THE TREATMENT OF THE INSANE.

THE present unsatisfactory condition of English law in rela- tion to Lunatics, which has been brought home to the in- telligence of our readers by a recent trial, may be brought home to their imagination by means of a parable, in which the prin- ciples at present applicable to mental, should be applied to moral, disorder. Acting on the maxim which, as a MIMm of law, we believe to have done more harm than any other mistake what- ever,—the maxim that "prevention is better than cure,"—the legislators of Laputa, we will say, aim at preventing crime in- stead of punishing it. The moment any Laputan has reason to be anxious about the moral condition of a friend or relative, he proceeds to call in two clergymen, who severally visit the hypo.- thetical criminal and investigate his moral condition. A B, they declare, as the result of their investigations, is capable of com- mitting a murder. He is cherishing sentiments of deadly hatred towards a person who has given him no cause for moderate re- sentment. On their inquiring whether he wished for the death of that person, he frankly allowed that he should feel a con- siderable satisfaction in being secured from ever setting eyes on him again, in answer to the question how be should regard the murderer of his enemy, he was heard to mutter something about a public benefactor. When the un-Christian, and, indeed, un-Socratic, character of these sentiments was represented to him, he had no answer but " Bother !" Both clergymen, being men of good character and repute, have, therefore, no hesitation in signing a declaration that A B is not a fit person to be at large, and he is accordingly put into confinement, and kept there till they can convince themselves that his moral sentiments have undergone a radical change.

This imaginary incident of a voyage to Laputa translates the principles on which medical men have acted into those which would justify the clergy, if equal power were given to -them, in shutting up unamiable, unconscientious, and un- principled men and women. It will be objected that the clergy know no more about morality than other men, and doctors do know more about insanity than other men. Sup- pose we accept that distinction which, no doubt, embodies -the dominant belief of the hour, can we also allow that doctors are more secure from bias in applying their knowledge than other men are? Is a medical man anxious to persuade himself that a wealthy patient is in a condition to stop paying him £400 a year ? Can we accept the assurance of a distinguished physician (Dr. Forbes Winslow, in the Pall Mall Gazelle for March 25th) that "all the proprietors of Asylums in England are actuated by one motive—the welfare of their patients and their restoration to a sound state of mind " ? What are we to think of a law which can only be justified by such nonsense ? "In this world," it was said by a witty statesman, "we are saved by our want of faith." That should be the maxim of the legislator. Trust character, let all individual arrangement em- body and exercise that faculty, so hard to define and so im- possible to mistake, by which we evoke the qualities we refuse to test at every step ; but distrust classes, leave the minimum of

space for faith in bodies of men united by their interests, let all legal arrangement embody and exercise the sifting watchful- ness of a continual readiness to doubt. It is the same principle which enjoins both habits of mind. We shall never know when to trust if we never know when to suspect. Observe, we say when,- not whom. It is not that you must trust this indi- vidual and suspect that individual, though of course that is true also, but you must trust only individuals. You should never trust men when you are dealing with them in their corporate capacity. You should, from this point of view, always be ready to suppose that they will do right just so far as it is their in- terest to do right. Ordinary common-place mortals—doctors, clergymen, lawyers—all do right when it is their interest to do wrong, no doubt. But the law should never assume that they will do so ; for while they do right, it will not have to take cognisance of their existence.

These reflections may appear at the present moment almost superfluous. Most people are beginning to see that medical men can no longer be regarded as an inspired caste, qualified not only to know the truth, but also to resist the temptation of speaking falsely when they would be gainers by doing so. But it is slowly that we reject all the inferences from an assumption that has been abandoned. The notion that doctors alone should have to do with the insane, implies that the change by which sane people become insane is a sort of magical transformation, dividing them, as by the rod of Circe, from their former selves and from the rest of humanity. It appears to us the least disadvantage resulting from this view of insanity that we are thereby prevented from doing justice to the most afflicted of mankind. We make, under its influence, the same mistakes about sanity as we should make

about morality if we supposed that the criminal law exhausted the whole sphere of ethics. The very word immorality, in its specific meaning, is a reminder to us that the criminal law leaves a great part of wrong untouched ; in common parlance, we use' the name literally applicable to all sin to point out sins which the law refuses to recognise. What we want is to have it

accepted as much in regard to mental distortion as to moral wrong that the law deprives no subject of liberty, except when that is necessary for the protection of others, and that it deputes to none but its own officers the investigation of this necessity. Is A B in a condition in which life in an asylum would be beneficial to himself ?—there is a ques- tion for the doctors. Is he in a condition in which his incarceration is necessary to the well-being of his fellows ?- there is a question for the State. By confusing these two questions we have exchanged two truths for one important errior. We have combined the truth that the State is not bound to consult individuals before it deprives them of liberty with the truth that the physician is the referee as to disease, so as to sanction the delusion that the physician may forcibly lay hands on any one whom he believes would benefit by becoming his patient. Let us hope that the first basis of any fresh legislation on this subject will be a distinct separation of these two prin- ciples with all their consequences. Undoubtedly, the physician is the best judge of disease. Let us take the patient to him in the hope of cure, and, if necessary, persuade the patient to submit to seclusion in an asylum. But when we ask the ques- tion, not how to cure insanity, but how to prevent its being dangerous to other people, we have quitted a problem of medical

science for a question of common-sense, and can attend to the physician only as to anybody else who has evidence to give which will bear the sifting of lawyers and convince ordinary men.

But how, it may be urged, are we to induce insane persons to submit to cure, if we can no longer coerce them ? Are they not to be considered as children, whom we do not, if we are wise, consult in the matter of their disposal, but settle that they shall come here or go there, as we see to be best for them? The idea that all insane persons are to be treated as children is the very theory that we are anxious to combat. It will rarely be found in practice that there is the slightest real difficulty in dealing with insanity that does resemble childishness ; and there are many reasons why we should not assume that all insanity resembles childishness, besides the most important of all, that it is untrue. We decide wrongly for our children, very -often. But we have all been children, and we all love our children. In the case of lunacy, on the contrary, we have never any help from our recollections, and sometimes none from our affections. A lunatic is often a person who rouses no wish in all who are connected with him so strong as that never to see him again.

Can the best of men and women trust themselves to settle irre- sponsibly the future of one of these unhappy beings, as they would to settle the future of a beloved son ? Many a dyspeptic

might be greatly benefited by incarceration in a doctor's house- hold, perhaps, but we do not give his kindred the right of handing

him over forcibly into medical care. And, after all, are we so absolutely certain that a doctor's judgment is infallible, that we should wish to take the responsibility of imprisoning a person who does no harm ? Is it consonant with general experience that contact with other morbid minds is the best cure for a morbid condition of mind ? There are, no doubt, cases in which contact with the insane is good for the insane. "I saw," said a friend of the writer, in describing the process of cure, "that

all the inmates of the asylum where I was placed were no less certain of some delusiou, which I saw clearly to be mere insanity, than I was of what seemed to me a fact, and by degrees I came to the inference that my own conviction was of the same nature as theirs." But this surely was an exception ; and if, as seems probable, mental disease, like bodily disease, should in many cases be surrounded by the atmosphere of health, we have to consider, not only from the magistrate's point of view bow best to restrain insanity, and from the doctor's point of view how best to care it, but also. from the point of view of the ordinary citizen, how to deal with it, as we consider bow to deal with any other form of moral disorder, so as to make it as little of a misfortune as possible. No technical knowledge is what we need here, but the same principles of common-sense and rectitude as are demanded by all other intercourse. The moral wisdom, the reverence for humanity, which we need for treating the sane rightly, is doubly needed for treating the insane rightly, just as fresh air is more important in sickness than in health. The self-accusation of a morbid nature, for instance, some- times shelters grievious faults, and it is not at all certain that the condition of mind we call insanity will hinder a person from being able to feel this when it is brought home to his conscience by directness and simplicity. We recall an incident which strikingly illustrates this possibility, all concerned in it having been dead for more than a generation. A physician eminent in his day for his acuteness and skill, but who will be remembered as the father of Charles Darwin, once detected, amid a variety of crimes due to the fantastic egotism of the lunatic who de- clared himself guilty of them, the influence of a real remorse, and, startled into truthfulness by the mere contact with his penetrating insight, the madman confessed the truth—an actual crime. How needful for such a being is the atmosphere of truth !

It is not only in the region of sincerity, but of kindliness and respect, that the principle we would urge would be a great reform. One wonders sometimes how much mere craziness has been turned into violent insanity from the notion that all mental eccentricity leads the sufferer into a mysterious region, where the rules of common sense afford no guidance in dealing with him. Dr. Maudslay, for instance, in his interesting volume on "Respon- sibility in Mental Disease," gives the account of a dangerous lunatic who set a house on fire and tried to kill a child, with no apparent motive for either crime, and whose original condition was merely one of mental weakness, together with a few oddities, of which one was a passion for watching windmills. But mark the connection between these two states. The family of this young man, we should suppose, would take the greatest care that he should, when possible, always have an opportunity of gratifying his harmless taste. But neglecting this single interest, they had taken him to a part of the country in which he could see no wiudinillss and these crimes were committed simply in the hope of getting back again ! In the neighbour-

hood of windmills, perhaps, he might have passed life as a crdzy. poor creature, harmless, and possibly not utterly useless. What a lesson against the notion of the ordinary mind that the moment we label a person insane we mark off his instincts aS something to Le necessarily thwarted ! What an impressive sermon on the text that our duty to, every human being is to treat with respect all instincts and desires which we do not perceive to be hurtful, however little sense we may see in them.

And not less important is the same principle on the other side. As we would further all harmless wishes in a lunatic, so we svonld oppose all harmful feelings in a lunatic. This is the point in which we believe medical opinion to be most liable to bias. Those who give themselves up to the study of insanity seem drawn away from the broad simple principles of ordinary life ; they are led partly by their knowledge, and partly by their prejudice, to assume that we should "leave all that to medical men." They see very often that a case that to a non-medical observer looks very simple can be detected by the experienced eye of a physician as complicated by delusion. We allow the possibility, and would illustrate it from the reminiscences of the same physician, already quoted, who drew from a lunatic the confession of a crime. In this case, the lunatic was himself a physician, who became aware of insane tendencies in his own mind. With the wisdom of medical experience he mentioned these to a sister who kept house for him, and he gave her directions for having him conveyed to an asylum if the disease assumed an acute form, which it did. The methods pursued with him were apparently successful ; he left the asylum, to all appearance, a sane man ; his intellect was free from all delusion whatever. But now observe the mysterious correlation of mental and moral disease. The sister who had simply obeyed his directions in having him conveyed to an asylum, felt a change in his manner towards her. The restraint to which she had subjected him, though it was simply the result of his own wise self-control, seemed remembered with resent- ment. The change was not impossible to ignore, and seemed to lessen as time went on ; but on his death, which took place not very long afterwards, it was found to be deep-seated, for he left this faithful guardian, who must have suffered so much in her task, totally unprovided. for. Now here is surely a double moral for the initiated and uninitiated alike. We are forced, by such instances as these, to recognise that moral insanity is a word with a meaning. When we see first that a man has delusions, and then that delusions disappear but that he has wrong feelings and acts on them, we must remind ourselves that he was not responsible for these wrong actions in the way that a person would be who had had no delusions. But it is quite as true, and it is a fact more necessary to remember, that while this is the right retrospective view of moral insanity, yet the less we admit of it into any reasonings concern- ing the future, the better. A righteous man, called in as a lawyer to draw up this iniquitous will, would surely- have remonstrated with the testator exactly as if he had never been insane, though he might have been quite certain that insanity was the motive cause which directed the will. The idea that all insane impulses are irresistible is a part of the view of insanity which we would combat most earnestly, it tends to make them irresistible. It is curious to see how an able mind, possessed with the medical bias in this matter, misses the force of the evidence which it supplies. Dr. Mandslay, for instance, in the treatise above quoted, refers more than once, as to a natural and ordinary circumstance, to the fact that insane persons con- trol their impulses from fear of medical restraint ; yet the volume may be described as an eloquent pleading for the with- drawal of all criminals in whom physicians can detect any signs of insanity from liability to punishment, on th? plea that they never control these impulses from fear of legal punishment. The State, we are certain, will not consent in this matter to take directions from the physician. It will take evidence from him, and give that evidence a large place, but it will, in doing so, allow for his prejudice as well as for his knowledge. The principle we would urge—the principle that except when we treat a human being as a mere channel of misfortune to others we should invariably appeal to sanity within his mind—is not a principle that students of insanity are likely always to. remember ; for the continued attention to disorder tends to deadens the mind to the importance and the very existence of the world of order. We would hardly allow that the principle has exceptions. It is true that while we should pat before a sane mind the reason for rejecting its conclusions, we should rarely use any argument with a person in a morbid state of intellect ; that a part of the mind occupied in delusion should not be exercised in any way. But after all it is questionable how far this warning does not apply to all minds on some subjects, and perhaps the rule to appeal to sanity in insanity, if it were consistently carried out, would be seen to include even those cases which seem at first a mere exception to it.

We have said that it is the smallest disadvantage of our present mode of regarding insanity that we are prevented from giving help to the most afflicted of mankind. When we consider all that is implied in any want 'of understanding the trial of the insane we feel inclined to retract that sentence. Those who are debarred from all intelligent pleading for themselves—those who are in many cases liable to arouse all that disgusts and repels us, and are disabled from any self-control in overcoming what is disgusting and repelling—these need our aid as much as any needy being on this earth. But still there is a sense in which the sane are more important than the insane ; and perhaps it is even more important that the light which a true understanding of morbid mental conditions throws on the whole constitution of our moral being in this world should not be lost to every-day life, than even that those afflicted with these morbid conditions should have the benefit of it. Insanity is like that arrangement of the lecture-room, by which the audience sees the experiments of the lecturer in a highly magnified form upon the wall. It shows us the tendency of those indistinct movements of which the will refuses to take cognizance, and makes us hear, as a shout, what has been often whispered in our own hearts. For the insane person is the person who acts as if he were alone in the world, the person for whom his fellows have become things, the man who is ready to kill a child that he may watch a windmill, to whom the taste of the moment is more than the lives of his fellows. He interprets to us the true meaning of the impulses of luxury, self-indulgence, and vice ; he teaches us the precipice which we approach when- ever we exchange the we for the I. There is no delusion, how- ever wild, which does more than detach and exhibit clearly the blinding tendency of the spirit that makes self its centre. In- sanity is only this process fully achieved, the complete loss of all proportion which comes upon the mind, when it surrenders itself to that centripetal impulse, the hopeless confusion on which the finest intellect may enter if it confuse the far with the near. We witness such confusion daily in a hidden form ; but insanity teaches us to see it undiluted by the "tribal sense" that corrects, to some extent, the aberrations of egoism, and shows us the goal of all modes of thinking which ignore that membership one of another, in which is included all intellectual soundness, no less than all rightness of moral life.