Liberty need not necessarily be denied him; and to the glory of our age it is not in the majority of American asylums for the insane, because the conditions under which he may safely enjoy liberty, to his own and the community's welfare, are changed by disease. The free sunlight and the fresh air belong as much to him in his changed mental estate as to you or me, and more, because his affliction needs their invigorating power, and the man who would chain, in this enlightened age, an insane man in a dungeon, because he is diseased and troublesome or dangerous, would be unworthy the name of human. Effective restraint may be employed without the use of either iron manacles or dismal light and air excluding dungeons.
The insane man is one of our comrades who has fallen mentally maimed in the battle of life. It may be our turn next to follow him to the rear; but because we must carry him from the battlefield, where he may have fought even more valiantly than ourselves, we need not forget or neglect him. The duty is all the more imperative that we care for him, and in such a manner that he may, if possible, be restored. Simple sequestration of the insane man is an outrage upon him and upon our humanity. "Whatsoever ye would that men should do unto you, do ye even so to them," is the divine precept, which, if we follow it as we ought, will lead us to search for our fallen comrades in the alms-houses and penal institutions and reformatories, and sometimes in the outhouses or cellars of private homes, to our shame, where errors of judgment or cruelty have placed them, and to transfer them to places of larger liberty and hopes of happiness and recovery. The chronic insane are entitled to our care, not to our neglect, and to all the comforts they earned while battling with us, when in their best mental estate, for their common welfare and ours.
Almshouses and neglected outhouses are not proper places for them. They are entitled to our protection and to be so cared for, if we cannot cure them, as that they may not do those things, to their own harm or the harm of the race, which they would not do if they were sound in mind. Society must be protected against the spread of hereditary insanity, hence such kindly surveillance, coupled with the largest possible liberty, should be exercised over them as will save posterity, so far as practicable, from the entailment of a heritage more fatal than cancer or consumption.
The insane man is a changed man, and his life is more or less delusional. In view of this fact, we should endeavor always to so surround him that his environments may not augment the morbid change in him and intensify his perverted, delusioned character.
Realizing the fact that mind in insanity is rather perverted than lost, we should so deport ourselves toward the victims of this disease as in no wise to intensify or augment the malady, but always, if possible, so as to ameliorate or remove it.
Realizing that the insane man in his best estate may have walked the earth a king, and in this free country of ours have been an honored sovereign weighted with the welfare of his people, and contributing of his substance toward our charities, we should, with unstinting hand, cater to his comfort when this affliction comes upon him.
We should give him a home worthy of our own sovereign selves, and such as would suit us were we providing for ourselves, with the knowledge we have of the needs of this affliction, pending its approach to us.
That his home should be as unirritating and restful to him as possible it should be unprison-like always, and only be an imprisonment when the violent phases of his malady imperatively demand restraint. An hour of maniacal excitement does not justify a month of chains. Mechanical restraint is a remedy of easy resort, but the fettered man frets away strength essential to his recovery. Outside of asylums direct restraint is often a stern necessity. It is sometimes so in them, but in many of them and outside of all of them it may be greatly diminished, and asylums may be so constructed as to make the reduction of direct restraint practicable to the smallest minimum. Direct mechanical restraint for the insane, save to avert an act of violence not otherwise preventable, is never justifiable. The hand should never be manacled if the head can be so influenced as to stay it, and we should try to stay the hand through steadying the head.
Every place for these unfortunates should provide for them ample room and congenial employment, whether profitable to the State or not, and the labor should be induced, not enforced, and always timed and suited to their malady. A variety of interesting occupations tends to divert from delusional introspection.
Most institutions attempt to give their patients some occupation, but State policy should be liberal in this direction.
Deductions are obvious: Every insane community of mixed recent and long standing cases, or of chronic cases exclusively, should be a home, and not a mere place of detention. It should be as unprison-like and attractive as any residence for the non-criminal. It should have for any considerable number of insane persons at least a section (640 acres) of ground. It should be in the country, of course, but accessible to the supplies of a large city. It should have a central main building, as architecturally beautiful and substantial as the State may choose to make it, provided with places of security for such as require them in times of excitement, with a chapel, amusement hall, and hospital in easy covered reach of the feeble and decrepit, and accessible, without risk to health, in bad weather.
Outhouses should be built with rooms attached, and set apart from the residence of trustworthy patients, for farmer, gardener, dairyman, herdsman, shepherd, and engineer, that those who desired to be employed with them, and might safely be intrusted, and were physically able, could have opportunity of work.
Cottages should be scattered about the ground for the use and benefit of such as might enjoy a segregate life, which could be used for isolation in case of epidemic visitation. Recreation, games, drives, and walks should be liberally provided.
A perfect, but not direct and offensive, surveillance should be exercised over all the patients, with a view to securing them the largest possible liberty compatible with the singular nature of their malady.
In short, the hospital home for the chronic insane, or when acute and chronic insane are domiciled together, should be a colonial home, with the living arrangements as nearly those which would be most congenial to a large body of sane people as the condition of the insane, changed by disease, will allow.
It is as obvious as that experience demonstrates it, that the reigning head or heads of such a community should be medical, and not that medical mediocrity either which covets and accepts political preferment without medical qualifications.
The largest personal liberty to the chronic insane may be best secured to them by provision for the sexes in widely separated establishments.
It is plain that the whole duty of man is not discharged toward his fallen insane brother when he has accomplished his sequestration from society at large, or fed and housed him well. The study of the needs of the insane and of the duty of the State in regard to them is as important and imperative a study as any subject of political economy.
 Remarks following "Definition of Insanity." published in the October number of The Alienist and Neurologist. and read before the Association of Charities and Corrections at St. Louis, Oct. 15, 1884.