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By this time two paramount questions have no doubt arisen in the mind of the reader: First, is there in the problem of managing and treating the insane an inherent difficulty which will forever prevent the correction of such abuses and deficiencies as have been discussed in this book? Second, if not, how may the individual assume part of the burden which in the telling of my story has been shifted to the shoulders of the many?

An emphatic answer to the first question may be given.

No inherent difficulty stands in the way of the universal correction of all abuses and deficiencies of treatment complained of in this book -- unless it be the inherent apathy of a public which for centuries has failed to do its duty by the insane. Proof of the soundness of this conclusion may be found in the fact that at this moment an encouraging number of our hospitals for the insane are so ably managed that abuses, common in the poorly managed ones, rarely occur in institutions of the approved class. Freedom from the supposedly inevitable evils complained of may usually be traced and rightly attributed to the character and capacity of the man at the head of a given hospital. A high-minded, efficient superintendent, regardless of the apathy of the public, the costly economy of ill-informed legislators, or inadequate, even crude, material equipment of the hospital itself, may so conduct his institution as to protect his insane wards against physical abuse, indignities, and what, in so many cases, amounts to criminal neglect of patients scarcely able to help themselves.

Surely the situation is by no means hopeless, so long as a superintendent of the right type can (almost single-handed) overcome a sufficient number of the inevitable difficulties to raise the standard of treatment in his institution to a humane level. For, if the efficient few, working under such unfavorable conditions as obtain generally to-day, can convert their respective hospitals into the semblance of model ones, how absurd to contend that there can be found among the more than one hundred thousand physicians in this country, fewer than four hundred men capable of assuming the responsibilities of a superintendency? When intelligent and non-political care in the selection of superintendents shall be rigorously and universally exercised, then, threats, curses, camisoles, muffs, straps, unwarranted seclusion, illegal exile and physical abuse in general will take their belated place in history along with the horrors of the Dark Ages.

For bringing about the reforms which, of necessity, must precede any such correction of century-old abuses, the interest of every right-thinking person in this country must be enlisted. Few, indeed, are endowed with great riches. Few are able to convert their best impulses into an acceptable medium of exchange. But every man and woman can lend a hand, or at least speak a word. Our subject has for generations been neglected. It is the discussion of it that will create and mold Public Opinion, and Public Opinion, vigorously expressed, will, more than any other factor, tend to correct the evils I have denounced. Has my story utterly failed of its purpose? If it has stirred your sympathy it is your duty to give expression to this aroused interest, not to me, but to everybody within your sphere of influence. Continual and sincere expression will wear away that rock of indifference against which the distressed souls and abused bodies of the insane have been bruised for centuries. Has my story -- not as the story of my life, but as representing the experiences of thousands of others still living and of thousands whose terrible secrets died with them -- has this story, I say, aroused within you the healthy desire to contribute at least your influence to the corrective and overwhelming force of Public Opinion? If so, your duty is plain.

Individual assistance may be given in an easy way. Let each convinced reader of this book be prepared to send his name and address to whatever "Society," "Association" or "Committee," may be organized when the necessity for its existence has been brought home to the public. These names, in the aggregate, will form a mighty petition, the force of which no Federal or State official -- or Committee of Investigation, will care or dare to ignore. Thus, for the first time in history, legislators throughout the land will have impressed upon them the fact that the public desires hospital managements to have support -- such support as will enable them to discharge their obligations to the public -- and discharge them in a manner that will bring credit, not disgrace, to a nation distinguished for its love of fair play.

If the individual may be enlisted in the work of reform, so may the Federal Government. I trust that in this I do not fall into the delusional fad which now seems to prevail of turning to Washington as the panacea for all the States' shortcomings. But, the principal business and justification of government is the protection of the weak against the strong, and, naturally, there are some things which the Federal Government can do better than any other agency. Everyone knows that through its Department of Agriculture this Nation each year expends many thousands of dollars in economically sound endeavors to exterminate the parasites which prey upon valuable plant and animal life. To annihilate the gypsy-moth in Massachusetts and the cattle-destroying tick in Texas, fortunes have been spent. All crops, except the crop upon which prosperity itself depends -- the brain crop -- have received, or are about to receive, their due protection at the hands of the Government. Yet generation after generation the health of men's minds has been neglected.