Belgium, amid a vast uncultivated plateau consisting of heath and sand,
called the Campine, affords an extraordinary example of the pre-eminent
advantages of the present mode of managing lunatics. Until the era of
railroads this spot was so out of the ordinary track of the world, that
but few persons even of those who were interested in the treatment of the
insane were aware of its existence. Here we discover, like a fly in amber,
a state of things which has lasted with little change for twelve hundred
years. Here we see the last remnants of the priestly treatment of
insanity, coupled with a system of non-restraint which certainly existed
long before the term was ever heard of in England and France. Gheel owes
its origin to a miracle. Saint Dympna, the daughter of an Irish king,
suffered martyrdom in this place from the hand of her father in the sixth
century. So great was her fame as the patron saint of lunatics, that her
shrine, erected in the church dedicated to her, speedily became the resort
of pilgrims, who journeyed hither in the hope of being cured of their
madness or of preventing its advent. Her elegantly-sculptured tomb
contains among other bassi-relievi one in which the devil is observed
issuing from the head of a female lunatic, while prayers are being offered
up by some priests and nuns, and close at hand another chained maniac
seems anxiously awaiting his turn to be delivered from the demon. The idea
carefully inculcated by the priests, that lunacy meant nothing more than a
possession by the devil, has long been banished from other lands. Here,
however, it has flourished for many centuries, and the ceremony of
crawling beneath the tomb has existed so long, that the hands and knees of
the devotees have worn away the pavement. The act is still occasionally
performed amid a scene in which superstition and terror are combined in a
manner calculated to cure any lunatic, if deep mental impressions were
alone required to purge away his malady. But what is far more interesting
and astonishing to those accustomed to the bolts and bars, the locks,
wards, and high walls of crowded European asylums, is the almost entire
liberty accorded to the lunatics resident in the town of Gheel and its
neighbouring hamlets, to the number of 800, or one-tenth of the whole
district. No palatial building, such as we encounter in nearly every
county in England, is to be seen. The little army of pauper and other
patients gathered from the whole superficies of Belgium, instead of being
stowed away in one gigantic establishment, in which all ideas of life are
merged in the iron routine of an enormous workhouse, are distributed over
five hundred different dwellings, three hundred of which are cottages, or
small farmhouses, in which the more violent and poorer classes are
dispersed, and the remaining two hundred are situated in the town of
Gheel, and are appropriated to quieter lunatics and those who are able to
pay more liberally for their treatment. In these habitations the sufferers
are placed under the care of the host and hostess; more than three persons
never being domiciled under one roof, and generally not more than one. The
lunatic shares in the usual life of the family; his occupations and
employment are theirs, his little cares and enjoyments are the same as
theirs. He goes forth to the fields to labour as in ordinary life; no
stern walls perpetually imprison him, and make him desire to overleap
them, as Rasselas desired to escape even from the Happy Valley. If it is
not thought fit for him to labour with plough or spade, he remains at
home, and takes care of the children, prunes the trees in the garden, and
attends to the potage on the fire; or if a female, busies herself in the
ordinary domestic duties of the house. The lunatics, as may be supposed,
are not left to the discretionary mercies of the host and hostess. A
strict system of supervision prevails, somewhat analogous to that of the
lunacy commissioners and the visiting justices of England. The entire
country is divided into four districts, each having a head guardian and a
physician, to whom is entrusted the medical care of every inmate belonging
to that section. There are, in addition, one consulting surgeon and one
inspecting physician for the whole community. The general government of
the colony is vested in the hands of eight persons, who dispense a code of
laws especially devised for it. The burgomaster of Gheel presides over
this managing committee, whose duties are to distribute the patients among
the different dwellings, to watch over their treatment, and to admit or
discharge them. A visiting commissioner is annually appointed, who
inspects the dwellings of the different hosts, and sees that the patients
are properly cared for. The oversight of the lunatics falls almost wholly
upon the hostess, the man rarely interfering, unless called upon to
control a disorderly patient. The people of Gheel, from having been
engaged for ages in the treatment of the insane, are said to have acquired
extraordinary tact in their management, which, Dr. Webster remarks, may be
considered to exhibit a most judicious mixture of "mildness and force."
Although instruments of restraint, such as the strait-waistcoat, and the
long leathern thong below the leg, to prevent patients from running away,
are occasionally resorted to, the sectional physician must be instantly
informed of their imposition, and their use cannot be continued without
his sanction. So little are they required, that Dr. Webster found less
restraint in this colony, unconfined by walls, than in the asylum at
Mareville, in France, containing a similar number of lunatics. Yet there
were fewer escapes than from the strictly-guarded restraint-abounding
prison, only eleven persons having fled from Gheel in the course of last
year, and nineteen from Mareville. Here also, it will be observed, there
is no separation of the sexes. The lunatics live the life of the other
inhabitants, and males and females associate in the same household. If we
compare the effects of this simple treatment with that of the most
expensive of our own asylums, we are compelled to admit that the balance
is in favour of Gheel, where, notwithstanding the free admission of
chronic cases, upwards of twenty-two per cent. of cures takes place
annually, while at Hanwell and Colney Hatch the cures never exceed
fifteen per cent. No fair comparison can be instituted between the expense
per head at Gheel and in our English establishments, inasmuch as living is
much cheaper in Belgium; but we may state, that the average cost of board
and lodging for each pauper in the colony is 10_l._ per annum, or exactly
the sum charged for lodging alone in our county asylums.[17]
A plan, towards which we have been slowly advancing during the last
half-century, will speedily, we hope, be more closely followed. A trial is
already, to some extent, being made of it in the neighbourhood of existing
asylums, and might supplant, with immense advantage, the prevailing custom
of building new wings, and over-populating old wards. The present system
of enormous buildings, which destroys the individuality of the inmates,
and suppresses all their old habits and modes of life, is evidently
disapproved by the commissioners, as appears from the language they hold
in their tenth annual report:--
"We have the best reason for believing that the patients derive a
direct benefit, in many ways, from residing in cheerful, airy
apartments detached from the main building, and associated with
officials engaged in conducting industrial pursuits. A consciousness
that he is useful, and thought worthy of confidence, is necessarily
induced in the mind of every patient, by removal from the ordinary
wards where certain restrictions are enforced, into a department where
he enjoys a comparative degree of freedom; and this necessarily
promotes self-respect and self-control, and proves highly salutary in
forwarding the patient's restoration. As a means of treatment, we
consider this species of separate residence of the utmost importance,
constituting in fact a probationary system for patients who are
convalescing; giving them greater liberty of action, extended
exercise, with facilities for occupation; and thus generating
self-confidence, and becoming not only excellent tests of the sanity
of the patient, but operating powerfully to promote a satisfactory
cure. The want of such an intermediate place of residence is always
much felt; and it often happens that a patient just recovered from an
attack of insanity, and sent into the world direct from a large
asylum, is found so unprepared to meet the trials he has to undergo,
by any previous use of his mental faculties, that he soon relapses,
and is under the necessity of being again returned within its walls.
Commodious rooms contiguous to the farm-buildings are now in the
course of construction at the Somerset County Asylum; and there is
every reason to believe that the patients will derive benefit by
residing in these apartments, which at once possess a domestic
character, and afford every facility to carry on agricultural
pursuits."
It strikes us forcibly that the commissioners have tended to create the
evil they deprecate in not protesting against the erection of gigantic
asylums; but it is cheering to find that the idea of supplemental
buildings possessing a "domestic character" has taken possession of their
minds, and that they are now enforcing it on the minds of others with
their well-known zeal and ability. The Devon Asylum, among others, has
adopted the plan; and its accomplished physician, Dr. Bucknill, the editor
of the _Asylum Journal_, bears important testimony to the great advantages
to be derived from it.
"I have recommended the erection of an inexpensive building, detached
from, but within the grounds of the present asylum, in preference to
an extension of the asylum itself. My reasons for this recommendation
are, that such a building will afford a useful and important change
for patients for whom a change from the wards is desirable. The system
of placing patients in detached buildings, resembling in their
construction and arrangements an ordinary English house, has been
found to afford beneficial results in the so-called cottages which
this institution at present possesses. _These cottages are much
preferred to the wards by the patients themselves, and permission to
reside in them is much coveted._ I am also convinced that such
auxiliary buildings can be erected at much less expense than would be
incurred by the enlargement and alteration of the asylum itself. I
propose that in the new building the patients shall cook and wash for
themselves."
"These cottages are much preferred to the wards by the patients
themselves, and permission to reside in them is much coveted." In these
few lines we read the condemnation of huge structures like Colney Hatch,
built externally on the model of a palace, and internally on that of a
workhouse, in which the poor lunatic but rarely finds any object of human
interest, where his free-will is reduced to the level of that of a
convict, and the very air of heaven necessary to his health is doled out
at intervals, when, with infinite lockings and unlockings, the attendants
order a batch of persons into the stagnant and tiresome airing courts.
Infinitely better for the lunatics would be the freedom and homeliness of
the smallest cottage to the formal monotony of cheerless wards; better far
that they should, as Dr. Bucknill suggests, cook and wash for themselves,
than that the offices should be performed wholesale in the steam-laundry
and the steam-kitchen. A patient would undoubtedly feel a far greater
interest in peeling his own potatoes for the pot, and in cooking his own
bit of bacon, than in receiving them ready cooked. It is the duty of the
physician to interest the patient in his daily work, and no more effectual
method of accomplishing this could be suggested than in putting him to
work for himself.
Wherever large asylums are already erected, no better plan could perhaps
be suggested than the building of satellite cottages, which would form a
kind of supplementary Gheel to the central establishment; but we should
like to see the experiment tried, in some new district, of reproducing in
its integrity the Belgian system. The colony of Gheel was once a desert
like the country which surrounds it; it is now, through the happy
application of pauper lunatic labour, one of the most productive districts
of the Low Countries. Have we no unoccupied Dartmoors on which we could
erect cottages, and train the cottagers to receive the insane as members
of the family? The performance of domestic offices, the society of the
goodwife and goodman, and the influence of the children, would do far more
to restore the disordered brain of the lunatic--pauper or otherwise--than
all the organization of the asylum, with its daily routine, proceeding
with the inexorable monotonous motion of a machine, and treating its
inmates rather as senseless atoms than as sentient beings, capable, though
mad, of taking an interest in things around them, and especially awake to
the pleasure of being dealt with as individuals rather than as
undistinguishable parts of a crowd. The children are of particular
moment. Lunatics are singularly gentle to them, and are interested in all
their actions. At Gheel it is customary to send the bairns into the fields
to conduct the patients home from their labour in the evening; and we
learn from Dr. Webster that a violent madman, who would not stir upon the
command of his host, will suffer himself to be led, without a murmur, by
an urchin scarcely higher than his knee. The presence of the young in the
ward of an asylum seems to light it up like a sunbeam. The love of
children does indeed lie at the very foundation of the human heart, and we
cannot estimate too highly their beneficial influence upon the brain which
is recovering from the horrors of insanity.
One of the most important points in reference to insane paupers, as we
have already intimated, is the bringing them as speedily as possible under
treatment. The reluctance of the lunatic himself to be removed is usually
extreme, and it is marvellous what ingenuity he will often employ to
thwart the design. Southey relates that a madman who was being conveyed
from Rye to Bedlam slept in the Borough. He suspected whither he was
going, and, having contrived by rising early to elude his attendant, he
went to Bedlam, and told the keepers that he was about to bring them a
patient. "But," said he, "in order to lead him willingly, he has been
persuaded that I am mad, and accordingly I shall come as the madman. He
will be very outrageous when you seize him, but you must clap on a
strait-waistcoat." The device completely succeeded. The lunatic returned
home, the sane man was shut up, and until he was exchanged at the end of
four days, remained in his strait-waistcoat, having doubtless exhibited a
violence which amply justified its use. The aversion of the sufferer
himself to be taken away coincides with an equal aversion on the part of
his relatives and friends to send him from home, nor do they take the step
till the madness grows intolerable. Precious time is thus lost at the
outset, and when the removal occurs it is mostly to the workhouse. Here
the patient is usually kept during the remainder of the curable stage of
his malady. The parochial authorities are generally guided by an immediate
consideration for the pockets of the rate-payers, rather than by any care
for the welfare of the lunatic; and, as they can maintain him in the
"house" at three shillings a-week--when they would have to pay nine if
they transferred him to the county asylum--in the workhouse he remains
until he becomes so dirty or troublesome in his habits that the guardians
are willing to pay the difference to get rid of him. The first few months
of the disease, within the narrow limits of which full 60 per cent. of the
recoveries take place, are thus allowed to run to waste. Months fly by,
and the victim subsides into the class of incurables. This produces a
second evil. As the drafts of incurables are perpetually flowing into the
asylums, they become "blocked up" in the course of a few years, and are
converted into houses for the detention of hopeless cases. To this
condition three-fourths of the asylums are already reduced, and the
efforts of philanthropic medicine are brought to a dead lock by the
short-sightedness of the parish authorities, who do not consider that for
the sake of saving a few shillings in the board of Betty Smith in the
first weeks of her craziness, they are converting her into a chronic
burthen, seeing that she will probably live on to a good old age in the
asylum, and cause them an ultimate expenditure of hundreds of pounds. To
the swifter removal after the outbreak of the disorder we must look for a
permanent remedy; but in the mean time something must be done to
disembarrass the public asylums of the dead-weight of hopeless cases, if
we seriously intend to take advantage of the curative appliances we
already possess. The commissioners seem inclined to favour the erection of
separate asylums for those who are beyond the reach of medical art. To us
it seems that the more economical plan would be to apportion certain wards
in the various workhouses for the reception of chronic cases, and to draft
off the idiots alone to special establishments. By this means our
water-logged asylums would speedily right themselves, and again become
what they should never have ceased to be--hospitals for the _cure_ of the
insane. At present we encourage an elaborate system for the manufacture of
life-long lunatics. It is well known that the cures of early cases of
insanity throughout England amount to 45 per cent., and at Bethlehem and
St. Luke's, where no others are received, the cures have amounted to 62
per cent. and 72 per cent. respectively; whereas at Colney Hatch, Hanwell,
and the Surrey County Asylum, the three great receptacles for the weepings
of the metropolitan workhouses, the average cures do not exceed 15 per
cent. If we take the lowest averages of cures, there is still a difference
of 30 per cent. of human creatures who sink down into the cheerless night
of chronic dementia and idiotcy, or who dream away the remainder of their
lives in hopeless childishness. Another ground of complaint is, that a
degree of clerk's work is imposed upon the medical superintendents of
large asylums which is quite inconsistent with a proper discharge of their
chief duty--the recovery of their patients. Irrespective of the
routine-labour of making daily and quarterly and yearly reports, which is
very considerable, they have far more to do in their strictly professional
capacity than they can possibly accomplish. The three great asylums near
the metropolis contain upwards of 3,000 patients, or the population of a
good-sized country town; and their moral and physical training is confided
to exactly six medical men, or as many as will be found in an hospital of
a hundred beds! It is needless to observe how little attention can be paid
to each individual, and that the more promising patients must be
inevitably swamped in the sea of hopeless lunatics. As long as our asylums
remain mere houses of detention, the want of medical superintendence is
not so apparent; but immediately these establishments are restored to
their proper functions, we predict that the evil will become too glaring
to last.
In many boroughs the authorities have entirely evaded the requirements of
the Act of Parliament relative to their insane pauper poor, and have not
only neglected to erect proper asylums, but have resisted for years the
attempts of the commissioners to compel them to do their duty. In all such
cases the lunatics not only suffer the ills consequent upon insufficient
care, but when too numerous for home accommodation are subjected to a
system of _transportation_, which is not only disgraceful to the
municipal authorities themselves, but to the age for permitting it. True
to their economical instincts, the guardians of the poor often "farm out"
their insane paupers to the proprietor of some private asylum, quite
regardless of distance. The commissioners, justly indignant at this sordid
practice, state in one of their Reports that--
"At present, large numbers of these patients are sent to licensed
houses far from their homes, to distances (sometimes exceeding, and
often scarcely less than, 100 miles) which their relations and friends
are unable to travel. The savings of the labouring poor are quite
insufficient, in most cases, to defray the expense of such journeys,
and their time (constituting their means of existence) cannot be
spared for that purpose. The consequence has been, that the poor
borough lunatic has been left too often to pass a considerable portion
of his life, _and in some cases to die, far from his home, and without
any of his nearest connexions having been able to comfort him by their
occasional presence_. The visits of his parish officers are
necessarily cursory and unfrequent, and he is, in fact, cast upon the
humanity of strangers, whose prosperity depends upon the profits which
they derive from maintaining him and others of his class."
This is a system which we are confident is as illegal as it is heartless,
and we are astonished that bodies of Englishmen should dare to insult the
miseries of lunatics by thus punishing them and their friends for their
affliction. There were not long since twenty-five insane paupers at
Camberwell House, London, who had been sent from Southampton, a distance
of eighty miles, though the Hants County Asylum is situated within sixteen
miles of the borough. Seventeen persons were in like manner banished from
Great Yarmouth to Highbridge House, near London, and their relations, who
had to travel 146 miles to see them, passed, in the course of their
journey, the Norfolk and Essex County Asylums, both of which
establishments had many vacancies and would willingly have received them.
The pauper lunatics of Ipswich, King's Lynn, Dover, Canterbury,
Portsmouth, and various other boroughs, are in the same way transferred by
the local authorities to some of the metropolitan licensed houses.
The feelings of the poor for their afflicted relatives are often of the
deepest kind, and the utmost distress is entailed upon them by these cruel
separations from those they love. In one case, a native of Ipswich, too
poor to go by the railway, walked to London and back on foot, a distance
of 140 miles, for the sole purpose of visiting his wife, who had been
wickedly banished to Peckham House, London. In other cases parents have
pleaded so piteously to be conveyed to their children, that the
commissioners have suggested that the expenses should be paid out of the
parish funds, but the authorities who had contrived the original
proceeding in order to save two or three shillings a head, could not of
course be induced to furnish money for so sentimental a purpose. The
commissioners have resolutely refused their sanction to such disgraceful
transactions whenever they have come within their knowledge and
jurisdiction--one instance out of many which prove that, however much the
borough authorities may denounce them as a centralized power, they have
done excellent service in checking local ignorance, selfishness, and
inhumanity.