1845, The Principles of Medical Psychology, Ernst von Feuchtersleben.

Treatment


To an over-excited will, we oppose removal of the object [i.e., that excite the will]..., repose, solitude, especially in combination with darkness and silence; and in the higher degrees, restraint. This restraint, whether it be purely psychical , by inspiring awe, or whether it be effected by corporeal means, as by fetters, &c., is a necessary condition in psychical cures. [...] Every insane patient must be treated, according to circumstances, at the commencement of his disorder with uncompromising firmness. The commands should be short and decisive, but such only as can be carried into effect. Corporeal restraint must be carefully adapted to circumstances. There lies a peculiar controlling power, especially in men of great vital energy, in the eye; we know that this power, which Neumann attributes to a light actually emanating from the optic nerves, is applied even to animals, as, for instance, in shoeing horses. The English call it "to catch or meet the eye," and Esquirol frequently mentions that he looks steadfastly at his patients. Here, again, it must be borne in mind that the physician who would exercise this kind of magnetism ought to be sure of his success, or he will make himself ridiculous.

The psychical influence is effected by an individuality of the physician, to which that of the patient (for the most part females) becomes subject or passive, so that the spontaneity of the latter is, as it were, merged in that of the former. In cases of great susceptibility on one part, and of great energy on the other, this rapport is often produced by the mere look, often too without intentional influence.

The remedial dietetics of the mind (as the prophylactics of psychopathies), are those among the psychical remedies which are applicable to a still healthy personality. [...] That strength of mind is partly a prophylactic against the psychosis is evident from this circumstance, that the energies of the functions and organs in general, and in this instance, therefore, those of the functions of thought and of the organs of the brain, help reciprocally to develop and heighten each other. Hence it follows that the individual concerned can not only contribute to the prophylaxis, but must himself have the chief share in it. Its basis is, therefore, self-knowledge...; its sum and substance, self-command. Here, then, we are at the limits of our medical domain, actually on the confines of ethics; and, in fact, as Schiller, in a physiological view, so Esquirol, led by psychiatrical observation in a pathological view, recognises virtue as the moral aegis of physical health. That the diffident man should not wholly rely upon himself, but, where his own judgement is not sufficient (as in choosing a profession, in contracting marriage, in various other affairs, &c.), should seek the advice of a qualified psychological physician, ought to be understood as a matter of course.

The first problem of mental-dietetics, is to make ourselves objective; that is, to acquire self-knowledge. After understanding our psychical relations, the second problem is to harmonise them; that is, to do away with the preponderance of one tendency over another. Above all, it is requisite for our purpose that fancy should be restrained and kept in subordination. [...] IT is very necessary that we should in particular excercise ourselves in recognising and internally balancing these ever-fluctuating extremes of life-- joy and sorrow, in order that... the equilibrium may be restored. Lastly, let a genuine religious state of min, "the free relation of man to a superior power," that aegis against everything mean, morbid, and destructive, in faith and moral conduct be preserved, and we shall be able to look from within with tranquility on the threatening terrors of insanity.
All this must be effected and enforced by the physician, as a psychagogue or instructor of the mind, where the individual himself in not equal to it.
Langermann, if not the first, was, at all events, the foremost to compare the treatment of mental disorders to education, and to advise mental development and cultivation with a therapeutical view. As a prophylatic, it is fully adequate to its object... . Children and lunatics are said to have this in common, that "they speak the truth;" they have many other and more important resemblences.... . Moreover, that self-command is possible, even in a state of mental disease, and consequently offers a means of cure, is proved by the cunning of lunatics, by which they are often able for a long time to conceal their insanity.

1824, A Treatise on Mental Derangement, Francis Willis (Junior).

For therapeutic purposes [Francis] Willis [senior, who treated King George III] fostered a sense of fear in his patients, ‘because', he was quoted as saying, 'fear provides the only grip that one can obtain on the mind of a maniac.' Willis acquired a reputation for gaining control over patients by catching their eye. One writer noted that he had an eye like Mars, to threaten or command... his numerous patients stood as much in awe of this formidable weapon, as of bars, chains or straight-waistcoats.

1806, Treatise on Insanity, Philip Pinel.

1813, Description of the Retreat, Samuel Tuke.

Some years ago a man, about thirty-four years of age, of almost Herculean size and figure, was brought to the house. He had been afflicted several times before; and so constantly, during the present attack, had he been kept chained, that his clothes were contrive to be taken off and put on by means of strings without removing his manacles. The were however taken off, when he entered the Retreat, and he was ushered into the apartment, where the superintendents were supping. he was calm; his attention appeared to be arrested by his new situation. he was desired to join in the repast, during which he behaved with tolerable propriety. After it was concluded, the superintendent conducted him to his apartment, and told him the circumstances on which his treatment would depend; that it was his anxious wish to make every inhabitant in the house as comfortable as possible; and that he sincerely hoped the patient's conduct would render it unnecessary for him to have recourse to coercion. The maniac was sensible of the kindness of his treatment. He promised to restrain himself, and he so completely succeeded, that during his stay, no coercive means were ever employed towards him. This case affords a striking example of the efficacy of mild treatment. the patient was frequently very vociferous, and threatened his attendants, who in their defence were very desirous of restraining him by the jacket. The superintendent on these occasions, went to his apartment; and though the first sight of him seemed rather to increase the patient's irritation, yet after sitting some time quietly beside him, the violent excitement subsided, and he would listen with attention to the persuasions and arguments of his friendly visiter. After such conversations, the patient was generally better for some days or a week; and in about four months he was discharged perfectly recovered.
Can it be doubted, that, in this case, the disease had been greatly exasperated by the mode of management? or that the subsequent kind of treatment had a great tendency to promote his recovery.

To encourage the influence of religious principles over the mind of the insane is considered of great consequence, as a means of cure.

The principle of fear, which is rarely decreased by insanity, is considered as of great importance in the management of the patients.

In an early part of this chapter, it is stated, that the patients are considered capable of rational and honourable inducement; and though we allowed fear a considerable place in the production of that restraint, which the patient generally exerts on his enterance into a new situation; yet the desire of esteem is considered, at the Retreat, as operating, in general, still more powerfully. This principle... is found to have great influence, even over the conduct of the insane. Though it has obviously not been sufficient powerful, to enable them entirely to resist the strong irregular tendencies of their diseases; yet when properly cultivated, it leads many to struggle to conceal and overcome their morbid propensitites; and, at last, materially assist them in confining their deviations, within such bounds, as do not make them obnoxious to the family. This struggle is highly benifitial to the patient, by strengthening his mind, and conducting to a salutary habit of self-restraint; an object which experience points out as of the greatest importance, in the cure of insanity, by moral means. That fear is not the only motive, which operates in producing self-restraint in the minds of maniacs, is evident from its being often exercised in the presence of strangers, who are merely passing through the house (recall the salutary role which Adam Smith attributes to the presence of strangers in Theory of Moral Sentiments); and which, I presume, can only be accounted for, from that desire of esteem, which has been stated to be a powerful motive to conduct.

The Retreat has demonstrated beyond all contradiction the superior efficacy, both in respect of cure and security, of a mild system of treatment, in all cases of mental disorder.

The modes by which self-restraint may be induced... whatever tends to promote the happiness of the patient, is found to increase his desire to restrain himself, by exciting the wish not to forfeit his ejoyments... .

The study of the superintendents to promote it with all the assiduity of parental, but judicious attention, has been, in numerous instances, rewarded by an almost filial attachment. In their conversation with the patients, they adapt themselves to their particular weakness; but, at the same time, endevour to draw them insensibly from the sorrow, or the error, which marks the disease.
The female superintendent, who possesses an uncommon share of benevolent activity, and who has the chief management of the female patients, asw well as of the domestic department, occasionally gives a general invitation to the patients, to a tea-party. All who attend, dress in their best clothes, and vie with earch other in politeness and propriety [see the description of the rules of the brothers attached to a lazor house]. The best fare is proovided, and the visiters are treated with all the attention of strangers. The evening venerally passes in the greatest harmony and enjoyment. It rarely happens that any unpleasant circumstance occurs; the patients control, in a wonderful degree, their different propensities; and the scen is at once curoius, and affectingly gratifying.



Appendix

Rules for the Government of Ackworth School (Established in 1779):

...the mistresses in particular endevour, by divine assistance, early to impress upon the minds of the children the necessity of a strict adherence to truth, and abhorrence of falsehood, as well as a remembrance of their Creator in the days of their youth; having the fear of the Lord before their eyes, which will preserve [them] under the various temptations to which they are incident, and lead to the enjoyment of real happiness, by keeping a conscience void of offence towards God, and towards men.

1792, Observations on Maniacal Disoders, William Pargeter.

The government of maniacs is an art, not to be acquired without long experience, and frequent and attentive observation. As maniacs are extremely subdolous, the physician's first visit should be by surprize. He must employ every moment of his time by mildness or menaces, as circumstances direct, to gain an ascendancy over them, and to obtain their favour and prepossession. If this opportunity be lost, it will be difficult, if not impossible to effect it afterwards; and more especially, if he should betray any signs of timidity. he may be obliged at one moment, according to the exigency of the case, to be placid and accommodating in his manners, and the next, angry and absolute.

The maniac was locked in a room, raving and exceedingly turbulent. I took two men with me, and learning that he had no offensive weapons, I planted them at the door, with directions to be silent, and to keep out of sight, unless I should want their assistance. I then suddenly unlocked the door- rushed into the room and caught his eye in an instant. The business was then done- he became peacable in a moment- trembled with fear, and was as governable as it was possible for a furious madman to be.

1748, The Spirit of the Laws, Montesquieu.

"Hobbes inquire, 'For what reason go men armed, and have locks and keys to fasten their doors, if they be not naturally in a state of war?' But is it not obvious that he attributes to mankind before the establishment of society what can happen but in consequence of this establishment, which furnishes them with motives for hostile attacks and self-defence?
[...] Fear... would induce men to shun one another; but the marks of this fear being reciprical, would soon engage them to associate. Besides, this association would quickly follow from the very pleasure one animal feels at the approach of another of the same species. Again, the attraction arising from the difference of sexes would enhance this pleasure."

"Honour, that is, the prejudice of every person and rank, supplies the place of... political virtue... , and is everywhere here representative: here [in Monarchical Governments] it is capable of inspiring the most glorious actions... ."

"A monarchical government supposes... pre-eminences and ranks, as likewise a noble descent. Now since it is the nature of honour to aspire to preferments and titles, it is properly placed in this government
Ambition is pernicious in a republic. But in a monarchy it has some good effects; it gives life to the government, and is attended with this advantage, that it is in no way dangerous, because it may be continually checked.
It is with this kind of government as with the system of the universe, in whcih there is a power that constantly repels all bodies from the centre, and a power of gravitation that attracts them to it. Honour sets all the parts of the body politic in motion, and by its very action connects them; thus each individual advances the public good, which he only thinks of promoting his own interest.
True it is that, philosophically speaking, it is a false honour which moves all the parts of the government; but even this false honour is as useful to the public as true honour could possiblybe to private persons.
Is it not very exacting to oblige men to perform the most difficult actions, such as require an extraordinary exertion of fortitude and resolution, without other recompense than that of glory and applause?"

"It is pride that renders us polite; we are flattered with being taken notice of for behaviour that shows we are not of a mean condition, and that we have not been bred with those who in all ages are considered the scum of the people."

"Now a government is like everything else: to preserve it we must love it."

"In monarchies there should be no censors; the former are founded on honour, and the nature of honour is to have the whole world for its censor. Every man who fails in this article is subject to the reproaches even of those who are void of honour."

"The severity of punishments is fitter for despotic governments, whose principle is terror, than for a monarchy or a republic, whose spring is honour and virtue.
In moderate governements, the love of one's country, shame, and the fear of blame are restraining motives, capable of preventing a multitude of crimes."

"It is a constant remark of the Chinese authors that the more the penal laws were increased in their empire, the nearer they drew towards a revolution."

"Mankind must not be governed with too much severity; we ought to make a prudent use of the means which nature has given us to conduct them.
[...] Let us follow nature, who has given shame to man for his scourge; and let the heaviest part of the punishment be the infamy attending it."



"Some Advantages of a conquered People.

[...] A conquest may destroy pernicious prejudices, and lay, if I may presume to use the expression, the nation under a better genius.
What good might not the Spaniards have done to the Mexicans? They had a mild religion to impart to them; but they filled their heads with a frantic superstition. They might have set slaves at liberty; they made freemen slaves. They might have undeceived them with regard to the abuse of human sacrifices; instead of that they destroyed them.
[...] It is a conquerer's business to repair a part of the mischief he has occasioned. The right, therefore, of conquest I define thus: a necessary, lawful, but unhappy power, which leaves the conqueror under a heavy obligation of repairing the injuries done to humanity."

"It is too much for a nation to be obliged to bear not only with the pride of conquerors, but with their incontenence and indiscretion; these are, without doubt, most grievous and intolerable, as they are the source of infinite outrages."

"The prosperity of states is frequently greater in the insensible transition from one constitution to another than in either of those constitutions. Then it is that all the springs of government are upon the stretch... ."

"[W]hen the Romans aggrandised themselves; when their slaves were no longer the companions of their labour, but the instruments of their luxury and pride; as they then wanted morals, they had need of laws. It was even necessary for these laws to be of the most terrible kind, in order to establish the safety of those cruel masters who lived with their slaves as in the midst of enemies."



"That Everything ought not to be corrected.
Let them but leave us as we are.... and nature will repair whatever is amiss. She has given us a vivacity capable of ofending, and hurrying us beyond the nbounds of respect: this same vivacity is corrected by the politeness it procures, inspiring us with a taste of the world, and, above all, for the conversation of the fair sex.
Let them leave us as we are; our indiscretions joined to our good nature would make the laws which should constrain our sociability not at all proper for us."

"[F]ashion is a subject of importance; by encouraging a trifling turn of mind, it continually increases the branches of its commerce.1 [1. Fable of the Bees]"

"Of the Vanity and Pride of Nations.
Vanity is as advantageous to a government as pride is dangerous. To be convinced of this we need only represent, on the one hand, the numberless benefits which result from vanity, as industry, the arts, fashions, politness, and taste; on the other, the infinite evils which spring from the pride of certain nations, as laziness, poverty, a total neglect of everything- in fine, ... . Laziness is the effect of pride; labour, a consequence of vanity."

"[P]ride, joined to a vast ambition an notions of grandeur, produced such effects among the Romans as are known to all the world."

"All the passions [of a free people] being unrestrained, hatred, envy, jealousy, and an ambitious desire of riches and honours, appears in their extent; were it otherwise, the state would be in the condition of a man weakened by sickness, who is without passions because he is without strength."

"[W]hen an impression of terror has no certain object, it produces only clamour and abuse; it has, however, this good efect, that it puts all the springs of government into motion, and fixes the attention of every citizen.
[...] A people like this, being always in a ferment, are more easily conducted by their passions than by reason, which never produces any great effect in the mind of man; it is therefore easy for those who govern to make them undertake enterprises contrary to their true interests."

"[T]his nation [England], having been formerly subject to an arbitrary power, on many occasions preserves the style of it, in such a manner as to let us frequently see upon the foundation of a free government the form of an absolute monarchy.
[...] [A]s these men who are naturally so proud live much by themselves, they are commonly bashful when they appear among strangers; and we frequently see them behave for a considerable time with an odd mixture of pride and ill-placed shame."

"Men being made to preserve, to nourish, to clothe themselves, and do all the actions of society, religion ought not to give them too contemplative a life.
[...] Penances ought to be joined with the idea of labour, not with that of idleness... ."

1759, The Theory of Moral Sentiments, Adam Smith.