To this first appeasement of internal agitation by all the voices of nature, labor comes to add its powerful revulsion. Its benefits are now so universally known and proclaimed that, wherever space permits, it is becoming one of the bases of treatment. At Bicêtre, the neighboring farm of Saint Anne is in great part cultivated by a squad of lunatics chosen among those who most readily accept the discipline of command and corporeal exercise. Work is at Gheel the easy law of every day and every dwelling, allowing for the antipathy which certain lunatics evince toward every occupation, and for incapacity by certain kinds of illness. But industry at Gheel has this precious distinction, that there the insane works among persons of sane mind, whose speech and actions bring him back to reason, whereas elsewhere he is surrounded with his companions in misfortune, whom he finds the same in the fields as at the asylum. Instead of being sequestrated in fantastic and unnatural society, he continues to live in the real bosom of a social family whose children are reared by his side, he hears rational conversations and witnesses amusing scenes. Does he desire to take part in these? He is obliged to the act of intelligent reflection. Occasions naturally supervene when the lunatic, butting against inflexible reality, is led to recognize the bewilderment of his ideas.
The family compassionates his real or imaginary troubles, and the latter are not the least afflictive. The lunatic is very sensible of such kindness; for among many of them, the memories of childhood, of friendship, or of neighborhood, are preserved quite vivacious amid the ruins of the intellect. The death of a parent or friend will often draw warm tears. The unfortunate is consoled by showing interest in him. When this sympathetic indulgence can no longer be asked of the natural family, where hope for it elsewhere than in the adoptive family? Less discomposed by its tenderness, the latter more easily obtains the obedience of the lunatic, who even through his darkened reason, fails not to perceive that he has neither the right nor the means of imposing his caprices on strangers.
One fact constantly occurs at Gheel upon the arrival of raving maniacs. After a few days passed in their guardian's house they can scarcely be recognized. Coming with the strait-jacket or in bonds, they are appeased as soon, almost, as these are taken off. Must this change be attributed to the new sphere that environs them, to the regard that is extended to them, or to the new current of impressions and ideas that traverses their own folly? These influences, severally useful, are strengthened by their association. Through them, what remains sound in the mind is aided by good tendencies; what there is morbid, is restrained. At Gheel is perpetually renewed the phenomenon which occasioned so much surprise at Bicêtre, at Charenton, and in all the hospitals of Europe, when intrepid humanity broke their chains and whips, considered, until then, the only possible instruments for controlling the insane. It now remains for science to confess that every closed establishment is in itself a chain, the last but the heaviest that remains to be suppressed.
The lunatic taken to an asylum is, from the first, assailed with painful impressions, bunches of large keys, massive doors, bolts, bars, cells, yards, walls, guardians, uniforms, regulations, bells, all the appearances and all the realities of a prison. At Gheel, welcomed with alacrity by the family to which his abode secures a pension, he feels himself at his ease. This first welcome exerts over the insane soul the most auspicious influence; for one who comes from a hospital, it is a true emancipation. By daily repetition, this contentment soon becomes an energetic preference. When of late years certain councils of the Belgium hospitals decided on withdrawing their insane from Gheel, to transfer them to a rival establishment for the sake of some trivial economy, it occasioned the most touching scenes. Guardians and lunatics embraced each other weeping, and several of the latter hid themselves to escape from this transfer. Force had to be employed with others. Besides breaking in upon their affections and their habits, they knew they were passing from liberty to confinement! When questioned on this subject, their feelings clearly appear. A foreign physician visiting Gheel with me, one day asked a lunatic who had spent some time in one of the lock-up establishments, which system he preferred. "You may answer that for yourself," he replied reservedly; but a long and silent look beaming with joy was the expressive interpretation of these words. This attachment to Gheel and to the guardian's family often survives the cure. Guardians have often been known to keep gratuitously, wards restored to their right minds, but who had lost their families or their relations with the world. Not seldom is a friendly correspondence kept up all their lives, while living far apart. Annual pilgrimages from Brussels to Gheel renew ties formed during the malady.
There seems to be no possible doubt that life for the insane is more benign at Gheel than in the immense majority of asylums. Patients sent there in the initial period of insanity, frequently experience a change for the better, and many recover their reason. Some cures have been effected at Gheel, after two or three years of abortive treatment elsewhere. Maniacs, much agitated, in whom the spring of life preserves its energy, are cured sooner than the quiet ones, who often become imbecile. Monomaniacs, especially religious monomaniacs, are seldom cured. They are more fortunate with intermittent forms of insanity, and such are the patients preferred by the Gheelois, as most helpful in their work. Cures are more frequent on the farms, where the insane labor, than in the village, where they are less occupied. It seems to be ascertained that the number of cures has diminished with the falling off in devotion, and this result is no surprise to science, which, without intervening in the religious question, accounts faith among the most powerful therapeutic agents. Among the patients classed as curable, the proportion of cures has averaged between fifty and sixty-five per cent. Unfortunately, about three fifths of the patients sent to Gheel are desperate cases, on whom all the resources of art have been vainly exhausted elsewhere; for Gheel makes no flourish of trumpets, and only of late years has possessed even an infirmary, or a corps of physicians. Its simple hygiene of liberty, and the family life of poor peasants, is not calculated to exert the prestige of those sadly magnificent palaces in which the insane are confined by thousands, and where pretentious science so unwisely snubs nature. Certain medical administrators have even pretended that Gheel was only fit for the incurable. Formerly, they came in search of miracles; now, they seek a last abode here. It should be remarked, moreover, that hospitals, where the keeping of the insane is a burden, are inclined to dismiss them as cured on the earliest signs of real improvement; while at Gheel, where their keeping is a source of profit, and where the patient is often more comfortable than at home, nothing hastens his departure, which is authorized only after mature examination by the physician of the section and the general inspector. The chances are greater here than elsewhere, that the patient's dismissal corresponds to a solid cure.
In default of complete restoration, the conditions of life at Gheel determine in the insane a general amelioration which constitutes the gentlest manner of being compatible with mental derangement. The morbid state, reduced to its simplest expression, excludes neither physical comfort nor a certain order of moral enjoyments, some of which are delicate even to refinement. The subversive tendencies are attenuated, if not quite annulled. A young lady, confined for a year in a large asylum, used to break up there everything that she could lay her hands upon, and the severest restraints had to be forced on her. At Gheel, free among the peasants, she breaks up only little bits of wood. Unable to overcome entirely the fatal impulse that besets her, still she understands that she is in a family which deserves consideration, since, far from oppressing her, they allow her to obey her instinctive needs of active movement. The young lunatic does her hosts as little harm as she can, and this trait admirably exhibits the influence of Gheel, which mitigates when it cannot cure, and obtains, better than any other system, the state of passive "innocence."
This innocence rises occasionally to a sympathetic and rational benevolence. Among the old lunatics there are, generally, compatriots or acquaintances of the new-comers. The former become the interpreters of their companions in misfortune; they initiate them into the kind of life led at Gheel; they advise them how to manage, point out to them what the place presents of interest, and thus assist in naturalizing them. If liberty is the first principle of the colonial system, labor is the second. Although every lunatic is free to abstain from it, and no physical discipline or coercive measure is brought to bear on him, a few sympathetic words and example frequently suffice to wean the insane from idleness. From half to two thirds of the whole number are usefully occupied. The household cares are shared by women, by the aged and the infirm, along with the children and servants of the family. Most of the artisans, such as tailors, shoe-makers, cabinet-makers, blacksmiths, bakers, curriers, etc., find a place in the local industry. Some work on their own account, and are patronized in proportion to their skill. There used to be at Gheel an excellent cabinet-maker, very intelligent, and who earned a good deal of money in the exercise of his trade. A Dutchman, he had served in the French army, was made prisoner in Russia, then incorporated among the Cossacks of the Don. In 1815, being in Belgium, he deserted, or rather resumed his liberty and nationality, and married at Brussels, where he fell into hallucinations which occasioned his transportation to Gheel. He lived twenty-five years there, practising his art with success, and talked very rationally about matters in general, only he affirmed that the devil every night entered his body by the heels, and lodged somewhere in it, which led him to conclude all his discourses by asking for a probe to hunt the evil spirit. Care is taken to place every lunatic in a family so situated in village or country, as to employ his or her industrial capacities to the best advantage. The furious maniacs are most in request by the peasants, a preference easily explained. Fury attests the energy of the organism; the internal force, physical or moral, is disordered but abundant. In their periods of calm, madmen of this class are vigorous laborers; whereas no profit can be made of an idiot or a paralytic. On a sudden and violent paroxysm of acute mania, the farmer's family, aided by the passengers and neighbors, soon obtain control of it. Quieted again, the lunatic resumes his work, and this work, which profits the farmer, ameliorates by an energetic and continuous diversion the state of the patient, rendering his paroxysms less frequent.
Although the importance of working is now very generally understood, few asylums are provided with adequate grounds, workshops, and implements for employing their patients to advantage; hence this progress is still a rare exception, and even when it exists, its benefit is much diminished by the vexatious constraint of its discipline resembling penitentiary labor. In most of the rich establishments life passes in oppressive idleness, leaving the patient all day long to his dreams, without procuring him that muscular fatigue so propitious to sleep at night. It is enough to drive a sane man mad.