On the State of Lunacy and the Legal Provision for the Insane / With Observations on the Construction and Organization of Asylums

by J. T. Arlidge

In the introductory chapters on the statistics of insanity, we have remarked on the very incomplete records of the prevalence of the disease, and on the consequent impossibility of discovering the actual number of the insane, and of determining the question of their increase in the community. Yet it will be granted that such statistics are of great importance in a civilized country, and have bearings upon several questions in social economy.

The Earl of Shaftesbury, in his valuable evidence before the ‘Select Committee on Lunatics’ (1859), observes, in answer to query 263, “I think it would be very desirable if we could have proper statistics upon insanity drawn up and put upon a good footing. It would require great trouble and expense; but I think it would be worth the trouble and expense, if it could be put in the hands of some competent persons; and I have no doubt that some remarkable results would be brought out.” Every one, who knows how defective are the existing statistics of the disease, will cheerfully second his Lordship’s wish. This, however, does not go so far as our own; for Lord Shaftesbury appears, as far as we can judge from his words, solicitous only to take a sort of census of the insane and to deduce from it certain facts; whereas we desire not only an accurate census at present, but also a well-arranged scheme for keeping up the correctness of the statistics of the insane for the future, by making every instance of insanity returnable to the Lunacy Board. Our desire, in short, is to bring every lunatic in the kingdom within the cognizance of the Commissioners in Lunacy, either directly or by some recognized agent acting in their place, so that protection and proper care may be assured to every such afflicted individual. A necessary supplementary provision to placing a name on the register would be required for removing it on certified recovery; the return of which should be made through the same channels as the report of the attack.

Should the registration proposed be enforced by law,—as it must be to render it at all perfect, under a penalty,—it would afford a remedy against the wide-spread plan of placing lunatics where they are unheard of, and unknown to all except those concerned in their detention. It would make the Commissioners acquainted with all those very numerous patients who often drag on a painful and neglected existence in lodgings, under the control of persons of all sorts, with many of whom, it is to be apprehended, the gain to be got by their detention is the ruling motive in their actions.

Another advantage obtainable by a system of registration, so conducted as to ensure the reporting of cases immediately, or almost so, on their occurrence, is, that it would prepare the way for early treatment, more particularly so perhaps in the case of pauper lunatics. In the instance of the last-named class of insane, the law might render their removal to an asylum imperative, on the report of the onset of their disorder, by refusing their friends the attendance of the parochial medical officer on the patient at home as well as parochial relief, and by holding them responsible on the ground of culpable neglect for anything untoward that may happen to the patient or others. We anticipate that such an arbitrary interference of the law would be but very seldom required, for the poor mostly would be only too happy to rid themselves of a troublesome and useless member of the family.

Moreover, in the case of those raised above poverty and competent to provide for their insane relatives, it would be no undue stretch of legal authority to require them to satisfy some duly appointed and experienced officer, that the provisions contemplated or furnished by them for the patient were of a satisfactory character and calculated to favour recovery. The existing law, indeed, goes so far as to interfere with the friends of a lunatic and to deprive them of his care, if there be evidence to show that he is cruelly treated or neglected. It moreover imposes upon the friends all costs incurred on behalf of the patient. The section cited is sect. lxviii. 16 and 17 Vict. cap. 97, and the suggestion we offer is but an amendment of this, so far as to require the friends of every insane person not placed in a licensed house or asylum, to show that such lunatic is properly treated and taken care of.

The registration must be accompanied by visitation. The appointed medical registrar must be a witness to the fact he is called upon to register; and a case once registered should be visited at least once in three months, until recovery or death takes place, when in either case the return of the patient as a lunatic would be cancelled under a certificate to the fact supplied by the registrar. These remarks apply specially where patients are placed out singly. This plan of registration, coupled with that of visitation, would not only give security that the patient was properly treated, but would also prevent secret removals to lodgings or other uncertified receptacles for lunatics, or to a foreign country.

With reference to the last-named proceeding, there ought assuredly to be some stringent legal provisions, if not to prevent it entirely, at least to place it under great restrictions. The Lunacy Law in its intent and administration is both stringent and minute where it deals with asylum provision for the insane in this country; but it is impotent if the friends of a lunatic choose to send him out of the country. The act cuts him off from all protection of the laws he was born under and has never forfeited. Certainly it must be granted, that in every civilized country of the world lunacy laws are enacted for the protection of the insane; yet even where those laws are good, we know of no realm, and we believe there is none, where the interests of the insane are so well watched over and so adequately provided for, as in our own. This opinion we assert as the result of personal observation in most of the countries of Europe, and the perusal of the reports on the state of the insane in those countries.

Where English lunatics are transferred to foreign public asylums—and there are many sent to such, particularly to those in France—there is often very excellent treatment and moderate State supervision; but it must be borne in mind, that the poor patients are thrust among strangers by nation, by habits, and by laws; there is no security against their being placed among the lowest classes of pensioners, who are less tenderly dealt with than our asylum paupers; and they are besides entirely at the mercy of their relatives or friends, who may as far as possible ignore their existence, prey upon their substance at home, and allow only some pittance for their maintenance in the foreign land.

We are persuaded that the allusion to this defect in the laws of lunacy is sufficient to extort attention to it, and obtain its redress. The project of the law of lunacy for Sardinia, which we translated for the pages of the ‘Journal of Psychological Medicine’ (vol. x. p. 818), contained the two following clauses:—“Art. 21. It shall be incumbent on all individuals who shall place an insane person in a foreign asylum, to present, every thirty days, to the Minister of the Interior a precise report of the physical and mental condition of the patient, prepared by the physician of the asylum. Art. 22. It shall be in the power of the Minister of the Interior, by previous concert with his colleague for foreign affairs, to cause any patient confined in a foreign asylum to be brought back to his own country, provided that this can be done without injury to the patient, and that he can be readily provided for in his own family, and is in possession of sufficient pecuniary means for his maintenance.”

Some such clauses need be added to any new Act of Parliament for the care and treatment of lunatics in this kingdom. The Commissioners in Lunacy would be the right persons to move first in the matter by calling upon friends for information respecting their lunatic relatives abroad; and the Foreign Minister, acting upon their recommendation, would, we presume, be the proper official to arrange with the authorities abroad for the transfer of the patient to his own country.