Disputes have often been agitated on the utility of harsh measures, compared with those of a milder kind. Tyran nical principles, aided by the same passion for the extra ordinary which in former ages led to a harsh treatment of almost all diseases, have been in some measure the causes of the cruel severities often practised with this description of patients. They have, for the most part, had the effect of inflaming and irritating the disease. In more enlight ened times, iron fetters, tight ropes, cruel floggings, and blows, have given place to the use of the straight waistcoat, which is at once milder and more efficacious. There is no doubt, however, that a mild treatment has sometimes fail ed, or even appeared to be hurtful. Some writers, on com paring these facts, have contented themselves with observ ing, that harsh or mild measures ought to be employed,ac cording to the state of the patient, and our experience of the effect of each method upon him. We must, however, beware of suffering a mixed practice of this sort to degene rate into an ambiguous and immethodical empiricism. The principle which we should follow is, to practice uni form decision without harshness or indignity, and to allow the patient, within a certain range, a liberal degree of free dom without trifling. In the management of a lunatic, ta lents of the same sort are required as in conducting the moral education of children, or the political affairs of na tions. The general principles to be adopted are the same, and the difference in their application is less in reality than in appearance. A keeper should spew the patient that he is so completely in his power as to render all resistance on his part vain, and at the same time convince him that his power is not to be exercised under the influence of passion or caprice ; that it is to be confined to salutary restraint, and not extended to the infliction of severities. The boun daries of indulgence ought, however, to be clearly under stood ; the patient's requests, when improper, must be re fused with a mild firmness, and no vague hopes held out t' hint which are not to be fulfilled. The mild character of the treatment must always appear to be that in which the patient's attendants take the greatest pleasure.
The plan of treatment, with respect to severity or mild ness, requires to be adapted to the former habits of the pa tient. A man who has lived in polished society, in which deference has been shewn to his feelings, will be greatly in jured by a degree of harshness which would be productive of no burin to a person who has been used to submit tame ly to severities. As instances of the latter, Pinel particu larizes the negroes of Jamaica ; but it may be doubted, con sidering the former history of a great part of these indivi duals, how far their minds are subdued to their situation. In the Russian boor, who is accustomed to feel the mas ter's lash as a necessary incitement to his daily labours, we i probably have a better example of a person to whom. in a state of a mania, a certain degree of harshness would be of service. If a person, of these habits were to be treated with all the mildness that is used in a French lunatic asy lum, he would be tendered unfit for returning to his for mer situation. Universal experience slims the dancer of habituating any person For a time to indulgences, which can not be secured to him for the remainder of his life.
Any sort of reasoning with a maniacal patient ought to be very sparingly employed. Pinel mentions a case of re ligious mania, which he attempted to cure by reasoning the patient out of his irrational opinions ; but the attempt only served to rouse him to the most furious indignation against the impiety of the person who disputed the sacred ness of his favourite doctrines. Reasoning even on more indifferent affairs only gives the patient an opportunity to gratify his vanity by displaying his eloquence in reply.
Our object is, not to improve his accuracy in the applica tion of language, but to restore that solidity of thought which is independent of the use of words, and that mental composure N% hiCh no words can represent. Verbal rea soning shews too touch haste to accomplish the recovery of our patient. Silent and steady means, accompanied with frankness, and free from all sullen affectation of taciturnity, will enable us, by much surer steps, to conduct a favoura ble case to a complete recovery.
Pinel and others mention instances in which a little fraud has been resorted to with marked advantage : it is not, however, void of danger. II the fraud is suspected, it not only loses its effect, but excites the patient's indignation. Instances have happened in which, after an apparent re covery produced in this manner, an explanation of the de ception has created reflections which have been followed by a complete relapse. Perhaps this is less liable to occur with the French than with the British as the fainter, set ting more value on the politeness of the moment, and less on plain dealing, are probably less affected by a slight de ception where no other serious consequences are produced by it.
Regular labour is often of great use in assisting the re covery of maniacs ; but in public establishments in this country, a general provision for that object has nut been made. It requires very exact precautions to find employ ment for such as are fit for it, and at the same time to pre vent any of the patients from having access to tools of which they might make a dangerous use. For this purpose, the separation of the patients, according to a judicious classi fication of their cases, is indispensable ; and provision will undoubtedly be made for this in the arrangement of all new public establishments for the treatment of the insane.
When the high symptoms of mania have subsided, it will be proper to allow the patient to sue a little of society ; hence those is ho are in a mild or convalescent state in an hospital are allowed to associate together, and those who are farther advanced associate with the servants and super intendants of the house. There are certain states in which an opportunity' may be allowed for the return of the former sympathies of life, by gradually permitting the patient to receive frequent visits from his near relations. One in stance,in which sympathy operated in the cells of the Man chester Woikhouse, forcibly struck the writer of this al ti tle as one of those fortunate occurrences which it is not easy to repeat by any contrivance. A maniac was visited by his wife and two children, one of whom gave him an ap ple : this circumstance awakened his sensibility, and made him melt into tears. The scene was observed by the worst patient in the house, the furious woman who has been al ready mentioned ; her ferocity was immediately subdued, and she wept along with that unfortunate parent, recollect ing, no doubt, the children whom she herself left at home. Prom that day she made speedy advances to a state of per fect composure, and in a few weeks was dismissed cured. In this instance it was apparent that, though the incident was in itself lot tunate, it was equally fortunate that she had not, in the first instance, seen any of her own children. In that case, the association of ideas might have recalled to her mind those feelings of passionate irritation with which she was affected in the beginning of the disease ; whereas the feelings of maternal affection, being excited free from such associations, had time to acquire greater influence, till they became sufficiently 'towel fug to fortify her against those passions by which they had been supplanted.