Chapters in the History of the Insane in the British IslesTuke, Daniel Hack
History
Chapters in the History of the Insane in the British Isles
Tuke, Daniel Hack
Mental health laws -- Great Britain; Mental illness -- Great Britain; Mentally ill -- Care; Psychiatric hospitals -- Great Britain
"'_The Open-Door System._--It is only of late years that the disuse of
locked doors has been regarded as forming an important feature in the
administration of an asylum. Detached houses, or limited sections of the
main buildings, the inmates of which consisted chiefly of patients
requiring little supervision, have long been conducted in some
institutions without locked doors. But the general practice of all large
asylums has been to keep the doors of the various wards strictly under
lock and key....
"'When an attendant could no longer trust to locked doors for the
detention of troublesome and discontented patients, it became necessary
that he should keep himself aware at all times of where they were and
what they were doing. And it therefore became his interest to engage
them in such occupations as would make them contented, to provide an
orderly outlet for their energies, and to divert their minds from
thoughts of escape. The relations of an attendant to his patient thus
assumed less of the character of a gaoler, and more the character of a
companion or nurse; and it was eventually found that this change in the
character of the form of control could be adopted in the treatment of a
much larger number of the patients than was at first anticipated. It is
not difficult to over-estimate the extent to which a desire to escape
affects the minds of patients in asylums. The number who form a definite
purpose of this kind really constitutes only a very small proportion of
them. The special watchfulness required of attendants in guarding
against determined efforts to escape, therefore, need be directed to a
few only of those under their charge, and it soon becomes habitual to
the attendants to keep themselves aware of where those patients are,
about whom they entertain doubt. And it should be borne in mind, in
regard to this kind of watchfulness, that its very persistency renders
it more easily kept up than if it could be occasionally relaxed. It
appeared further that the disuse of locked doors had an influence on
some of the patients in diminishing the desire to escape. Under the
system of locked doors, a patient with that desire was apt to allow his
mind to be engrossed by the idea of watching for the opportunity of an
open door, and it was by no means infrequent to find such a patient
watching with cat-like eagerness for this chance. The effect of the
constantly open door upon such a patient, when the novelty of the thing
had worn off, was to deprive him of _special_ chances of escape on which
to exercise his vigilance, since, so far as doors were to be considered,
it was as easy to escape at one time as another; and it was found that
the desire often became dormant and inoperative if not called into
action by the stimulus of _special_ opportunity. It is, indeed, a thing
of common experience that the mere feeling of being locked in is
sufficient to awaken a desire to get out. This happens both with the
Public-domain text, read in full here on John Shaqi.
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