“It not unfrequently happens that idiots who have lived for many years in union houses, and have always been considered harmless and docile, under the influence of some sudden excitement, commit a serious overt act, and are then sent to an asylum. One of the most placid and harmless patients in this asylum, who is habitually entrusted with working tools, is a criminal lunatic, of weak intellect, who committed a homicide on a boy, who teased him while he was breaking stones on the road. If this is the case with those suffering only from mental deficiency, it is evidently more likely to occur in those suffering from any form of mental disease, which is often liable to change its character, and to pass from the form of depression to one of excitement. For these reasons I am convinced that all lunatics, and many strong idiots, can only be considered as ‘not dangerous to themselves or others,’ when they are placed under that amount of superintendence and care which it has been found most desirable and economical to provide for them in centralized establishments for the purpose.
“For the above reasons, I am unable to express the opinion that any insane patients who are not helpless from bodily infirmity or total loss of mind are unconditionally harmless to themselves and others. I have, however, made out a list of sixty patients who are incurable, and who are likely, under proper care, to be harmless to themselves and others.
“Of the patients in this list who are lunatic, only nine have sufficient bodily strength to be engaged in industrial pursuits. The remaining twenty-three are so far incapacitated by the infirmities of old age, or by bodily disease, or by loss of mental power, that they are unable to be employed, and require careful nursing and frequent medical attendance. The patients who have sufficient bodily strength to be employed, are also with the least degree of certainty to be pronounced harmless to themselves and others. As the result of long training, they willingly and quietly discharge certain routine employments under proper watch; but it is probable, that if removed from their present position, any attempts made to employ them by persons unaccustomed to the peculiarities of the insane, will be the occasion of mental excitement and danger.
“The twenty-eight idiots have, with few exceptions, been sent to the asylum from union houses, where it has been found undesirable to detain them, on account either of their violent conduct, or of their dirty habits, or some other peculiarity connected with their state of mental deficiency; habits of noise or indecency for instance.”
Probably the following extract from the Report of the Committee of the Surrey Asylum (1856) may have more weight with some minds than any of the arguments and illustrations previously adduced, to prove that the detention of presumed “harmless patients” in workhouses will not answer. The declaration against the plan on the part of the Surrey magistrates is the more important, because they put it into practice with the persuasion that it would work well. But to let them speak for themselves, they write,—“The committee adverted at considerable length in their last Annual Report to the circumstance of the asylum being frequently unequal to the requirements of the County, and of their intention to attempt to remedy the defect by discharging all those patients, who, being harmless and inoffensive, it was considered might be properly taken care of in their respective union houses.
“The plan has been tried, and has not been successful. Patients who, under the liberal and gentle treatment they experience in the asylum, are quiet and tractable, are not necessarily so under the stricter regulations of a workhouse; indeed, so far as the experiment has been tried, the reverse has been found to be the case; most of the patients so discharged having been shortly afterwards returned to the asylum, or placed in some other institution for the insane, in consequence of their having become, with the inmates of the workhouse, ‘a mutual annoyance to each other.’ Any arrangement, short of an entire separation from the other inmates of the workhouse, will be found to be inefficient.” This is the same as saying that if lunatics are to reside in workhouses, a special asylum must be instituted in the establishment for their care, and the comfort and safety of the other inmates.
If the well-being of the insane were the only question to be settled, no difficulty would attend the solution, for experience has most clearly evidenced the vast advantages of asylums over workhouses as receptacles for insane patients, whatever the form or degree of their malady. Dr. Bucknill has some very forcible remarks in his paper on “The Custody of the Insane Poor” (Asylum Journal, vol. iv. p. 460), with illustrative cases; and in his Report last quoted, reverts to this subject of the relative advantages of asylums and workhouses; but we forbear to quote, if only from fear of being thought to enlarge unduly upon a question which has been decided long ago by the observation and experience of all those concerned in the management of the pauper insane; viz. that whatever the type and degree of mental disorder and of fatuity, its sufferers become improved in properly managed asylums, as intellectual, moral, and social beings upon removal from workhouses; and by a reverse transfer, are deteriorated in mind, and rendered more troublesome and more costly. To the workhouse the lunatic ward is an excrescence, and its inmates an annoyance: in its organization, there is an absence or deficiency of almost all those means conducive to remedy or remove the mental infirmity, and the very want of which contributes as much as positive neglect and maltreatment to render the patient’s condition worse, by lowering his mental and moral character. But such deterioration or degradation is not an isolated evil, or the mere negation of a better state; for it acts as a positive energy in developing moral evil, and brings in its train perverseness, destructiveness, loss of natural decency in habits, conversation and conduct, and many other ills which render their subjects painfully humiliating as human beings, and a source of trouble, annoyance, and expense to all those concerned with them.
In a previous page we have sought to determine what was the proportion of lunatic inmates found by the Lunacy Commissioners in workhouses considered to be not improperly detained in them, and have estimated it at one-half of the whole number. The foregoing examination, however, of the adaptation of workhouses for the several classes of lunatics distinguishable, leads to the conviction that a very much less proportion than one-half ought to be found in those establishments. For our own part, we would wish to see the proportion reduced by the exclusion of most of its component members, reckoned as “harmless” patients; a reduction which would well nigh make the proportion vanish altogether. What is to be done with the lunatics removed from workhouses, is a question to be presently investigated.
But before proceeding further, some consideration of the legal bearings of workhouse detention of lunatics is wanting, for it has been advanced by some writers that such detention is illegal.
Now, in the first place, it must be admitted that a workhouse is not by law, nor in its intent and purpose, a place of imprisonment or detention. Its inmates are free to discharge themselves, and to leave it at will when they no longer stand in need of its shelter and maintenance. Whilst in it, they are subject to the general rules of workhouse-government, and to a superior authority, empowered, if not by statute, yet by orders of the Poor-Law Board, or by Bye-Laws of the Guardians, to exercise discipline by the enforcement of penalties involving a certain measure of punishment. Temporary seclusion in a room may be countenanced, although not positively permitted by law; but prolonged confinement, the deprivation of liberty, and a persistent denial of free egress from the house, are proceedings opposed to the true principles of English law.