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thrown around establishments for the insane shall be cleared away, Dante’s inscription over the gates of Hell, will be no longer applicable to them,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]
this, or perhaps another passage from Euripides, has been imitated by our Milton,
“Here hope never comes, which comes to all.”
They will be considered houses of cure, or hospitals for the insane.
The erroneous and false impressions, concerning the character and state of the insane, will be corrected. The popular impression, that they are all violent and vociferous, destructive and dangerous, will be removed. Hitherto medical writers, by selecting the most striking cases, have contributed their share to this popular error. They have been led to do this, partly because they are cases, which more naturally arrest their own observation; but chiefly, because they are more easily described; make a more interesting picture, and are the most curable. A statement of the recovery of such patients, though it may serve to exalt the writer in public estimation, is wrong in itself, and very injurious in its influence; for it increases the unreasonable horrors and false impressions entertained about the insane, and propagates and perpetuates the evils of which the public and legislature complain. They receive impressions from extreme cases, which average about five per cent. then speak just as if all the insane were in a similar condition.
Mr. Samuel Tuke says, “Many errors in the construction, as well as in the management, of asylums for the insane, appear to arise from excessive attention to safety; people in general have the most erroneous notions of the constantly outrageous behaviour, or malicious dispositions of deranged persons; and it has in many instances, been found convenient to encourage these sentiments, to apologize for the treatment of the unhappy sufferers, or admit the vicious neglect of their attendants.”
In the construction of such places, cure and comfort ought to be as much considered as security; and I have no hesitation in declaring, that a system which, by limiting the power of the attendant, obliges him not to neglect his duty, and makes it his interest to obtain the good opinion of those under his care, provides more effectually for the safety of the keeper, as well as of the patient, than all “the apparatus of chains, darkness, and anodynes.”