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The Moral Treatment Of Insanity
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33 | M. Leuret, the distinguished Physician of the Bicetre Hospital at Paris, in his valuable work, "Du Traitement Moral de la folie," has made many very useful suggestions, and done much good in calling attention to the vast importance of moral treatment in insanity. Most writers previous to Leuret, had considered the moral treatment as auxiliary to the medical, but Leuret considers the latter as of trivial importance compared with the former. He proposes to cure all cases of uncomplicated insanity, solely by moral means. For this purpose, he often excites pain or unpleasant sensations and ideas, in order to prevent and dispel those still more unpleasant. | |
34 | Unfortunately for the establishment of the many excellent precepts contained in this profound work of M. Leuret, he has created a prejudice against himself and his writings by some of his recommendations, particularly by that of the Douche, which, however valuable it may be in some cases, is, we believe, liable to great abuse. In some of the prisons in this country, where it has been used extensively with refractory criminals, we have been informed on good authority, the use of it has occasionally proved dangerous, and in a few cases, fatal. But apart from this, and this is only one of a great variety of measures which he recommends for exciting the hopes and fears of his patients, dispelling their morbid fancies and teaching them habits of self-control, his work abounds with useful suggestions, and is well worthy of our careful study. He recommends resorting to a great variety of means to direct and engage the attention of patients. He insists on the importance of out door exercise and bodily labor, walking, riding, engaging in active sports, and more particularly on the value of mental labor, such as reading, committing pieces to memory and reciting them, add other school exercises, acting plays, attention to music, &c. | |
35 | On all these subjects and many others relating to the mental treatment of the insane, more full and useful details will be found in the work of Leuret, than in any other with which we are acquainted. | |
36 | In the main we coincide with him, that in a majority of cases of insanity, the moral treatment is of more importance than the medical, and we fear we shall never avail ourselves of the full value of the former, nor cease to do injury to some patients by administering too much medicine, until we heartily embrace this view of the subject. | |
37 | That some cases of insanity require medical treatment we believe, but we also believe that a large majority of the patients in Lunatic Asylums do not. There is much analogy between many of the patients found in all such institutions, and the passionate, mischievous, and what are called bad boys in a school, and there is about as much propriety in following the example of Mrs. Squeers, and physicing and medicating the latter as the former, in order to cure them or to change their propensities. Rational hopes for the improvement of either, should we believe, be founded on moral management alone. | |
38 | Bodily labor as a measure for benefiting and curing the insane is generally recommended, and we allude to it now, but to express the hope that better arrangements for this purpose will be made in institutions for the insane, than have hitherto been. Some have an insufficient quantity of land, and are destitute of work shops. We think every such institution should have a good farm attached to it; but still, a farm is not sufficient, as it can afford employment but to comparatively few, and only for part of the year. We think several work shops should be connected with every large establishment for the insane, and be so connected, that the patients of each class can go to them without risk or exposure. One or more rooms in connection with each hall for patients, is needed in order to afford employment to all that would be benefited by it. In such rooms, dress-making and tailoring, cabinet work, the manufacture of toys, basket-making, shoe-making, painting, printing, book-binding, and various other employments may be carried on to the advantage of many patients, some of whom can not be employed on the farm or in shops disconnected with the asylum. In the construction of asylums for the insane, we think there should more care be taken to provide convenient rooms for the purposes mentioned. | |
39 | But however useful bodily labor may be to some, we regard it as less so generally as a curative measure, and less applicable in many cases, than mental occupation or the regular and rational employment of the mind. | |
40 | In fact, manual labor, we believe, proves more beneficial by producing this result, that is, by engaging the attention and directing the mind to new subjects of thought, than by its direct effect upon the body. Not unfrequently manual labor appears to be injurious, especially in recent cases; it accelerates the circulation, and sometimes reproduces excitement of mind in those that have become quiet and convalescent. |