Essay on the Classification of the Insane

by M. Allen

In some cases, I have known the convalescence of patients confirmed, not merely by placing them on their parole of honor, but by discharging them as patients, and inviting them to remain and consider themselves as voluntary visitors.

It is astonishing what a stimulus all this is to others to exert their SELF-CONTROL, and to behave more correctly; and still more so, on promising that on their continuing correct for a given length of time, they shall have these indulgences. But all this shall be more minutely detailed under the Essay, Moral Treatment; when I shall state the effects produced by always treating them as rational beings, and allowing them, in proportion as they conduct themselves more rationally, to have the privileges of, and as far as possible to associate with, those who are so.—The efforts which (in consequence of this principle being observed in all our conduct towards them,) they constantly and anxiously make to be considered rational, is an acquisition of prodigious moment and when we see they possess it, we may pronounce it an excellent symptom of the returning control of the will and understanding.

This is in perfect accordance with the principle which stimulates men, in society, to the useful or baneful exercise of their understandings; and where it exists not, the mind will rapidly sink into a state of apathy and indifference, [99a] and I have no doubt, that many an insane patient who feels that he no longer possesses this stimulus to mental exertion and control, gives way to his foolish thoughts, and still more so, when he finds it more easy to give pleasure to others by their utterance than by endeavouring to talk rationally: thus he acquires the habit of talking nonsense, and hence this constitutes the character of many of the old insane, who might, I believe, have otherwise been brought into a more rational state. [99b]

We should never for our own ease encourage their delusions, but tell them (when we do notice them at all, for silence is often the most effectual reproof we can give; but when we are obliged to notice them, we must honestly, but with charity, tell them) what is false and dangerous, and which often has a good effect; and if it does not cure, it restrains them from talking on the subject of their delusions.

Many instances of cures on this principle are recorded, and many more of my own I shall have to state when I come to Moral Treatment.

Nothing can be worse than the common practice in public institutions of allowing idle visitors to amuse themselves by listening to, and of course encouraging, their conversation on the subject of their individual insanity.—When we do notice these delusions, and it must be seldom, it must be a very important and grave matter; and we must exert all our eloquence, and call forth the most overpowering arguments against the folly, wickedness and direful consequences of encouraging these delusions.

Dr. Crowther says, “Mad persons are frequently capable of being reasoned with; and it is sometimes in the power of the physician to remove false impressions from the patient’s mind, by a well-directed reply and judicious reasoning.”

Another patient imagined himself to be Jesus Christ; and in proof of it showed me a scar he had in his side, which, he said, had been occasioned by his having been pierced with a spear.—I remonstrated with him on his assertion, and remarked that our Saviour was wounded on the side opposite to that be had indicated as the part wounded in himself.—Convinced, and apparently ashamed at the consciousness of the fallacy of his own reasoning, the patient recoiled, hid himself under the bed clothes, and never reverted to the impression under which he had previously laboured.

In many points the insane are accessible to reason; and at all times and in all cases, as a rule, they should be treated as if they were still reasonable beings.—Many are able to detect ignorance, and can appreciate and respect knowledge: convicted ignorance in a superintendent is fatal to his influence and authority. To have the character of being intelligent, is of great service.—Nothing impresses them with this conviction so much, as proofs that you possess a key to unlock their minds—that you have a perfect insight into the peculiarities of each—can trace to its origin their insane state,—the evil of extremes,—and more especially can meet these with clear views of the truth of that which they have perverted.—But all this still more requires that you are not merely esteemed for talents, but also for goodness; then will your arguments and example be like oil on the stormy waves, calming turbulence and breathing peace even upon the victims of passion, misery, and distraction.

All this will be acknowledged to be of great importance, when it is considered that to call forth the exercise of self-control is the most powerful moral means of recovering the lost equipoise of mind. And that this may be done, is certain, for many have some power of self-control remaining, but self-control in a state of misdirection. Numbers also have many avenues of the mind still open, through which the understanding may be stimulated into active exercise, and the will turned into a right direction; and thus the same principle may in many cases ultimately become the means of promoting their restoration.