TREATMENT OF THE INSANE

New Zealand Tablet, 6 April 1911, Page 616

TREATMENT OF THE INSANE

THE QHEEL COLONY IN BELGIUM In the February issue of the Month there is an interesting and instructive article on the treatment of the insane at Gheel, Belgium. The writer (Alice Vowe* Johnson) says:— It was a hot summer's day when I took the train from Antwerp to Gheel, and we crawled the twenty-five miles with a deliberation which suited the weather. I was met at the station by the medical superintendent, M. le Docteur Meens, and his secretary, M. Lauryssens. After the usual polite salutations, I was handed over to the secretary for the morning to be shown round the village, and after luncheon I was to see the infirmary under the allspices of one of the doctors. M. le Secretaire was, like all the other officials I met there, a delightful man, simple and good, with his whole heart in the work of the colony, of which he was very proud, thinking nothing too much a trouble in connection with his work. He spoke English admirably, although he had never been out of Belgium, and had acquired it entirely from books. And he was greatly exercised at what he called my ' American accent,' and it took me some time to convince him that it was English English, not American. Gheel was en fete that day; flags were flying everywhere, and all the villagers were dressed in their Sundaybest. There was to be a distribution of prizes at the boys' school, and at this function, as at all other festivities, the lunatics take part. They go with the Nourricies (as their foster-parents are called) and the rest of the family, sharing with them their joys and honors. The Village of Gheel. The village consists of a long road running from the station to the infirmary, and on each side are shops, inns, and small detached villagers' houses. There is scarcely one without its boarders. A NourricJer is allowed not more than two boarders, and they must be of the same sex. Opening out from the main street is a village green, with a church and one or two cross-roads. The village has a population of 16,000, 1800 of which are the boarded-out patients. It consists of 24,000 acres, the centre being given over to the houses, shops, and one or two manufactories, and the outlying districts to farms and fields. There is a Central Infirmary of fifty beds, where new patients are placed on arrival so as to be under observation for at least fifteen days; the period may be extended to three months if considered necessary. At the end of that time if they are neither homicidal, suicidal, incendiaries, nor runaways, they are boarded out with a villager. But if they.are found to be dangerous to themselves or others they are sent away to an enclosed asylum. Great care is exercised in the choice of the Noun-triers, and one that most suits their former circumstances both with regard to occupation and pocket is chosen. Thus a man who has been working at tailoring is boarded with a tailor, and a man who has been working at a felt-hat manufactory goes to a hatter; a farm-hand is sent to a farmer and a seamstress to a dressmaker, and they become in reality one of the family. They take a full' share in the domestic life —love and take care of the children, join them at table, go to church and entertainments with them, taking part in the singing and acting—and it is a point of honor that they should never be allowed to feel in the way. Seventy per cent of the patients are capable of work: of the whole colony five per cent, have epileptic fits. All patients are encouraged by the Nourriciers to work, and if the work is well done, on Saturdays the head of the family gives them pocket-money, but" not too much, as the authorities are afraid that they should spend it in the many public-houses that exist in Gheel. But public opinion is so healthy that the drunkenness of a patient is of very rare occurrence. Each patient has a fair-sized bedroom of his own with plenty of light and air; his clothing, bedding, and furniture are provided by the authorities. There are stringent rules which are enforced as to the time of going to bed, getting up, the amount and kind of work, meals, and clothing; otherwise there are very few regulations. J The patients go out alone * into the streets, shops, churches, and fields of the colony, wherever and whenever they wish, and in every direction you find them wandering alone at their own sweet will with no one taking any notice of them or their- moods. Never are they teased by tho Gheelese children, who accept them as a matter of course. lon will ask, 'Does not the presence of the insane in village life have a bad effect on the sane population?' No, it certainly has not; the Gheelese are a good set of people, hard-working, kind, sober, and healthv, physically and mentally, and not at all nervous or wanting in selfcontrol. This is doubtless the result of education, as they have nursed the. insane since the seventh century, and it would seem that the spirit of St. Dympna is still "an active force amongst them, which may account for their goodness and simplicity.

The Founding of the Colony. : Zl": At the beginning of the seventh century there was a pagan king living in Ireland with his wife and baby daughter. The queen, being converted to Christianity

was baptised with her baby by a monk named Gerebern. Soon after this the mother died, leaving the girl's education in the hands of the monk. When Dympna, as the child was called, arrived at a marriageable age she was very beautiful, and her pagan father sought her in marriage. To avoid this terrible fate she fled by the aid of the monk Gerebern over the seas to Antwerp, and arrived as far as Gheel. Here she was overtaken by her infuriated father, who captured and beheaded her on the spot. She was buried at Gheel, and a church was erected to her memory, and shortly after her death it was found that many miracles were worked at her tomb, so that she was canonized. The cures that occurred were principally of insane people, so that the place gained a great reputation, and lunatics were brought there by their relations from all parts. Those who sought cures stayed near the church and made a novena, and at the end of that time, if the patient was not cured he remained longer. So as to house and board these patients a Religious Order built some simple little rooms that may still be seen, the patients' relations paying towards their board whenever they could. The reputation. of the cures grew so that the* accommodation soon proved inadequate, and the patients and their relations were boarded out with the' villagers. This system continued under the control of the religious until 1833, when the local authorities made rules and regulations with regard to patients and Nourriciers. In 1849, the Belgian Government took over the entire control of the colony, leaving the religious to nurse in the infirmary only. At present, if a patient has a severe illness that requires nursing or if they have a mental relapse, they are removed to the infirmary until they return to their usual condition of health. There is very little sickness in the colony, and. at the time that I visited the Infirmary, there was not a single sick person there; only a few mental cases that had relapsed and a few newcomers. The infirmary consists of a male and a female side, offices, and a simple but adequate laboratory and beautiful gardens. The wards of the infirmary are bright and not too big, consisting of about six beds, including that of the nun in charge. There is also a night-Sister who periodically visits each ward. In each of the few single rooms that exist there is an iron lattice-window, without any glass, opening into a wide corridor which has a window opposite the rooms looking into the garden, so that the patient not only gets fresh air through the lattice, but can be observed in the night. During the day-time the patients and the nuns live out in the garden. The Sisters and the Nourriciers have to attend regular courses of lectures on anatomy, physiology, and care of the sick and insane, and they are carefully taught to recognise early symptoms of a relapse, and many instructive leaflets are printed for and distributed in the colony. Each Nourricier has to keep a written report of her patients, which is read and signed by the medical officer during his visit. The "Noiirricicrs are excellent women who are devoted to their patients. One of those I saw had two idiots as boarders, one. of whom was a very poor type, but the Nourricier showed her to me with great pride and explained what improvement she had made; the other was clean in her habits and ways, but very dull ; she took the Nourricier' s baby out and was very attached to it, and the baby seemed to return her affection. I inspected the bedroom and bedding of each of these idiots, and in both cases the bedding was clean and fresh, and the patients were happy and well-cared-for. Not only are the foster-mother and her family good to the patients, but they extend their hospitality to the patients' relatives, who, whenever they wish to, come and stay with them, and are boarded and looked after by the Nourrieier for a small fee.

M. le. Directeur has a house in the grounds of the infirmary, and receives a salary of £4OO. He has five assistant doctors, each of whom'has a house to himself in different parts of the village and has a salary of £240 per annum. Methods of Treatment.

The village is divided into four districts, and each district has a doctor of its own, who is allowed no private work and has to give his whole time to. the colony. Not only has he to know and keep in touch with his patients and their Nourriciers and inspectors, but he keeps up an active correspondence with the relations. Each patient has to be visited once a month, and new and improvable cases once a week or oftener. Besides the doctor, there are two non-medical inspectors for each .district, whose business it is to visit each patient once a fortnight or oftener if necessary, and who keeps in touch with all the Nourriciers-. The doctors and inspectors bring daily reports to the medical superintendent, who in his turn" is bound to visit each case once a year at least and oftener at his discretion. One doctor devotes his whole time to the laboratory and post-mortem work. Each district has a bathing establishment of its own, and patients are encouraged to have baths as frequently as possible, but it is obligatory to be bathed and weighed once every month, and when the patients are aged or infirm they are driven- in a conveyance from their home to the bathing establishment. The Dutch, I am told, held the best record for cleanliness. A doctor is in attendance during the bathing hours, and weighs the patients, and if there is a loss of one pound or more in weight, a medical examination is

made, and if the cause is found to be neglect, underfeeding or over-working, the patient is removed from the Nourricier, and the house put on the prohibition list. So keen is the competition amongst the Nourriciers that this is the only punishment required. The prices charged for the patients vary according to accommodation. First class, £BO a year; second class, £4B— £72 a year; third class, £2B—£4o a year; fourth class, £2o— £24 a year. Two pence a day is deducted by M. le Directeur' for administration and medicine, the rest going to the Nourriciers, so that in the fourth class the Nourricier receives for a clean, well-behaved patient 8d a day, and for a dirty, troublesome one Is, a very small sum, you will think, and yet there is not only much competition for patients, but the Nourriciers are really fond and proud of them, and the whole family look upon them as a real advantage to the home. The Nourriciers all know one another's business in the most pleasant sense, and are proud of showing each other their patients, and compete in their treatment of them. Each district has one or more churches, and patients are allowed to go there unattended whenever they wish. One .Dutch lady whom I visited (a case of religious melancholia) spent most of her time going to the different churches; she was in no way prevented as she would have been in an enclosed asylum, and certainly obtained some pleasure from — and who shall say, no profit? There is no restraint of any kind, either in the infirmary or outside it. No padded rooms, no strait-jackets, and certainly the results are excellent. The patients are very happy and healthy, the mortality only 5 per cent., the recoveries 25 per cent., and as there are so many chronic cases sent here, this result compares favorably with other systems. In thirty-one years there have only been four deaths from accidents, and all these were patients who were killed by the train when the line was first opened. There are every year two or three attempted escapes, but they do not get far away as the whole village is on the alert and turns out to find them, and the mere suggestion to a patient of sending him to an enclosed asylum usually has the effect of preventing his running away.' Besides the baths in the infirmary a central bathinghouse is being erected for the sole use of the better pavine patients. ° mi The whole colony has the exclusive service of a priest Ihe Protestants are visited by a Lutheran minister, and the Jews by a Rabbi. Patients are taken from all parts of the world In one house I saw a Polish prince who had the use of a pleasant sitting-room and a garden full of flowers. Another a Dutch lady, was having a lesson from a singing mistress,' who was coaching her for a concert that was shortly to be given at the Town Hall. Further on I saw a West Indian, and an Englishman, and even the latter seemed quite contented, and not at all desirous of returning; to his native land. ■ **

A sheet of twenty-five questions is given to the relations of each patient to answer before thev are admitted to the colony, and care is exercised so that this is accurately answered, as the replies help the authorities to understand not only the mental condition of their patients, but their general circumstances, and to decide the most suitable home tor them. The Welfare of the Patients. c Al The AT welf 3 re of tn <l patients lies mostly in the hands ot the A ourriciars, and one must not run away with the idea that all village wives are suitable for this special work. Besides a great deal of hard work and a considerable amount of knowledge and shrewdness, it requires unselfishness and personal devotion. And all this for Is a day! „„ i° l Y i l -n 1 " 1 the Gheelese are exceptional: one "knows om English villagers would not readily put themselves out, even tor twice this pay, but these conditions can gradually be altered There is, of course, something in temperament, and besides our tradition lies more in the direction ot every mans house being his castle, and every nonhl hnllf stranger, if not ian enemy. The history of Gheel «nfn£i JI a l ronf ? publlc °P illion which has made this E U « f *** a r appy P° ssibili ty; there is no doubt state TW . r 01 f in mental patients it is an ideal Sit?' ha i 7 % " 0t all sub ! llltt ed to the many rules that must be enforced in an enclosed asylum. Thev are not alu ays depressed by the constant sound of the key locking the door which they know they .-.Jean never pass except with an-- attendant. They have a family life which thev enter into, and do the • work that they have been ed to. The cottages are homely, and do not frighten them with must Sce;sariiy a do d VaStneSS ' M many ' of ° Ur larg6 aSyl ™ s . The difference . between the insane and the feebleminded is so radical that the latter are entirely unsuitable of i this boarclmg-out system, as in it they lack the stimulus ot being and working with patients of their own mental calibre, and become depressed by the companionship of their mental superiors. They also require special teaching, which cannot be obtained except from trained teachers and in most cases both at work,, at play, and during the night they require more .supervision than can be obtained in a

There have been other colonies started on these lines at Liernieux in the Ardennes, and three in France at Dun-siir-Anon, D'Aunay, and at De-Levet, all of which have been successful. ' ■'■ "