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Page 48
In short the patient should be always treated as much like a rational
being as the state of his mind will possibly allow. In order that he may
display his knowledge to the best advantage, such topics should be
introduced as will be most likely to interest him; if he is a mechanic
or an agriculturalist, he should be asked questions relating to his art,
and consulted upon any occasion in which his knowledge may be useful.
These considerations are undoubtedly very material, as they regard the
comforts of insane persons; but they are of far greater importance as
they relate to the cure of the disorder. The patient, feeling himself of
some consequence, is induced to support it by the exertion of his
reason, and by restraining those dispositions, which, if indulged, would
lessen the respectful treatment he wishes to receive, or lower his
character in the eyes of his companions and attendants.
Even when it is absolutely necessary to employ coercion, if on its
removal the patient promises to control himself, great reliance may
frequently be placed upon his word, and under this engagement, he will
be apt to hold a successful struggle with the violent propensities of
his disorder. Great advantages may also be derived, in the moral
management of maniacs, from an acquaintance with the previous
employment, habits, manners, and prejudices of the individual: this may
truly be considered as indispensably necessary to be known, as far as
can be obtained; and, as it may apply to each case, should be registered
in a book for the inspection of the Committee of the Asylum, and the
physician; the requisite information should be procured immediately on
the admission of each patient; the mode of procuring it will be spoken
of hereafter.
Nor must we forget to call to our aid, in endeavouring to promote
self-restraint, the mild but powerful influence of the precepts of our
holy religion. Where these have been strongly imbued in early life, they
become little less than principles of our nature; and their restraining
power is frequently felt, even under the delirious excitement of
insanity. To encourage the influence of religious principles over the
mind of the insane, may be considered of great consequence, as a means
of cure, provided it be done _with great care and circumspection_. For
this purpose, as well as for reasons still more important, it would
certainly be right to promote in the patient, _as far as circumstances
would permit_, an attention to his accustomed modes of paying homage to
his Maker.
In pursuing the desirable objects above enumerated, we ought not to
expect too suddenly to reap the good effects of our endeavours; nor
should we too readily be disheartened by occasional disappointments. It
is necessary to call into action, as much as possible, every remaining
power and principle of the mind, and to remember, that, "in the wreck of
the intellect, the affections very frequently survive." Hence the
necessity of considering _the degree_ in which the patient may be
influenced by moral and rational inducements.
The contradictory features in their characters, frequently render it
exceedingly difficult to insure the proper treatment of insane persons;
to pursue this with any hopes of succeeding, so that we may in any
degree ameliorate their distressed condition, renders it indispensably
necessary that attendants only should be chosen who are possessed of
good sense, and of amiable dispositions, clothed, as much as possible,
with philosophical reflexion, and above all, with that love and charity
that mark the humble Christian.
Agreeably to these principles, I beg leave to suggest the following
regulations to be adopted, in accomplishing the objects in view.
1st. No patient shall hereafter be confined by chains.
2nd. In the most violent states of mania, the patient should be confined
in a room with the windows, etc., closed, so as nearly to exclude the
light, and kept confined if necessary, in a straight jacket, so as to
walk about the room or lie down on the bed at pleasure; or by strops,
etc., he may, particularly if there appears in the patient a strong
determination to self-destruction, be confined on the bed, and the
apparatus so fixed as to allow him to turn and otherwise change his
positions.
3rd. The power of judicious kindness to be generally exercised, may
often be blessed with good effects, and it is not till after other moral
remedies are exercised, that recourse should be had to restraint, or the
power of fear on the mind of the patient; yet it may be proper
sometimes, by way of punishment, to use the shower bath.
4th. The common attendants shall not apply any extraordinary coercion by
way of punishment, or change in any degree the mode of treatment
prescribed by the physician; on the contrary, it is considered as their
indispensable duty, to seek by acts of kindness the good opinion of the
patients, so as to govern them by the influence of esteem rather than of
severity.
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