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of no doubt that in some cases the eager impatience, the restless anxieties, the meddlesome interference, and the disagreements of friends thwart the best efforts of the physician. Sincere and sound advice, founded on experience, is not adopted, or, if adopted, not steadily followed; meanwhile that time in which there is the best hope, and sometimes the only hope, from treatment passes; and the period of recovery is delayed, if the progress of it be not permanently arrested. It is not an unwarrantable assertion to make, that some insane persons have owed their lifelong mental affliction to the injudicious conduct of those to whom they were most dear.

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CHAPTER VII.

THE TREATMENT OF INSANITY.

IT may be safely said that in no other disease are the difficulties

of treatment so great as they are in insanity; for they are not only difficulties appertaining to the nature of an obscure disease, but they are increased and multiplied by the social prejudices attaching to it; by the frequent concealment and misrepresentation, witting and unwitting, on the part of the friends of a patient; by the unsatisfactory character and position of the institutions especially established for the reception of insane persons; and, in some measure also, by the tendency of recent lunacy legislation, which has suffered not a little from popular panic and professional philanthropy. The practical result of laws eagerly and hastily made under the influence of popular excitement and clamour has unquestionably been in some respects prejudicial to the true interests of the insane. The land has been covered with overgrown and overcrowded asylums to which almost the whole lunatic population of the country has been consigned, while the greatest difficulties have been put in the way of the early treatment of insanity. No one who has had experience of the working of the Lunacy Acts in England can feel altogether satisfied with the results. That there has been a steady increase of 1,000 patients a year in the asylums of England and Wales during the last fifteen years may be good evidence of the close supervision exercised over them, but it is not convincing evidence that all has been done which can be done to secure the best medical treatment of those who are curable and the greatest comfort of those who are incurable.

It would not be difficult to show that the iniquities practised upon the insane in olden times, the countless unnecessary and

cruel sufferings which they underwent, originated fundamentally in the shame, horror, and dread of insanity which still infect the public mind. Whether these unjust feelings were legacies from that ancient superstition which looked on an insane person as tormented with an evil spirit, in consequence of some great sin committed by him or his parents, it is needless to inquire here; suffice it to say that the cruel feelings of suspicion and fear inspired a most cruel practice. To shut the insane up from gaze, and, if possible, from memory, to be rid at any cost of their offending presence, that was the one thing to be done, and fit implements were not wanting to do it. Consequently it happened that infinite cruelties grew up and flourished under the influence of false views and hostile feelings with regard to them; and to be the victim of the most pitiful of diseases became a reason, not for undergoing proper medical treatment, but for enduring the severest punishments. The memory of this iniquitous past is thought to justify, and certainly strengthens, the public jealousy of asylums and of those who superintend them now; they are weighted with an inherited odium; and a stringent legislation, designed to mitigate the uneasiness of the public conscience on account of the real horror of the insane which is still felt, and to condone past sins, does not conduce altogether to their best interests.

It is by no means an unnecessary thing to watch carefully any public action taken in regard to the insane; for it is very certain that the people have not been in times past, and are not now, their true friends: the vulgar fear or horror of them has always prevented that, and the social disgrace thought to attach to insanity still prevents a genuine reform of opinion. How often did l'inel appeal, and appeal in vain, to the authorities before he was permitted to make the experiment of removing the chains from a few lunatics, and of treating them with kindness and consideration! Against what an embattled phalanx of obstructive prejudices, selfish indifference, and interested opposition did the humane system of treatment, the conception and realization of which were not with the people but in spite of them, win its slow way to general adoption in this country! A few earnest members of the medical profession, inspired by benevolent feeling, but little aided from without, clung to the drooping

standard, and, animated with firm conviction and nerved by a sublime determination, bore it onward to triumphant victory. The names of Pinel and Conolly, the great and victorious champions of the humane reform, will ever be remembered with gratitude and honour. But, alas! while men accept and praise the reforms that have been accomplished, they fail not to oppose and despise those which are to come. What a terrible outcry is now raised by an alarmed and angry public when some poor madman who has committed homicide in a paroxysm of his frenzy is permitted to pass the remainder of his unhappy life in confinement instead of being hanged forthwith! How many veritable lunatics are year after year executed in obedience to ignorant and unrighteous judgments inspired by the popular prejudice! When the superintendent or proprietor of an asylum sends a few of his patients to the seaside, to reside there for a short time, how frequently does it happen that the whole neighbourhood rises in rebellion, and hastens to protest against the outrage thought to be practised upon it! And when the protest has been unsuccessful, with what a singular consideration does this public, so eagerly censorious of those who have the difficult charge of the insane, behave with regard to them: it stares at them, points at them, perhaps follows them at a distance, as they take their walks, exactly as if they were so many wild beasts, and no longer brothers, sisters, fathers, and mothers! To be a lunatic, as public sentiment goes, is to be cut off socially from humanity. With such feeling prevalent with regard to the insane, can it be thought possible that the treatment at present sanctioned by general approbation should be the most just and humane possible? The feeling is one that cannot be justified, and the system which it inspires cannot be just. That system is the system of indiscriminate sequestration-of locking up a person in an asylum simply because he is mad.

Now I believe this practice to spring out of an unjust feeling, as already said, and to be founded on a false principle, as I shall now endeavour to show. The principle which guides the present practice is that an insane person, by the simple warrant of his insanity, should be shut up in an asylum, the exceptions being made of particular cases. This I hold to be an erroneous principle. The true principle to guide our practice should be this,—

that no one, sane or insane, should ever be entirely deprived of his liberty, unless for his own protection or for the protection of society. Therefore, instead of acting on the general principle of confining the insane in asylums, and making the particular exceptions, we ought to act upon the general principle of depriving no one of his liberty, and of then making the numerous exceptions which will undoubtedly be necessary in the cases of insane persons, as in the cases of criminals. We imprison criminals in order to punish them, to reform them if possible, and to protect society from their vices: in dealing with the insane, who are suffering from disease, there can be no question. of punishment, but we confine them in order to apply proper means of treatment, and to cure them, if possible; and, secondly, to protect themselves and society from their violence. If any one says that, on the admission of these principles, the practical result as regards the insane would be very much what it is now -for they would actually embrace so many of them that the exceptions would be few-I confidently question the assertion; I venture, indeed, to affirm in opposition to it, that there are many chronic and incurably insane persons, neither dangerous to themselves nor to others, who are at present confined in asylums, and who might very well be at large. But they are kept in asylums because they have been once put into them; because it is sometimes desirable that their existence should not be known to the world; because they cost less there than they would if in private houses; because they are well taken care of there; because it is heedlessly taken for granted that it is no injustice to confine them thus so long as they are mad; and for many other like reasons. But the fundamental reason which in-pires all these other reasons, and without which they would want firin root, is, that the world has grown to the fashion of thinking that madmen are to be sequestrated in asylums, and cannot now, with every desire to be sincere and unbiassed, conceive the possibility of a different state of things. Even those devoted men who laboured so well to effect the abolition of restraint within asylums never dreamt of the abolition of the restraint of asylums.

I know well the objections, some fanciful and some weighty, that may be made to the doctrine just propounded. It may be

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