Where 'The Sick in Mind' Are Free
THE problem of dealing with the insane has always presented difficulties to the physician and to the humanitarian. It has been assumed that some form of restraint is needful, lest such unfortunate beings prove a danger to themselves or to the community at large; but restraint is more or less synonymous with confinement, and confinement necessarily implies loss of liberty to the individual, while the exercise of constant surveillance tends to develop a cunning desire to elude control, on the part of the patient, and to deprive him of any incentive to exert the feeble gleams of reason that would justify a different treatment. If we compare the methods employed in asylums at the present day, and the care and consideration bestowed upon their inmates, with the Bedlam of a century ago, the difference is certainly as marked as light from darkness; but the principle of seclusion from the outer world, of non-intercourse with their fellow men, remains the same. Once the insane patient has been consigned to an asylum, however humanely planned and perfectly organized, he must perforce associate, not with the mentally sane, but with others from whose disordered brains, as from his own, the divine light of reason has fled.
In the colony of Gheel it is far different. There, the lunatic, the idiot, the epileptic, and those grown childish from great age, live untrammeled and unrestrained, except for humane rules and regulations framed for their own welfare and protection; immured behind no lofty walls, in no strictlyguarded inclosures, such as give to the most admirably ordered asylum the atmosphere of a prison, they lead there aquiet, peaceful existence, among people whose life-work it is to care for and protect them; they are free to wander through the country lanes, to work at will beneath the open air of heaven, to engage in whatever occupations and recreations their dwarfed or diseased intellects permit. There, too, they are surrounded, not by warders and attendants, trained to regard them merely as patients to be coerced and controlled, but by friends, who treat their ‘boarders’ with genuine kindness and unvarying consideration. The colony of Gheel, under these conditions, may be truthfully described as a place where ‘the sick in mind’ are free.
Where or what is Gheel ? It is a town of some fifteen thousand inhabitants, situated in that part of Belgium known as La Campine — a district differing much in outward aspect from the fertile, cultivated country round. It consists for the most part of wide tracts of barren heath, covered with stunted brushwood and sparsely planted trees; here and there scattered hamlets cluster beneath a tall church spire, but there are few towns of any size or importance; and it is no doubt due in some degree to this natural isolation from the more thickly-populated districts of Belgium that the peculiar characteristics distinguishing the colony of Gheel were developed in the earlier periods of its history.
Some thirteen hundred years ago, so runs the tale, the beautiful daughter of a heathen king of Ireland fled from her father’s court and, crossing the seas, took refuge at Gheel. Dymphna had been converted to Christianity by the teaching of a monk named Gerebern, and it was under his protection that she sought deliverance from her unnatural father, who strove to force upon her an incestuous union. The infuriated king followed the fugitives and discovered their retreat. Gerebern was cruelly put to death by the savage soldiery, and the king himself, regardless of his daughter’s pleading for mercy, seized her long hair, and with one blow cut off her head; then, without waiting to give his victims burial, he returned to Ireland. After a time, it began to be rumored that strange miracles of healing from sickness and disease were wrought on the scene of this horrible crime; and, curiously enough, it was those afflicted mentally who derived especial benefit. The spot came to be considered holy ground, and soon a church was built, and dedicated to St. Dymphna, within which the bones of the martyrs were laid to rest in a vault prepared for their reception beneath the high altar.
Such is the legend of St. Dymphna, and visitors to Gheel to-day may find its closing scene portrayed in a quaint group of figures rudely carved in stone, placed on the very spot where the saint is said to have met her death. Her festival, kept on the fifteenth of May, is the red-letter day of the entire year for Gheel. Then the ancient shrine is wreathed with garlands, and the figures are half buried under the sweet spring flowers strewn over them. People flock into the town from all the neighboring villages; special masses are chanted before the tomb of the saint in the handsome late-Gothic church that bears her name, and high holiday is kept by the inhabitants, sane and insane alike.
As years passed on, Gheel became more and more frequented as a pilgrimage resort by the sick in body and mind. Not far from the church of St. Dymphna is an interesting old building founded by one Hendrik Berthaul, Heer of Gheel, as a ‘Gasthuis’ to receive the many pilgrims who came seeking health and strength. It is now an almshouse for the aged poor, under the direction of sisters of charity; but for centuries the old Gasthuis fulfilled its founder’s intention, until the village grew and increased in importance, and the people gradually accustomed themselves to take into their own homes as boarders those who desired to sojourn at Gheel.
It would appear that the belief in a peculiar benefit to be derived by the mentally afflicted has always existed here, and it is probably owing to this very early association with various forms of brain disease that the Gheelois have acquired and fostered that singular aptitude for dealing with such maladies, which distinguishes them. There are certain families, so the writer was told, in which for generations certain classes of patients have been received and cared for. It may be they are lunatics or idiots or epileptics; but the appropriate treatment that each differing phase of brain-affection requires is so thoroughly understood, that the physician in charge has no difficulty in deciding upon the most suitable home for special cases.
It may here be remarked that this institution, originally semi-religious, semi-communal in character, was taken over and reorganized by the Belgian government in 1852, and during the past sixty years the Système Belge, as carried out in the colony of Gheel, has acquired a world-wide reputation.
On leaving the railway station, the visitor follows the tramway line along a broad, cobble-paved street, with neat two-storied houses on either side, whitewashed and green-shuttered, the curtain-draped windows bright with flowers; here and there a more pretentious villa, in a shrub-bordered garden, may be seen. On one side, a narrow stream, the Nethe, flows beneath tall shady trees; in the centre of the town is the market-place, and near by rises the red-brick church of St. Amand, in which one may see some interesting carved wood-work. Beyond the church is a tree-planted inclosure laid out with winding walks and flowerbeds.
At this point the main street divides, one branch leading past the ancient shrine and Gasthuis that commemorate Hendrik Berthaul’s liberality, to St. Dymphna’s church; the other continuing in a straight line through the town until it reaches the asylum. The latter is a large, handsome, redbrick structure with two wings, standing in well-kept grounds, somewhat back from the highroad, which is here lined by an avenue of stately elms. On either side of this central edifice, and connected with it and with each other by covered passages, are pretty villas, also of red brick and uniform in design with the asylum. These villas are occupied by the resident medical staff; and the surrounding gardens and pleasuregrounds of the entire block of buildings are laid out with extreme care and taste.
And now some details must be given as to le patronage familial (the family system), upon which the organization of the colony of Gheel is based. The district throughout which the mentally afflicted patients are distributed includes the town, together with several neighboring villages, each having its own church, and numerous outlying farms, — all within a circumference of about thirty miles. It is divided into five sections; for each of these a fully qualified doctor is appointed, who has under him two surveillants (inspectors), the entire staff being subordinate to the medical director.
The patients, male or female, who are sent to Gheel for treatment, are received first into the asylum, or infirmary, as it is locally called, where they remain under close supervision and scrutiny until the médecin-directeur is satisfied that there is nothing in their mental affliction likely to prove incompatible with the non-restraint methods that form an integral part of the ‘colony’ life. This period of probation may last for a few days or be extended to several weeks; but so soon as it is considered that patients can, with perfect safety to themselves and others, be placed as boarders in a private family, and that they are likely to derive benefit from freedom from restraint, they are removed from the infirmary, the greatest care and forethought being exercised in the choice of a suitable home.
Before any inhabitant of Gheel can obtain the coveted privilege of having his or her name placed upon the register of nourriciers,—a suggestive title that includes the quality of fosterparent equally with that of guardian and keeper, — the strictest investigations are made as to the social position and moral character of the aspirant and his family, as to the sanitary and other conditions of the house they occupy, and as to the size of the room or rooms destined to the use of the prospective boarders. These investigations apply equally to all classes, for as the patients at Gheel belong to different social grades, so, too, do the homes to which they are consigned. The authorities endeavor so far as possible to obtain for the aliénés the conditions of life to which they have been accustomed: thus lunatics of the working class will be placed in working-class families; patients coming from towns are boarded out among the townspeople; while others hailing from country villages are located in farm-houses.
Strictly speaking, there are no poor in Gheel; the inhabitants are for the most part either well-to-do, or possessed of small but independent means, and belong chiefly to the petite bourgeoisie, the retired tradesman or artisan class. Most of the houses have gardens; to these is sometimes added a plot of ground where vegetables for the household are cultivated, and where the owner may keep poultry, and perhaps a goat or a cow, or rear two or three pigs. There are no local industries or manufactures, with the exception of two tobacco factories.
The pensionnaires (or private patients) have regular occupation and recreation provided for them in the families whose hospitality they enjoy. It is significant, too, that these afflicted beings are rarely spoken of as ‘insane,’ but are generally referred to as les malades; truly ‘sick in mind,’ and therefore not only to be treated as guests, with kindly courtesy and consideration, but to be cared for and helped in every way to recover the lost balance. Nearly every house in Gheel contains one or two malades — not more than two being allowed by the regulations of the Système Belge. They are encouraged to share in the usual avocations — the daily toil, the simple pleasures of their hosts; the poorer patients work in the gardens or on the farms; the women sew and help in household duties; those of a higher social position are stimulated to follow any pursuit that interests or amuses them. Music, painting, and other arts are cultivated; as regards the former, there is an excellent Harmonic Society in the town, which holds its regular gatherings and periodical concerts, the sane and insane members alike taking part in the programme, to the enjoyment of the whole community.
It might, perhaps, be supposed that constant association and intercourse with those who are mentally afflicted would have an injurious effect on the children of Gheel; but the writer was assured that, on the contrary, accustomed as they are from infancy to the eccentricities and harmless vagaries of the unfortunate creatures around them, they learn to regard these inmates of their home, not with fear, but rather with a sympathetic tenderness and protecting love. It is no unusual thing to see the lunatic boarder nursing the baby, or watching the little ones, while their mother is busied about her household occupations, or walking happily hand-in-hand with them to church on Sunday; and this mutual affection, so pathetic to an onlooker, is not only soothing, but often absolutely beneficial to the distraught brain of the patient.
Needless to say, no dangerous patients are allowed to enjoy perfect freedom from restraint: it is a stringent rule that no insane person showing a tendency to suicide, homicide, or to vicious habits shall be admitted to the colony of Gheel; if any such are sent there for treatment, they are detained in the infirmary, where they are cared for by the gentle, sweet-faced sæurs de charité. All possible risk to the community being thus guarded against, no irksome restrictions are put upon the liberty of the patients; they are permitted to come and go unquestioned, to take long country rambles alone or in company; and it is very rare indeed that the trust reposed in them, or the privileges they enjoy, are abused. It is true that the isolated situation of the town would make escape difficult; then, no malade is allowed to have money in his or her possession, except, perhaps, on Sundays or festival days, when half a franc, or a franc, may be given them, to be spent only in the town. The sale of intoxicants to the insane in the public houses is strictly forbidden, and all nourriciers are required to see that their boarders are safe indoors, in winter at four o’clock, in summer at eight o’clock in the evening, unless an extension of time has been authorized by the doctor.
The entire colony is kept under constant medical supervision. Night and day the houses where patients are received must be open for inspection if it is thought desirable; the surveillants (inspectors) are instructed to time their visits at all hours: in the early morning, to see that the patients are not compelled to rise too early or against their will; at mid-day, to note if the food prepared is sufficient and nourishing; at night, when the family are about to retire, to make sure that a due regard is paid to the warmth, comfort, and ventilation of the sleeping apartments. The medical staff (who are not allowed any private practice) have also their regular daily rounds; incurable cases in each section are visited at least once a month by the doctor in charge, and twice by his subordinate inspector; and those cases where there is hope of ultimate recovery are always visited once a week, and, if need be, more frequently.
The médecin-directeur of this interesting colony, upon whom rests the immense responsibility of administering and controlling its affairs, not only keeps in touch with all that is going on, through the daily reports of his subordinates, but once, at least, during the year personally inspects every house, and visits every patient throughout the entire district. The members of the permanent committee, in two series, also pay a visit once a year.
It may be mentioned that as the mentally afflicted people under treatment at Gheel include many not of Belgian nationality, — England, France, Holland, and other countries send patients there, — freedom in the exercise of religion is carefully maintained: the two Catholic churches have already been alluded to; in addition, a Protestant pastor and a Jewish rabbi minister regularly to the spiritual needs of their respective co-religionists.
As regards the payment made on behalf of the ‘alienated,’ where these are paupers, or in indigent circumstances, the cost of their maintenance is defrayed by the district or parish from which they are sent; those whose friends are in a position to pay for them are charged in accordance with their own social condition and that of the family with whom they reside. For lunatic patients in easy circumstances the cost of maintenance at Gheel varies from six hundred to six thousand francs a year (that is, from about one hundred and twenty to twelve hundred dollars).
And here, to prove that the annual revenue derived from these payments amounts to no inconsiderable sum, the following words may be quoted from a letter written by Dr. Peeters, who for many years, until his retirement in 1909, held the post of médecindirecteur. He says,
‘If the town of Gheel wears an unwonted aspect of prosperity, it owes it most certainly to the colony. We [the executive] always insist that the laws of hygiene shall be strictly observed, that perfect cleanliness shall reign in the houses, that the windows shall be bright with flowers. We have the right to make these and other demands, for the sums paid by our patients to the inhabitants of Gheel amount to over eight hundred thousand francs a year.’
At the present time two thousand three hundred and twenty-five mentally afflicted patients are under treatment in the colony; out of which number between sixty and seventy only are sequestrated in the asylum, all the others enjoying perfect liberty and the advantages of le patronage familial. As to the results of the system, it is stated by the authorities that the general health of the patients is excellent; during the past few years the death-rate has averaged about four per cent; fatal accidents, from whatever cause, are rare; while, with regard to recoveries, these at Gheel, at least since 1889, have been nineteen per cent. Epileptic patients especially appear to derive benefit here, and during a period of twenty years, out of some three thousand received, only once has there been an attempt on life, and that not a serious one.