Popular Science Monthly/Volume 39/September 1891/Schools for the Insane
| SCHOOLS FOR THE INSANE. |
By CHARLES W. PILGRIM, M. D.
THE teaching of the insane is by no means a new idea. Early in the history of the Utica Asylum Dr. Brigham made the experiment of having winter classes, and wrote in his annual report for 1844 of the great advantages resulting therefrom. These classes, however, were not long continued, and, if I mistake not, a like history was enacted in the Northampton Lunatic Asylum, where Dr. Earle, our oldest American alienist, instituted a similar work at about the same time. Dr. Kirkbride, another pioneer in American asylums, advocated the education of the insane; but, instead of having organized schools, he had what were known as "companions," who visited the patients in different wards and gave them instruction by reading and conversation. I know, however, of no single attempt in this direction in any of the American asylums which was at all prolonged, and, with one exception, the result was the same with the experiments which were made from time to time in various parts of Great Britain and the Continent. The exception was the Richmond District Lunatic Asylum in Dublin, where Dr. Lalor's zeal and energy elaborated the idea and made of it such a success that his asylum became known on account of its school to alienists in the most distant parts of the world. In 1885, when the school had been in successful operation for about thirty years, I had the pleasure of spending three days with the venerable old man, who is justly called the "father of the school system." He has since laid down the burden of life, but the system which he inaugurated still lives, and is carried on under the direction of his successor.
At the time of my visit there was a daily average of about four hundred and fifty men, and, as the two departments of the asylum are conducted practically in the same manner, I shall confine my-self to a description of the male division and its school. About forty of the four hundred and fifty men were in the hospital ward and took no part in the school exercises. Of the remainder, eighty-five were engaged during the day in the garden and various industrial occupations, but about seventy of them attended school on three evenings in the week for an hour after supper. A little more than a hundred were occupied solely in masonry, farm-work, tailoring, basket-making, shoemaking, etc., and more than two hundred were occupied during the greater part of the day with the school exercises. It will thus be observed that nearly every patient in the asylum, excepting those in the hospital department who were physically incapacitated, was engaged either in the school or industrial exercises, and that seventy were engaged in both. It is true that quite a number of the patients whom I saw were too demented to take a very active interest in the exercises, but it certainly seemed to me that constant effort in this direction could not fail to produce a beneficial effect by infusing a spirit of order among the patients, even if it did nothing more. Object-teaching was the plan most in favor among the more stupid ones. For instance, a piece of India rubber would be handed to one of the class, the teacher asking him at the same time to name it; he would then ask its color, shape, and qualities, getting the patients, by experiment, to find out that it was tough, smooth, opaque, pliable, etc., finally ending by questions as to its uses. Some other object, as a piece of glass, would then be taken up until the time allotted for the exercise in that particular way was exhausted. On one or two occasions the Irishman's natural wit could not be restrained. As, for instance, when one was asked in regard to the most important uses of glass, he replied, for "making whisky-tumblers, sir"; and another, when asked in regard to another object, said, "Sure, you know, sir, without asking me to tell you." The more advanced pupils were instructed in reading, writing, arithmetic, and geography. Music occupies a most important place in the system, and I was told that, when a patient's attention could not be gained in any other way, it was frequently possible to get him interested in the singing-class, and afterward in the other classes. The singing is accompanied with instrumental music. Even the theory of music is not neglected, a portion of the daily singing half-hour being devoted to practicing the scale. It should be mentioned in this connection that music also exerts an important influence in another direction, as it naturally leads to drilling and marching, and by placing the less active patients here and there in the line even the most inert can be induced to take part in the exercises, and thus obtain an amount of physical training which it would be difficult to give them in any other way. A number of patients also act as monitors, keep records, etc. The object of the school as formulated by Dr. Lalor is, first, to provide occupation for a large class who otherwise would be unemployed; secondly, to vary the occupation of the patients; thirdly, to apply a system of education to the relief of mental disorders; and, fourthly, to promote the happiness and welfare of all the inmates.
I have visited a large number of asylums in various parts of the world, and I am sure that I have never seen any in which there was better discipline and order among the patients. Like all Irish asylums, the wards of the Richmond District Asylum were poorly furnished, and they lacked many of the features which characterize our sometimes palatial institutions. But, though cheerless in other respects, there were cheap harmonicums even in the most disturbed wards; and, although they were little better than our street hand-organs, it seemed to me that they served a far better purpose than the solitary grand piano which is only seen in the convalescent wards of our State institutions. There were signs of activity everywhere, and a gratifying absence of that gloomy monotony which is so apt to pervade asylum life. The other Irish asylums which I visited were in marked contrast to this; and there was nothing, so far as I could observe, to account for the superiority of the latter, save the school system so energetically pursued.
In proof of the old adage that history repeats itself, the experiment that was tried in the Utica Asylum nearly half a century ago was again taken up some three years since. A similar revival of interest in this subject also took place in two or three other American asylums. In Utica, a small class for the men, with a recovered patient as teacher, was first organized, two hours in the morning being devoted to the teaching of the simpler branches. Such was its success that another class was soon formed for the instruction of the women. The next winter the school was again opened, and it is now in its third year of successful working; and the interest maintained is so great that it is at times difficult to find places in the school-room for all who wish to attend.
The female department of the school (the one to which I shall confine my description) is in charge of an experienced teacher, who is assisted by three patients. Two are melancholiacs who have delusions of a depressing character, and one frequently makes the ward doleful with her moans. The third has the delusion that she is the wife of a prominent physician in a distant part of the State, and insists upon being called by his name. All three, however, manage to keep their delusions in abeyance, and appear to quite forget them while engaged in their work. The population of the women's wards is a little above three hundred, and of this number about seventy are enrolled as members of the school. The average attendance is about fifty. This number could be greatly increased; but, as the school-room is small, only selected cases, and those who are particularly anxious to become pupils, are allowed to attend. The session is held between the hours of ten and twelve in the morning. The teacher first reads a chapter from the Bible, the question of the Bible in the school not being a disputed one in this particular instance; the pupils then repeat the Lord's prayer in unison, and afterward unite in singing one of the gospel songs. The books are not taken from the school-room; the lessons are given out, and about a quarter of an hour is allowed for their preparation.
The school is divided into three sections—advanced, intermediate, and primary. The advanced course consists of geography and historical reading, and is in charge of one of the patients. In the intermediate division, arithmetic as far as percentage, reading, geography, and grammar are taught; it is in charge of two other patients. The primary division, contrary to the general rule, is in charge of the schoolmistress, and the pupils are taught to read, spell, write numbers, and do easy sums. No two in this division are equally advanced, and its successful working requires a large amount of tact and exhaustless patience. At first this department was in charge of the patients, but experience has shown that the pupils get along much better under the more experienced instruction of the head of the school. The pupils range in age from fourteen to seventy-seven. Preference, however, is given to the younger ones who desire to attend, more than half being under forty, nearly one third under thirty, and about one eighth under twenty years of age. They suffer from the various forms of mental trouble, but here again preference is given to those who have melancholia and the more acute forms of insanity. Chronic cases are not excluded, however, and among those who can receive no benefit save the two hours' daily relief from the monotony of asylum life are two Virgin Marys, one queen of the world, one daughter of ex-President Cleveland who is nearly seventy years of age, two who imagine that they have passed from the scenes of earth and dwell among the dead, and one who has the curious delusion that people are constantly walking upon her fingers. As curable cases, and those most likely to recover, are the ones who generally attend the school, the direct curative influences can not be accurately estimated; but, as might be expected, the most encouraging results are met with in the young and in those whose insanity has been of comparatively short duration. I can recall two cases where the patient could not read or write before becoming insane, but became fairly proficient in both before returning home. Three others also occur to me who appeared to be in the depths of dementia, but were, after several days of patient trial, made to feel an interest in a "puzzle map," and each went on uninterruptedly to recovery and home. Another patient is the terror of the ward, in which she stays until ten o'clock in the morning, when she goes quietly to school and remains for two hours one of the most interested of them all. After leaving the school she again becomes ugly and irritable, and it is only the fear of being kept away from it that makes her at all controllable. Surely these scattered instances show results sufficient to justify the efforts made; but I am sure that, even where the results are not so marked, the school is at least an important adjunct to employment, games, out-of-door exercise, and amusements.
All alienists are now agreed that occupation, no matter what form it may assume, is one of the most important measures in the treatment of the insane; and, if the school does nothing more, it fills out a portion of the day, relieves to some extent the tedium of asylum life, and turns for a time at least the patient's morbid thoughts into healthier channels. Pascal says: "Whence comes it that this man who has lately buried his only son, and who this morning was so full of lamentation, at present seems to have forgotten all? Be not surprised," he replies; "he is altogether taken up with looking which way the stag will turn which his hounds have been pursuing so hotly for the past six hours. He needs no more. However full of sadness a man may be, he is happy for the time if you can only get him to enter into some diversion."
The same writer also says, "Without diversion no joy, with diversion no sorrow"; and if this be a truth applicable to the sane, who will doubt that it applies with equal force to those of unsound mind?
The treatment pursued in cases of bodily disease has been not inaptly used to illustrate this system. To deprive the stomach altogether of food in case of trouble in that organ would be fatal; instead, by administering suitable foods, varied, simple, and in limited quantities, we may overcome the disease and bring about a healthy condition; so, too, in disease of the brain, if intellectual food be given in suitable quantity and form, why should we not expect equally good results?
While I would not exaggerate the importance of this system, my experience leads me to believe that much is to be expected from its conscientious and persistent use, and I would fain hope that the time is not far distant when, in every well-organized hospital for the insane, a school will be considered one of the essential features in "ministering to the mind diseased."