If I had been psychiatrist-in-chief from 1890 to 1923…

I would definitely be a man and I would be known as the medical superintendent of the Protestant Hospital for the Insane at Verdun. I would be facing the task of introducing the often ridiculed "moral treatment of the insane" and would be working hard at convincing authorities and colleagues to replace mechanical restraints with a healthy living environment, a full program of work and amusement, and a kind and humanistic attitude.

I would have no outpatients, 354 involuntary inpatients—as voluntary admissions were not permitted by law—and would have only a few diagnoses to choose from. I would be treating melancholia and mania, but also 3 types of dementia, and general paresis, also known as tertiary syphilis. My observations would also indicate that some ill-fated individuals suffered from both mania and melancholia. Although by law we would not be expected to care for “idiots, imbeciles and morons”, unless dangerous, scandalous, malformed or epileptic, I would have to be wary of attempts by families and authorities to have us care for these unfortunates. One of my main preoccupations would be to deal with pulmonary tuberculosis, a severe and contagious illness, for which there was no treatment or cure. As for medications or therapies, none would be available, and my working tools would be good food, a good living space and a good attitude.

My 1896 statistics would prove that we were doing something right: of the 1,279 patients admitted over the previous 6 years, we would consider 447 as cured and 151 as improved. What other asylum could boast a 47% discharge rate? Unfortunately, within a few years of opening the Hospital, good living space would become a problem and overcrowding a top item on my agenda. My salary for dealing with financial woes, medical manpower shortages, precariously high staff turnover and unhappy neighbours fighting our attempts to use our land to build new pavilions, would not even reach $3,000 a year. But, then again, in 1905 I would be rewarded by moving from the main pavilion, where I lived with the other staff, to the modern and beautiful Burland Villa. I would also enjoy the benefits of fresh produce from the farm?45 varieties of fruit and vegetables, and full-time domestic help provided by our very own patients.


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