Annotated and Abridged Artifact


Popular Feeling Towards Hospitals For The Insane

Creator: Isaac Ray (author)
Date: July 1852
Publication: American Journal of Insanity
Source: Available at selected libraries

Abridged Text


2  

Within a few years past, no class of charities has obtained so strong a hold on the public sympathies as hospitals for the insane. Most of the States have endowed and fostered them with unusual liberality; private beneficence, living and posthumous, has showered upon them its favors, and the time has come when no community among us is supposed to have discharged its obligations to this unfortunate class of our fellow-men, that has not provided an establishment expressly for their care and protection. [1 »] In the older States they are crowded to their utmost capacity of accommodation, and for a considerable period, every year has witnessed the erection of a new, or the enlargement of an old one. It is a curious fact, however, that, in connection with this general current of public opinion, there is a strong under-current of a very different character. None but those who have our opportunity of knowing, can have any adequate idea of the amount of bad feeling, gross misconception, scandalous gossip, and even fierce hostility, that quietly pervades the community, with the effect of circumscribing more or less their sphere of usefulness. [2 »] The most of us, fortunately, are so much concerned with the increasing pressure upon our means of accommodation, and intent, perhaps, on schemes of enlargement, as to make too little account of this state of feeling and of its legitimate consequences. [3 »] I believe, however, it will be worth our while to give this subject a thorough consideration -- more thorough than I find it within my power to give it at this time. My observations must be very brief and general rather calculated to suggest discussion than exhaust it, and while freely commenting on existing defects and errors, disclaiming all intention of a particular application.


4  

Generally, no doubt, these allegations are entirely unfounded, and it will not be difficult to explain their origin. Some of it springs, in fact, from the ordinary principles and feelings of our nature, and some from causes of a special and peculiar character. The seclusion to which patients are subjected, by withdrawing them from constant observation, involves the institution in an air of mystery which stimulates the imagination and excites the apprehensions of the ignorant and credulous. Any appearance of concealment very naturally, gives rise to the suspicion of something wrong, and thus the very measures designed to promote the restoration of the patient, are apt to be regarded as indications of a management that will not bear the light. [4 »] Cooperating with this cause of ill-feeling, is the natural disposition to attribute to others unworthy motives and a readiness to abuse whatever power or confidence may be placed in them. The most prolific source of this distrust of hospitals for the insane, is, undoubtedly, the communications of patients themselves, the more effective for falling, as they generally do, on willing ears. We instinctively believe whatever is seriously related, and this disposition is increased by every appearance of sincerity and plausibility. That the stories of the insane, as well as of some who are discharged from hospitals partially restored, exhibit these qualities in a remarkable degree, is well known to us, while it is equally well known that no moral traits are so common among the insane as a total disregard of veracity, and a feeling of hostility toward those who have had any part in controlling their movements and thwarting their wishes. [5 »] It is not strange, therefore, that they should abuse the institution whose benefits they enjoyed, nor is it more strange that such abuse, should be received as the honest and truthful expression of a matter of fact. It is not in human nature to listen to a coherent and circumstantial account of ill-treatment, without allowing it to make the slightest impression, even though a very large, personal experience with the author of the narrative, may have shown him utterly unworthy of credit. Such plain, deliberate, and touching statements are supposed, in spite of one's better judgment, to have some shadow of foundation in fact, and thus many a friend or relative gives a hesitating assent to a patient's abuse of others, who would consider himself hardly dealt with, if a tithe of the same person's abuse of him were supposed to be true. The friends of patients, too, are apt to be exacting and fault-finding, never satisfied that enough is done for the patient, though infinitely more, perhaps, than they ever did themselves, and are restrained by no feeling of delicacy or gratitude from free and frequent expressions of their dissatisfaction. [6 »] In point of fact, however, I presume there can be no difference of opinion among us on this subject, and that all are ready to admit, that the charges above recited cannot be entirely attributed to these sources.

Page 2:


10  

The first step towards increasing the confidence of the public in our hospitals, will be to deprive them, as far as possible, of their prison-like or peculiar features, and assimilate them to domestic dwellings. Narrow, dark halls, low ceilings, and bare walls, should give way to more spacious and cheerful apartments. The monotonous ranges of windows, row above row, the long, blank wall, extending its dreary monotony for many a rod, a style of building in short, which is no style at all, but that of providing the greatest number of rooms at the smallest expense, should be replaced by more pleasing forms of architecture, reminding us less of a jail or a factory, and more of a comfortable and graceful private residence. [7 »]


15  

To these architectural defects, there is frequently added another evil well calculated to produce a disagreeable result. That niggardly economy which, in our State-Legislatures, is swift to cripple any project or enterprise that has nothing to recommend it but its benevolent character, and grudges the necessary means for executing even the poorest plan in a generous and liberal way, has frequently led to the opening of hospitals before their completion, and while wanting some important provisions. A whole wing perhaps, is left unfinished, and patients and attendants of both sexes are placed in fearful proximity to one another, the lamentable fruits of which constitute a page it the history of our insane hospitals, which would deter any body less reckless and irresponsible than a State-Legislature, from marring an important project solely for the sake of saving the people's money. Doors and windows are left improperly secured, water is inadequately supplied, and the danger of fire has been scarce considered. Solitaries for noisy patients have been left to be provided at a more convenient season, and thus the noisy and the quiet, the violent and the convalescent, are mixed up together so as to disturb the peace of the day and the slumbers of the night. For want of proper fences, intruders make their way to the windows, and the grounds are left in the rough, year after year; at one season covered with pools of water and heaps of rubbish, and at another, the scene of blasting operations that involve the risk of life and limb. Any remonstrance upon the insufficiency of such provisions for accomplishing the highest objects of a hospital for the insane, is met by the usual reply: -- "We have already spent considerable money, and the people are anxious to see some result. We do not expect you will accomplish as much as if the establishment had that degree of completion we would wish to give it. But we are prepared to make due allowances; all we ask of you is to do the best you can, and at a future time as our means increase, these deficiences shall be supplied." All this sounds very fair and very reasonable, but if any one is sufficiently verdant to be deceived by it, I can assure him, on the strength of much personal experience, in times long since gone by, that he will have abundant opportunity of learning how far this promised allowance for his anticipated short-comings will be endorsed by the public, when the first murmur of complaint, shall reach its ears. Were this matter rightly understood, I am sure that no man with a proper regard for his own reputation and peace of mind, would embark in the care of one of these unfinished establishments. [8 »]

Page 5:


18  

It has been a common practice to place our insane hospitals in the neighborhood of the Capitol, and of all the evils of a bad location, I do not hesitate to say, this is the greatest. The political vortex which is eternally boiling and seething there, does not spare the hospital. Its proximity to the scenes of political intrigue and aggrandizement is enough to suggest the idea of making it an element in every scheme of party-operations, and if the purpose require it, detraction varied by every artifice of a malignant ingenuity, is unscrupulously used. The hospital may thereby lose the confidence of the public, but some needy camp-follower has got his reward, or some other equally commendable political end is obtained. [9 »]


33  

To ensure the success of a hospital for the insane, there is another requisite more important perhaps than all others, of which it may be expected that I should speak. I refer to the personal character of the superintendent. My own limits, if not the occasion, will forbid my dwelling upon this point. I must therefore confine myself to the simple statement, that unless he possess the talents necessary to command the respect of intelligent men, that devotion to his profession which will lead him to spare no pains to qualify himself in the most perfect manner for the performance of its duties, that temper and disposition that will establish something stronger and dearer than a merely professional relation between himself and the objects of his charge, and that moral and intellectual elevation which is only satisfied with high aims and substantial results, -- unless he possess these traits, he has much reason to believe that he has mistaken his calling and that he will fail to obtain that public confidence which ought to be as the very breath of his nostrils. [10 »]

Annotations

1.     Ray notes that asylums have benefited from private gifts and public funding.

2.     Despite an increase in sympathy for the insane, Ray, through personal experience, knows that public opinion was a two-edged sword. Negative public opinion could damage the ability of asylums to do their work, writes Ray.

3.     Directing his comments to fellow asylum superintendents, Ray argues that lobbying efforts to enlarge asylums often ignore the role public opinion can play in the way existing asylums operate. He wants superintendents to be more aware of this issue.

4.     Ray is aware of the bind asylums face. Moral treatment requires privacy, but privacy suggests concealment and public suspicions.

5.     Ray’s opinion of the people confined in asylums borders on disdain. From people like Hunt, he certainly faced hostility.

6.     Patients, their friends, and their families, argues Ray, are likely to complain, no matter what conditions actually exist in asylums.

7.     Ray wants asylums to be designed more like homes and less like prisons. Ironically, prison reformers were trying to make the same changes Ray wanted for asylums.

8.     Ray dislikes the power politicians have over the funding of asylums. His reforms were expensive, and state legislatures did protest the rising costs of asylum construction.

9.     Note that the Maine Insane Hospital was in Augusta, the state capital.

10.     Ray concludes with an emphasis that superintendents must be good men. Upon their personal character, more than anything else, rests the effectiveness of an asylum.

[END]