Physician and patient

by Worthington Hooker

Besides, let the insane man once see that you have deceived him, and you lose the principal, perhaps we may say the only, moral means that you have for curing his malady. Confidence is essential to any good moral influence that you may exert upon him. I might cite many facts to prove this, but will advert to only one. The wife of an insane man was the only person among all his friends that had any control over him, and she could manage him with perfect ease. After his recovery she asked him the reason of this fact, and his reply was, ‘You was the only one that uniformly told me the truth?

The bad influence of deception upon the insane man is rendered the more certain and effectual from the fact that his insanity incapacitates him for appreciating the kind motives which may have prompted the deception. You cannot convince him as you can the sane sick man, that you have deceived him for his own good. His suspicious eye sees nothing but a sinister purpose in the cheat which you have practised upon him.

One of the most vivid recollections of my childhood is that of a scene which illustrates these remarks. A poor crazy man who wandered about the streets was thought to have become dangerous, and it was proposed to confine him in the common jail. A plan was laid to do it by stratagem. He fancied himself to own some large possessions, and talked much about going to Boston to see his friend the governor, and attend to his business there. A neighbor offered to go with him, and he accepted the offer. As they passed by the jail, his friend proposed to visit it. As they entered one of the cells he adroitly slipped out, and the door was closed upon the insane man. His dream of earthly happiness and wealth was in a moment at an end, and he beheld himself the victim of base treachery in the narrow cell of a prison. Never shall I forget how eloquently he pleaded for his release, how he asked what crime could be charged to his account, how he denounced those who had thus without cause shut him up like a felon, and especially with what sorrowful but burning indignation he spoke of the man, ‘who under the guise of friendship, had decoyed him into this snare of his enemies.’ Though a mere boy, I pitied him. I sympathised with him. I had known him only as a pleasant old man, who used to amuse us as we met him in the streets with stories of his immense wealth and of the splendid plans of building on which he loved to speculate. I felt that it was wrong to confine him among vile criminals, and wondered not that the keen sense of such injury prompted to the utterance of curses on those who inflicted it. But these natural feelings gave way in my bosom, as they did in older ones, to what was then supposed to be the necessity of the case—a necessity which, I rejoice to say, has since that been found not to exist in similar cases. A very great improvement has been effected in this as well as in other respects, in the management of the insane. Most of those whom it was once thought necessary to confine with bolts and bars, and perhaps chains, and upon whom deception was continually and systematically practised, thus adding poignancy to the pangs of the oppressed spirit, are now permitted to have so much liberty, that they are cheerful and happy, reposing entire confidence in their attendants, who are careful never to deceive them. And those whom it is thought necessary to confine, are not doomed to the cheerlessness and disgrace of the cell of the felon, but they are placed in as agreeable circumstances as is consistent with safety. And it has come to be an established rule with those who have the care of the insane, that force is always preferable to deception. But still, erroneous views are very prevalent in the community on this subject. It is common to this day, even among the excellent and well informed, to propose to send their insane friends to a Retreat by stratagem, and this has often been done even by the advice of physicians. So far as I recollect, in all the cases of insanity that have gone to Retreats from under my care, this mode of management has been spoken of by some, and generally by many, as the only proper mode. The public need to be instructed and reformed on this point.

It is a common observation that the insane are apt to look upon their best and most intimate friends as their enemies. Why is this? It is clear, that it is in part to be ascribed to the influence of deception, waking up, as might be expected, feelings of resentment and enmity in the bosom of the insane, which would not otherwise be there. This point I have commented upon in the Chapter on Insanity, and I need not dwell upon it here.

The extent to which deception is practised upon the insane cannot be fully appreciated, except by those whose attention has been specially called to this subject. As I have already remarked in regard to children, so also it is with the insane—deception is so common, that people often make use of it almost unconsciously. The whole course of management on the part of their friends, is often characterized throughout by an absence of candor and veracity.

The tendency of such a course is invariably to increase insanity, making it more intense and obstinate. And not only so, but it modifies to a greater or less degree its character. Deception prompts the insane man to exercise his ingenuity in forming plans to foil and circumvent his deceivers, whom he supposes very naturally to be his enemies. Of course, new feelings and thoughts are thus excited in his bosom, giving in some measure a new cast to his insanity.

I will here relate a case that illustrates these remarks.

The friends of an insane gentleman determined to send him to a Retreat by stratagem. For this purpose, he was induced by one of them to go a journey with him. On, their way, his friend proposed to him to visit an Insane Retreat as a matter of curiosity. When they arrived there, he was given to understand that he was to remain as an inmate. Great was his rage at being so grossly deceived. After the first burst of indignation was passed, he saw that it was of no use to say anything or to make any resistance. He was a shrewd man, and therefore, as a matter of policy, he submitted with apparent cheerfulness to his new situation. He did not forget, as the insane sometimes fortunately do, the wrong which his friends had done him, and as he was decoyed there by stratagem, it is no wonder that he at length made his escape by stratagem also. He came out, as might have been expected, with his insanity more thoroughly fixed than it was when he went in, and he added to it a deep hatred of Retreats, and of course of the man who had betrayed him into one.

Another attempt was made to carry him to the same Retreat, which from mismanagement utterly failed. The insane man was victorious, and he felt himself to be so, over his friends, who he supposed were bent upon cheating and oppressing him. All this not only made him more crazy, but it gave a new shape to his insane ideas. In a conversation which I chanced to have with him, he said to me, ‘It is perfectly evident, doctor, that these Insane Retreats are joint-stock institutions, and the stockholders are chiefly lawyers and doctors and ministers. And it’s good stock too. Just see how much they charge for board—full double at least of the actual expenses. I need not tell you anything about it, however, for you own some of this stock, and you know how profitable it is to you.’

‘Oh no,’ said I, ‘this is all new to me.’ He looked at me as if he would look me through. He had been deceived so much, that he believed, he trusted no one. Although I gave him the most positive assurance that I owned no such stock, still, in spite of the confidence which he ordinarily reposed in me, he showed that he did after all suspect me on this point, so firmly was this notion about Retreats fastened in his mind. He went on to give his reasons for his opinion.