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“Some years ago, a man, about thirty-four years of age, of almost herculean size and figure, was brought to the house. He had been afflicted several times before; and so constantly, during the present attack, had he been kept chained, that his clothes were contrived to be taken off and put on by means of strings, without removing his manacles. They were, however, taken off when he entered the Retreat, and he was ushered into the apartment where the superintendents were supping. He was calm; his attention appeared to be arrested by his new situation. He was desired to join in the repast, during which he behaved with tolerable propriety. After it was concluded, the superintendent conducted him to his apartment, and told him the circumstances on which his treatment would depend; that it was his anxious wish to make every inhabitant in the house as comfortable as possible; and that he sincerely hoped the patient's conduct would render it unnecessary for him to have recourse to coercion. The maniac was sensible of the kindness of his treatment. He promised to restrain himself; and he so completely succeeded, that, during his stay, no coercive means were ever employed towards him. This case affords a striking example of the efficacy of mild treatment. The patient was frequently very vociferous, and threatened his attendants, who, in their defence, were very desirous of restraining him by the jacket. The superintendent on these occasions went to his apartment; and though the first sight of him seemed rather to increase the patient's irritation, yet, after sitting some time quietly beside him, the violent excitement subsided, and he would listen with attention to the persuasions and arguments of his friendly visiter. After such conversations, the patient was generally better for some days or a week: and in about four months he was discharged perfectly recovered.
‘Can it be doubted that, in this case, the disease had been greatly exasperated by the mode of management 2 or that the subsequent kind treatment had a great tendency to promote his recovery 2” — (pp. 146, 147. 172, 173.)
And yet, in spite of this apparent contempt of danger, for eighteen years not a single accident has happened to the keepers.
In the day-room the sashes are made of cast-iron, and give to the building the security of bars, without their unpleasant appearance. With the same laudable attention to the feelings of these poor people, the straps of their strait waistcoats are made of some showy
colour, and are not infrequently considered by them as ornaments. No advantage Wo: has been found to arise from reasoning with patients on their particular delusions: it is found rather to exasperate than convince them. Indeed, that state of mind would hardly deserve the name of insanity where argument was suf. ficient for the refutation of error.
The classification of patients according to their degree of convalescence is very properly attended to at the Retreat, and every assistance given to returning reason by the force of example. We were particularly pleased with the following specimens of Quaker sense and humanity:—
‘The female superintendent, who possesses an uncommon share of benevolent activity, and who has the chief management of the female patients, as well as of the domestic department, occasionally gives a general invitation to the patients to a teaparty. All who attend, dress in their best clothes, and vie with each other in politeness and propriety. The best fare is provided, and the visitors are treated with all the attention of strangers. The evening generally passes in the greatest harmony and enjoyment. It rarely happens that any unpleasant circumstance occurs. The patients control, in a wonderful degree, their different propensities; and the scene is at once curious and affectingly gratifying.
“Some of the patients occasionally pay visits to their friends in the city; and female visitors are appointed every month, by the committee, to pay visits to those of their own sex, to converse with them, and to propose to the superintendents, or the committee, any improvements which may occur to them. The visitors sometimes take tea with the patients, who are much gratified with the attention of their friends, and mostly behave with propriety.
“It will be necessary here to mention, that the visits of former intimate friends have frequently been attended with disadvantage to the patients, except when convalescence had so far advanced as to afford a prospect of a speedy return to the bosom of society. It is, however, very certain that, as soon as reason begins to return, the conversation of judicious indifferent persons greatly increases the comfort, and is considered almost essential to the recovery, of many patients. On this account, the convalescents of every class are frequently introduced into the society of the rational parts of the family. They are also permitted to sit up till the usual time for the family to retire to rest, and are allowed as much liberty as their state of mind will admit.”— (p. 178, 179.)
To the effects of kindness in the Retreat are superadded those of constant employment. The female patients are employed as much as possible in sewing, knitting, and domestic affairs; and several of the convalescents assist the attendants. For the men are selected those species of bodily employments most agreeable to the patient, and most opposite to the illusions of his disease. Though the effect of fear is not excluded from the institution, yet the love of esteem is considered as a still more powerful principle.
‘That fear is not the only motive which operates in producing self-restraint in the minds of maniacs is evident from its being often exercised in the presence of strangers who are merely passing through the house; and which, I presume, can only be accounted for from that desire of esteem which has been stated to be a powerful motive to conduct.
“It is probably, from encouraging the action of this principle, that so much advantage has been found, in this institution, from treating the patient as much in the manner of a rational being as the state of his mind will possibly allow. The superintendent is particularly attentive to this point in his conversation with the patients. He introduces such topics as he knows will most interest them; and which, at the same time, allows them to display their knowledge to the greatest advantage. If the patient is an agriculturist, he asks him questions relative to his art; and frequently consults him upon any occasion in which his knowledge may be useful. I have heard one of the worst patients in the house, who, previously to his indisposition, had been a considerable grazier, give very sensible directions for the treatment of a diseased cow.
* These considerations are undoubtedly very material as they regard the comfort 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 receives, or lower his character in the eyes of his companions and attendants.
“They who are unacquainted with the character of insane persons are very apt to converse with them in a childish, or, which is worse, in a domineering manner; and hence it has been frequently remarked by the patients at the Retreat, that a stranger who has visited them seemed to imagine they were children. “The natural tendency of such treatment is to degrade the mind of the patient, and to make him indifferent to those moral feelings which, under judicious direction and encouragement, are found capable, in no small degree, to strengthen the power of self-restraint, and which render the resort to coercion in many cases unnecessary. Even when it is absolutely requisite to employ coercion, if the patient promises to control himself on its removal, great confidence is generally placed upon his word. I have known patients, such is their sense of honour and moral obligation under this kind of engagement, hold, for a long time, a successful struggle with the violent propensities of their disorder; and such attempts ought to be sedulously encouraged by the attendant. “Hitherto, we have chiefly considered those modes of inducing the patient to control his disordered propensities which arise from an application to the general powers of the mind; but considerable advantage may certainly be derived, in this part of moral management, from an acquaintance with the previous habits, manners, and prejudices of the individual. 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 is considered of great consequence as a means of cure. For this purpose, as well as for others still more important, it is certainly right to promote in the patient an attention to his accustomed modes of paying homage to his Maker. ‘Many patients attend the religious meetings of the society held in the city; and most of them are assembled, on a first day afternoon, at which time the superintendent reads to them several chapters in the Bible. A profound silence generally ensues; during which, as well as at the time of reading, it is very gratifying to observe their orderly conduct, and the degree in which those who are much disposed to action restrain their different propensities.”— (p. 158–161.)
Very little dependence is to be placed on medicine alone for the cure of insanity. The experience, at least, of this well-governed institution is very unfavourable to its efficacy. Where an insane person happens to be diseased in body as well as mind, medicine is not only of as great importance to him as to any other person, but much greater; for the diseases of the body are commonly found to aggravate those of the mind; but against mere insanity, unaccompanied by bodily derangement, it appears to be almost powerless.
There is one remedy, however, which is very frequently employed at the Retreat, and which appears to have been attended with the happiest effect, and that is the warm bath, – the least recommended and the most important, of all remedies in melancholy madness. Under this mode of treatment, the number of recoveries, in cases of melancholia, has been very unusual; though no advantage has been found from it in the case of mania.
At the end of the work is given a table of all the cases which have occurred in the institution from its first commencement. It appears that, from its opening in the year 1796 to the end of 1811, 149 patients have been admitted. Of this number 61 have been recent cases: 31 of these patients have been maniacal; of whom 2 have died, 6 remain, 21 have been discharged perfectly recovered, 2 so much improved as not to require further confinement. The remainder, 30 recent cases, have been those of melancholy madness; of whom 5 have died, 4 remain, 19 have been discharged cured, and 2 so much improved as not to require further confinement. The old cases, or, as they are commonly termed, incurable cases, are divided into 61 cases of mania, 21 of melancholia, and 6 of dementia; affording the following tables: —
* Mania. * 11 died. 31 remain in the house. 5 have been removed by their friends improved. 10 have been discharged perfectly recovered. 4 so much improved as not to require further confinement.’