18 NOVEMBER 1871, Page 18

BEHIND THE BARS.*

We should be sorry indeed to believe that there would be any appropriateness in publishing an English edition of this American book. It describes the treatment of the insane in the private -asylums of the United States,—that is, we should hope, and almost believe, in the one private asylum in which our authoress was her- self a patient for a space of two years. We gather that this unique volume—the reflections and observations made during the confine- ment consequent upon an attack of temporary insanity, and re- -corded after the recovery of sanity and liberty—is the work of a lady, because all the illustrations of treatment are taken from the ladies' wards, and because the whole tone of the book reveals a generous indignation for the patient and readiness to impute motives to the physicians, a disinclination to look at the ques- tion from the physician's point of view and a disposi- tion to generalize, which we hope we arc not unfair in thinking more characteristic of woman than of man. And yet we do not find—and rejoice that it is so—proof or even evidence that the writer knows of more than the one such private asylum of which she was herself an inmate. No doubt, she would not be far wrong in supposing that the one of which she had experience is by no means a solitary exception ; but it is -especially true of private asylums that the same system is not likely to be adopted at all universally in them, as theories of treatment are as numerous as the opportunities for putting them into practice. Nevertheless, as far as the institution is concerned from which the illustrations are taken, and any others managed on the same prin- ,ciples, a protest against them can scarcely be too strong, nor an appeal to humanity at large and to all concerned in particular, to inquire deeply and immediately as to the truth of the charges made -against them, too earnest. The book is a clever one ; not only full cf warm commiseration and indignant sympathy for fellow-sufferers, in which we heartily share, but of quick observation, discrimina- tion, and tact, and a sharpness which often detects the mixture of unworthy motive but wants the candour, or more probably the insight, to recognize the honest as well as the unworthy. it addresses itself to two distinct questions—not in an orderly way, for it wanders discursively between the abstract and concrete, dis- cussing alternately the nature of insanity and the treatment watched by the writer—the propriety of restraint and rule and seclusion in slight or convalescent cases and administered by con- scientious physicians, and the severity of the treatment in private -asylums generally in the United States. Accepting the statement as it stands, remembering that it does not assert—though it implies—that more than one institution is attacked, it is -sufficiently serious, and we trust earnestly that no such system, er anything approaching it, exists in England. If any sus- pect its existence, it behoves them to look to it at once, what does not appear unwise or cruel to an American physician may approve itself also to an English one ; or, looking at it from the writer's point of view, if there are dishonest and selfish doctors for the insane in America, there may be also in England. The broad charge, then, is, that these pri- vate asylums of the United States are for making, not curing, insanity, and that patients slightly affected and soon well are -kept on and on and on till depression and then imbecility ensue. The charges in detail are almost too many to enumerate. The patients, concluded on entering to be "suicidal," have their "chests, arms, and hands" " bound " in " tow-cloth " "corsets" when they go to bed ; they are watched during the night by ghostly sentries, who wake them periodically with their rattling keys and lamps turned full on their faces, and report "no sleep "; if they * Behind the Barr. Boston: Leo and.Shopard. 1571.

cry or struggle they are tied to their beds ; if they are cheerful and conversable they are called excited," and removed to the wards of the really mad and idiotic and imbecile; if patients converse with wit, humour, or originality, the ignorant attendant stops them peremptorily, designating their conversation " crazy talk ;" and if attachment springs up between two patients (we mean the attach- ment of one woman for another), they are immediately separated, " and actually prohibited from speaking to each other upon a casual meeting in the grounds." Letters are not allowed to be either written or received, paper and peas and pencils are forbidden. "The physician would never permit such speaking evidences of sanity to write their mark upon the hushed-up friends without." Friends and relatives are not allowed private in- terviews. One lady, from her barred window high up, saw, after a two years' absence, "her husband pass from the house, and proceed to untie his horse She threw up the window and called to him loudly, but it was of no avail She paid the penalty of her anguish ; for, as if the doom of not being satisfied

were not enough, she was presently ordered from her room and for the rest of that day she was turned out and locked out of the room, and, moreover, threatened with a dark room below stairs, if she did not cease to express her tribulation ; yet she did not faint, or scream, or behave violently." Tears are regarded as an evidence of insanity. "'Madam,' said a physician to a patient, 'you never can get home until this weakness of shedding tears is given up.'" "I simply assert what I hkve seen," says the writer, "that many a female inmate in an asylum is detained far beyond the natural expectations of family or friends, simply because of their habit of weeping in misery. And it may chance that on first entering the place, -this habit was nothing in comparison with what it afterwards became from the continuance of the detention." If a patient walk fast, the physicians and attendants alike brand him as " excited ; " if slowly, as "depressed ;" if he talks much, he is "exhilarated ;" if little, he is "in one of his moods ;" when downcast, he is " morbid ;" if he weep, " emotional ; " if greatly depressed, "very suicidal,"—suicidall though he is hopeless, as the writer remarks, in "that he cannot got into, not out of the world." These may be but the expressions of foregone conclusions, but they are death to the hopes of the patient, and show, at best, a very complete unfitness for their work on the part of doctor and nurses. These nurses, we are told, are, in the female wards, all very young women, and to all intents and purposes neither more nor less nor better than housemaids, with neither the tenderness of a sufferer nor the experience of age. So destitute are they of the latter, that the patients often have to nurse each other; and so completely without the former, that the aged lady and the delicate girl are alike domineered over, threatened, and insulted. They are treated like children, and like naughty children, and often as only these would be treated in cruel and unnatural families. A horrible feature of this—it would be unfair to say of these asylums— is the frequent use of the restraint-chair and the feeding-pipe, which are resorted to on the slightest, or rather without the slightest excuse ; partly, it seems, to save the expense of procuring tempting or even reasonably nice food, and partly from a sort of habit of bullying ; and our author believes that the use of the bandages at night and of the restraints generally is to set the attendants at liberty, and so decrease the cost and trouble of management. Such an institution as this, in which patients are not only debarred from intercourse with friends, either personal or by letter, however slight the nature of their illness, but are actually made worse by bad nursing, bad food, rough and even cruel usage, punishment for natural feeling, and separation from those they learn to like, and even driven mad by a year's sole intercourse with patients suffering the very worst forms of this saddest malady, —such an institution, we say—but has not the author unintentionally exaggerated? —ought to be swept from the face of the earth, and the physician hung from the bars of his gratings with his own straps and tow-cloths. But we cannot believe that for the sake of filling these institutions and keeping them full, there is in the present day a body of physicians, or even many a physician, or even one, who deliberately deceives his patients and their friends, insinuating much that he dare not affirm, hoodwiuking and over- reaching the trustees of his asylum, betraying the trust of his patients' guardians, cruelly keeping asunder for months and years child and parent, husband and wife ; and more than all this, by rough and brutal treatment, by isolation, and by association with the worst forms of the disease, plotting to prolong and even increase and make permanent a malady so terrible, and chuckling the while at the increasing plethora of his purse.

If our author stopped short after unfolding the baneful effects of the system which uses repression, isolation, physical restraint,

and threats—especially in slight or improving cases—we should join heartily in the warm appeal in behalf of these unfortu- nate sufferers which breathes through her whole book, and of which the following passage is a striking illustration :— " Most of the well patients in an asylum, who are living there in more conformity to the prolonged system of cure, fool keenly the want of use- ful, practically useful, occupation, and the utter wastefulness of life there. They live in constant self-reproach for the time that is passing unem- ployed, and in such eontraet to that of the world outside. Even though they may have work brought to them, or are employed in charitable sewing, or choose to send home garments of their own making up, this is a merely incidental employment, in comparison with that of which they fool themselves physically and mentally capable. And there are some who cannot bring themselves to work for those at home ; they are rendered nervous and impatient at the very thought of working for and fixing their minds, through the operation, upon those from whom they are out off. If they cannot see them, know of them, communicate with them, then they say they cannot sit and think of them. They try to keep up with the system prescribed—to forget them, banish them, and live as if the asylum and its interests were their only world. With some patients it is a constant struggle between the present and the past—between memory and reality ; and in this confusion what a tax and strain comes upon the heart and the understanding! What harassments of the imagination and what denial must be exercised to keep up with such an unnatural code of life! When they remember the domestic duties that filled up tho too short hours, the events crowded in of business, necessity, or pleasure, the change and variety of the day, the spring and motion of life whioh cries out, 'No time no time!' instead of, What shall we do with it?'—what a shock comes upon them in the contrast! Let those who love their own way think of this moral rigour, those who may stroll where they please, who indulge in their amusements, enjoy freedom of action, their visits and their visitors, their particular church, their favourite minister and physician, their chosen companions and selected servants, and all the social latitude and liberty of an unfettered life—in short, have their own independent management of themselves. Let those who hold possession of all those privileges fancy themselves cut suddenly off from them all, sensible of the place they are removed to, and the primal cause of the removal, yet now, while in a rational condition, living under the prescribed regulations of an insane asylum."

The outcome of the whole thing, however, seems to be this,—that without doubting our author's facts, or even denying that there are some grounds for the belief in the suggested motives, we cannot accept the views put forward on this subject without hearing the doctors' side of the question. But we can and do most earnestly agree with what is really the important point in the book, the necessity for much freer intercourse between the patient and his or her friends. It seems clear that from time to time the relatives should not only have private interviews with patients free from the espionnage of the physician, but be permitted to examine as unreservedly as possible the saner patients who have daily intercourse with their charge, and also the nurses and attendants. These will all know much more of the usual and unrestrained tone of the patient's mind than the cleverest physician can, whose very presence not only banishes the natural play of thought and manner, but puts in its place a timid and suspicious behaviour. In English private asylums, froo and private intercourse with friends is allowed, and it is singular that national jealousy—we suppose—has led the author, while quoting largely the merciful and wise system adopted in Eng- land by Conolly, Hill, Maudsley and many others, to taunt us not- withstanding—justly, we admit—with regarding lunacy as almost crime, and hiding the thing away from social and even domestic life as a shame and disgrace. In many forcible passages this feel- ing is condemned and deprecated, and yet it is significant that both author aud editor conceal their names, thus endorsing the popular view in the most impressive manner. For our own parts, we should rejoice to see all but dangerous lunatics—and in Gheel they say there are none such—free awl made much of ; treated as they are treated in Glwel, as entitled to liberty, awl claiming and receiving every possible indulgence.