsion of feeling, most dangerous to them in
their delicate and fragile state, and perhaps permanently fatal to their
recovery. This is more particularly the danger in the incipient stage of
convalescence in some violent cases of mania, {5} and where I am quite
certain delicate and judicious attention have been essential; and where
first, perhaps, removal to the family part of the house, then removal
altogether to our own house, was apparently their salvation.
_No._ 106, _admitted April_ 11_th_, 1820, _aged_ 65.
This was one of the cases apparently saved by such timely attention, and
which I intend hereafter to describe more particularly, for the purpose
of illustrating both the medical and moral treatment of many similar
cases of insanity. I shall, however, state so much of the case now, as
will be sufficient to show, that there is not only a critical period of
the disease, when judicious medical and intellectual attention arrests
and prevents its transition into another and equally dangerous form of
over-excitation, so dangerous, that if allowed to take its course, it not
unfrequently ends in dementia, but also, and more especially to show,
that in all cases our moral treatment must have in view the nature of the
existing causes, in order that we may be able to adopt the most suitable
methods of counteracting their effects,—a part of treatment which has
hitherto been either wholly overlooked, or else exercised without much
knowledge and discretion; although I am certain it is of great importance
in the treatment of all curable cases of insanity, and in many cases so
important, that by such methods we may ultimately succeed in removing
these causes altogether; and removing them, remove also the fear of their
again (at any future time) being allowed to have any baneful operation.
This person, who was a dissenting minister, had always been reckoned by
all parties, one who entertained gloomy views in religion, and pushed
these into extremes; his zeal was equally violent and vindictive, and he
besides possessed a mind with every opposite quality in excess, and which
had always, as far as I could ascertain, been in a state of irregular and
discordant excitation; it is quite certain that during many years past,
it had been habitually kept in a very painful and irritable state, by
several causes, and one more especially deserving notice. He lived
unhappily with his wife and her friends,—instead of union and harmony,
all was dislike and contradiction, perpetual storms and altercations,
which had just before terminated in a separation between himself and
them.
Thus, from the condition of his own unsettled and ill-constituted mind,
his gloomy and vindictive views in religion, his variable and irritable
temper, and from the nature of the domestic excitement under which he had
suffered most severely, it was easy to trace the distressing and awful
form of his derangement to the causes which had produced it.
He was in a state of the most furious mania;—his was one of the most
violent and distressing cases I had ever seen. It is impossible to
convey any adequate conception of its appalling nature. His language was
obscene and vulgar, and his horrible oaths and blasphemous speeches were
poured forth for some weeks without ceasing, and without sleep, with a
volubility, rapidity, and a voice so loud, and so foaming with passion,
and with such a frightful expression of countenance, that even those most
accustomed to such scenes, and of the strongest nerves, trembled before
him. He had a demoniac energy and eloquence, which was, indeed, of the
most harrowing and awful kind. It was truly terrific! for even at a
distance, his voice sounded like a river escaping from some narrowed
part, and rushing with impetuosity over every thing that would impede its
course.
Had a short-hand writer taken down his ravings, it would have proved that
this picture is far from being an overcharged one. One principle subject
of his furious raving, was his favourite doctrine of Election; or rather,
perhaps, I ought to say, his blasphemous doctrine of Reprobation. He was
constantly denouncing every one (and against myself he was peculiarly
severe) as lost, whose belief on this point was not, even in phraseology,
the same as his own;—calling on God to execute vengeance upon them;—then
blaspheming God, that his prayers and commands were neither heard nor
obeyed;—taunting and cursing Him with a contempt which no language can
describe;—calling his clemency weakness, and his not executing his
decrees a proof he did not possess the power he pretended to have. In
fact no one could hear and see him without feeling shocked, and without
having a conviction forced upon him that there must be something
wrong—some perversion of truth in those doctrines, as well as in his own
mental system, out of which all this dreadful spirit, and all these
terrific extremes originated, and of which this case appeared a Satanic
caricature. It is a truth, that there is no error or perversion of truth
that we may not perceive in reviewing the history of mind caricatured,
and perhaps in a still more striking manner among those who are in
confinement from being _directly_ denounced insane.
On the subsidence of his excitement, he was overwhelmed with the perfect
recollection of all he had uttered during the utmost fury of his dreadful
ravings, and his state was truly miserable and deplorable. In this state
I took great pains with him, treated him with every possible kindness,
and endeavoured to show him every possible mark of my confidence: one
instance of which may be mentioned.—I gave him, at a very early period of
his convalescence, a set of manuscript sermons, all in loose slips, and
which he read with great pleasure, and preserved with great care. They
were affectionate moral discourses, strictly, I believe, in agreement
with the spirit of Christianity, though not on any peculiar doctrines;
for in these I had purposely avoided all doctrinal points, although
doctrinal views may, when properly presented, be the best preventives,
and in some cases the best medicines, in the cure of insanity; but the
circumstances in which I was at that time placed, appeared to forbid even
their most cautious introduction, and were scarcely admissible to an
audience consisting of some of almost all denominations. However, he
said, the spirit of these discourses just suited his altered state of
mind, for he himself felt horror-struck at the views which had led to
such awful consequences.
Though no one can feel more than I do, the necessity of not busily trying
to proselyte or unhinge unnecessarily any one’s settled opinions, yet
this was an extreme case, and in such cases, where cure seems to depend
on the proper administration of counteractive views, every other feeling
should give way to this conviction; but at the same time, every thing
depends on the judicious mode of stating these sounder views. This case
was a remarkable instance of the necessity of such management; and where
such views were apparently of the utmost importance to his comfort and
peace. But it would require a separate Essay to defend what I conceive
those sounder views; and even were I to give this striking case as a
specimen of their happy influence, I still might lay myself open to
cavils and objections. I shall, therefore, in a separate Essay, bring
forth all the arguments, and exert all the power I possess in their
defence.
Though his furious state was so unusually violent, yet it was of long
duration, and after it had left him, it was some time before he was able
to overcome the painful reflections which came over him; he however
recovered, and returned home in the September following, since which
period I have received many, and almost constant proofs of his great
gratitude and attachment to me, one of which is worthy of being stated.
In the autumn of 1824, he walked about a hundred miles to see me, and not
finding my place of residence, he called on a medical acquaintance, to
whom his description of my kindness and attention, and their happy
influence upon himself, were so powerful and eloquent, that this new and
accidental medical acquaintance, became from that time to the present, my
first and warmest medical friend in encouraging me to establish myself in
my present residence, and to whom I have to attribute the origin of all
my success; so that this recovered patient’s gratitude, who followed me
unexpectedly, was the first step in my progress, and was the _sole_
foundation of every thing which I have done or exists in this place. It
was my only introduction. I may be permitted, therefore, to acknowledge
my great obligations to the warm-heart friendship of the person, of whose
melancholy state I have just given a general description, as well as, the
medical friend to whom I have alluded.
_No._ 195, _admitted October_ 27_th_, 1821.
This case, I shall hereafter show, was apparently saved by this
separation from former associates, at this critical period of
convalescence, and he was one who required very superior and intellectual
attention.
He was a young man of some talents, and of various pursuits and
acquirements, by far too many to be perfect in any one. Born with a
large proportion of the family failing, his vanity had been fed by
flattery and example, so much so, that it might be said he was bred in
vanity’s hot-house; and ultimately, from over excitation, and too little
collision with the world, he fancied himself a second Crichton. Of
course with such an estimate of himself, it could not be otherwise but
that he was constantly meeting with disappointments and mortifications,
on his entrance into his profession, and the real business of life. From
these causes, as well as from an increase at this time, of parental
embarrassments and mortifications, (and home had always been an
atmosphere of perpetual storms), from an hereditary scrofulous habit, and
from his self-made morbid state, his mind was at last overwhelmed. But
it is not my intention to enter into all the details of his history,
further than to prove that the causes which produced his disease, and the
form his insanity assumed, perfectly corresponded with each other.
On his arrival he was in a very exalted state of over-excitation; he was
the greatest of men in every mental capacity and acquirement; all
Philosophers, Poets, Painters, and Linguists, that had been, or were in
existence, were nothing in comparison with himself, nor were their works
to be compared with those he intended to execute, and the basis of which
he had already formed in his own conception. Nothing could exceed the
vain and pompous displays of his talents and acquirements; and it is
impossible to conceive, from the difficulty he had to support his
pretensions, with the defects under which he then laboured, what a very
painful and ridiculous exhibition it produced. Still his vanity and
exaggerated estimate of himself, combined with his ineffable contempt for
others, remained unchecked. One feature was very striking; he possessed
considerable powers of imitation, in the exercise of which he took great
delight, and in pouring forth his contempt against others, he did it with
the attitude and voice of Kemble; it was almost impossible not to feel
the force of his manner, and against myself he was particularly severe,
and his poignant expressions of contempt and indignity were most
provoking and overwhelming. When, however, a change of state occurred, I
felt so interested for his trembling and doubtful situation, that I had
even a bed put up for him in my own room. I had always some case of this
kind about me, and no one can conceive the sacrifice of health and
comfort it cost me.
This case, as well as the last described, may perhaps be detailed more
particularly in their proper place, to illustrate a general principle, of
far more importance than even moral treatment. And even in moral
treatment it will appear how important this general principle is, to
enable us to perceive how we may best counteract the effects which may
have arisen from the operation of baneful causes: for by it we shall be
able to trace errors to their source, and without this, we can never
counteract and cure them. And this we can only do with certainty, by
possessing correct views of the origin, nature, and constitution of the
human mind, and of the correspondence which exists between physical
effects, and mental or spiritual causes: out of which views this general
principle will be educed, and it will be found to be of universal
application.
In this case it is evident, a system of moral and intellectual treatment
was required, in order to counteract and cure the effects which had
arisen out of the soil in which he had existed, very different from that
which was necessary for the previous case; and it is equally evident,
without such knowledge, it is more than probable that neither of these
minds would ever have been restored to their balance, or right state.
He recovered, and his character appeared much improved by his severe
visitation. He became very much attached to me, and wrote a great deal
for me, as my amanuensis. It is worthy of remark, that he remained of
choice for a considerable time after his health was re-established, on
account of the dread he felt at returning to the place and circumstances
where his disease had arisen.
It is remarkable also, that after he had been some weeks in private
lodgings, assisting his father, in his profession at the Assizes, he, the
very night previous to their intended return home, made his escape to
America.
It is singular, that the first case I had, as an insane patient, after I
left York, was his sister.
I might select a great number of cases, where I conceive such attention
was apparently one principal cause of their recovery, and which I took
under my more immediate care on this account, and to whom I devoted much
of my time, and made many sacrifices of my comfort and convenience.
In order to show the importance of such attention, it will be necessary
briefly to explain the description and character of the cases to which I
more particularly allude, and that it may appear that these opinions are
not new, I shall quote from the first part of this volume already
published. I there say, “What is called mania and melancholia, are for
the most part effects of the same power being overactive, but overactive
in different directions.” If the distressing passions are overactive, we
have melancholia,—if the animal propensities, we have furious mania,—and
if the exhilirating passions, we have an exuberance of joyous activity.
“This is a view not before taken, and will account for much of the
difference in the effect from the same cause. This melancholy, or state
of depression, caused by the activity of the depressing passions, is to
be distinguished from the state of exhaustion and debility, which
succeeds some violent paroxysms, or which follows an exhausted state of
body and mind from overexertion, and assumes either an apparent
melancholy character, from torpor or partial suspension of mind, or is in
reality a case of melancholia of the most miserable description, from the
exclusive activity of these depressing passions, which are then more
likely to become the sole masters of the field of action.” {16}
In the former mentioned cases, it appears, that the exciting and
depressing passions alternately take on habitudes of action, so that it
is still over excitement, but the effects, from its direction being
different, are diametrically opposed to each other: in the one case, as I
have already said, this nervous energy is employed in exciting into
activity the passions which exhilirate: in the other, those which depress
us.
This excitement of the depressing and exhilarating passions alternately,
is the most striking characteristic of the insane. It is true, that both
these states or stages of the disease, if long continued and not well
managed, are necessarily followed by a third state of exhaustion. The
systems of body and mind are wholly worn out by exertion, and require
rest to recruit and manifest their renewed power, but changes from one
state to another is only a partial exhaustion; another class of feelings
become active, while the former are suspended, so that the melancholy and
“high state” are for the most part, states of mind or changes in the
direction of its energies, and not that the melancholy have less than the
furiously malignant or joyous maniac, of that power which is equally
necessary to mental activity of every description.
For instance, I have known the same person sent at one time as patient
under the influence of religious melancholy, originating in erroneous
extreme Calvinistic views; and at another period in the most joyous state
of religious excitement, from having come under the influence of extreme
Arminian views. On the same principle, I have by the most laborious
process of argumentation and the statement of what I conceive right
views, produced a counter-impression, given another character and form to
the disease, and in some cases, on this principle, effected a cure. {18}
As these cases are much more common, and these views of much more
importance than mankind, or even medical men imagine; and as many who
possess a susceptible constitution of mind, similar to those whose cases
I have described, are living in the world in this fearful and continual
state of mental excitation, and of course, may be on the verge of the
same precipice, it is right they should be warned of the danger to which
they expose themselves.
It need scarcely be mentioned, that the present constitution of society
is not in a healthy state. It is not bound together by that order and
sympathy which should exist, but on the contrary, discord and
disseverment prevail to an extent which seem to threaten its
decomposition and destruction. But too many individuals are intoxicated
with the fury of their various passions and inordinate desires, and mad
with the endless anxieties and reverses they produce. One part of
society, as well as one part of the mind, is at war with another. I wish
it, however, to be particularly observed, because I shall have to revert
to the fact hereafter, that it is not so much these exciting causes, or
even the sad effects of these feverish and wasting passions, that are in
themselves so dreadful and fatal, as they are when accompanied or
followed by the conflicts and condemnations of conscience. Wherever
there is the endeavour to overturn and sacrifice some confirmed and good
principle, that which is lowest is encouraged to struggle for
pre-eminence, and the mind suffers extreme misery and distraction.
It is in this way that we often find minds that have much that is amiable
about them, are soonest overthrown; but in all cases when (as in this and
what is in fatality next to this, perpetual domestic discord) _the fire
of our spirits_, which should give life, health, and support to our
exertions, is not united and clothed with that wisdom which ought to
diffuse itself in every useful direction; it is in an altered and
dangerous state, producing, according to this alteration of state,
disordered function, _acrid secretions_, and if long continued, disease;
and when disease is established, its state is further altered, so as
literally to “eat up the flesh,” and in one form or another burns,
scathes, withers, and consumes us, {20} but I need not now enter into all
the various evils, miseries, and conflicts in which the mind is involved,
and the dangers to which it is exposed, nor the corresponding physical
effects, nor show that even were these extremes exclusive and improper,
activity does not exist, but where the understanding seems most
completely called forth; still we have reason to fear that we pursue the
important duties of civil life, whether it be the weighty matters of
legislation, or the scarcely less responsible exercise of the learned
professions, or what ought to be the binding and sweet influence of
faithful dealings in trade, and our common intercourse with each other,
in an improper spirit, and from improper motives, and not with that
singleness and simplicity of heart for each other’s good, which alone is
useful and safe; which we could not fail to do, were we sufficiently
aware, that in as far as we depart from this purity of spirit, our views
of truth must be perverted, _and our __healthy vital energies changed_,
_causing fever_, _paralysis_, _or some morbid state_, and all our
sympathies poisoned and deranged. But I might find enough of matter for
illustration without detailing the effects of over-excitation, arising
from our mad desires after wealth, fame, and distinction, or even the
consequent distracting and overwhelming miseries of misfortune, poverty,
and starvation, in the modes and amusements of fashionable life, to which
sensitive persons, and especially those who have made themselves morbidly
sensitive, become, as in the case last stated, the victims.
Excitable and cheerful persons often fall into states of depression,
purely because they have drawn too largely and exclusively on their
exhilirating passions; whereas, had they drawn equally on the depressing
passions, they would have tempered and balanced each other, and kept the
mind in its right state; and such is the constitution of the world we
live in, that our duties require that both should have their relative and
appropriate share of exercise.
Persons, often, in company, think it necessary exclusively to exercise
the exhilirating passions, and they return home not only with these
feelings exhausted, but with the depression passions assuming in their
turn an over-active state, and in this state they perhaps encourage a
spirit of discontent, and peevishness, making sad havoc of domestic
peace, and producing an unhealthy state of mind, _an alteration in the
state of the nervous energy_, _generating an acrid and morbific matter in
the system_, _and ultimately disease_, both in themselves and others.
{22}
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.
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}