THE BETTER WAY; 
OK 
CONSIDERATIONS UPON THE NATURAL SYSTEM 
OF PROVIDING FOR 
She treatment of the Jnsane. 
By Andrew McFarTXNd, M. D , LL. D. THE BETTER WAY; 
OR, 
CONSIDERATIONS UPON THE NATURAL SYSTEM OF 
PROVIDING FOR THE 
TREATMENT OF THE INSANE. 
By ANDREW McFARLAND, M.D., LL.D., 
Formerly President of the Am. Association of Superintendents of 
i Hospitals for the Insane, Physician to the Illinois State 
Hospital for the Insane, the N. H. Asylum 
for the Insane, etc., etc. 
[ Extract from St. Louis Medical and Surgical Journal. ] 
The early history of the insane asylum is involved in 
much obscurity. While a ray of light on the subject comes 
down to us even from times somewhat remote, the great 
fact of the gathering of the insane into receptacles specially 
provided for them is one of modern date. Yet, that the 
phenomena of mental disease were well understood, and its 
manifestations attributed to their true causes with a good de- 
gree of pathological exactness, even in the earliest days of 
medical science, there is no reason to doubt. Hippocrates 
(B.C. 456) clearly recognized the real nature of insanity, 
placing its seat in the brain with as much diagnostic cer- 
tainty as is done to-day. Still more explicit were the views 2 
Original Communications. 
of Galen (A. C. 131), who made many admirable obser- 
vations on the disease, still instructive and to be had in 
remembrance. 
But medical science, unfortunately, unlike all other, has 
its flood and ebb ; and a long and dark night shut down 
on the progress of scientific truth, not materially to be lifted 
for the space of at least ten centuries. During all this 
gloomy period the phenomena of diseased mind seem to 
have wholly passed under priestly interpretation. It was a 
rich field whereon to point out the workings of the super- 
natural. That evil spirits, demons, witches, and other 
ghostly agents had liberty given them over the bodies and 
souls of certain mortal beings, was a belief not easily to 
be relinquished by those who drew both power and profit 
from its existence. Christianity had not then begun to 
assert itself in those humanizing sentiments that are now 
its blessed fruit. Learning was the possession of the few ; 
and that few were isolated and shut out from the warm 
touch of common human sympathies. 
It is not essential to our purpose to trace the relations 
sustained by the insane to society at large in those remote 
times. The more uncontrollable were, doubtless, held in 
chains, or by other means equally harsh ; while the more 
harmless were allowed the natural tendency of the insane 
mind-a life of vagabondage. The privileged fool, so 
common an appendage to courts and the houses of the 
great, was, no doubt, one of these latter, whose vagaries 
served as a certain substitute for wit. The only instance in 
which any thing like the real status of the insane in the 
middle ages stands transmitted to us is in the well-known 
village of Gheel. in Belgium. Attracted to this spot by 
the fame of a local saint, said to have wrought cures among 
those mentally diseased, such persons, and those caring for 
them, became numerous enough to constitute a hamlet by 
themselves. Modern science has supplied to this unique 
colony the essentials wanting in its rude state, till the sys- 
tem, thus accidentally established, challenges approval as The Better Way. 
3 
a triumphant demonstration of better things than is shown 
elsewhere. We shall hereafter have occasion to advert to 
its merits. 
For all useful purposes, we may date the system of the 
treatment of the insane now in vogue to the establishment 
of the Royal Hospital of Bethlehem, A.D., 1547. Founded 
by a sheriff of London, some three hundred years previ- 
ously, as a pious monastic brotherhood, dedicated to St. 
Mary of Bethlehem, it was handed over by Henry VIII, at 
the date above mentioned, to the city of London, which 
converted it into a receptacle for lunatics. Its original 
funds seem, for a wonder, not to have been wholly confis- 
cated, as its revenues have always been large-so large, 
indeed, as to have been at the bottom of many of the 
abuses of which it has been a most fruitful field. " It 
stood," says Stowe in his Chronicles, "in an obscure and 
close place, near unto many common sewers, and also 
was too little to receive and entertain the great number 
of distracted persons, both men and women." It was re- 
built, about a century later, in another locality; and some 
slight approach was made towards modern ideas, in a 
small provision of adjacent grounds, where patients, suffi- 
ciently well to be so far trusted, might have the privilege 
of walking for exercise. It is probable, however, that 
nearly the same internal arrangement was preserved in this 
as in the older institution-a range of cells on each side of 
a common corridor. Fortunately, a picture has been pre- 
served to us, showing its interior. Hogarth, always true 
in the surroundings of his pictures, has given us, in the 
eighth scene of his "Rake's Progress," a good view of a 
ward in "Bedlam," as the institution was always termed. 
Pepys, in his gossipy diary, speaks of a visit there, where 
he saw "several poor, miserable creatures in chains," and 
Steele, in his "Tatler," mentions a similar visit with friends, 
"to show them the sights there"-a morbid taste not yet, 
we fear, wholly extinct. 
Such a gloomy and repulsive state of architectural ar- 4 
Origin a I Com m u n icat ions. 
rangements as existed in this "Bedlam," from its erection 
in 1675 to its abandonment in 1815, could not fail to have 
its natural effect in perpetuating a system of treatment in 
full accord with it. If "the dark places of the earth are 
full of the habitations of cruelty," the truth always has its 
countei part in a receptacle for the insane where gloom and 
obscurity prevail. Long after Pinel had shown in France 
that chains and dark cells were no fitting instrumentalities 
in restoring the lost reason, this place abounded in atroci- 
ties from which the sense recoils. It is difficult to conceive 
that more than a quarter of a century after the French 
philanthropist had proclaimed the success of his grand 
experiment, a committee of the House of Commons should 
have found such a state of things as the following : 
" In the women's galleries, one of the side rooms contained 
about ten patients, each chained by one arm or leg to the wall, 
the chain allowing them merely to stand up by the bench or form 
fixed to the wall, or to sit down on it. The nakedness of each 
patient was covered by a blanket, made into something like a 
dressing gown, but with nothing to fasten it in front. This was 
the whole covering, the feet being naked. In another part were 
found many of the unfortunate women locked up in their cells, 
naked and chained on straw, with only one blanket for a covering. 
In the men's wing, in the side room, six patients were chained 
close to the wall, five hand-cuffed, and one locked to the wall by 
the right arm as well as by the right leg; he was very noisy ; all 
were naked except as to the blanket gown or small rug on the 
shoulders, and without shoes ;-their nakedness and their confine- 
ment gave this room the complete appearance of a dog-kennel." 
But the crowning horror of Bethlehem Hospital remains 
to be told : 
"In one of the cells on the lower gallery we found Wm. Nor- 
ris. He stated himself to be 55 years of age, and that he had 
been confined about 14 years; that in consequence of attempting 
to defend himself from what he conceived the improper treatment 
of his keeper, he was fastened by a long chain, which, passing 
through a partition, enabled the keeper, by going into the next The Better Way. 
5 
cell, to draw him close to the wall at pleasure ; that to prevent 
this, Norris muffled the chain with straw so as to hinder it passing 
through the wall ; that he afterwards was confined in the manner 
we saw him, namely, a stout ring was riveted round his neck, 
from which a short chain passed to a ring, made to slide upwards 
and downwards, on an upright massive iron bar, more than six 
feet high, inserted into the wall; round his body a strong iron 
bar, about two inches wide, was riveted ; on each side of the bar 
was a circular projection, which, being fastened to and enclosing 
each of his arms, pinioned them close to his sides. This waist- 
bar was secured by two similar bars, which, passing over his 
shoulders, were riveted to the waist-bar, both before and behind. 
The iron ring round his neck was connected to the bars on his 
shoulders by a double link ; from each of these bars another short 
chain passed to the ring on the upright bar. We were informed 
he was enabled to raise himself so as to stand against the wall on 
the pillow of his bed in the trough-bed in which he lay ; but it is 
impossible for him to advance from the wall in which the iron bar 
is soldered, on account of the shortness of the chains, which were 
only twelve inches long. It was equally out of his power to repose 
in any other position than on his back, the projections on each 
side of the waist-bar enclosed his arms, making it impossible for 
him to lie on his side, even if the length of his chain from his neck 
to his shoulders would permit it. His right leg was chained to 
the trough, in which he had thus remained encaged and chained 
for more than twelve years ! " 
We are elsewhere informed that this poor wretch, thus 
held as strongly as iron bar and chain could confine him, 
was not released till about three weeks or a month before 
death came to his rescue. The result of these, and simi- 
lar disclosures, was, to induce the abandonment of the 
institution where they occurred, and cause its re-erection 
in 1815, on a site then eligible, but now swallowed up by 
the tide of ever-increasing London. Yet the old fatality 
did not leave it, notwithstanding change of site, and all the 
advantage of new light on the best form of hospital con- 
struction. In 1851 the attention of Parliament was again 
called to its condition. "In reading the evidence taken by 
the commissioners," says a late writer, "it is striking how 6 
Original Co in tn un ic al ions. 
much the story of 1851 is a repetition of the story disclosed 
in 1815, allowance being made for the difference of time. 
There is, happily, a limit to the distance at which the most 
inveterate obstructive institution or individual can lag be- 
hind the spirit of the age. There was no patient now 
found chained as poor Norris was chained till death 
released him,-that was impossible even at Bethlehem in 
1851 ; but the same heartless neglect, the same spirit of ob- 
structiveness, the same inefficient superintendence, the same 
strong feeling evinced, that the magnificent revenues of the 
wealthy charity existed for the sake of administrators and 
officials, and not administrators and officials for the purpo- 
ses of the charity; and the same incapacity to perceive 
that the condition and management of the hospital was of 
any just interest or concern to any one but those who 
derived interest or profit from it,-all these were as plainly 
exhibited as when they were more completely realized in 
a more iniquitous practice." 
It would seem as if these repeated animadversions of 
Parliament, and these repeated changes of site, would have 
had the effect to bring this prominent institution into such a 
state of perfection that it might become something like a 
touchstone of English civilization, standing, as it did, at 
the very center of the nation's intelligence, and closely in 
sight of its august parliament, which had its interests in 
keeping, Yet, so late as 1864, the same old story had to 
be repeated. The Commissioners of Lunacy, at this date, 
utter the following language : 
" We take exception to the present construction of the building. 
We maintain that it is most unfit for the purpose. . . Though 
not intended as a prison, it was constructed on the same princi- 
ples as a prison. . . . The general aspect ol the hospital, 
externally and internally, notwithstanding the efforts made within 
the last few years to enliven the corridors and day-rooms, cannot 
but exercise a depressing influence upon the inmates, whose 
means of out-door exercise are so limited and inadequate." 
It must be remembered that these censures were upon an The Tetter Way. 
7 
institution that had been twice rebuilt, the last time after 
the great flood of light marking the close of the eighteenth 
century had been thrown on the whole subject in all its re- 
lations. And it must also be remembered that Bethlehem 
hospital, for three centuries, represented nearly all of Eng- 
land 's interest in this department of humanity; so much so 
that the words "bedlamite," and "Tom o' bedlam," were 
generic terms, applied to the lunatic as one of a particular 
class. 
So much of length would not have been bestowed upon 
this institution if it had not, most unfortunately, stood 
as the type and copy of so many that were to follow, and 
if its evil influence had not extended into our own time. 
Originally the habitation of ascetic men, who made the 
monastic gloom of their surroundings a part of their 
habitual penance, it passed, with little or no. alteration, to 
the use of those who need cheerfulness, and the largest 
permissible liberty, as absolutely essential conditions. The 
form thus inherited was pertinaciously adhered to in the 
twice repeated change,-showing a conviction that it was 
the best, and perhaps the only, way in which the insane 
could be safely associated for treatment. Those who chained 
up William Norris were doubtless as well convinced that 
rows of cells on each side of a dark corridor were abso- 
lutely the only way to lodge the insane, as Philip II was 
that torture and the stake were the only remedy for heresy 
in the Netherlands. In each case, a thorough conviction 
dictated the arrangement and the remedy. But, unfortu- 
nately for humanity, while the mistake of the Spanish 
bigot cures itself under the light of human progress, it is 
the very nature of mental disease to be violent in its mani- 
festations just in proportion to the harshness of the means 
used to repress them, and thus their necessity always seems 
to grow in proportion as they are used. William Norris 
doubtless reached the position in which we have seen him 
through a series of graduated restrictions on the part of 
his keepers, and increasing demonstrations of violence on 8 
Original Commit nications. 
his own, till those who could not realize the facts of the 
case reasoned themselves into the belief that their triple 
array of chains, iron bars and bands were really necessary. 
It is one'of the instincts of human nature to make use of 
the most extreme means of power put into its possession. 
If, in the control of the insane, strong cells, chains and 
iron bars, are among the recognized instrumentalities, they 
will be used ; and the necessity for their use will all the 
time seem to increase, till the state of things above por- 
trayed becomes to exist. As we come to consider the two 
modes of providing for die insane, now contesting for pub- 
lic favor, we shall see how one system, in its natural ten- 
dency, inclines to the abuses we have seen,-requiring 
incessant vigilance in their avoidance; while the other 
almost as naturally tends to emancipate this branch of 
philanthropic science more and more from all that has 
made the insane asylum the theme for the sensational nov- 
elist, a target for the newspaper itemist, and the oppro- 
brium of the social reformer. 
Whether or not Bethlehem Hospital stood as the type 
and model on which the great majority of modern insti- 
tutions have been formed is not material to the present 
purpose ; suffice it only to say the type has been accepted, 
and all changes since made are in minor points, and not 
materially varying from the model. It is true that every 
variety of external form has been given that architecture 
can suggest; the Gothic, the castellated, the Tudor, and 
the Romanesque - each has had its turn as fancy may 
have dictated. But the old form of interior - a range of 
small rooms (which the uninitiated will persist in calling 
"cells"), on each side of a central passage way or corridor, 
remains the same virtually to-day as it did when Henry 
VIII gave the monastery of St. Mary of Bethlehem to be 
converted into a retreat for the insane. This will not seem 
so strange to those who reflect how much easier it is to 
accept a model already established than to strike out a new 
course. It unfortunately happens that those who are called 'rhe Better PFizy. 
9 
on to make the preliminary arrangements for the custody 
and treatment of the insane are, almost invariably, persons 
who have given the subject no previous attention. The 
responsibility they are saddled with precludes the exer- 
cise of any originality of thought upon the subject. They 
leave what they are accustomed to style untried experi- 
ments to those who may come alter, and content themselves 
with what has been tried a hundred times before. They 
employ the best architect they can procure, and bid him 
go to work and show the best thing that can be had for the 
money. It is not to be expected that this functionary will 
be an original thinker on a subject beyond his province, 
or that he will fail to present a picture that appeals to the 
eye, or gratifies the taste for the fanciful, and, perhaps, the 
grand. The externals of his picture harmonize with the 
site chosen, and gratify the all potent local pride that dic- 
tates the choice. The externals are the architect's chief 
concern, for in these lies his monument. Building com- 
mittees are not averse to seeing their names blazoned on 
the lintels of a stately edifice, and so a hundred Bethlehems 
have grown out of the one original. 
It will be claimed that the old, repulsive picture, pre- 
sented by Hogarth, has been so much softened by the 
humane sentiment of later times that, save in form, it no 
longer exists.-that pictures, libraries, musical instruments, 
and garnished walls have hidden all the bald features shown 
in the satirist's representation. This is a statement particu- 
larly calculated to satisfy the easy going and thoughtless. 
If these additions could be made to absorb the attention of 
the mentally diseased, to the exclusion of all other thoughts, 
they might measurably satisfy. But those conversant with 
the cravings of the insane mind well know that, save in 
the rare instance, all these have but little real effect on the 
dulled sense of those supposed to profit by them. Hamlet 
has truly expressed the exercise of the insane mind : 
" I have of late (but wherefore I know not) lost all my mirth, 
foregone all custom of exercises; and, indeed, it goes so heavily 10 
Origin al Co m m u n ica t io n s. 
with my disposition, that this goodly frame, the earth, seems to 
me a sterile promontory; this most excellent canopy, the air, 
look you, this brave o'erhanging firmament, this majestical roof 
fretted with golden fire, why it appears no other thing to me than 
a foul and pestilent congregation of vapors." 
If the goodly frame of the earth, and the majestical roof 
of the heavens awaken no emotion whatever, can their 
painted imitations do more? Without wishing to disparage 
those who profess to rely largely on these substitutes, their 
ostentatious display must be pronounced little else than 
blinds-tubs thrown to amuse the larger whale outside-or, 
as one who has used them largely has neatly phrased it, 
"conductors laid to carry off public sentiment." As a matter 
of fact, such objects produce an effect on those deprived of 
greater boons, almost infinitesimal. Those who, in suc- 
cessive attacks of insanity, have had experience of several 
institutions, are found expressing no preference of those 
where such agencies extensively abound over others where 
they are greatly wanting. They are by no means to be 
despised as accessories, but as material reliances, held up 
as substitutes for better things, they are to be rated at their 
worth. If a whole system is radically wrong, a few pic- 
tures more or less, or libraries unopened by the vast ma- 
jority, make but small impression. It is only a gilding of 
the wires,-the cage remains a cage still. 
That a vicious system has been allowed to perpetuate 
itself, is explained by the excessively conservative qualities 
of the Saxon mind. How long has it taken to emancipate, 
even in democratic America, woman from her unjust posi- 
tion in social equality and property rights, as established 
by English common law? How long must it be before the 
true relation of the State to the criminal classes shall get 
any satisfactory recognition ? For how long a time were 
capital punishment for petty offenses, imprisonment for debt, 
and the harsh laws of distraint, allowed to remain a blot upon 
humanity ? If reforms of evils that come home to men's busi- 
ness and bosoms were suffered to lag so slowly, how natural The Better Way. 
11 
to " let well enough alone " in a matter that seemed to touch 
only upon the interests of the few. It is the pride and boast 
of our own time not merely to remove evils that are glaring 
and wide-spread, but to hunt up those that lie hidden by 
reason of the obscurity and powerlessness of those who 
suffer under them. Every year sees some new class of the 
unfortunate or erring brought under the eye and protection 
of the State. 
Not only is it the spirit of our time to widen the area of 
public beneficence, and bring within its protecting influence 
new classes, but to reconsider former provisions, and in- 
quire if they have kept pace in the grand march of human 
progress. Such a process is a healthy one, and always 
justifiable, it for no other purpose than to make way-marks 
to show the rate of our advance. That a style of institu- 
tion that has held its place unchanged for some centuries is 
a fit subject for this species of reconsideration, no one will 
call in question. 
As a preliminary to our inquiry, it must be stated that 
notwithstanding institutions for the custody and treatment 
of the insane have had so long an existence, they have 
been singularly objects of popular distrust. While general 
enlightenment has established the status of all other conso- 
ciations of equal age, these alone stand subjects of mys- 
tery and doubt, of which the most intelligent partake. 
While granting that the ideas concerning them are too often 
got from perverted representations by those who have been 
in no condition to form a correct judgment, and therefore 
should be cast aside as unworthy of notice, it is allowing 
too little to human discernment not to believe that, had 
there been no general obstacle inherent to the system itself, 
correct and abiding impressions would have become estab- 
lished. It is the want of these that gives impunity to the 
dealer in fiction, in laying his most sensational scenes in 
the wards of the lunatic asylum, where perversion, exag- 
geration, and sheer invention may revel to their full bent. 
In a dispassionate and unprejudiced state of the public 12 
Original Commun nations 
mind, these caricatures would long ago have died out. as 
stale and unprofitable. What book, professing to describe 
such scenes from experience, however abounding in the 
most insane vagaries, does not find its thousands of greedy 
purchasers? Why is it that the best men that society can 
produce-giving their time and pains as a labor of love 
entirely-chosen as their managers, have no success in 
lifting this load of popular opprobium? Why is it that the 
"mad doctor.''whenever his acts or opinions bring him into 
notice, must get off with the reputation of being a cross of 
the fool and the knave? The explanation of many of these 
anomalies must be found in the fact that a branch of medical 
science, the most dignified and important of all, has here- 
tofore been mainly pursued in a theater whose very con- 
struction does an injustice to the best endeavor, while also 
peopled by the imagination of those outside with every 
kind of distorted shape. It is not alone the subjects 
treated, but those who treat them, who are the victims. 
We shall now proceed to show, as briefly as possible, 
what are the main defects of our present system of hospital 
arrangement, and suggest the proper remedy. 
And, first, we must consider their radically faulty plan 
of construction ; as this error lies at the bottom of all the 
evils of which they are the subject. The idea that all the 
subjects of mental disease are "madmen," and need certain 
special surroundings as such, wqs the original foundation 
of this grave mistake. This error seems to have been so 
deeply planted that all experience to the contrary of that 
misconception has not served to eradicate it. As the fea- 
tures of insanity get their character very much from sur- 
roundings, it is easy to see how such an error can be 
perpetuated. Is it a wonder that those who successively 
rebuilt Bethlehem hospital should hold to the belief that all 
bereft of reason needed all the controlling forces required 
by savage and dangerous beasts? When Pinel made his 
memorable visit to the Bicetre. and released its inmates 
from their long accustomed chains, the affrighted keepers- The Better Way. 
13 
no doubt, honestly-protested against the act as full of 
peril to his life ; and none were more astonished at the 
tranquility that followed than themselves. And it is a note- 
worthy fact that the general features of insanity have soft- 
ened with every step to ameliorate the system of its treat- 
ment. 
The idea of security, then, as the first and foremost 
consideration, has always been one of the chief obstacles to 
the adoption of a more rational system than the present. 
As this idea is best promoted by compactness of construc- 
tion, it is plain to see how the effort is persevered in to get 
just as much as possible under a single roof. Nothing is 
so fatal to this idea as simple extension or segregation. 
Hence the passion to pile story above story, and perpetuate 
a penitentiary in all things but the name. As partition 
walls are solidly built from the bottom, it necessarily follows 
that each story is a counterpart of all the others. If there 
is any difference in any of our institutions, in the uniform 
solidity of finish, and the uniform style of doors, locks and 
gratings, in each of these superimposed stories, the instance 
has not been cited. The eye then rests upon an endless 
monotony of surroundings, everywhere suggestive of re- 
pression and strength. The only note of those within, 
that has no variation, is that of Sterne's imprisoned 
starling-" I can't get out! " 
Now, if all those thus held had the quality of jail break- 
ers, this might be well. But all experience has abundantly 
proved that the great majority of the inmates of our insane 
asylums are willing, if not contented residents. If there is 
anything all pervading in the feeling of such, it is a sensi- 
tiveness as to their condition, as a separate, and perhaps 
outcast class. Not high excitement-as the theory seems 
to suppose, but depression, is the great preponderating 
condition. If there is one delusion more common than all 
others, it is that of personal unworthiness-of having for- 
feited the love and confidence of others-of merited ban- 
ishment, unfitness to live, etc. Throwing out epileptics Original Communications. 
14 
and paralytics, it is safe to say that fully two-thirds of the 
insane committed to asylums, suffer from the insanity of 
depression. To such, the unvarying monotony of their 
surroundings is a corroding weariness, and the universality 
of locks and gratings a perpetual reminder that they are 
unfit to be trusted. The most unreflecting need not be told 
how ill-fitted are these to cheer and re-assure. Where a 
pleasing variety of surroundings is an indispensable stimu- 
lant, nothing meets the eye but a sameness that can under- 
go no change whatever. Even his companions in suffering 
remain in many instances the same. The writer was in- 
formed by a gentleman who revisited, after a year's absence, 
an institution with which he had been connected, that in 
one ward of twenty-four patients, one death and one new 
comer were the only change of occupants. Who can be- 
lieve, that knows anything of the effect of change upon 
such subjects, that had all these been turned loose, or trans- 
ferred even to the homely aspects of an almshouse, some 
one at least might not have recovered ? 
The bane of such a state of existence is found in the 
search after stimulants, the most unnatural and hurtful. 
Among men, the craving for tobacco is almost insatiable ; 
and, when withheld, the substitutes are revolting, and worse 
than beastly. And all concerned in the care of such insti- 
tutions deplore, and vainly strive to remedy, the enormous 
prevalence of those secret vices that need not be named. 
But the most universal, and perhaps the least hurtful, of all 
stimulants indulged in by the insane, when subjected to 
this monotonous life, is the gorging the stomach with quan- 
tities of food, often many fold greater than the necessary 
ration for the hardest worked laborer. The amount dis- 
posed of at a meal, by many long-time residents of our 
public institutions, would excite wonder in those professing 
to know the capacity of the human stomach. Other aims 
and objects being wanting, all thought and anticipation is 
for the return of the hour when these feats of gastric dis- 
tention can be repeated. The- Better Way. 
15 
It is often said, in defense of this compacted system ot 
providing for the insane, that it secures a closer and more 
direct supervision on the part of responsible officers, and 
therefore is the best guarantee against the abuses of those 
less responsibly interested. The facts do not sustain this 
assumption. At Gheel, where the separation between those 
held publicly responsible and the objects of their charge is 
as wide as the confines of an entire village, whatever objec- 
tions may have been alleged, that of inhumanity has never 
been raised. Surely, if any man evei' lived whose per- 
sonal character was a guarantee against any thing of the 
nature of an abuse, it was the late lamented Dr. Conolly, 
whose inauguration of a system of non-restraint, at Han- 
well, marks an era of itself. Yet an examination of the 
reports of the English Commissioners in Lunacy will show 
how severely Han well has been censured for the very 
abuses most complained of,Jn modern times, since not 
only have the chains and riveted bars of iron, found in the 
olden time at Bethlehem, been utterly done away with, 
but also nearly every form of personal restraint; what are 
generally now termed "abuses" are quite of another nature. 
They almost universally consist of acts purely personal 
between the patient and his attendant. A book of rules in 
the hands of the latter, breathing the highest sentiments 
of humanity, and dictating every part of his relation to his 
patient, is found not sufficient to prevent collisions, and 
sometimes aggressive acts, in which the patient is doubt- 
less, more or less frequently, the sufferer. So long as 
attendants on the insane are merely men and women, with 
the ordinary power to remain unmoved by vile and insult- 
ing language, keen provocation and sometimes dangerous 
attack, while al the time, perhaps, outworn with sleepless- 
ness and overwork no insane asylum will ever be wholly 
exempt from the charge of this species of abuse. Its remedy 
will be found, not by gathering the patients as closely together 
as a brood of hovered chickens, but in adopting a system 
which preserves, and not quickly destroys, the self-pos- 16 
Original Commu nications. 
session and moral vigor of the attendant. A strength and 
evenness of temper, only found once in a thousand, is alone 
proof against the strain imposed on the attendant, under 
our prevailing system. With little society save the objects 
of his charge ; inhaling for the twenty-four hours of the 
day an oft-times polluted atmosphere, with no relief except 
the brief forenoon walk ; tasked to the extreme by never- 
ceasing duties, often of the most revolting kind, the most 
elastic spirit and temper soon succumbs. Before he can 
have obtained any of that insight into the nature of the dis- 
ease of the subjects of his charge, on which his usefulness 
much depends, he will have become impatient, soured, 
and unfit for further service. Of course, exception is made 
of those rare instances where a very high principle, and 
much of that moral accomplishment termed grace, serve 
to sustain one against almost any physical odds. Thus a 
current of fresh life has to be continually poured into the 
service of our hospitals, to run off' at the end of two or 
three years at the utmost, exhausted of its indispensable 
element. Of those tales of abuse carried from our hospitals 
by discharged patients, that have the color of foundation, 
nine-tenths would be found to proceed either from the 
worn-out attendant, whose ill-humor proceeds from the 
thread-bare state of his kindly elements, or from the novice 
in duty, whom timidity renders hasty and severe. 
Again, while human nature remains as it is, the 
continual presence of the means of restraint or repression 
will be provocative of their use. Where everything about 
breathes the spirit of force, can it be otherwise than that 
the one trusted with its use, under no very heavy re- 
sponsibilities personally, will not abuse it? The Better Way. 
17 
Fancy one or two young men or women, having the 
novel sense of the possession of pozuer-power over twenty 
or thirty others-a majority their superiors in age, natural 
social standing, and, perhaps, intelligence ; with the means 
always in hand to curb, annoy, and even covertly punish; 
will not indiscretion, vanity, and arrogance, under such 
a relation of the parties, give rise to petty oppression 
on one side, and physical resistance on the other? It is 
vain to say that vigilance, on the part of those primarily 
responsible to the public, can prevent this. Nothing short 
of omnipresence would be equal to the task. It is only 
by reducing means and opportunity to the very lowest 
possible minimum-leaving in sight just as little as pos- 
sible whatever is even suggestive of force, restraint, or 
repression, and thereby taking from the attendant rhe ever- 
present sense of power, which is so dangerous, that we 
are to create that new atmosphere in which the moral 
force supplants the physical. In a word, then, the ar- 
rangements, appliances, even many of what are called 
the conveniences, of the insane asylum ward, ,are de- 
moralizing in their effect, as promoting the sense of power, 
and too easily suggesting its exercise. What, for in- 
stance, is more convenient than the bath-tub, accessible 
on the instant, with its bountiful supply of hot and cold 
water always laid on? And yet, for how much of abuse 
is this convenience not responsible? How many scores is 
it made to pay oft'; how many sly grudges to satisfy; how 
it always stands an engine of petty tyranny-a Damocles' 
sword, always suspended? And yet it always does its 
mischievous work under the sober mask of a necessity of 
cleanliness. And so, almost every other convenience and 
facility, designed and fashioned for the use of the insane 
specifically, seems to have elements in it capable of perver- 
sion and abuse. To this point of the subject we shall again 
allude. 
Another grave evil pertaining to our present asylum sys- 
tem, is, the great size and usual style of exterior of the 18 
Original Communications. 
building that generally constitutes the institution proper. 
Three, four, and even five stories, is no unusual height for 
the portion allotted patients, while other parts rise higher 
still, and all made additionally imposing by towers, domes, 
or pinnacles, as taste or means dictate. That buildings to 
serve certain uses, and also, we may add, to express cer- 
tain ideas, should be ornate, and even grand and imposing, 
is not to be questioned. The purity of taste that made St, 
Peter's the grandest creation of mortal hands, and dedi- 
cated it forever to the worship of the Most High, as the 
offering of a universal church, is beyond a cavil. So, also, 
the capitol of a nation or State-the center of its power and 
the fountain-head of its edicts-may express dignity and 
command. The sentiments of awe these inspire, in the 
devout Christian or the patriotic citizen, are every way salu- 
tary. But the insane asylum should awaken no such senti- 
ment, but its direct opposite. Everything calculated to 
repel, as indicative of the abode of state, or the repository 
of power, should be discarded. A. home-like and unpre- 
tentious tastefulness-the quality that invites and assures- 
should mark every feature. The face of a generous host, 
who welcomes his guest to "a rump and dozen," should, if 
possible, be no more cheery than its every out-look. 
We have said that depressing emotions are largely pre- 
dominant among the insane. The insane subject suspects, 
dreads, apprehends. His spirit tends to put itself constantly 
on the defensive. He sees - or construes - in everything 
with which he comes in relation, some agency that is to work 
evil to his interest. In this state he approaches the insane 
asylum, where, it is fondly hoped, his grievous malady is 
to be cured. Its great size and far-seen elevation, so much 
exceeding, in many instances, every thing before witnessed, 
inspire an awe both deep and lasting. A chilling sense of 
the nature of that untried life which the building looming 
up before him suggests, takes possession of him. These 
fears and forebodings are not lessened by the strange faces 
that peer out of the grated windows, story above story, all J'hc Better Way. 
19 
unmistakably reminding him that the pile whose portal 
he is approaching is for one use and no other. All these 
influences serve to impair, if not altogether destroy, the 
hopefulness and mental elasticity that promote restoration. 
They all increase the idea that he is an outcast, doomed 
henceforth to separation from the life of the past. We 
need not follow him within, for we have already seen how 
much there meets him calculated further to depress. To 
the furious madman who needs the strong arm of restraint, 
these first impressions are innoxious, and may even be 
salutary. But how opposed they are to the winning of 
confidence, the removal of insane misapprehensions, and 
to the promotion of the peace of mind of the timid and 
depressed, we need not stop to consider. 
We have before alluded to the ideas, more or less prevalent 
even among the intelligent, that the modern insane asylum 
still contains the cells, dungeons, and dark places, whose 
conception is an inheritance from an olden time. Although 
printed reports by the million, issuing from such institu- 
tions, have been scattered broadcast, the burden of which 
is to disabuse the public mind, there now and then comes 
up a revelation that these ideas are almost as fixed as ever. 
They are unquestionably fostered by the magnitude of the 
imposing piles in which the insane are treated. The pass- 
er-by shakes his head in doubt as to the use of so many 
up-piled stories if they are not to afford concealment of the 
bugbears his imagination supplies. And the casual visitor, 
who makes the usual call of curiosity, is still worse im- 
pressed. Unless he walks about with a plan of the edifice 
in his hands, and "spots" waymarks of his passage, it is 
ten to one that he goes away with the belief that the closets 
containing the skeletons have been skipped-that what he 
has seen is an ingenious blind, like the fictitious machinery 
in Kempelen's automaton, got up merely to hide the sub- 
stance of the imposition that lies behind. Imaginings, in 
such cases, take their form from the apparent possibility of 
their existence ;-the nunnery, with its high wall and com- 20 
Original Communications. 
pact edifice, will always be the scene of dark fiction, while 
the Shaker village, domestic and scattered, affords it no 
room. The argument drawn from appearance merely is 
not indeed a very strong one, but where the effects of ap- 
pearance are adverse to great interests of humanity, their 
correction is one of the first steps in the way of advance. 
And is it not true that any system really adapted to its 
end will vindicate itself, not in the fact alone, but in the 
appearance also ? It will be time to complain of a too credu- 
lous and censorious public when the exterior of the insane 
asylum shall be of a style that of itself provokes no suspicion. 
It is often said that our insane asylums, usually number- 
ing their three, four, and even five hundred subjects, are 
each too great a charge to be safely imposed upon a single 
responsible head ; and this is, in a modified sense, quite 
the fact. But the charge weighs heavily, not from the 
physical labor involved, nor from the administrative care 
exercised, nor even from the amount and variety of thought 
needed in the treatment of such a multitude of cases. It 
exhausts rather from the never-ceasing sense of responsi- 
bility which the conscientious man feels in being the re- 
pository of the well-being of so many of his suffering and 
innocent fellow men. He can never forget, for an hour, 
how many hopes rest in him, and how many disappoint- 
ments follow his want of success. This feeling attends 
him in every round he takes among the objects of his 
charge. To form some faint conception of the exhausting 
nature of this apparently easy task, let the reader take in 
his hand even ten photographic likenesses of as many of 
his best-known friends, and, as he passes them in succes- 
sion before his eye, devote three minutes of undivided 
thought to each,-recalling a full ideal of the expression 
of countenance when last seen, the facts of the person's 
history, his traits of character, and all else pertaining to 
him, so abstractedly that the individual will, as if in per- 
son, have passed before him, and observe how the mind 
will have become wearied over even so short a list. And The Better Way. 
21 
yet this process must be gone through with daily, to many 
hundred times the extent, involving recollection, compari- 
son, and judgment, by every one in such a trust, if he 
professes to bear on his mind his full responsibilities.-the 
individuals themselves being before him and not the pic- 
tured representations. Now, it is a well-known fact, that, 
as our institutions are peopled, fully three-fourths of all 
those his eye at any moment rests on, are, save almost by 
miracle, utterly beyond hope of restoration, and need little 
care except the supply of common wants. Yet his mind, 
in dealing with the mass, can make no relieving distinc- 
tion. As the classifications of no insane asylum are based 
on the element of curability, all weigh heavily alike. It 
is a great body of suffering, which he can only see in the 
overpowering concrete. It is impossible, save by special 
effort, to distribute thought and attention according to the 
degrees in which it is really demanded ; and hence atten- 
tion is bestowed on those to whom it is nearly valueless, 
which should have been paid to those on whom it would 
have been profitable. Energies which should be husbanded 
have been frittered away because those to whom they are 
directed have been improperly brought under view. If 
the system through its own working, could establish these 
distinctions, and responsibility be made to press only where 
it ought, we should hear less that the heads of such institu- 
tions are so often overworked and short-lived men. 
From the foregoing considerations we have seen that 
the fundamental error of asylums upon the Bethlehem 
model consists in holding to the idea that insanity is an 
absolute condition, and not recognizing the essential fact 
that it is as wide in degree as the shades of physical dis- 
ease, each shade needing its own conditions of treatment. 
What would be thought of the practitioner of surgery who 
condemned every injury of a limb to the fixedness of the 
starched bandage; or of the physician who considered 
going to bed a sine qua non in his treatment. Such a Pro- 
crustean condemnation would be pronounced an absurdity Original Commitnications. 
22 
at once. The system would be regarded as wofully defi- 
cient in expedients that had no wider range. If the limb 
needs mechanical appliances of any kind, is there not an 
immense choice, for the patient's comfort, between the 
immovable and unyielding fixture supposed above, and the 
milder one that performs its office just as well and yet allows 
a harmless liberty of motion? The steadfast adherent of 
our present asylum system, we fear, has no other argument 
than the surgeon above supposed would urge in support of 
his practice,-"it holds things tight." If this were the be 
all and the end all, in both cases, the argument would hold 
unquestionably good. It is the experience of all institu- 
tions, and all customs that depend on the advance of sci- 
entific knowledge, to ameliorate their earlier harsh aspects, 
and better adapt themselves, in the lapse of time, to the 
wants of the human race. How much has surgery parted 
with its terrors since boiling oil and the actual cautery have 
gone out of use, and, under the blissful unconsciousness of 
anaesthetics, the most formidable operations are performed 
during the changes of a dream I How much is the sweat 
and toil of the agriculturalist lessened by labor-saving dis- 
coveries ; how much are all the pleasures of life increased 
since fundamental principles are better understood and ap- 
plied ! With these changes in mind, it is the inevitable 
tendency of modern thought to run the plowshare through 
even many well accepted usages, to see if the upturning 
alone will not prove beneficial. God's truth-that which is 
eternal-is good bccatise it is old ; while the very reverse 
must apply to all things of human ordination. 
We have seen that, for some centuries, the insane asy- 
lum has adhered to one fixed type; and have shown, in 
all fairness, in what manner its bolder features have been 
softened in more recent times. But it cannot have failed 
to appear that the entire system is much behind the com- 
mon sense conceptions of thinking minds. In proceeding 
to consider the remedy for evils thus brought under review, 
the leading ideas that should govern the association of the The Better Way. 
23 
insane for treatment will first be stated, and each treated as 
briefly as an understanding of the subject will admit. 
1. The largest practicable amount of direct and free 
■contact between the insane and the sane mind; or, con- 
versely, the least massing of the insane element, by which 
it acts and re-acts upon itself. 
2. The banishing from the system of treatment of every- 
thing possible, deemed distinctive in the control of the 
insane, whether it be in the material form of an architectural 
arrangement or a mechanical appliance, or whether it be 
in the form of a custom or usage, where its abandonment 
is not plainly inconsistent with health or safety. 
3. The limiting of confinement, repression, or restraint 
to the individual case alone where it is indicated; the re- 
garding such a case as the exception to the rule which 
would remove the insane as little as practicable from the 
surroundings and customs of ordinary life. 
No remark is more common among those of the insane 
who retain a sense of their own condition than-"Its enough 
to make a well man crazy to be shut up with such com- 
pany"-an idea which must have often impressed the vis- 
itor, who, for the first time, pays an understanding visit 
to the wards of an asylum. Even in the mildest grade 
of cases, the uniformity of suffering reflected from each 
other's faces is an element of constant depression. Mute 
suffering is more eloquent, and its silent appeal more dis- 
tressing, often, than the most demonstrative. A single 
object of woe is exhausting enough to contemplate, as 
most have realized ; how much more then when the objects 
are multiplied by scores, and constitute the entire mass. 
To this uniformity, the relatively insignificant number of 
attendants, occupied, as they are, with duties that leave 
little time for cheer or converse, afford almost no break 
whatever. The infrequent visits of medical officers, or 
casual visitors, produce a brief brightening up, to be im- 
mediately followed by a relapse into the same melancholy 24 
Original Communications. 
vacuity. Nor are the insane good consolers of each other, 
but generally the direct reverse. Every one's own expe- 
riences render him selfish, and his language to his asso- 
ciates is anything but that of cheer and comfort. It is 
often said that ''insanity improves no man's morals;" and 
it is vain to look for mutual love and forbearance, or for 
the exercise of patience and sympathy among those who, 
under natural circumstances, have not learned to cultivate 
such graces. 
As this evil is one of the most apparent, it has most 
engaged the thoughts of those seeking to promote the good 
of the insane. We have before seen how far short even 
the best devices for relieving the tedium of in-door life 
among the insane fail of making any real impression on it. 
The checker-board and the often-thumbed cards are but an- 
other name for idleness ; pictures, after a glance from the 
more intelligent, are of little more account than blank sur- 
faces ; and the gaping listlessness of an audience of the in- 
sane, in attendance upon an intellectual performance, must 
show how feeble are all these as a substitute for what the 
average mind among this class substantially craves. None 
of the insane, whose minds and bodies are capable of being 
exercised at all, are satisfied with these make-believes. 
They are confessions of the importance of recreation, but 
very slight steps towards supplying it. The want of some- 
thing to do which shall show actual results, is that which 
the insane feel as do others, though not, to be sure, in the 
same degree. All that remains in him, capable of being 
built upon, is best fostered and encouraged by letting him 
prove that he can do things much as other people do them. 
Hence the necessity that the insane shall be brought, in 
the highest practicable measure, into contact with people 
in ordinary relations and doing the world's ordinary work. 
The success claimed for the Gheelor's system (that pur- 
sued at the hamlet of Gheel, before alluded to,) is all 
based upon the above-named principles. It is the close 
intermixture of the two elements, of mental health and The Better Way. 
25 
disease, that acts so favorably upon the latter. The low 
grade of general intelligence manifested by the ordinary 
villagers of Gheel has been subject of frequent remark ; 
yet that seems no objection, and may even be an advantage 
so long as they well comprehend what it is their set aim to 
do, which is to make their erratic guests comfortable and 
happy. They are forced to win the love and confidence of 
those committed to them, from the general absence of other 
means of control. One common habit becomes established, 
of an overseeing forbearance on the one side, and deference 
and willing obedience on the other. An act of abuse, per- 
petrated by an individual, is a blow at the common good 
name and interest; and the qualities of mind and heart 
that would endanger its repetition would make their pos- 
sessor an outcast from the community. The unfavorable 
criticisms sometimes expressed upon the Gheel community 
have invariably come from those educated in the Bethlehem 
system, who comment on a certain absence of the order, 
neatness, and regularity which the latter system can un- 
questionably enforce. Whether the "mint and anise and 
cummin" of well-blacked shoes, starched collars, and regu- 
lar processional walks are first considerations, and there be 
no "weightier matters," is worth careful thought before a 
superficial criticism is fully accepted. And it may seriously 
be called in question whether the perfectly orderly arrange- 
ments insisted on among the insane, gathered promiscuously 
from our rural population, before unused to such strictness 
of life, are not an irksome restraint, doing more harm than 
good. Is the exchange of the sun-browned face, unkempt 
locks, and firm muscle of the insane man, accustomed to 
all vicissitudes of "skyey influence," for the pallor, flabbi- 
ness, and appearance of high grooming, distinguishing him 
under the rule of standard asylum life, one that bodes hap- 
piness or long life to the subject? Would greater length of 
days have been assured Madge Wildfire, Barnaby Rudge, 
Crazy Kate, or any other of the true types of insanity found 
in the page of fiction, if the wild robustness of the picture 26 
Original Communications. 
was toned down and bleached out by the kind of life we 
have commented on? 
The good effect in the Gheelor's system, resulting from 
this intermixture of the two elements, has been successfully 
obtained in some other European institutions, by placing 
the more mild of the chronic insane as out-boarders among 
the surrounding rural populations,-the institution respon- 
sible for them still maintaining its supervision. In Scot- 
land, particularly, this plan is said to work well. But 
among the corresponding class in this country, the desire 
to "turn an honest penny' by assuming such a charge 
would not be so universal, and the real or fancied risks 
have prevented the adoption of any such measure. Yet 
ignorance and prejudice are the chief obstacles to such a 
plan, which has many strong arguments in its favor. If 
the superstitious fright aroused by the word "crazy" could 
be made to yield to a reasonable enlightenment, and the 
able-bodied but incurably insane could be allotted, under 
due restrictions, to the charge of neighboring agriculturists 
of known character, for brief experimental periods, the 
aggregate of bodily health and of happiness would unques- 
tionably be increased. Every one of extensive experience 
in the management of asylums has had his pride of science 
not a little taken down by the sight of the recovery, or 
very great improvement of his patient, after exchanging 
his own long protracted treatment for the no-treatment of 
some homely almshouse. 
We have before adverted to the fact that of the abuses 
that form the staple of complaint in patients lately resi- 
dent in our asylums, nearly all the justly grounded ones 
will be found to proceed from the existence of features that 
are distinctive of such establishments. The strong room, 
whose door may close at any time on the refractory, at the 
caprice of his attendant-the handy bath-tub, admitting 
almost any amount of abuse with impunity-not to speak 
of the "camisol" and "waist-strap," where these are still 
retained-with many kindred appliances and conveniences, The Better Way. 
27 
are too easily turned from their legitimate use into instru- 
mentalities of evil, to be viewed only with distrust. All of 
them are, at the best, evils-possibly necessary ones-to be 
dispensed with most rigidly, wherever the necessity for 
their continuance is not most apparent. Let us be under- 
stood : it is not the things themselves that are the subject 
of condemnation, but the temptation to and facility in their 
unwise use, given by a system of association and control 
inherently vicious. 
To take, for illustration, a single one of these, the bath. 
This is, most unquestionably, a highly important hygienic 
appliance, whose well-considered use confers decided bene- 
fit, as a special measure in particular cases, and whose 
general use, especially at certain seasons of the year, may 
safely be enjoined. In every institution claiming to be 
complete, this instrumentality will be found in every ward, 
placed in close proximity with the water-closet, for the 
sake of direct sewerage and water supply. Its very " handi- 
ness" is a strong temptation to its indiscriminate use, which 
is synonymous with its abuse. Its aid is often invoked, 
through sheer indolence, for purposes to which a basin 
and sponge would be better adapted. Now, while grant- 
ing, as above, all the value of the water-bath, let the 
general reader ask himself the question, how many of the 
average of men and women in his knowledge give them- 
selves the benefit of this luxury-if so it be termed-so often 
as even once a week? And in the houses of the wealthy, 
supplied with "all the modern conveniences," how generally 
it will be found that the bath-tub is merely the repository 
of the mops, buckets, and scrubbing brushes of the house- 
maid. It is like the sacred spring of the jolly friar of Cop- 
manhurst; or, rather, a fashion, which everybody extols 
and nobody uses. In cold, or even temperate climates, it 
has never established itself as an habitual usage, nor in 
any other, except where made a semi-religious rite. Man 
can not be made an aquatic animal, any more than any- 
other not born web-footed. To more than nine in the ten 28 
Original Communications. 
of those admitted to our asylums, recumbency in a bath-tub 
is a most novel and strange situation. A great proportion 
regard it, and treasure it up in memory, as a punishment. 
As such, it is often approached with a scream, a struggle, 
and a conflict, in which the weaker party has to yield. 
And what an opportunity to call to mind some past offense, 
and hold the subdued party under water, or apply the 
douche particularly cold, till better things in future are 
promised. No humane regulations, and no possible vigi- 
lance are proof against such perversions. The temptation 
to the abuse is ever at hand, and its discovery well-nigh an 
impossibility. 
In the same category are many other things which irre- 
sponsible power may avail itself of, and always have plausi- 
ble excuse or defense. From those who can have no idea 
whatever of the objective impressions of the insane (and 
it must include nearly all who accept subordinate service 
in our institutions), who abound in such remark as "he 
knows better"-"might do better if he would," etc., nothing 
else can be expected than if the means of compulsion are 
placed in hand they will be employed. The high blame 
rests on those who, knowing the inevitable consequences, 
countenance the evil in countenancing its opportunities. 
It is a feature of most great social reforms that they pro- 
gress by distinct steps, often taken at wide distances of 
time. Reform seems to requite ample breathing time be- 
tween each effort, and to view each advance with a long 
look of satisfaction before making another. This habit 
has particularly distinguished the reforms in the treatment 
of the insane. After Pinel had inaugurated a new era, pro- 
claiming that the insane were no more to be chained up as 
wild beasts, the world had to look with fifty years of admi- 
ration upon the triumph before it could bethink itself that 
something more remained to be done. Then came another 
loudly heralded achievement, the disuse of all mechanical 
restraints whatever, of which Drs. Conolly, Charlesworth, 
and Hill each claimed to be discoverers. But one other The Better Way. 
29 
grand step, in our conception of the subject, remains to be 
taken ; which is, to cease altogether regarding the insane as 
separated by a distinct gulf from their fellow men,-to cease 
regarding insanity as an absolute condition, operating as an 
utter disqualification, and tabooing its subject, as soon as the 
fact is known, from ordinary human relations, but coming 
to regard it as an idiosyncrasy merely, requiring a change 
of residence to be among those who understand the nature 
of this idiosyncrasy, and can regulate the impressions, fa- 
vorable or unfavorable, that bear upon it irom without. 
The insane person is often as one who has a local sore, 
which only spreads and involves the constitution after it 
has become irritated by unwise applications, when, by a 
simple covering from the atmosphere, it would have healed 
of itself. It is one of the more wretched fortunes of the 
insane that the world has so long been accustomed to re- 
gard his state as an absolute one ; that, as soon as it has 
been whispered abroad, its subject finds himself often at 
arm's length with the rest of the world, viewed with dis- 
trust, gazed on as an anomaly, and given to understand, 
on all hands, that a mysterious something makes him a 
social exile. Cold looks and lapse of confidence kindle 
into a flame what otherwise would have died out, and, as we 
have seen, every curb and fetter added, drives onward into 
ungovernable frenzy. 
Asylums upon the Bethlehem system have all been 
founded under the influence of these views. Their whole 
idea, from foundation stone upwards, is, that if all to be 
entertained are not absolute jail-breakers, they so certainly 
may be that a wholesome curb must be about every one 
without distinction, to be tightened at will. In no other 
instance has a set of old and fixed ideas so perpetuated a 
style of structures, or the structures themselves so reacted 
to fix and confirm obsolete ideas. Yet vast and costly 
masses of stone and brick are not proof against the up- 
heaval of correct ideas. All the asylums on the Bethlehem 
model on the western continent are probably not of greater 30 
Original Cowniunications. 
cost than the American navy at the breaking out of the 
late civil war. Yet a single afternoon's experience in 
Hampton Roads converted it all into useless lumber. 
We now come to consider what should be the true rela- 
tion of the insane toward surrounding objects, whether 
they refer to his control, his recovery, or his due share of 
common human happiness. We have, all along, accepted 
the idea as correct, that the best good of the insane is, as a 
general rule, promoted by removal from the scenes of his 
ordinary life. There is no question that the objective im- 
pressions of the insane are far more perverted, and become 
more fixed, when among those with whom they have been 
accustomed to have close relations, and among scenes with 
which they have always been familiar, than where those 
persons and scenes are totally changed. Hence the insane 
asylum in some form, is an absolute necessity in all civil- 
ized society. The question now becomes, Shall the Beth- 
lehem system, whose imperfections we have sufficiently 
considered, be perpetuated, or shall the other, which we 
shall term the Natural system, be adopted? The various 
names applied to the latter, such as the " segregate sys- 
tem," "cottage system," or "colony system," all imply the 
same thing; which means, a style of community associa- 
tion made so elastic, or upon a sliding scale of such easy 
working, that it presses nowhere save where individual 
repression is plainly required, leaving all else in the pos- 
session of a wholesome and enjoyable freedom. The only 
objection ever made to this great step is the time-honored 
argument of Noodledom-"It looks all very well in theory, 
but won't do in practice"-as if the experiment of hundreds 
of years at Gheel, despite all the crudities of that experi- 
ment, had not demonstrated its full practicability. 
The American insane asylum system was taken bodily 
from systems in vogue in England at the time of its adop- 
tion, and has closely followed the development of English 
ideas. The thought has never seemed to occur that our 
social and political institutions, especially the latter, have The Better Il ey. 
31 
wrought a state of society that make a purely English 
model the very last we should have adopted. To this day 
it seems almost impossible to establish a class of institutions 
in England corresponding to our American state institu- 
tions, where the rich and poor meet on a common ground, 
and no distinctions are recognized. The public institution 
there is a receptacle for paupers, or those verging upon 
that state. It has gradually molded itself to the purely 
English idea of pauperism, with insanity as its attendant. 
The paralyzing maxim, always in the mouths of English 
poor-law officials, "once a pauper always a pauper," has 
been powerful to fix the type they have inherited from their 
fathers. To lift men out of pauperism, by seeking out a 
system that shall develop manliness, independence, and 
self-reliance, is an idea that seems not yet to have dawned 
upon their field of social science. This idea of pauperism, 
as a fixed state, is a sore upon the English body politic 
that it just begins to feel. It has invaded the whole system 
of union relief, till the complaint begins to reach us that their 
favorite term "Work-house" has become a misnomer,-labor 
being the last thing thought of in a place bearing the name. 
If any superintendent of an American asylum ever finds 
among his subjects, one stalwart and vigorous, eating his 
rations with rare promptitude but utterly impervious to the 
idea of work, it is ten to one that his pauper education was 
gained under English training. Given a lunatic, and at 
the same time a pauper, and the remainder of the problem 
is, how to hold him tight, and lodge and feed him cheap. 
For these ends an asylum upon the Bethlehem model is 
as good as any-perhaps the best. American pauperism 
should only be an exceptional and transition state; and 
every institution should be framed to render that state 
as brief as possible. Hence no eleemosynary institution 
should be countenanced that does not make a well-adapted 
system of profitable employment its very foundation ele- 
ment. The eating of the bread of idleness, that so surely 
saps the foundation of manly independence, should be for- 32 
Original Communications. 
bidden where possible, as a two-fold evil. It will be objected 
to this, that the attempts hitherto made, and no doubt faith- 
fully, to introduce systems of labor in our asylums for the 
insane have failed, as remunerative undertakings. But 
these experiments have never fairly tested the question. 
They have never been tried under circumstances at all 
favorable to their success. But let an institution be organ- 
ized and built with the idea of systematized labor as the 
foundation element, and the imagined difficulties would 
vanish at once. 
Two distinct types of asylums for the insane will thus 
present themselves to the American mind for adoption, 
when opinion shall have setted down to its proper basis. 
The one will be for the pauper and more indigent classes, 
of plain and domestic style, where well devised labor 
will present itself, with facilities and attractions making 
it profitable and easy. The institution at Clermont, in 
France, with its adjacent industrial community of Fitz 
James, is the best existing model for this form. Here 
labor is made an attraction and a habit, which may be 
promoted by awards or payments to individuals in cases of 
marked success. Very few of the physically able among 
the insane, as we have shown, but will be made infinitely 
more happy in seeing that they are no longer blanks in the 
world, but filling a sphere of usefulness, of which a tan- 
gible reward is the most pleasing evidence. Many a man 
who, under existing systems, rots away in hopeless idleness 
and vacuity, feeding on the sensual and base stimulants we 
have alluded to, would at once be lifted into new life, and 
gain a new lease of the priceless boon of reason, if the 
system under which he is placed fostered the germ of am- 
bition in him, however feeble it might have become. 
The other type will be that adapted to the requirements 
of those more favored of fortune ; where the gratifications 
of a more Eesthetic taste will demand a style of construction, 
still domestic but more ornate than the other, and where 
access is had to different forms of employment, or recrea- The Better Way. 
33 
tion. It is useless to say, in this connection, that no dis- 
tinctions should be made-that what is good for one is 
good for all-that such discriminations are not in accord- 
ance with the spirit of democratic institutions. As well 
might it be said that all seminaries, hotels, and boarding- 
houses must be kept on the same scale of accommodation 
and price, or that no household in a city shall exceed 
another in architecture, furniture, or amount of expendi- 
ture. With increasing wealth and social advancement 
these distinctions become more defined, and the law of 
demand and supply will be as imperative as in all things 
else. 
The state or public institution, which is to be a burden 
upon taxation, should be established with every possible 
requisite for self support. Its area of lands should always 
be ample for the production of all its dairy and vegetable 
supplies. There is no excuse that these lands may not be 
fertile, or easily capable of becoming so by the fertilizers 
gendered upon them. The supply of pure, soft water from 
abundant perennial springs, or from a running stream be- 
yond possibility of failure in the greatest droughts, should 
be absolutely without doubt. There should be declivity 
enough for easy drainage. The want of any one of these 
essentials should promptly condemn any proposed location. 
After the many sad experiences arising from the ignoring 
of these prerequisites, any future mislocation of such an 
institution can only be explained on the ground of gross 
ignorance or absolute corruption. While a general scope 
of territory may be prescribed, for the sake of easy access 
for its populations, any "bidding" for location is liable to 
prove a most costly error, which no amount of money in 
the future can correct. 
The site being determined on, the great general idea 
to be kept in view is, that upon it a community is to be 
founded of men and women of like wants and tastes with 
all others, having among them certain exceptions of con- 
dition, to meet which peculiar accommodations are neces- 34 
Original Communications. 
sary. In the foreground, or as a central nucleus, as taste 
or convenience may dictate, the principal building, having 
two well-defined sets of apartments, for the excited and 
the sick, may be placed. The style of building which we 
have condemned, as hitherto indiscriminately used, may 
serve as the type of this. Instead, however, of having 
rooms on both sides of a central corridor, one side should 
be open to a full flood of light. Of course all regard 
should be had to ample warmth and thorough ventilation. 
With regard to the former, the idea should be discarded 
that steam heating is absolutely necessary in apartments 
for the insane. The application of steam in warming 
buildings, by a species of false logic, has been, of itself, a 
cause of evil, in the prolongation of our present system. 
"Steam heating is the most safe and convenient of any in 
apartments for the insane; steam heat is relatively cheap- 
est when used on a large scale; therefore, all buildings 
for the insane should be large;" is a syllogism, however 
absurd on its face, which has had more general use than 
is suspected. This form of heating involves large original 
expense, constant outlay for repairs, and a costly set of 
unnecessary officials. Neither does experience prove that 
it is any more healthful, sufficient, or agreeable than the 
heat afforded by the late improved ventilating furnaces. 
This building should not be more than two stories high, 
not including basement, with an attic above. In the latter 
should be placed the water tanks, communicating at will 
with a water-heater below, through which hot water may 
be distributed. The water-closets, sinks, and bath-rooms 
should be separate apartments; the latter always locked, 
and the key kept by a responsible officer, who should 
always be present when it is used. 
The general kitchen and store-rooms should be detached, 
though in near proximity to the building just named. Here 
the bread-making, and meat and vegetable cooking should 
be performed, and distributed as we shall mention. The 
laundry may be either connected with this, or made a The Better Way. 
35 
distinct department at convenience. The latter would be 
preferred, as removing to a distance everything offensive. 
The general bath-room, for the entire community, might 
well be in connection with this, with conveniences ample 
enough for the use of many at the same time. 
The chapel and assembly-room should form a center, of 
itself. Here, more than anywhere else, more ornamenta- 
tion should be observed. This edifice should be of tasteful 
style, clearly showing its purpose in its exterior Its site 
should be the most agreeable, and the avenues leading to 
it should be emphatically "ways of pleasantness." On 
the sabbath the same observances in dress-the wearing 
of bonnets by females, etc., should be cultivated, precisely 
as in ordinary communities. All the extraneous delights 
of church-going-and they are not few-should be sedu- 
lously maintained. The preservation of one suit for special 
occasions-so difficult to secure in ordinary hospitals-will 
be infinitely promoted by the universal desire to appear in 
public in the "Sunday's best" The important principle of 
self-respect thus gets a stimulus that lasts the entire week : 
and its cultivation, in many where it has been neglected, 
would be the first step in the way of recovery. The chap- 
lain should be, first of all, a common-sense Christian, 
whose ministrations should shine with the pure and cheerful 
lights of Christian truth, with none of the side obscurations 
of the mere sectarian. 
We have, thus provided, a body or center, from which a 
a community of the insane may expand, by a species of 
radiation, to any desired extent,-even to thousands, should 
such a reach of numbers be anywhere thought best. To 
those who can conceive of the millions of population to be 
gathered under one state organization, as must obviously 
be the case in many instances in our Union, such accumu- 
lations will not seem impossible. 
With regard to the ordinary habitation for such of the 
insane as need nothing of restraint beyond a proper vigi- 36 
Original Communications. 
lance on the part of their attendants, time and experi- 
ence alone can decide that which is best adapted. Those 
considerations of locality, convenience, fancy, or means, 
which decide the style of ordinary dwellings, may be left 
to settle this as safely. The subject should not be ham- 
pered by prescribed forms. 
As a single type, may be suggested a building, with a 
few distinct rooms at its extremity for a married attendant 
and his family, the major part of its space being laid off in 
a spacious saloon, well-lighted at its sides, with a row of 
adjustable iron bedsteads between the window's, made to 
turn up during the day in a case to resemble a common 
ward-robe; or, what would be equally unobjectionable, 
ranges of berths similar to those of a sleeping-car or steam- 
boat cabin. In the basement may be the sink-room, fur- 
nace, coal-room, and kitchen conveniences for cooking for 
the sick, and making tea and coffee, with a drying room 
for airing wet clothing or bedding. A most important 
adjunct to the sink-room is an apartment where coats and 
slippers may be exchanged for over-frocks and thick shoes 
or boots, and wrhere the latter may be brushed. The 
center of the saloon would be occupied by the dining- 
tables, made in extension form, capable of being reduced 
to center-table size, for social use at other times than at 
meal hours. This style, thus briefly outlined, would serve 
for the use of all male patients for whom out-door or shop- 
labor is adapted; and. indeed, for all classes who need no 
strong control. In no other way could such be so cheaplv 
accommodated, or more removed from the objectionable 
features of present asylum life. Much the same style of 
lodgment would be adapted for females, but with work 
rooms above. • 
All of the purposes of classification, so much valued in 
the treatment of the insane, would be as fully served in 
this style as in any other ; different buildings, with varying 
degrees of ornamentation or better furnishings, being pro- The Better Way. 
37 
vided for such as retain an appreciation of such surround- 
ings, or to whom a transfer to ordinary or better styles of 
lodgment or the reverse, would be a stimulus to self-control. 
In a suitable relation to the habitations of patients should 
be the grounds for tillage purposes and the workshops. In 
the latter may be pursued the kinds of in-door labor known 
to be well adapted for all classes of the insane not either too 
excited and erratic for application, or too demented. Two 
main conditions are required in selecting from the great 
range of manual employments those which the insane can 
pursue, with advantage, viz., those involving least cost in 
raw material, and pursued with implements least capable 
of being dangerous in their use. The manufacture of husk 
mattresses and mats ; broom and brush making ; weaving 
and whip braiding,-are all labors requiring the use of no 
dangerous tools, and consuming material largely of culture 
on the premises. So, also, the canning of fruits and vege- 
tables, and the putting up of flower and garden seeds, the 
curing and pressing of culinary and medicinal herbs. These 
alone, not naming many others, furnish ample and agreea- 
ble employment for any number of the insane. In the rais- 
ing and putting up of garden seeds alone, employment for 
both sexes, for a large portion of the year, might be ob- 
tained with but a reasonable effort. 
It will be seen that, by the adoption of styles of building 
devoid of extraneous ornamentation, by discarding as much 
as possible the cell arrangement, and ceasing to regard 
steam heating as necessary, the cost of providing for the 
insane will be reduced at least one half-which is no small 
consideration in view of the immense grants now habitually 
called for when an insane asylum is to be established. It 
is not possible that the public resources will long be con- 
tent to erect buildings in the styles hitherto in vogue, which 
now cost at the rate of fifteen hundred dollars for each one 
accommodated, with an expense of annual support quite in 
proportion. The sentimentally of benevolence-which has 38 
Original Communications. 
become almost a vice in our times-that which points with 
gratified pride to the turreted or domed palace for the in- 
sane, must apparently give way under the pressure of taxa- 
tion at no very remote period. The people will not long 
pay for what is sooner or later discovered to be merely a 
false sentiment whose origin we have sufficiently dwelt 
upon. 
The objection which will be first raised to an asylum on 
the plan outlined above, will be, its want of security. To 
those not conversant with the habits of the insane when as- 
sociated for treatment, this objection will seem plausible. 
But the fact should be kept in mind that the insane escape 
from asylums not always to reach some one other particu- 
lar place to which they are more attached, nor solely to 
get away from one they abhor, but more to indulge a spirit 
of vagabondage, which becomes a passion in some cases. 
These inveterate runaways are a well-marked and distinct 
class; and their never- ceasing centrifugal instincts are as 
strong when at their own homes as when in an institution. 
Ordinary locks and gratings, and ordinary vigilance, are 
not always proof against the strength and cunning of this 
peculiar class. The only way in which this habit of va- 
grancy can be broken up is by the inculcation of habits of 
fixed industry. Restraints, always visible, intensify the 
passion; while a certain air of freedom, and, above all, 
habitual and easy employment, cause it gradually to die 
away. 
But at bottom the true objection to this system will be, 
its substitution of the somewhat more laborious plan of direct 
personal supervision for the easy and summary one of the 
secure lock. This latter hears no arguments, is deaf to all 
pleadings, is worried by no fretfulness, and is an easy end- 
ing of all unpleasant responsibilities. "You have your 
man behind a strong bolt, and there he is ; but you have 
him outside the bolt, and where is he?" This qucestio cru- 
cis is the short one, that contains all the argument. The Better Way. 
39 
We have thus presented the requirements, in outline, of 
a state, or public, institution. The nucleus being prepared, 
its extension to any degree is left to circumstances as they 
may arise. 
The same general principles should be adhered to in pro- 
viding for those of the insane whose condition in life allows 
the use of accommodations adapted to a higher order of taste. 
It must be borne in mind that this treatise does not deny the 
necessity, in all institutions for the insane, for some apart- 
ments where strength and security are the leading features. 
Fortunately, in those cases demanding this form of accom- 
modation, the sense of appreciation of those surroundings 
that appeal to the eye, is, for the most part, wanting. We 
suppose, in an institution provided for the classes more fa- 
vored of fortune, a more limited scale as to extent, but a more 
careful regard for elegance of surroundings than is allow- 
able in the other. And here again we would advert to the 
fault appertaining to most of those things relied on to furnish 
what is called "recreation" among the insane in our institu- 
tions. They become distasteful because they are in a man- 
ner forced on those who are intended to profit by them. It 
has been aptly said that "happiness" is something that hap- 
pens." To none does this apply more surely than to those 
whose sense of enjoyment has become weakened. Sources 
of pleasure should appeal to such minds with the least pos- 
sible show of intent. Those provided by nature are, of all 
others, by far the best. A rustic seat, into which the loit- 
terer drops by an invitation he does not hear, placed to open 
pleasing view that needs no officious pointing out, affords 
a style of enjoyment that cannot help being salutary. If 
there can be a picture gallery into which he can saunter 
without being reminded that it is for him, because he espe- 
cially needs it; or a conservatory, a museum, or aquarium, 
to which he is led by the same kind of invitation, the sources 
of his enjoyment are multiplied. 
But we have carried these observations quite far enough 
to show the intent in view, which we believe the reader will 40 
Original Con? m u nicat ions. 
fully understand. It has been, to call back the philan- 
pic mind from a false departure, taken centuries ago, and 
unfortunately followed up through a set of false ideas most 
pertinaciously adhered to. If the ideas here advanced are 
founded in reason, they will surely take root in a country 
like ours, where the question is now being most anxiously 
put-"What shall we do with the enormously increasing- 
number of our helpless insane?" 
Oak Lawn (near Jacksonville, Ills.), May 14, 1872. 
Corrections-Page 15, 17th line from top, sentence closes with word 
"of." For "Gheelor's" read "Gheelois."