Essay on the Classification of the InsaneAllen, M. (Physician)
Science
Essay on the Classification of the Insane
Allen, M. (Physician)
Mental illness
These conditional plans of superintendance must be allowed the widest
range, a range which no inexperienced person, still less those who have
false notions and impressions of the general character of the insane, can
possibly imagine, and for which no acts or rules can give directions—How
then can those without knowledge and experience pretend to undertake such
a charge? Often we have only a choice of evils; and we must be less
anxious about the risk of accidents, our own credit, or interest, than
the cure or chances of good to be done. In some cases absolute
confinement would rapidly make the patient’s state worse, and we must
give either real or apparent liberty; a liberty which some would think
imprudent. {95}—Yet I believe it is a fact, that there are the fewest
accidents where to appearance the greatest liberty is given, {96} harsh
measures always increase the evils which they would pretend to cure; but
should one accident occur under this mild system, the person adopting it
would be more blamed than he who had twenty accidents on the old
plan.—With the first system, it is often difficult to persuade the
friends of the patients to concur and co-operate.—The family dispositions
often render this probable; nor can we always blame them: but he who
undertakes this charge, while he endeavours to persuade and conciliate as
far as possible, must in many cases feel himself called upon to act with
decision.—If he adopts the fears and prejudices of others, then his
system will become one of duplicity and tyranny, exciting suspicion and
vindictiveness, destructive alike of all confidence and chance of cure;
for unless we acquire the confidence of the patient, no good can be done;
mutual distrust will end in absolute slavery and restraint to the
patient, and in the baneful habit of exercising the love of power on the
part of those who have the superintendance.—Hence the evils apprehended
by their friends as likely to arise out of the patient’s vindictive
state, will be most effectually established and increased. Instead of
the calming effects of a system of confidence and liberty, tranquillity,
and peace, this contrary system will continue to goad, irritate, and
inflame that part of the brain through which the mind, in this state, is
operating; and in pursuing such a course we are clearly guilty of making
that become fixed and permanent which otherwise might only have been of
very temporary duration.
While nothing is more certain than that, _in most_ cases, too sudden a
return to old scenes and associations is extremely dangerous, there are
some others where I have known their returning home at an early period,
or even at some critical point of convalescence, decidedly expedite and
confirm their cure:—when there appear evident reasons to augur favourably
of such a change, the trial should be made—we have only a choice of
evils, and we must endeavour to choose the least.
Public-domain text, read in full here on John Shaqi.
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