Essay on the Classification of the Insane

by M. Allen

They generally know the points which others consider as proofs of their insanity, and they should be made ashamed to display them, but never directly irritated by a domineering opposition, which would only rouse the bad passions and the spirit of self-will to resist all means of counteraction. [102]—Hence where these rules are observed, it is often perceived that they will, on their first entrance, keep their delusions out of sight; so much so, that it is often for awhile difficult to discover their insanity.—The early prospect also of their liberation often induces this concealment: we must encourage this, but at the same time, they should see that we have the power to perceive when it is real, and when it is feigned for this purpose. When they know we judge from the state of the inner, and not the outward, man, the effect is wonderful.

It is not by any system of fear, as was once imagined, that all this is to be done. This is a restraining power, which must be seldom resorted to, and then only for specific and temporary purposes, and never of long duration, otherwise the mind will be thrown on itself, and feed on its notions. It should never be used except conjoined with the suspension and loss of sympathy which they have felt valuable, or for the sake of others whose comforts are not to be sacrificed merely that they may selfishly indulge in their absurd whims, and annoying conduct, or in their erroneous views and vicious propensities: for these reasons and purposes they must be separated, and if not corrected by occasional separation, then they must be classed with those whose comfort they cannot derange. They must feel all this as the effect of their conduct, and that their treatment depends on their behaviour; but any discipline or change must never be made without a self-evident cause, and never in the doing carry the air of tyranny, passion, or injustice.

All the principles applicable to the management of children, are equally applicable to them. Though we must watch every probable and threatening storm, we must not too eagerly anticipate its approach—we must wait until it breaks out and gives us an opportunity to justify the moral measures we conceive are best calculated to produce a beneficial influence.

As I have shown, we always endeavour most sedulously (especially in the first instance begin with) to act on this principle. We treat nearly all on their arrival as if they came merely as visitors, and never alter our conduct until they cease to behave as other people; and then they cannot but blame themselves for their confinement or any change of treatment that their conduct renders necessary, and which must therefore be always sufficiently gross, even in their own estimation, to justify the change. As classification must be based on these moral views, there is necessarily included in this Essay much that will fail to be more minutely considered under the Essay, Moral Treatment, and much more that, it may at present appear, I have, altogether omitted—such as the obvious necessity of separating the vociferous, the dirty, the epileptic, &c. from the more rational, delicate, and nervous.

One principle is very important, hereafter to be enforced, which is, that some must be classed so that bad habits may be prevented by the constant presence of others to call forth the sense of shame to restrain them.

In fact, this plan of treatment should embrace every means conducive to the cure of its objects, such as domestic quiet, and the removal of every possible annoyance; and we are, above all things, carefully to avoid every appearance of restraint, and to adopt as little of the reality as is compatible with the security of the violent, dangerous, and discontented, who must be restrained, and if possible, without exciting or increasing their diseased state. We must do every thing we can to soothe and comfort the disappointed and melancholy, and diligently labour to heal the broken-hearted; we must ascertain causes and effects, and remove or counteract them; we must strive to correct or cure wrong notions and impressions; we must cultivate and strengthen better feelings and principles, and discourage all that is bad, or allow it to die away for want of nourishment and exercise: for such purposes the superintendant must be armed with medical and moral means at all points, and be above selfish considerations. To describe all this in detail, would be to write volumes. It is evident then, that every variety of suitable treatment should be adopted, according to the nature and circumstances of the case.

All this is not to be done by mechanism, nor by the strictest attention to any plan which some cold rules prescribe. Acts of Parliament can never make these places what they ought to be, and which it is of the first importance they should be; I mean places for the voluntary seclusion of an exhausted mind, or nervous invalid, and in every case as institutions not so much for the confinement, as for the cure, of the insane.

Acts of Legislation may interfere with, cramp, or destroy the heaven-born and heaven-directed energies of the mind.—It is dreadful to paralyze or destroy the spirit of kindness, guided by experience and wisdom, by confining it to rules which have merely for their object the prevention of evil, and not the production of good! Those who legislate, should be careful not to meddle in the province out of the reach of human interference. By so doing, they may destroy, but they can never give, the spirit by which alone good can be done.

The present system adds to the horrid association of these houses, (and for which some of these houses may be accused of all the blame,) and prevents them from becoming what I conceive would be of the first importance,—I mean places for the voluntary seclusion of an exhausted mind, or of a nervous invalid, which would be of the first advantage to them, and would besides take away the feeling of horror associated with such houses. It is so in France. On the same principle, those who are sent without their own concurrence, should never be treated as if they were insane; the names “Asylum,” “Patient,” “Keeper,” “Insanity,” should never be heard among them; many have been made worse by a contrary system of treatment; and I may also mention that I am more and more convinced of the necessity and efficacy of proper medical aid, and of course of a medical man, or of one having acquired medical experience, being amongst them,—I repeat “that no man ought to keep a house for the care of the Insane, who does not make cure his ruling motive for receiving, detaining, or discharging patients from his house.”

Again, the arguments are endless to prove every thing should be done not to increase, but diminish, the horror associated with these places. No act of Parliament can give knowledge and principle, and good feelings; and no Act should be made as a substitute for knowledge and principle and good feelings, which every one in his specific sphere should possess. No Act can give knowledge and principle, but an Act can carry with it so much opprobrium, that men of feeling and knowledge and principle, are deterred from undertaking a department of the profession, which the law supposes is only in the hands of base, unprincipled men. The aim of the Legislature should be, to add to its respectability, and to offer encouragement to those persons who possess that knowledge and principle and have it in effectual operation.