By C. H. Hughes, M.D.
We live in an age when every uttered sentiment of charity toward the insane is applauded to its remotest echo; an age in which the chains and locks and bars and dismal dungeon cells and flagellations and manifold tortures of the less humane and less enlightened past are justly abhorrent; an age which measures its magnificent philanthropy by munificent millions, bestowed without stint upon monumental mansions for the indwelling of the most pitiable and afflicted of the children of men, safe from the pitiless storms of adverse environment without which are so harshly violent to the morbidly sensitive and unstable insane mind; an age in which he who strikes a needless shackle from human form or heart, or removes a cause of human torture, psychical or physical, is regarded as a greater moral hero than he who, by storm or strategy of war taketh a resisting fortress; an age when the Chiarugis and Pinels, the Yorks and Tukes, of not remotely past history, and the Florence Nightingales and Dorothea Dixes of our own time, are enshrined in the hearts of a philanthropic world with greater than monumental memory.
Noble, Christlike sentiment of human charity! Let it be cherished and fostered still, toward the least of the children of affliction and misfortune, as man in his immortal aspirations moves nearer and nearer to the loving, charitable heart of God, imaging in his work the example of the divinely incarnate Master!
But let us always couple this exalted sentimentality with the stern logic of fact, and never misdirect or misapply it in any of our charitable work. Imperfect knowledge perverts the noblest sentiments; widened and perfected knowledge strengthens their power. A truly philanthropic sentiment is most potent for good in the power of knowledge, and may be made most powerful for evil through misconception of or inadequate comprehension of facts. As we grow in aspirations after the highest welfare of the insane, let us widen our knowledge of the real nature of insanity and the necessities for its amelioration, prevention, and cure.
It is a long time since Grotius wrote, "The study of the human mind is the noblest branch of medicine;" and we realize to-day that it is the noblest study of man, regardless of vocation. Aye! it is the imperative study of our generation and of those who are to follow us, if we would continue, as we wish to be, the conservators of the good and great, and promoters of advancing capability for great and good deeds in our humanity.
One known and acknowledged insane person to every five hundred sane persons, and among those are unreckoned numbers of unstably endowed and too mildly mannered lunatics to require public restraint, but none the less dangerous to the perpetuation of the mental stability of the race, is an appalling picture of fact for philanthropic conservators of the race to contemplate.
The insane temperament and its pathological twin brother, the neuropathic diathesis, roams at large unrestrained from without or that self-restraint which, bred of adequate self-knowledge, might come from within, and contaminates with neurotic and mental instability the innocent unborn, furnishing histogenic factors which the future will formulate in minds dethroned to become helpless wards of the state or family.
The insane temperament is more enduringly fatal to the welfare of humanity than the deadly comma bacillus which is supposed to convey the scourge of Asia to our shores. The latter comes at stated periods, and disappears after a season or two of devastation, in which the least fit to survive of our population, by reason of feeble organic resisting power, are destroyed; while resisting tolerance is established in the remainder. But this scourge is with us always, transmitting weakness unto coming generations.
It is the insanity in chronic form which escapes asylum care and custody except in its exacerbations; it is the insanity of organism which gives so much of the erratic and unstable to society, in its manifestations of mind and morals; it is the form of unstable mental organism which, like an unstrung instrument jangling out of tune and harsh, when touched in a manner to elicit in men of stable organisms only concord of sweet, harmonious sounds; it is the form of mental organism out of which, by slight exciting causes largely imaginary, the Guiteaus and Joan d'Arcs of history are made, the Hawisons and Passanantis and Freemans, and names innumerable, whose deeds of blood have stained the pages of history, and whose doings in our day contribute so largely to the awful calendar of crime which blackens and spreads with gore the pages of our public press.
We may cherish the sentiment that it were base cowardice to lay hand upon the lunatic save in kindness; and yet restrain him from himself and the community from him. We may couple his restraints with the largest liberty compatible with his welfare and ours; we may not always abolish the bolts and bars, indeed we cannot, either to his absolute personal liberty in asylums or to his entire moral freedom without their walls, yet we may keep them largely out of sight. Let him be manacled when he must and only when he must, and then only with silken cords bound by affectionate hands, and not by chains. We may not open all the doors, indeed we cannot, but we can and do, thanks to the humanitarian spirit of the age in which we live, open many of them and so shut them, when it must need be done, that they close for his welfare and ours only; that he may not feel that hope is gone or humanity barred out with the shutting of the door that separates him from the world.
We may not always swing the door of the lunatic as facilely outward as inward - the nature of his malady will not always admit of this - but we should do it whenever we can, and never, when we must, should we close it harshly. And while we must needs narrow his liberty among ourselves, we should enlarge it in the community to which his affliction assigns him, to the fullest extent permissible by the nature of his malady.