LUNACY REFORM 
IV 
THE RIGHT OF THE INSANE TO LIBERTY 
BY 
E. C. SEGUIN, M.D. 
ONE OF THE CONSULTING PHYSICIANS TO THE HUDSON RIVER 
STATE HOSPITAL FOR THE INSANE, ETC. 
[Reprinted from the Archives of Medicine, August, 1880] 
NEW YORK 
G. P. PUTNAM’S SONS 
182 Fifth Avenue 
1880 LUNACY REFORM. 
IV. 
THE RIGHT OF THE INSANE TO LIBERTY.* 
“ The true principle to guide our practice should be this,—that no one, sane 
or insane, should ever be entirely deprived of his liberty, unless for his own 
protection or ior the protection of society.” 
Henry Maudsley. 
It is fair to say that, in the present state of psychiatry in Amer- 
ica, to be pronounced insane by physicians, by a judge, or by a 
jury, means imprisonment for months, for years, or for life. To 
put it in another way, there is a disease which reduces its victims 
to a level with persons accused of crime, and exposes them to 
loss of liberty, property and happiness. 
Is this just ? Is this worthy of a country like ours, which aims 
to be foremost in works of philanthropy, and preeminent as re- 
gards individual liberty ? 
Let us review the facts of medico-legal practice in the State of 
New York, on which these statements rest. 
1. A man has acute mania, he becomes unmanageable at 
home, is dangerous to himself and to others. This man is sum- 
marily placed in a carriage, taken to an asylum and locked in 
without any process of law. Before a certain time has elapsed 
after his reception (five days), certificates duly executed before a 
* Read before the National Conference of Charities and Corrections at 
Cleveland, Ohio, on Thursday July i, 1880. 
Reprinted from the Archives of Medicine, Vol. iv, No. 1. August, 1880. 2 
E. C. SEGUIN. 
judge of a court of record must be furnished to the superinten- 
dent of the asylum as a justification for further detention. 
Viewed without prejudice, this course seems the only one which 
can be pursued, and consequently we deem it right. For to wait 
many hours or several days for all the legal forms of commitment 
to be executed, might endanger the life of the patient or of those 
about him. Still it must-, be remembered that such cases of very 
severe acute mania are rare. In most cases a delay of twenty- 
four hours can do no harm. 
2. The same patient recovers in greater part; he becomes 
quiet, and, with the exception of an occasional false notion and a 
degree of mental enfeeblement, is like most well men. Yet by 
virtue of the power of the original commitment this man is kept 
confined to the asylum, he is yet a prisoner. F he wishes to walk, 
or to breathe fresh air, or to attempt some little out-door work, 
doors must be unlocked to let him pass, and when he returns to 
his room or ward he is locked in for the night. And this stage of 
partial recovery may last almost indefinitely. The sole power of 
discharge rests in the judgment and hands of a single man, the 
superintendent ; the patient is practically under a most singular 
form of tyranny for any enlightened State to permit to flourish. 
No matter how scientific or how good a man the superintendent 
may be, I hold that this degree of authority, of uncontrolled au- 
thority over the liberty of citizens, ought not to be allowed. 
3. The same sort of a case, i.e., one of acute mania, terminates 
unfavorably. The delirium is transformed into a group of more 
or less fixed delusions, kept up by hallucinations ; the memory 
and judgment are fatally impaired, in other words, secondary de- 
mentia is established. If, as in innumerable cases now in asy- 
lums, the delusions of the patient are not delusions of persecution 
or of any other form likely to lead to an outbreak of violence or 
destructiveness, is it right to keep this patient in the more or less 
costly and elegant prisons we call asylums ? 
Why should not this remains of a man enjoy freedom under a 
certain supervision ? Why should he not be allowed to go and 
come as he pleases and to have what little pleasure there remains 
for him in life ? THE RIGHT OF THE INSANE TO LIBERTY. 
3 
Let us make a further supposition, which is perfectly in accord 
with cases daily observed. If this harmless dement have prop- 
erty of his own, why should not this property be used to provide 
him with a suitable mode of life, and expended in reasonably 
amount for his benefit ? There is good reason to believe that 
many such patients are kept in asylums, private or public, indefi- 
nitely, unprovided with the luxuries or quasi-luxuries to which 
they are entitled. After a few years of patience on the part of 
the relatives, and of more or less conscious misery on the part of 
the patient, the disease ends in death, and the carefully pre* 
served property of the deceased is duly apportioned among heirsi 
4. A woman drifts through domestic trouble, semi-starvation, 
into a state of cerebral mal-nutrition and anaemia, delusions of a 
melancholic type appear, together with a depression and sadness 
which cannot be reacted against. 
Is it right to imprison such a woman, to place her actually un- 
der lock and key for months ? 
In some cases I am willing to admit that it is justifiable, but in 
the majority of cases I believe that such a procedure is unjust, 
morally and legally, and decidedly opposed to the patient’s rei 
covery. 
To decide which cases belong to the former category and which 
to the latter, and to judge when a given case passes from one cat- 
egory into the other, requires, I admit, careful observation and 
ripe judgment, but not more, I am prepared to maintain, than do 
many other problems in medicine and surgery which are decided 
every day in our midst with average good success. 
5. Cases of primary dementia occur frequently in both middle- 
aged and old people. Many such patients are simply foolish, but 
quite harmless. Why are they sent to asylums except for safe 
keeping, because of the lack of relatives, or because of pecuniary 
inability of friends to take care of the deteriorating member of 
the family, or lastly, pretty often, I fear, because of unwillingness 
to keep the patient at home ? 
In all these three categories I believe that confinement under 
fhe present asylum system is unjustifiable, legally and morally. 4 
E. C. SEGUIN. 
What right have we to bar a man’s window and keep him all 
day, or a part of the day, for months and years, under lock and 
key, because he is simple or foolish, or, to put it technically, de- 
mented ? 
The pauper insane of the harmless demented class must, I sup- 
pose, be aggregated in institutions, preferably under medical super- 
vision if not medical control, but have we not the right to demand 
that these unfortunates shall have the maximum of personal lib- 
erty consistent with safety to themselves and others ; that they 
shall be both employed and amused in an inexpensive manner ? 
Must we not remember that so long as any reason survives, per- 
haps longer, the animal capacity for simple enjoyment persists ? 
How many hundred chronic insane in this nation are quite cap- 
able of enjoying a game of cards or dominoes, bowling, a pipe of 
tobacco, etc., in comparative freedom, under a surveillance that 
need not at all resemble the present prison-like manner of watch- 
ing patients in asylums ? 
6. Epileptic and hysteric patients are not rarely detained in 
asylums without justification. I have had personal knowledge 
of such cases. 
The alleged cause of certification originally, and of unlimited 
detention afterward at the request of relatives, is some psychical 
disorder which, in a majority of cases, is temporary, and quite 
as much under the control of a physician as of a superin- 
tendent. 
I do not, let it be clearly understood, mean to say that such 
cases should not be sent to institutions, but I protest most ener- 
getically against their commitment to prison-like asylums, to their 
forced association with the insane, and their subjection to the im- 
perfect medical treatment which obtains in most asylums. 
Removal from home often does much good in these diseases, 
and is a sine qua non to recovery in certain cases of hysteria ; but 
from this statement to the present evil practice of judicial com- 
mitment and locking up there is a vast gulf—a gulf as deep and 
wide as is the great human right to personal liberty. 
I do not mean to refer in detail to a last class of cases, viz., THE RIGHT OF THE INSANE TO LIBERTY. 
5 
those in which a sane person is fraudulently imprisoned as insane 
under our present imperfect laws. 
I firmly believe that such cases are extremely rare, and from 
my personal knowledge of many of the superintendents of insane 
asylums, I do not believe that any of those gentlemen would tor 
one moment countenance such a procedure. 
I trust that I have made myself understood. 
With many others, some of them to be cited further on, I be- 
lieve : 
a. That a large number of the inmates of asylums could be 
taken care of with open doors and unbarred windows, and, of 
course, without restraining apparatus. 
b. That many insane now confined in our asylums could be 
trusted almost implicitly to go and come at will, could be given 
nominally remunerative occupation, and, above all, could be pro- 
vided with simple amusements suited to their stations in life (and 
I do not refer to costly stereopticons, or the solitary billiard table, 
or the lectures, to which superintendents now refer with so much 
complaisance). 
c. That the phases of insanity should be watched more closely 
with especial reference to early discharge of a patient, to his 
transfer to another institution, to the amount of liberty allowed 
him, etc. And I do not think it safe to leave this power wholly 
in the hands of the superintendent. 
d. That the time has come to look around and attempt in this 
country the English and Scotch plan of placing harmless insane 
persons singly in the families of farmers and of others willing to 
undertake the task under frequent and efficient visitation. 
There is not, I dare say, a single county in the State of New 
York where a number of harmless chronic or even sub-acute cases 
of insanity might not be safely and happily treated or kept in fam- 
ilies, and where a good yet just and firm country doctor could 
not be found to visit a dozen or more of these patients occasion- 
ally and unexpectedly, and keep a strict watch over their health 
and happiness, reporting fully to the State Commissioner or Com- 
missioners of Lunacy, or to a special general inspecting official. 6 
E. C. SEGUIN. 
There are, I have reason to believe, many families who would 
much prefer to keep their insane in this manner, at a reasonable 
cost, who are made to shudder at the mere mention of an asylum, 
whose long and desolate corridors they see in imagination, whose 
locks and keys they almost think they can hear, and whose deteri- 
orating influences upon patients they more than half suspect. 
While expressing the above views I also desire to state just as 
clearly my belief that certain cases of insanity, more especially acute 
mania or melancholia, all psychoses accompanied by homicidal, 
suicidal or marked destructive tendencies, should be placed as 
quickly as the law will allow in confinement. But even here we 
may implore that the confinement may be made as easy as possi- 
ble for the unfortunate patient, who is, contrary to public preju- 
dice, just as much a sick man as if he had phthisis or a chronic 
ulcer ; and that all the barbarous means of corporeal restraint, 
such as cribs, jackets, straps, etc., shall be radically done away 
with as asylum implements, as a part of the nosocomial arma- 
mentarium, and only applied by express directions of the medical 
officer in exceptional cases, very much in the same way as we 
resort to heroic medication or surgical procedures in general 
practice. 
If you will pardon a simile, I would say that I look upon re- 
straining apparatus in the treatment of insanity very much as upon 
the lancet in the treatment of general diseases. The sight of re- 
straining apparatus in an asylum seems to me as demoralizing 
and uncalled for, as would be the carrying of a lancet and the 
celebrated palette by a physician of to-day in his hospital visit. 
Bleeding is generally condemned, and so is physical restraint of 
the insane, excepting in this country, and yet I will not deny but 
that once in a while, under peculiar circumstances, both phlebot- 
omy and restraint are justifiable. Let us join in the hope that 
before many years both procedures will be equally rare. 
I desire to close this essay by reference to the opinions of much 
abler men, and much more expert specialists than myself upon 
this subject. And I believe that the gentlemen whose views I am 
to quote are so eminent in their specialty that the most bigoted 7 
THE RIGHT OF THE INSANE TO LIBERTY. 
defender of our present prison system of asylums cannot question 
their right to be considered as foremost authorities. 
Dr. Henry Maudsley, who has held almost every possible offi- 
cial position in relation to insane administration in England, and 
who is justly regarded as one of the most distinguished European 
alienists, expressed himself as follows years ago. I quote from 
the second edition of “ The Physiology and Pathology of the 
Mind,” London, 1868. 
“ To be a lunatic, as public sentiment goes, is to be cut off so- 
cially from humanity. With such feeling prevalent with regard to 
the insane, can it be thought possible that the treatment, at pres- 
ent sanctioned by general approbation, should be the most just 
and humane possible. The feeling is one which cannot be justi- 
fied, and the system which it inspires cannot be just. That sys- 
tem is the system of indiscriminate sequestration—of locking up 
a person in an asylum simply because he is mad. 
“Now I believe this practice to spring out of an unjust feeling, 
as already said, and to be founded on false principle, as I shall now 
endeavor to show. The principle which guides the present prac- 
tice is that an insane person, by the simple warrant of his insanity, 
should be shut up in an asylum, the exceptions being made of 
particular cases. This I hold to be an erroneous principle. The 
true principle to guide our practice should be this : that no one, 
sane or insane, should ever be entirely deprived of his liberty, 
unless for his own protection or for the protection of society.” 
(pp. 494-495.) 
“ I venture, indeed, to affirm in opposition to it, that there are 
many chronic and incurable insane persons, neither dangerous to 
themselves nor to others, who are at present confined in asylums, 
and who might as well be at large.” (p. 495.) 
“ Another objection to the liberation advocated will be, that 
the insane in private houses will not be as well cared for as they 
are, nor have any more comfort than they now have, in well- 
conducted asylums. The quarter from which this objection is 
urged taints it with suspicion ; I never heard it put forward but 
by those who are interested in the continuance of the present 8 
E. C. SEGUIN. 
state of things. Those who make it, appear to fail entirely to ap- 
preciate the strength of the passion for liberty which there is in 
the human breast; and as assuredly there are but very few per- 
sons who would not infinitely prefer a garret or a cellar for lodg- 
ings, with bread and water only for food, to being clothed in pur- 
ple and fine linen, and faring sumptously every day as prisoners. I 
can well believe that all the comforts which the insane person has 
in his captivity, are but a miserable compensation for his entire 
loss of liberty, that they are petty things, which weigh not at all 
against the mighty suffering of a life-long imprisonment.” (pp. 
496-497.) 
“ For the reasons adduced, I cannot but think that future pro- 
gress in the improvement of the treatment of the insane, lies in 
the direction of lessening the sequestration and increasing the 
liberty of them.” (p. 501.) 
“ Not the least of the evils of our present monstrous asylums, 
is the entire impossibility of anything like individual treatment in 
them.” (p. 502.) 
“ Indeed, I cannot help feeling, from my experience, that one 
effect of asylums is to make some permanent lunatics. * * * 
And I can certainly call to mind more than one instance in 
which I thoroughly believe that the removal of a patient from an 
asylum was the salvation of his reason.” (p. 503.) 
Our distinguished countryman, Dr. Samuel G. Howe, every- 
where known for his philanthropic efforts, enters a noble protest 
against the unnecessary restraint of lunatics by confinement to 
asylums, in the Sixth Annual Report of the State Board of Char- 
ities of Massachusetts, for 1869. I quote : 
“Yes, disguise it as we may, we do keep under unnecessary 
restraint and in a sort of slavery, a multitude of unfortunates who 
sigh for liberty, and to whom it would be very sweet. Their ap- 
pearance of quiet and their seeming acquiescence are oftentimes 
utterly deceptive. Bewildered, doubtful of their own power of 
self-guidance, half conscious of insanity, still they know enough 
to know that the whole power of society holds them in its grip, 
and they resign themselves in despair.” (p. lxxxvii.) THE RIGHT OF THE INSANE TO LIBERTY. 
9 
“ It would be folly to deny that restraint by walls, by iron 
sashes, by oaken doors and by constant guard is necessary for a 
certain class of patients under our mode of treatment. Hut it is 
equal folly to maintain that it is necessary for all, or for nine- 
tenths ; and if not necessary, upon what ground can we defend 
our violation of a right which the lunatic never forfeited ? 
It is sinful and criminal to abridge unnecessarily the freedom 
of an innocent man ; and it is, moreover, cowardly and cruel to 
abridge that of an unfortunate lunatic.” (p. lxxxix.) 
In the next place I quote from G. Fielding Blandford’s work 
on “Insanity and its Treatment,” London edition, 1870, Amer- 
ican edition, 1871. He says : 
“ Doubtless, you have all heard of the moral treatment of 
insanity, but shutting a man up in an asylum can hardly be called 
moral treatment.” (p. 379.) 
“ In asylums they dwelt from year to year, a few walking be- 
yond the premises, but none sleeping beyond, or going to any 
places of amusement like ordinary men. Now, from all asylums 
patients are sent to the sea-side, to the theatre, the picture gal- 
leries, and each proprietor vies with his fellows in providing 
recreation and entertainment for his patients—in proving, in fact, 
how little they need the restraint of an asylum.” (p. 383.) 
[The above passage applies only to a special class of private 
asylums in Great Britain, but its bearing on the general question 
is obvious.] 
“ As the last generation did away with the fetters and mechan- 
ical restraint used in asylums, so let the present release from the 
restraint of an asylum all those capable of enjoying a larger 
amount of liberty and a freer atmosphere than that in which they 
now fret and chafe.” (p. 385.) 
Dr. John Charles Bucknill is known to the profession in this 
country as an eminent authority upon the topic in hand. 
He has this spring given us in book-form the series of papers 
on Lunacy Law Reform which appeared in the British Medical 
Journal in 1879. The purpose of these papers is mainly warfare 
upon the private or proprietary asylums as they flourish in Eng- 10 
E. C. SEGUIN. 
land, but scattered throughout the volume are numerous passages 
proving how thoroughly Dr. Bucknill, after a most varied experi- 
ence with the insane and with asylums, coincides with Dr. Mauds- 
ley in the opinion that for many cases of insanity or mental un- 
soundness confinement to an asylum, subjection to asylum routine 
and deprivation of liberty and social enjoyments are cruel and 
legally unjustifiable. 
I quote a few sentences only : 
“ Custom-blindness (which is more than color-blindness, be- 
cause it blurs the outline of things as they are) often leads official 
people to associate unsoundness of mind with detention under 
care and treatment as correlative if not identical conditions ; but 
with the general public it is not so, and still less with the medical 
profession, and still less again with that of the law.” (pp. 25-26.) 
“ * * * And, therefore, it would appear to be imperative 
to a proper certification of a lunatic for detention in an asylum 
that the reasons for which such detention is needful should be 
fully stated upon the face of the documents, and distinguished 
from the facts which simply indicate lunacy.” (p. 26.) 
“ But it is not merely the happy change which takes place in 
confirmed lunatics when they are judiciously removed from the 
dreary detention of the asylum into domestic life, it is the effi- 
ciency of the domestic treatment of lunacy during the whole 
course of the disease, which constitutes its greatest value, and of 
this the author’s fullest and latest experience has convinced him 
that the curative influences of asylums have been vastly overrated, 
and that those of isolated treatment in domestic care have been 
greatly undervalued.” (p. 114.) 
“ Many a suicidal patient can live as safely with two faithful 
and skillful attendants in a villa or cottage as in any asylum, and 
in the free air he will walk or drive, employ or amuse himself in 
various ways, and recover without the asylum brand or the asylum 
danger of falling more and more into subjective ways of thought 
and shunting into the sad list of incurables.” (p. 116.) 
E. C. Seguin. ARCHIVES OF MEDICINE FOR 1880. 
A BI-MONTHLY JOURNAL. 
Edited by Dr. E. C. Seguin, in conjunction with Thomas A. McBride, M.D., Lecturer-on 
Symptomatology in the College of Physicians and Surgeons, New York, in charge of general medi- 
cine ; Matthew D. Mann, M.D., of Hartford, Ct., Clinical Lecturer in Gynecology in the 
Medical Department of Yale College, in charge of Obstetrics, and Diseases of Women and Chil- 
dren ; and Lewis A. Stimson, M.D., Professor of Pathological Anatomy ih the Medical Depart- 
ment of the University of New York, in charge of Surgery. 
The Archives of Medicine will continue to be published every two months. 
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Prior to entering upon the second year of the Archives existence, the Editor does hot desire 
to make any loud promises of things to be done, but prefers simply to point to what has appeared 
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pressed their intention to be collaborators. 
Among Original Articles published in the first five numbers of the Archives, we may cite the 
following as possessed of general interest. 
Supplementary Rectal Alimentation by Dr. A. Id. Smith ; The Self-limitation of Phthisis by 
Dr. Austin Flint, Sr. ; Fibroids gf the Uterus by.Dr. T. G. Thomas; Phthisis Pulmonalis by 
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Psycho-physiological Training of an Idiotic Hand by Dr. Edward Seguin ; and Mr. Delafihld’s 
series of Lessons upon Electricity. 
The five Editorial Articles have treated of the following subjects : The Present Aspect 
of the Question of Tetanoid Paraplegia by the Editor ; The Utility of the Sphygmograph in 
Medicine by Dr. Thomas A. McBride ; Obstetrics in Siam by Dr. Sam’l R. House ; Ulceration 
of the Cervix Uteri by Dr. Matthew D. Mann ; Lunacy Reform, Historical "Considerations by 
the Editor. 
In the Department for Original Observations twenty valuable cases have been recorded, several 
of which might have formed the basis of original articles. 
COLLABORATORS. 
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