John Harwood - The Asylum

“Tell me,” I said, casting around for a topic, “I realise I know nothing of what an asylum is really like—how you cure your patients, I mean.” The words had scarcely left my mouth before I remembered that his father had been confined and died here; but then, he had chosen to work as Dr. Straker’s assistant.

“The truth is, Miss Ferrars, that for the most part we don’t cure our patients; all we can do is provide them with the conditions most favorable to recovery. Dr. Straker has come to believe that for the afflictions we commonly see in our voluntary patients—melancholia, nervous exhaustion, inanition, morbid anxiety, and the like—the conventional treatments are largely ineffective. He says that trying to relieve melancholia with mercury, or hydropathy, is like shooting blindfold at a target; if you fire often enough, you are bound to hit it sooner or later, but only by chance. Whereas clean air, kindness, nourishing food, exercise and occupation—and, above all, respite from the cares of everyday life—can only be conducive to healing.

“What we practise here is a form of moral therapy: we encourage every patient to take responsibility for his or her own cure. In my own case, for example, when I feel a bout of melancholia coming on, I know that there is nothing I can do—nothing anyone can do—to forestall it. I can take a glass of wine to ease the oppression, but then I am tempted to take another glass, and another; I can drug myself with opiates, but then I am fit for nothing. My only desire—in so far as I am capable of desiring anything—is to stay in bed and pull the blankets over my head, as I have done all too often, even though I know that it will only make things worse.”

We had recovered our composure while he was speaking, and I ventured to ask him whether melancholia was like grief, only worse, or quite different.

“It is different from grief because grief is a living emotion—to grieve, you must have loved—whereas melancholia is at once the worst pain imaginable—worse than any physical pain I have experienced—and the negation of feeling. It is like a leaden blanket of darkness—darkness and fear, because you are possessed by dread: a universal dread that clamps like a limpet onto every passing thought. In the depths of an attack, I wake each morning feeling as if I have committed a capital crime and been sentenced to hang. The overwhelming temptation is to seek oblivion, and at the worst, the thought of the ultimate oblivion is always with you.

“But I also know, even in those depths—and this is where I am fortunate—that the darkness will pass, and that if I can drag myself out of bed, and face whatever the day requires of me, the oppression will diminish somewhat. And that, if you like, is the essence of moral therapy. I have Dr. Straker to remind me that I will be better if I get up, but only I can do it. He could drag me out of bed—which is what happens in less enlightened asylums—but I would not benefit in the slightest.”

“How can you call yourself fortunate,” I asked, “when you endure such anguish?”

“Because, for much of the time, I am free of it, whereas for some of our patients, the darkness never lifts. And because my father and grandfather were so much more grievously afflicted; I have been spared, thus far, from mania.”

These last words had been accompanied by one of his expansive gestures, but then his expression changed; he looked suddenly stricken, and averted his eyes.

“I am sorry,” I said. “I did not mean to stir such painful memories.” It struck me as I spoke that he had very little but painful memories to draw upon.

“It is not that,” he replied, “only . . . But you were asking me about cures. There are some conditions that can be cured: phobias, for example. Dr. Straker has had remarkable success with a technique he calls dramatic therapy, in which the patient is gradually brought face to face with the thing he fears most. We had a patient who was morbidly afraid of serpents. Dr. Straker began by bringing him into a room in which there was a stuffed cobra in a glass case, well away from the door. The man was gently encouraged to approach a little closer each time until he was able to stand right next to the case; then to watch Dr. Straker reach in and grasp the snake, and finally to handle it himself.

“For the next stage of the cure, Dr. Straker replaced the stuffed cobra with a live one, whose fangs had been drawn, and repeated the sequence—which took a good deal longer—until the man was able to handle a living serpent without any sign of fear, and even to acknowledge that the creature had a certain beauty about it.

“He—Dr. Straker—has had equally good results with several other phobias, and so he naturally wondered if the technique might be extended to more serious cases. A couple of years ago we had a patient who was firmly convinced that he had heard the voice of God commanding him to assassinate Mr. Gladstone; I remember Dr. Straker saying that many perfectly sane men might be tempted to do likewise, without divine instruction. He was actually arrested on his way to the Houses of Parliament with a pistol in his pocket, but because his family were wealthy, he ended up here rather than in Bedlam. Dr. Straker wanted to see if he could cure a patient of monomania by allowing him to act out his obsession under controlled conditions—like drawing fluid off the brain, or lancing a boil—and this man, whose name, appropriately enough, was Isaiah Gadd, seemed an ideal subject for the experiment.

“Dr. Straker began by getting the attendants to say to one another, within the man’s hearing, that Mr. Gladstone would shortly be visiting Tregannon House. Gadd was in a locked ward, but he wasn’t closely confined; on any subject other than Gladstone he seemed quiet and sensible. He sat and read his Bible, did what he was told without argument, was polite to his fellow patients, and seemed to understand perfectly well why he was confined. And as you might expect, he was greatly agitated by the news of Gladstone’s visit.

“As it happened, we had an elderly attendant who looked remarkably like the great man; I am sure he cultivated the likeness. Dr. Straker said that if we hadn’t found anyone on the staff, he’d have engaged an actor. On the morning of the supposed visit, Gadd was told that we were moving him to another wing, where he would be locked up until Mr. Gladstone had left.

“He was taken to a cell on a badly lit corridor in the old wing, got up to look like a Hogarth engraving: a bare stone floor, with an iron door and vertical iron bars, far enough apart to get your arm through, right along the front. Dr. Straker and I were in the room opposite, with the door standing open and the light arranged so that we could see Gadd, but he couldn’t see us.

“He was left alone for an hour, growing more and more agitated, pacing up and down like a wild animal. Then a couple of attendants came running down the corridor, shouting that Mr. Gladstone would be coming this way, and to be sure to bring the guards up first.

“By this stage, Gadd was in a state of uncontrollable excitement, clutching the bars with his face pressed against them. Then a man in a warder’s uniform, with a pistol stuffed into his belt, came up and stationed himself right outside Gadd’s cage, as it effectively was.

“Gadd’s eyes fell on that pistol, and he grew very still; you could see his mind racing. Very slowly, he let his hands fall to his sides and edged along until he was just to the left of the guard, who was standing rigidly to attention, looking straight ahead of him. There was a tramping of feet; two more warders marched past, and then Gladstone appeared. My heart was thumping wildly; in that electric atmosphere, anyone would have sworn he was the Prime Minister.