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say *) some of them encourage both by precept and example.
Thirdly. If the deception be discovered or suspected, the effect upon the patient is much worse than a frank and full statement of the truth can produce. If disagreeable news, for example, be concealed from him, there is very great danger that it will in some way be revealed to him so abruptly and unexpectedly, as to give him a severe shock, which can for the most part be avoided when the communication is made voluntarily. And then, too, the very fact that the truth has been withheld, increases, for obvious reasons, this shock. We will relate a case as an example. It occurred during the prevalence of an epidemic. lady was taken sick and died. The fact of her death was studiously concealed from another lady of her acquaintance who was liable to be attacked by the same disease. She was supposed by her to be doing well, until one day a child from a neighboring family accidentally alluded to the death of her friend in her presence. The shock which the sad news thus communicated, produced upon her, was almost overwhelming, and it was of course rendered more intense by the reflection, that her friends thought her to be exceedingly in danger of dying of the prevailing disease, and therefore had practiced this concealment in order to quiet her apprehensions. She soon followed her friend, and it is not an impossible supposition, that the strong impression thus made upon her mind had some agency in causing her death.
In another case of a similar character, the first intimation which a lady had of the death of a friend, was from seeing the husband of this friend pass in the street with a badge of mourning. She was immediately prostrated upon her bed, and was a long time in recovering from the shock.
In both of these cases the concealment of the truth was prompted by the best of motives—pure kindness; and yet nothing is more plain than that it was a mistaken kindness. Whatever may be true in other instances, the result showed this to be the fact in these two cases. And if it be true, as we think all experience will prove, that success, and not failure, in the attempt at concealment, is the exception to the general fact, it clearly follows that deception is impolitic as a measure of kindness, and therefore, aside from any other consideration, it should be wholly discarded in our intercourse with the sick. We have a case in mind, which exhibits in contrast the influence of frankness and of deception. A little girl, the daughter of a farmer, had her arm torn to pieces up to the elbow in a threshing machine constructed very much like a picker. As her mother was confined to her bed with severe sickness, the child was carried into the house of a neighbor. When I arrived, I was told that her mother was in great distress, and fears were expressed that the accident would have a very bad influence upon her case. I asked if she knew what had happened. ‘No,' said her husband, “not exactly. She found out by the children that Mary was hurt, and then sent for me, and asked me what was the matter. I told her at first that she had got her finger hurt. She said, she knew that was not all, and I at length, after she had begged and begged me to tell all, told her that her hand was hurt badly. And now she is crying most piteously, and says that we are deceiving her, and that she knows that Mary is almost killed.” I immediately went in to see the mother, and found her indeed almost distracted with the great variety of dread visions that had suggested themselves to her fancy in regard to her darling child. As I entered the room she cried out, ‘Oh, she's dead, doctor, or dying— torn to pieces in agony—Oh, is n’t it so 2 tell me, tell me the truth !' “Be quiet,” said I, ‘and I will tell you all the truth. I will not deceive you.' I assured her that she need give herself no anxiety about the life of her child—that was safe. This announcement quieted her in a good measure, and I went on to tell her that the arm was badly torn, and that I must amputate it above the elbow. I told her that this would take but a minute or two, and then the child would be essentially well. It was necessary to go into these particulars in answer to her enquiries, (which were the more minute from the fact that she had been deceived,) or else I should forfeit her confidence, and thus commit the same error that had already been committed. She thanked me for being so frank with her, and said, that though it was hard to think of the operation, she could bear that, if the child's life was only spared. She grieved still, it is true; but there was none of that overwhelming distraction that results from vague apprehension. Fourthly. The destruction of confidence, resulting from discovered deception, is productive of injurious consequences to the persons deceived. The moment that you are detected in deceiving the sick, you at once impair or even destroy their confidence in your veracity and frankness. Every thing that you do afterward is suspected, and a full and unshrinking trust is not accorded to you even when you deserve it, though you may try to obtain it by the most positive and solemn assurances. If, for example, you wish to encourage a patient, and you tell him that though the bow of hope is dim to his eye, it is bright to your own: ‘Ah!” he will think, if he does not say, “how do I know but that it is as dim to him as it looks to me—he has de
ceived me once, and perhaps he does now.” Every physician has seen the injurious influence of deception upon children. Sometimes it is of a most disastrous character, and occasionally, we have not a doubt, it proves fatal. Deception is more frequently practiced upon children than upon adults, and many seem to think that they have not the same right to candor and honesty in our intercourse with them. But a child can appreciate fair and honest treatment as well as an adult can, and he has as good a right to receive it at our hands. He sometimes claims this right in terms, and by acts not to be mistaken. And when it is taken from him, he shows his sense of the wrong by remonstrances and retaliatory language, and by a system of rebellion to an authority which he despises, as well as fears, for its falsehood. Suppose a mother succeeds in giving a dose of medicine by stratagem, the administration of every dose after it is accompanied with a fearful struggle. The strife which results from the spirit of resistance thus engendered, perhaps in the beginning of a long sickness, and which might in most cases have been avoided by frank and candid treatment, continues through the whole course of the disease to the last hour of life if the case prove fatal, the little creature feebly but obstinately resisting its mother till the exhaustion of coming death puts an end to its struggles; and though she plies every art that fondness can devise to win back the lost confidence of her darling child, it is all in vain. If the reader have any adequate idea of the importance of quietness in the management of the sick, we need not spend time to prove, that this resistance of the sick child has an injurious effect upon the disease, and that in those cases where life has but a feeble trembling hold, where the silver cord is worn down almost to its last thread, such a struggle may break that thread by its violence. We have not a doubt that many a child has died under such circumstances, that might otherwise have recovered. Let us not be understood to imply, that the resistance made by children to the administration of medicine is invariably the result of deception practiced upon them, though this is the cause undoubtedly in quite a large proportion of the cases, and those too of the worst and most unconquerable character. And it may be remarked, that in many cases this may be the cause of the difficulty where it is little suspected. For it is so common a habit to deceive children in this matter, that it is often done unconsciously. But though the parent may not remember it, the child does, and the cruel oppressive act (for so it may be properly called) locked up in the memory of the child, wakes up rebellion in his heart that is not easily quelled. Many a parent has thus in a moment, for the sake of a slight temporary advantage, sown the wind to reap the whirlwind. Deception has very often been made use of in the management of the insane, though recently not to the same extent that it once was. The consideration which we have been illustrating and enforcing, lies against the practice of it in our intercourse with this unfortunate class of patients, with the greatest force, because in their case the mind is diseased, and any bad mental influence has therefore a worse effect than it would have upon a case of mere bodily disease. The reason is obvious—it acts directly upon the seat of the disease in the former case, but indirectly in the latter. Besides, let the insane man once see that you have deceived him, and you lose the principal, perhaps we may say the only moral means
that you have for curing his malady. Confidence is essential to any good moral influence that you may exert upon him. We might cite many facts to prove this, but will advert to only one. The wife of an insane man was the only person among all his friends that had any control over him, and she could manage him with perfect ease. After his recovery she asked him the reason of this fact, and his reply was, “You was the only one that uniformly told me the truth.” The bad influence of deception upon the insane man is rendered the more certain and effectual from the fact, that his insanity incapacitates him for appreciating the kind motives which may have prompted the deception. You can not convince him as you can the sane sick man, that you have deceived him for his own good. His suspicious eye sees nothing but a sinister purpose in the cheat which you have practiced upon him. One of the most vivid recollections of our childhood is that of a scene which illustrates these remarks. A poor crazy man who wandered about the streets was thought to have become dangerous, and it was proposed to confine him in the common jail. A plan was laid to do it by stratagem. He fancied himself to own some large possessions, and talked much about going to Boston to see his friend the governor, and attend to his business there. A neighbor offered to go with him, and he accepted the offer. As they passed by the jail, his friend proposed to visit it. As they entered one of the cells he adroitly slipped out, and the door was closed upon the insane man. His dream of earthly happiness and wealth was in a moment at an end, and he beheld himself the victim of base treachery in the narrow cell of a prison. Never shall we forget how eloquently he pleaded for his release, how he asked what crime could be charged to his account, how he denounced those who had thus without cause shut him up like a felon, and especially with what sorrowful but burning indignation he spoke of the man, “who under the guise of friendship, had decoyed him into this snare of his enemies.” Though a mere boy, we pitied him—we sympathized with him. We had known him only as a pleasant old man, who used to amuse us as we met him in the streets, with stories of his immense wealth and of the splendid plans of building on which he loved to speculate. We felt that it was wrong to confine him, an innocent man, among vile criminals, and wondered not that the keen sense of such injury prompted to the utterance of curses on those who inflicted it. But these natural feelings gave way in our bosom, as they did in older ones, to what was then supposed to be the necessity of the case—a necessity which, we rejoice to say, has since that been found not to exist in similar cases. A very great improvement has been effected in this as well as in other respects, in the management of the insane. Most of those whom it was once thought necessary to confine with bolts and bars and perhaps chains, and upon whom deception was continually and systematically practiced, thus adding poignancy to the pangs of the oppressed spirit, are now permitted to have so much liberty that they are cheerful and happy, reposing entire confidence in their attendants who are careful never to deceive them. And those whom it is thought necessary to confine, are not doomed to the cheerlessness and disgrace of the cell of the felon, but they are placed in as agreeable circumstances as is consistent with safety. And it has come to be an established rule with those who have the care of the insane, that force is always preferable to deception. But still, erro
neous views are very prevalent in the community on this subject. It is common to this day, even among the excellent and well informed, to propose to send their insane friends to a Retreat by stratagem, and this has often been done even by the advice of physicians. So far as we recollect, in all the cases of insanity that have gone to Retreats from under our care, this mode of management has been spoken of by some, and generally by many, as the only proper mode. The public need to be instructed and reformed on this point. It is a common observation that the insane are apt to look upon their best and most intimate friends as their enemies. Why is this 2 It is clear to our mind, that it is for the most part to be ascribed to the influence of deception, waking up, as might be expected, feelings of resentment and enmity in the bosom of the insane, which would not otherwise be there. This is conclusively proved by the fact, that these feelings do not ordinarily exist toward the physicians and attendants in Retreats, who pursue a frank and candid course with their patients. The extent to which deception is practiced upon the insane can not be fully appreciated, except by those whose attention has been specially called to this subject. As we have already remarked in regard to children, so also it is with the insane —deception is so common, that people often make use of it almost unconsciously. The whole course of management on the part of their friends, is often characterized throughout by an absence of candor and veracity. The tendency of such a course is invariably to increase insanity, making it more intense and obsti. nate. And not only so, but it modifies to a greater or less degree its character. Deception prompts the insane man to exercise his in
genuity in forming plans to foil and circumvent his deceivers, whom he supposes very naturally to be his enemies. Of course, new feelings and thoughts are thus excited in his bosom, giving in some measure a new cast to his insanity. We will here relate a case that illustrates these remarks. The friends of an insane gentleman determined to send him to a Retreat by stratagem. For this purpose, he was induced by one of them to go a journey with him. On their way, his friend proposed to him to visit an Insane Retreat as a matter of curiosity. When they arrived there, he was given to understand that he was to remain as an inmate. Great was his rage at being so grossly deceived. After the first burst of indignation was passed, he saw that it was of no use to say anything or to make any resistance. He was a shrewd man, and therefore, as a matter of policy, he submitted with apparent cheerfulness to his new situation. He did not forget, as the insane sometimes fortunately do, the wrong which his friends had done him, and as he was decoyed there by stratagem, it is no wonder that he at length made his escape by stratagem also. He came out, as might have been expected, with his insanity more thoroughly fixed than it was when he went in, and he added to it a deep hatred of Retreats, and of course of the man who had betrayed him into one. Another attempt was made to carry him to the same Retreat, which from mismanagement utterly failed. The insane man was victorious, and he felt himself to be so over his friends, who he supposed were bent upon cheating and oppressing him. All this not only made him more crazy, but it gave a new shape to his insane ideas. In a conversation which I chanced to have with him, he said to me, ‘It is perfectly evident, doctor, that these Insane ReVol. III. 10
treats are joint-stock institutions, and the stockholders are chiefly lawyers and doctors and ministers. And it's good stock too. Just see how much they charge for board—full double at least of the actual expenses. I need not tell you any thing about it however, for you own some of this stock, and you know how profitable it is to you.’ “Oh no,” said I, ‘this is all new to me.” He looked at me as if he would look me through. He had been deceived so much, that he believed, he trusted no one. Although I gave him the most positive assurances that I owned no such stock, still, in spite of the confidence which he ordinarily reposed in me, he showed that he did after all suspect me on this point, so firmly was this notion about Retreats fastened in his mind. He went on to give his reasons for his opinion. ‘I can look back,” said he, “to my very childhood, and see that from that time to the present, there has been a series of efforts on the part of these stockholders to make me a crazy man; and they at length succeeded, and then contrived the mean plan of tricking me into one of their Retreats. The minister that I lived with when I was ten years old began this scheme, and all the ministers and lawyers and doctors that I have had any thing to do with since that time, have had a hand in it—have exerted their influence on me, all in relation to this one object. It's a regular moneymaking business. Of course, the stockholders all want to see these Retreats well filled up. Just see how they have treated me lately. They have combined to cross my purposes, break up my plans, defeat my projects, ruin my business, and all this to irritate and disappoint me, and thus craze me. And then, to cap the whole, they lied to me and betrayed me into their prison to die a slow death, paying them all the time about twelve dollars a