An excerpt of Dorothea Dix's plead for a state mental hospital:
"Moral treatment of the insane with a view to induce habits of self-control, is of the first importance. Uniform firmness and kindness towards the patient are of absolute obligation. The most exact observance of truth should be preserved in all intercourse with the insane. They rarely violate a promise, and are singularly sensitive to truthfulness and fidelity in others. They rarely forgive an injury and as seldom betray insensibility to kindness and indulgence. Once deceived by a nurse or attendant they never a second time bestow their confidence upon the same individual.
Moderate employment, moderate exercise, as much freedom as is consistent with the safety of the patient, and as little apparent anxious watchfulness with cheerful society should be sought. The condition of the patients must determine the number of nurses in a ward. The general opinion is holden that all patients do better without special nurses, wholly devoted to their care.
“The proper mental and physical employment of the insane,” says Dr. Kirkbride, “is of so much importance that the full treatment of this subject would be to give at once a treatise on the insane and on insanity. Whatever it maybe, it must embrace utility, and it is well to combine both physical and mental occupation. Active exercise in the open air, moderate labor in the gardens, pleasure grounds, or upon the farm, afford good results. Short excursions, resort to the work shops, carpentering, joining turning, the use of a good library&c.,&c., are aids in advancing the cure of the patient.” Sedentary employments are not in general favorable to health. The operations of agriculture seem liable to the least objection. There is a limit to be observed in the use of labor as a moral means; for there are always some patients to whom it is decidedly injurious. This effect is manifested oftenest in recent cases.
Dr. Ray says that it is an error to suppose that the insane can labor as productively and as uniformly as the sane man. The working hours of a patient should seldom exceed six or seven per diem, and not seldom work is altogether intermitted.
The manner in which labor exerts a beneficial influence upon the insane mind differs no doubt in different forms of the disease. In highly excited patients the surplus nervous energy will be consumed, if no other way is provided, in mischief and noise; but let it be expended in useful labor, and although the work may not always be perfectly well done yet the patient thinks it is, and experiences the gratification of having done what he believes is a good thing, and consequently, so far as it goes it is beneficial."