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Page 47
This interesting subject has closely engaged my attention for some
years, and I conceive that the further investigation of it may prove
highly beneficial to the cause of humanity, as well as to science, and
excite us to a minute inquiry, how far we may contribute to the relief
and comfort of the maniacs placed under our care. In pursuing this
subject, my views have been much extended, and my mind considerably
enlightened, by perusing the writings of Doctors Creighton, Arnold, and
Rush; but, more particularly, the account of the Retreat near York, in
England. Under these impressions I feel extremely desirous of submitting
to the consideration of the Governors, a plan to be adopted by them, for
introducing a system of moral treatment for the lunatics in the Asylum,
to a greater extent than has hitherto been in use in this country. The
great utility of confining ourselves almost exclusively to a course of
moral treatment, is plain and simple, and incalculably interesting to
the cause of humanity; and perhaps no work contains so many excellent
and appropriate observations on the subject, as that entitled, _The
Account of the Retreat_. The author, Samuel Tuke, was an active manager
of that establishment, and appears to have detailed, with scrupulous
care and minuteness, the effects of the system pursued toward the
patients. I have, therefore, in the course of the following remarks,
with a view of illustrating the subject with more clearness, often
adopted the language and opinions of Tuke, but having frequently mixed
my own observations with his, and his manner of expression not being
always adapted to our circumstances and situation, I have attempted to
vary the language, so as to apply it to our own institution; this will
account for many of the subsequent remarks not being noticed as taken
from Tuke's work.
It is, in the first place, to be observed, that in most cases of
insanity, from whatever cause it may have arisen, or to whatever extent
it may have proceeded, the patient possesses some small remains of
ratiocination and self-command; and although many cannot be made
sensible of the irrationality of their conduct or opinions, yet they are
generally aware of those particulars for which the world considers them
proper objects of confinement. Thus it frequently happens, that a
patient, on his first introduction into the asylum, will conceal all
marks of mental aberration; and, in some instances, those who before
have been ungovernable, have so far deceived their new friends, as to
make them doubt their being insane.
It is a generally received opinion, that the insane who are violent,
may be reduced to more calmness and quiet, by exciting the principle of
_fear_, and by the use of chains or corporal punishments. There cannot
be a doubt that the principle of fear in the human mind, when moderately
and judiciously excited, as it is by the operation of just and equal
laws, has a salutary effect on Society. It is of great use in the
education of children, whose imperfect knowledge and judgment, occasion
them to be less influenced by other motives. But where fear is _too
much_ excited, and especially, when it becomes the chief motive of
action, it certainly tends to contract the understanding, weaken the
benevolent affection, and to debase the mind. It is, therefore, highly
desirable, and more wise, to call into action, as much as possible, the
operation of superior motives. Fear ought never to be induced, except
when an object absolutely necessary cannot be otherwise obtained.
Maniacs are often extremely irritable; every care, therefore, should be
taken, to avoid that kind of treatment that may have any tendency
towards exciting the passions. Persuasion and kind treatment, will most
generally supersede the necessity of coercive means. There is
considerable analogy between the judicious treatment of children and
that of insane persons. Locke has observed "the great secret of
education is in finding out the way to keep the Child's Spirit easy,
active and free; and yet, at the same time, to restrain him from many
things he has a mind to, and to draw him to things which are uneasy to
him." Even with the more violent and vociferous maniacs, it will be
found best to approach them with mild and soft persuasion. Every pains
should be taken to excite in the patient's mind a desire of esteem.
Though this may not be sufficiently powerful to enable them to resist
the strong irregular tendency of their disease; yet, _when properly
cultivated_, it may lead many to struggle to overcome and conceal their
morbid propensities, or at least, to confine their deviations within
such bounds as do not make them obnoxious to those about them. This
struggle is highly beneficial to the patient; by strengthening his mind,
and conducing to a salutary habit of self-restraint, an object, no
doubt, of the greatest importance to the care of insanity by _moral
means_.
It frequently occurs, that one mark of insanity is a fixed false
conception, and a total incapacity of reasoning. In _such_ cases, it is
generally advisable to avoid reasoning[24] with them, as it irritates
and rivets their false perception more strongly on the mind. On this
account, every means ought to be taken to seduce the mind from unhappy
and favourite musings; and particularly with melancholic patients; they
should freely partake of bodily exercises, walking, riding,
conversations, innocent sports, and a variety of other amusements; they
should be gratified with birds, deer, rabbits, etc. Of all the modes by
which maniacs may be induced to restrain themselves, regular employment
is perhaps the most efficacious; and those kind of employments are to be
preferred, both on a moral and physical account, which are accompanied
by considerable bodily action, most agreeable to the patient, and most
opposite to the illusions of his disease.
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