Chapter III Treatment of the Insane
As the abnormal and the rationally eccentric were considered witches, and held to have been disciples of the devil, so the more obviously sense-bereft were thought to be controlled by the fiends within them. Both witches and lunatics were held to be beneath the sway of infernal powers, but the former as willing agents of the devil, and the latter as involuntary victims, who were deemed to be possessed. In ancient Egypt, by the Temple of Saturn,612 in classic Greece with the Asclepieia, and by the laws of Pagan Rome,613 the mentally afflicted were treated with humanity, and, if without the aid of our present science, at least upon the same broad principles which we adopt to-day.
In the warm sunlight of the Eastern lands the life of the population was spent in the open air. As we read in the Scriptures and in books of travel, the lunatic might dwell amidst the tombs. He could wander through the soothing cypress groves in the moonlight or lie under shading palm in the noontide heat. He dwelt apart, like the leper, cut off by his terrible infirmity from the kinship of reason, but free at least in the air and sunlight, and often allowed a quite especial licence614 as being in the guardianship of God.615 But the troublesome conduct into which lunatics were ever liable to be led616 would frequently rouse the instinct of retaliation, and bring down swift and heavy punishment upon them.617
In Europe also and in England the less-dangerous lunatics “were allowed to wander about the country,618 beggars and vagabonds, affording sport619 and mockery.” We get a vivid glimpse from Shakespeare of that “poor Tom620 that eats the swimming frog, the toad, the tadpole, the wall newt and the water newt, that in the fury of his heart, when the foul fiend rages, eats cow-dung for sallets, swallows the old rat and the ditch dog, drinks the green mantle of the slimy pool;621 who is whipt from tything to tything, and stocked, punished, and imprisoned.”622
This was the lot of sufferers in those times, and beyond doubt a certain number of them, unmindful or unheedful of savage laws, obeyed the obsessing suicidal impulse which is so common among mad people; and through this many of the most afflicted must have been taken, in the mercy of nature, out of the world of men in which they had no part. But if the half-witted poor were allowed to wander,623 those of the richer class were less fortunate. Their families were shy and ashamed of them; they were concealed and locked in garrets and cellars, or penned apart, secured in sheds and outhouses—fastened up anywhere about the premises.624
Medicines there were indeed for the insane patients, and some of them might have added to the witches’ cauldron.625 Among the less nauseous of these came wolf’s and lion’s flesh,626 and as our Saxon forefathers were skilled herbalists, we find the clovewort, polion, and peony recommended,627 also the mandrake, round which many stories were woven from its resemblance to the human form. They said: “For witlessness, that is, for devil sickness or demoniacal possession, take from the body of the same wort mandrake by weight of three pennies, administer to drink in warm water as he may find convenient; soon he will be healed.”628
Doubtless in all civilisations the more acutely insane would have to be a care for the community.629 The early Christians tended them in their churches, in which they stood in a special part,630 and where they were provided with food “while they abode in the church, which, it seems, was the chief place of their residence and habitation.”631
The monks to some extent looked after them in their monasteries.632 But whatever medicines or other remedies they may have employed, the main idea of those days about lunacy was that it came through demoniacal possession. The object was to drive the devils out. To accomplish this they seem to have resorted to all sorts of incongruous “cures,” both ghostly and physical.633 The great spiritual weapon has always been exorcism. This was the primal art of all religions, and it was practised also by the early Christians.
In the third century the exorcists were formed into a special order.634 “When an exorcist is ordained,” we read, “he shall receive at the hands of the bishop a book wherein the forms of exorcism are written. These forms were certain passages together with adjurations in the name of Christ commanding the unclean spirit to depart out of the possessed person.” This custom has continued through the centuries,635 forming the subject of innumerable legends and pictures relating to saints and teachers in the middle ages; and though the practice seems to be in abeyance,636 the old idea of exorcism is not dead. We must perceive this when we read,637 for instance, “Water and salt are exorcised by the priest, and so withdrawn from the power of Satan, who, since the Fall, has corrupted and abused even inanimate things.638 But besides the weapons, mystic and spiritual, employed by the Church, were others of a more corporeal character.
The patients were bound to venerated crosses at evening, to be released as cured in the morning.639 They were chained fast to stones in various churches; they were dipped into holy wells—this custom lasted in Cornwall to modern times; and they were sent as pilgrims to shrines,640 at some of which they underwent a regular course of treatment; music was often an important element.641 And remedies far more drastic might be provided, which relied not so much upon the power of the saints as on the human weakness of the devils.
Thus, scattered among the recipes for herbs and all the indescribable filthy mixtures which were advocated for insanity,642 we come across the following prescription, the effects of which would prove anything but imaginary:—“In case a man be a lunatic, take skin of a mereswine or porpoise, work it into a whip, swinge the man well therewith, soon he will be well. Amen.” At one monastery the lunatics in the charge of the monks are said to have received ten lashes every day.643
The insane have been flogged for various reasons:—(1) Superstitiously, to drive out the devil, and even to scare away a disease; (2) therapeutically, because pain and shock would often subdue the ravings of the patients, although only temporarily; (3) instinctively, as a relief to their keepers’ feelings. The medical and the brutal whippings we shall meet again later on, long after devil-driving had been abandoned, though it prevailed through Christendom for probably over sixteen hundred years. To understand it we must turn aside to savages.
Primitive peoples,644 like children, personified everything. Disease appeared to be a sort of personal entity—like that deceitful dream645 Zeus sent to Agamemnon—a “thing” “to be drawn out in an invisible form, and burnt in the fire or thrown into the water.” A foe invisible, but yet so human in its limitations as to be stopped by thorns placed in its path.646 And if all manner of physical ailments were looked upon as being, or, at any rate, as emanating from personal demons, much more would such a fearful and mysterious affliction as insanity be held to indicate a devil’s presence and immediate handiwork.647 Moreover, to the primitive mind, the demons of all sorts were much too near, too vividly conceived, too real, too commonplace, to be regarded as spiritual beings within the modern meaning of the word. They were conceived as obviously living and moving about,648 and therefore as being human in their character. Thus among savages “the souls of the dead are thought susceptible of being beaten, hurt, and driven like any other living creatures,”649 and demons could be hunted out of the houses and scared away to woods and outer darkness.650
The ideas of the profoundly superstitious middle ages resembled these. Even the great opponent or accuser, Satan, who was restored by Milton to the rôle of Ahriman,651 was but a wretched creature, a poor devil,652 in the popular imagination. “He” is continually outwitted like the pantomime policeman,653 and nonplussed by the shallowest equivocations.654 He beats a man655 and is beaten and vanquished.656 He aims a stone at Dunstan and misses,657 and when seized by the nose with pincers, his bellowings are heard for three miles round.658 He howls when sprinkled with holy water,659 and Luther hurls an inkstand at his head.660 This man-like and material monster of course felt pain, and when he took up his abode in a human body he was supposed to feel the blows inflicted on the sufferer.661 It was the devil (or his representative) who might be driven out of man or woman; the demons could be commanded to quit each portion of the invaded body, member by member.662 The fiends were supposed to writhe in anguish663 when the possessed cowered beneath salt water or the whip.664 On them the curses and the stripes were meant to descend,665 until at last, through unendurable torments, they fled the body by the nearest orifice.666
This crude and savage way of expelling “devils” was long continued; belief in it is probably by no means dead in the minds of some countryfolk. Hawthorne, writing of the seventeenth century Puritans,667 makes the gaoler say of his prisoner, “Verily she hath been like a possessed one, and there lacks but little that I should take in hand to drive Satan out of her with stripes.” But there were times enough when exorcism failed and flogging proved unavailing. Then the insane would have to be restrained and subjected to some sort of treatment668—to say some sort of ill-treatment were nearer the truth. Doubtless they always aimed at quieting the more troublesome patients, and bringing them into order, if not back to reason.
Says Andrew Boorde in his strange Regyment of Health:669 “I do advertyse every mā the which is mad or lunaticke or frenticke or demoniacke, to be kept in save garde in some close house or chambre where there is lytell lyght. And that he have a keper the which the mad man do feare.” The same idea we see expressed by Shakespeare:670 “We’ll have him in a dark room and bound,” is the immediate cry towards the mad. Shut up and bound they were, in all manner of ways and places, by relatives, monks, and keepers. As we have seen, many were executed as witches or malefactors, and would be thrown into gatehouses and prisons,671 where they might furnish horrible diversion for the other prisoners,672 and where they were sometimes drugged to make them silent and to cease from raving.673 Sometimes they were placed in such hospitals as there were,674 along with fever and accident cases.675
In the course of time, as population spread and townships grew, the old resorts were found to be inadequate. The number of the lunatics was increasing, and the whole country was filling up and enclosing. Whipping from place to place became ineffective, and there had been no public institutions available but monasteries, gaols, and hospitals.676 In the year 1247 was founded by Bishopsgate the Priory of St. Mary of Bethlem,677 and here insane people were kept and tended, at any rate from 1403. Doubtless there came to be other places thus put to use, such as, for instance, one St. Katherine’s by the Tower,678 where, we are told, “they used to keep the better sort of mad folks.” But it was not until about the middle of the eighteenth century679 that grim and sombre circumvallate buildings began to be erected to intern the troublesome.680 “They were,” says Dr. Conolly,681 “but prisons of the worst description. Small openings in the walls, unglazed, or whether glazed or not, guarded with strong iron bars, narrow corridors, dark cells, desolate courts, where no tree nor shrub nor flower nor blade of grass grew.682 Solitariness, or companionship so indiscriminate as to be worse than solitude; terrible attendants armed with whips... and free to impose manacles and chains and stripes at their own brutal will; uncleanness, semi-starvation, the garrotte, and unpunished murders—these were the characteristics of such buildings throughout Europe.” What may be called the theoretical treatment was bad enough. Those who could not be cured must be subdued;683 the teaching of Boerhaave and Cullen admitted this, and the latter wrote: “Fear being the passion that diminishes excitement, may therefore be opposed to the excess of it, and particularly to the angry and irascible excitement of maniacs; these being more susceptible of fear than might be expected, it appears to me to have been commonly useful.”684
It was desired “to acquire some awe over them,”685 and he declares that “sometimes it may be necessary to acquire it even by stripes and blows.”686 This was the therapeutic flogging already alluded to.687 Shock, terror, blistering, bleeding, purging, the use of chains and all manner of manacles688—these were the means employed and set down in the textbooks to heal the disordered mechanism of the brain.689
In the Gentleman’s Magazine of 1765690 we read of the private asylums that “persons were taken forcibly to these houses without any authority, instantly seized by a set of inhuman ruffians trained up to this barbarous profession, stripped naked, and conveyed to a dark room.” So ignorant were the doctors of those days as to the nature of insanity that the harsh cruelties practised on private patients were carried out even upon the king. Of the eighteenth-century practice Mr. Massie has written:691 “Mental disease was at that time a branch of art little understood, and the specific treatment of lunatics was worthy of the barbarous age of medicine. The unhappy patient” (King George III.) “upon whom this most terrible visitation of Heaven had fallen, was no longer dealt with as a human being. His body was immediately enclosed in a machine, which left it no liberty of motion. He was sometimes chained to a staple. He was frequently beaten and starved, and at least he was kept in subjection by menacing and violent language.” That, like most lunatics, he was very annoying is certain; he once talked for nineteen hours unceasing. But all his troubles were intensified by ill-treatment;692 they left him to be knocked about by a German servant,693 and the first doctors kept him even from his own children, at which the poor old man complained “very heavily.”694 Such, then, was the orthodox treatment applied against the highest in the land. But the worst deeds were done behind thick walls. “Sane people,” says Beach,695 writing of private establishments, “were frequently confined in these asylums, for persons frequently availed themselves of the facilities696 then in use in order to get rid of a troublesome relative or to obtain some selfish object.”
And what of the really mad?697—irritable, violent, irrational, helpless, often with as little control over the functions of the body as on the workings of the mind. We can imagine what their state became when left in the hands of ignorant practitioners and brutal attendants, with chains and instruments of restraint convenient and ready. Screened off from all kith and kin they writhed with sores and rotted in ordure.698 Sometimes—mostly on Monday mornings after the Sabbath rest and accumulations—they might be carried out into a yard698 to be mopped and soused from pails in the coldest weather.699
The condition of the living rooms and wards700 was often such that visitors grew physically sick from going into them;701 but they were rare within those private prisons,702 strangers are never welcome behind the walls. At York Asylum703—an especial plague spot opened in 1777 and burnt,704 it is said, to avoid disclosures that might hang its keepers,705 in 1814—a rule was adopted in 1813 “that no person706 shall be allowed to visit any of the patients without a special written order signed by the physitian.” Official visitors were generally harmless.707 At York the worst rooms were not shown them.708 For most of the small asylums there were none at all.709
Even the larger public asylums during the eighteenth, and also far into the nineteenth century, were horrible monuments of cruelty and neglect. The miserable patients lay upon straw in cells,710 or upon wooden shelves to which they were fastened. Many were naked or decked over with one blanket.711 In the wards they were frequently chained to the wall by wrist or ankle,712 and occasionally by both. One patient at Bethlem,713 a fierce, powerful man whose name was Norris, after a fracas with a drunken keeper, had his arms and shoulders encased in a frame of iron obtained from Newgate.714 This instrument715 was attached by a twelve-inch chain to a collar round his neck, from a ring round a vertical iron bar which had been built into the wall by the head of his bed.716 His right leg was secured to the frame upon which he lay. The effect was that the patient could move up and down as far as the ring and short chain round the upright bar permitted, but he could not stir one foot from the wall, and could only rest lying upon his back. “In this thraldom,” says Dr. Conolly,717 “he had lived for twelve years. During much of this time he is reported to have been rational in his conversation. At length relief came, which he only lived about a year to enjoy. It is painful to add that this long-continued punishment had the recorded approbation of all the authorities of the hospital. Nothing can more forcibly illustrate the hardening effect of being habitual witnesses of cruelty, and the process which the heart of man undergoes when allowed to exercise irresponsible power.”
The medical men were poorly paid and proportionately neglectful. At the time of which we are speaking—the end of the eighteenth and the beginning of the nineteenth century—the physician at Bedlam got only £100 a year.718 However, he kept a private asylum, and sometimes left the public institution for months together.719 One of the surgeons is described as having been “generally insane and mostly drunk,” in spite of which he was retained there for ten years.720
With such shameful neglect and callousness on the part of the doctors—there appear to have been no chaplains in those days721—it is not to be wondered that the unhappy patients fell entirely into the hands of their keepers and immediate attendants, and most of these were quite ignorant people, rendered impatient and brutal by the exasperating ways of the demented inmates, and by their boundless power over them. Instinctive and retaliative floggings (the third kind, alluded to on p. 149), assaults, and possibly even murders, were not uncommon, as well as the distressing and unlimited restraints already referred to.722 One doctor invented and introduced a special instrument to prize open the patients’ mouths at compulsory feeding. He mentions that, by the usual process, teeth were apt to be broken, and some were left “without a front tooth in either jaw.”723
In the eighteenth century724—up to 1770—and in some places, doubtless, even to later times, the mad people were reckoned among the “sights.”725 The public paid726 to go round the asylums, as they do now to gaze upon wild beasts.727 The baser and more mischievous among them would irritate and purposely enrage the secured patients, as their descendants tease caged animals to this day;728 and thus reproduced for their ghastly diversion “exhibitions of madness which are no longer to be found, because they were not the simple product of malady, but of malady aggravated by mismanagement.”
Such conduct appears to have been general in those times.729 At Geneva730 some lunatics would be given grass and horrible things to eat to amuse visitors. This also happened at the Bicêtre,731 in certain parts of Germany, etc.732 “Les Fous de Charenton” became, for a time, notorious for their plays,733 which were presented with much sound and fury, attracting spectators from very grotesqueness. They were forbidden in 1811.
High walls kept things dark for years, but the light stole through in the end, as it always will.734 In 1793 Pinel removed the chains from patients in the Bicêtre. At home, the York Asylum, already alluded to, began to bear an evil reputation. In 1788 it incurred the Animadversions735 of the Rev. William Mason.736 In the year 1791 some friends of a female patient desired to visit her, but were not allowed, upon the plea that she was not in a suitable condition to be seen by strangers (she probably was not!) A few weeks after this she was reported dead.737 The woman belonged to the Society of Friends, and the suspicious circumstances of her incarceration caused much resentment among the Quakers. Soon after, William Tuke resolved that they should have a hospital of their own. The Retreat was started in the year 1792, and its humane and enlightened methods were soon contrasted with the barbarous and secret administration prevailing at the older institution. But the years rolled by while patients languished and died. It was in 1813 that Samuel Tuke—a grandson of the founder of the Retreat—brought out a little work738 describing the system there. It “excited universal interest, and, in fact, achieved what all the talents and public spirit of Mason and his friends had failed to accomplish. It had still better effects. A very inoffensive passage in this book roused, it seems, the animosity of the physician to York Lunatic Asylum, and a letter which this gentleman published in one of the York newspapers739 became the origin of a controversy among the governors of that establishment, which terminated in August 1814, after a struggle of nearly two years, in the complete overthrow of the old system, and the dismission of every officer of the asylum, except the physician himself.”740
The conflict was taken up by others and carried on. Towards the close of that same year (1813), a case of alleged misconduct was brought forward by Mr. Godfrey Higgins, a magistrate for the West Riding. “Mr. Higgins’ statement was read” (before twenty-seven governors), “after which the accused servants of the house were called in and sworn. They denied upon oath the truth of the charges. No other evidence was called for; nor was any minute committed to writing of what had been sworn by the servants. The following resolution was passed:—The governors having taken into consideration the statements published in the York and other newspapers respecting the treatment of William Vicars, lately a patient in this asylum,... are unanimously of opinion that... he was treated with all possible care, attention, and humanity.”741 It was of no avail; thirteen gentlemen of the county came forward with donations, in virtue of which they qualified as governors. These new men brought their votes to bear to force on an inquiry, and though the old gang of scoundrels never got their deserts, and, to conceal their guilt, are said to have set the premises on fire, yet they were driven out of their situations, and soon investigation became national.
In 1814 Mr. George Rose brought in a Bill to regulate asylums, which passed the House of Commons. But the authorities at Bedlam opposed the measure,742 spending over £600 in so doing. They had good cause, as we shall see presently. The York Asylum governors—nineteen of them, including the archbishop—sent in a petition against it; and the intrepid Mr. Higgins sent one in its favour, signed by himself.743 The Bill was thrown out by the House of Lords,744 but a committee of the House of Commons was then appointed, and collected the inconceivable and horrible evidence from which we have quoted. Its report was presented by Mr. Rose in 1815,745 and though the committee at Bedlam formally exonerated its officials for all things they had done and neglected to do, including even the dreadful instrument placed round Norris,746 the unofficial mind of the public had been roused to indignation, and many of the worst abuses were presently remedied.
Mr. Rose died in 1818, but in the following year Mr. Wynn brought forward another Bill, which was, however, opposed by Lord Eldon, who observed747 that “there could not be a more false humanity than over-humanity with regard to persons afflicted with insanity,” a line of argument which we shall come on again. That Bill shared the fate of its predecessor. It was not until nine years afterwards that Mr. Gordon secured the passing of an Act748 to improve the asylums, in the year 1828. Though abuses continued into the middle of the nineteenth century,749 and many Acts of Parliament were subsequently brought in,750 the monstrous evils of which we have spoken continued as crimes where previously they had been customs, and took place on a much diminished scale.
At Lincoln Asylum,751 about 1838, Dr. Gardner Hill removed mechanical restraints, and Dr. Conolly752 followed at Hanwell in the succeeding year. In this they were, of course, opposed in the Profession,753 but new ideas and new conceptions were coming, which are still working in the treatment of insanity. All along, heretofore, the Mind and the Body had been conceived as two separate things. People had ceased to believe in the interference of devils, but they spoke vaguely of “a mind diseased.” There being often no physical injury that could be detected, “the common opinion seemed to be confirmed that it” (mental disorder) “was an incomprehensible, and consequently an incurable, malady of the mind.”754
A medical writer755 of the early nineteenth century could allude to lectures he had attended, at which the doctor had declared that treatment and physic were useless in a case of furor uterinus, because it was a disease of the mind, not of the body. No doubt there loomed the fear of Free Will and Theology. “... Many very able men,” says Dr. Halliday,756 “led away by what appeared to be the general opinion of mankind, shrank from a strict investigation of a subject that seemed to lead to a doubt of the immateriality of mind, a truth so evident to their own feelings and so expressly established by divine revelation.” It is not for us to turn aside into labyrinths, or to attempt to settle what “mind” may mean. But we know that, to our present power of comprehension, the mind can only function through the body. How it first formed, and if it can yet rekindle, are vital questions which may never be answered; at any rate they lie beyond our range.
Gradually metaphysics and moral concepts were left behind as experts examined facts. “... Derangement,” says a nineteenth-century writer,757 “is no longer considered a disease of the understanding, but of the centre of the nervous system, upon the unimpaired condition of which the exercise of the understanding depends. The brain is at fault and not the mind.”
“The old notion,” says Dr. Wynter,758 “that derangement of mind may happen without any lesion of the instrument of thought being the cause or consequence, has long been exploded.”
The physical origin of insanity “became gradually accepted. Its mental phenomena were more carefully observed, and its relation was established to other mental conditions which had not hitherto been regarded as insane in the proper sense of the word.... Hitherto the criteria of insanity had been very rude, and the evidence was generally of a loose and popular character; but whenever it was fully recognised that insanity was a disease with which physicians who had studied the subject were peculiarly conversant, expert evidence obtained increased importance, and from that time became prominent in every case. The new medical views of insanity were thus brought into contact with the old narrow conceptions of the law courts, and a controversy arose in the field of criminal law, which, in England at least, is not yet settled.”759
The instinct of retaliation was not readily restrained by reasoning or proofs of irresponsibility. In postulating freedom of choice under all physical conditions; in assuming plenary responsibility in men and women under all circumstances; in refusing to recognise any abnormal state unless it were so extreme and obvious as to render the person before the court unconscious of his actions and surroundings, the judges were defending their own position. Thus the new theories760 were disputed and sneered at, and arbitrary standards as to sanity were set up at variance with all facts and expert evidence.761
Some contended that the more subtle and amazing forms of madness or abnormality perceived by the specialists were but new names for old perversities.762 Others averred that nothing physical ought to exculpate. Smollett wished that all lunatics guilty of grave offences might be subjected “to the common penalties of the law.” Upon this Mr. Tuke observes in comment that “The entire inability to distinguish between voluntary and involuntary acts,... between motives and consequences, is singularly well shown. Unfortunately it was not peculiar to Smollett.”763
And I might add that this instinctive feeling continued—as everything instinctive generally does. Turning to the work of a writer still living (in 1908), we come upon the following: “Of late years a certain school of thinkers764... have started some theories respecting the responsibility or irresponsibility of many dangerous criminals and murderers, which have very properly been objected to by more practical observers.” And the writer continues with all the sweet simplicity of ignorance: “Even the inmates of lunatic asylums know well the distinction between right and wrong. And it is precisely upon this knowledge that the government and discipline of such establishments are based. Hence no theories of criminal irresponsibility should be permitted to relax the security and strictness of the detention of dangerous offenders, whether sane, or partially insane, or wholly mad. And it is important to observe that the treatment and condition even of mad murderers should not be made attractive to others outside.” But the hard scientific facts persisted. Injustice and cruelty, practised upon the weak and helpless, do not, alas! and pace good Mrs. Stowe, bring down upon nations the visible wrath of God; but the manifest falseness of the old assumptions, and the continued failure of the mediæval methods, could not be hidden through unending years. Slowly the light of science began to penetrate into the dark places of punishment. The entirely mad were first rescued and treated as patients, and these now, happily, no longer concern us; their case belongs to Medicine, not to Criminology. With regard to the half-mad we are in a state of slow change and transition. Their wrongs, long known to the alienists, are being brought before the law-makers. “Crime,” says the Report of Mr. Secretary Gladstone’s Committee,765 “its causes and treatment, has been the subject of much profound and scientific inquiry. Many of the problems it presents are practically at the present time insoluble. It may be true that some criminals are irreclaimable, just as some diseases are incurable, and in such cases it is not unreasonable to acquiesce in the theory that criminality is a disease and the result of physical imperfection. But criminal anthropology as a science is in an embryo stage....” With regard to the abnormal we are only on the threshold of justice; a multitude of causes, theological and instinctive, prevent the facts from being faced and known.
We may take comfort in the course of evolution; in that the violently mad (employing the word in a wide and general sense) are no longer exorcised and tormented; in that the eccentrically mad are no longer burned and tortured for what was imagined against them; in that the weak-minded and the partially deranged are being considered, with a view to their segregation in special places apart from healthy offenders; in that innate and absolute abnormality of emotions has been established by the specialists upon overwhelming evidence; and that the knowledge of this is quietly spreading, and being recognised and admitted among educated people, throughout the civilised world.
The End