Gheel

I

SANDY, pine-covered levels of the Campine, then a return to the multicolored carpet of vegetables and grains that covers most of Belgium. A cool green canal, more purple cabbages and flowering beans, and geese and cows in pasture. The spires of Saint Dimphna and Saint Amand. Our little train rolled quietly into the station of Gheel.

I was unencumbered and dropped lightly to the platform. Eagerly I looked about for Dr. Sano, who was to be my conductor through this extraordinary town, unique among the villages of the world, hospitable abode of disordered minds.

Some dozen stolid, amiable-looking Flemings lingered at the station, inspecting the train and the stranger. But no familiar Dr. Sano, nor could I catch sight of him anywhere along the wide paved street. In any like circumstance, in another town, I should have started off quickly to find him. But in Gheel I hesitated. Perhaps my face showed a certain anxiety; at any rate it was not long before a youngish, darkhaired man moved toward me and said in a friendly tone, ‘If you wish to see the town, I will show it to you. It is small; we can make the tour as quickly as you like.’

‘Well, why not?’ I answered mentally. This might, after all, be a fruitful beginning. It would postpone by very little the real visit.

The young man appeared happy over my decision. We turned into the clean, quiet street — quiet, but by no means deserted. What a pretty, fresh look the little place had, with its plain gray façades, its churches, and green fields in the distance! What an uncanny naturalness about it! Everywhere geraniums and lace behind the window glass. The perpetual Belgian pail and broom and mop in full activity, the perpetual painting of lintels and sills in progress. I peered inside the doorways when I could, and scrutinized the moving groups of grown-ups and children, but I noticed no strangeness in their general appearance. After a few minutes my sense of unreality had increased to the point where I was ready to call out, ‘This cannot be; I have missed my station.’ But my interesting guide, quite oblivious of my uneasy perplexity, led on. And then, in answer to my question, ho replied in some astonishment, ’Mais oui, c’est bien Gheel!’

We had passed through the churchyard gate, and were following a winding path toward the oldest and most beautiful wall of the Cathedral of Saint Dimphna. As we walked, he suddenly stopped, facing quickly about. But even in advance of that swift movement she too had turned — the shadowlike figure in the purple calico dress and black sun hat — and stood already, her back toward us, before a tall gravestone, so close to it, so immovable, that she seemed a purple shadow thrown against the gray marble.

We watched her silently a few moments; then my guide began pointing out especially fine bits of carving over the chapel entrance. As we turned again down the path toward the gate, there, as still, seemingly as imponderable as the air, was the purple figure against the gray stone. Butterflies hovered about her.

Just outside the gate, children were playing with hoops and ropes. Again the startling naturalness of the cheery street and its tranquil people. Only fifteen minutes, and yet I could no longer support this sensation of the abnormality of the normality of the atmosphere of Gheel. I must go directly now to Dr. Sano.

‘You have been most kind,’ I began — but my guide was entirely absorbed in the approach of a villager.

‘Ah, there you see’ — he took me suddenly by the arm — ‘a poor man, a demented one, for he has the hallucination that he is Jesus Christ. And you must know’ — deeply and impressively — ‘that I am the true Jesus Christ.’

I caught my breath. I had not missed my station!

He waited for no comment, serenely certain of my acceptance of him. And I realized that not far away I should find Napoleon and Charlemagne and Mohammed and Julius Cæsar, and others who at some moment had captured the world’s imagination. Here they enjoyed a bizarre immortality.

II

A few more sights pointed out, and then at last Dr. Sano. After the first exclamations and explanations, ‘But it was, after all, better this way,’ he said. ‘I could not have planned it so well. You have begun, however, near the end, for your conductor is almost restored to society. Now we will begin at the beginning.’

Dr. Sano, in charge of the colony of the insane at Gheel, is rather below than above medium height, slight, with brown hair and eyes and a neatly trimmed beard. His manner is strikingly quiet and sure. One has at once the impression of a man whose energies are focused, whose devotion to an ideal is complete.

We walked away from the centre of the town, — the Director has no motor, — turned into an avenue of magnificent trees, and soon reached a pleasant red-brick building set in a park — the Infirmary and administration centre. Some eight or ten aids were standing at desks in an advance office, beyond which we found Dr. Sano’s plain little room with its books and reports.

My disquietude over the incongruity of the usualness of Gheel did not surprise him. ‘But I warned you of that,’ he smiled. ‘The uninformed visitor does not realize that it differs from other pretty Flemish towns. And just there, of course, is our triumph. Here we have a city of eighteen thousand inhabitants, and we bring to them three thousand insane — one insane for every six sane — whom they must guard and nurse, who will share their houses and their work in the fields or at small trades, or who will pass their days aimlessly following their careers of emperors or Christs. And we manage the commingling of normal and abnormal so naturally that you, a normal, are unstrung as you comprehend it.’

In truth, day and night each patient is under surveillance, but that, surveillance is so naturally a part of the life of the inhabitants that one is unaware of it. The least child is almost unconsciously a guardian. If he sees an innocent wandering too far away, he leads him home. If he suspects trouble anywhere, he quickly reports it either to the family concerned or to the district physician — the town is divided into five sections, each in charge of an expert alienist. For thirteen centuries children have been born into this milieu; to watch an innocent is as normally a part of their day as to eat a tartine.

Nothing more natural, then, than the naturalness of the surveillance. The great majority of families share their lives with either one or two guests; in fact, the family that has none is rather looked down upon as a slacker. To have them in the house has become a habit, even a necessity; and this is the very core of the explanation of Gheel’s success. But that is the ‘time’ story, and must wait.

Incoming patients are received in the Infirmary and held for observation until the method of treatment is determined and they can be properly placed in families. Here they return, later, during periods of excitation or when for some reason they need special watching.

They enter Gheel from all parts of Belgium and from foreign countries as well. There is, of course, a special selection before anyone is sent at all. Since the purpose is to give each individual a course of treatment calculated to bring him back into society, no case known to be hopelessly a danger to society can be accepted. There is thus no place for imbeciles, who completely lack a base on which to build. A mental aberration may be cured; an imbecile, who may have been quiet for years, remains still an imbecile.

' We do not wish a stationary colony, and indeed there is much movement in it,’ said Dr. Sano. ‘From six hundred to seven hundred arrive each year; about one hundred and fifty are sent back to society, about one hundred and fifty are returned to asylums, and about one hundred and thirty-five — approximately four per cent — die.’

Immediately after the war there was a marked increase in the number of patients sent, and after the enactment of Belgium’s partial prohibition law a marked decrease, especially in cases of delirium tremens and kindred ailments. In the past three years there has been again an increase, due probably, the Gheel physicians believe, to a larger percentage of alcohol in beer and a more prevalent use of port wine.

Patients come from all classes of society, but in Gheel they are thought of as belonging to one of three classes: there are the poor, those from families fairly well off, and those from families better off. There is besides, since the war, a special colony for children. The State pays for the indigent — two and a half francs a day to the family host; but to that is added the labor of the guest. To many a peasant the innocent is as much an asset as the family cow. Relatives pay as they are able — sometimes as much as ten or fifteen francs a day, and the innocents thus paid for need not work unless they choose to.

All have the same relation to the Infirmary. An anthropological dossier, as complete as possible, is prepared for each, and as complete a history of his heredity and environment as can be obtained, including all the direct and indirect causes of his dementia. From that information the line of proposed treatment is determined and the family host is chosen.

I asked again about the proportion of insane to sane.

‘We do not feel that we can hope for the results we aim at if our percentage is more than one to six. Five or six times other countries have tried to imitate our experiment and have failed, largely because they did not sufficiently realize this principle of separation, of favorable proportion, in our eyes so important.’

Some patients need not pass through the Infirmary. It is often an advantage if the dossier can be carefully prepared in advance, and the placing arrangements made. The aliené has been told that he will be taken to the country. He will not, then, have the further disillusionment of finding himself again in detention.

The choice of the family is of the utmost importance. Not everyone can qualify. Those who aspire to be listed as hosts must give proof of irreproachable conduct and good will. If they can do that they are given professional instruction to prepare them for their delicate métier of nurse-friend. In general, the direction attempts to give the newcomer an accustomed environment. If he has been an artisan, he is lodged with an artisan’s family. Patients from cities are placed with families of the bourgeoisie in the middle of the town, while those from the country live with cultivateurs. The great number of available families permits much liberty of choice, and the adaptation of the aliené to his new environment can be made under excellent conditions.

‘This is the Infirmary,’ the Director concluded, ‘ the starting point of our work — our laboratory, and at the same time our hospital. And just leaving it, there, is Dr. —, in charge of readaptation. When a physician thinks a patient in his district is ready to return to the world, he gives him over to this specialist.

‘It is highly desirable that the person going back to society should find himself in a new environment, where no familiar conditions will facilitate the return of the old malady. And he must, of course, be surrounded by the best moral influences. But that is another story — that of his return to the world, and of our increasing effort to engage the coöperation of larger and larger groups of normal citizens to help him remain there. Groups, for instance, like the volunteer one in Antwerp.’

III

We went from the Infirmary to visit a few of the alienés in their homes, beginning in the simplest peasant house, — simple, yet a perfect Breughel picture, — a kind of shop-counter in front, where the robust wife was arranging her raisins and a few provisions, the big general room at the left, where the man was smoking after the midday meal and the children and two innocents were cleaning up. Dr. Sano had entered without knocking — every door is his own door. From all there was a smiling welcome.

These were both congenital cases, paid for by the State. One was a flaxen-haired, pink-cheeked young woman, who had worked all morning in the vegetable field at the rear, who did not once speak, but kept very close to us, smiling continually; the other was a deaf-mute, dark and agitated. At the moment of our entrance she had begun running back and forth, clapping her hands and uttering weird cries. The mistress had gone to fetch the ‘patient’s book,’ which every family must keep, recording the name, date of arrival, and various facts regularly reviewed by the attendant physician, and we did not read any meaning in all this agitation until she returned.

‘Oh, I think it must be the new calf,’ she laughed; and we followed to that most fascinating part of every Belgian homestead, the animal-shed. There the excitement culminated. It was, indeed, the calf that the deaf-mute wished us to see. Her cries ceased, but she continued running about between the lambs and the geese, clapping her hands. She had been chiefly engaged all morning in caring for these animals.

We inspected the small, airy bedrooms, each with its window looking on the garden, and then went on to a family a little higher in the social scale. There they had just begun dinner — the postman, his wife, several children, and two young men guests. No disturbance over our visit, though all got up to greet us. One of the young men, as he stood with closed eyes and delicate immobile face, seemed asleep. Dr. Sano took his hand; it was purple. ‘You will scarcely believe,’ he said, ‘that there is much improvement here; yet I have strong hope for this young man.’

In this case there is no question of a contribution in labor; the family pays and the hosts carry out the prescribed treatment. At the rear of the house again the gardens and the quarters for the animals, among them a goat that furnishes the milk ordered for the young man who seemed asleep.

A few doors farther along we found a still more comfortable type of home, and again two guests — women. The fair and gay one was at work with threads and beads; her companion was dark and melancholy and unoccupied. And while the bead-worker was happily excited over our praise of her chains, the other’s burning glance asked, ‘Your praise, how can it interest her? How can she laugh?’ ‘In prison,’ she muttered, as we passed her. Originally a menopause case, she has been there sixteen years.

We next visited the daughter of a former director of Gheel and her two charges. The fine old house was surrounded by green lawns and great trees and flowering red-rose bushes. Monsieur Louis, the brother of a French physician, was crossing the hall as we entered, but he paid no attention to Dr. Sano when he called him. It was only when Madame herself went to fetch him that he came, and then for some time he would have nothing to do with us; but finally Dr. Sano’s questions about a proposed visit to his brother in France brought him round. A proposed visit! Louis has been in Gheel thirty-six years!

‘You do some work? What is it?’ I asked.

M. Louis shook his head.

‘Oh, yes, he is very busy indeed,’ Madame interrupted quickly, ‘He keeps constantly au courant with all that goes on in the village. I need never leave the house, for M. Louis reports all the news. Then he is continually going on errands for me — which is not saving, however, that he may not add to or subtract from my commission,’ she laughed. ‘Yes, indeed, he is a very much occupied person!’

‘And what news of Mr. John?’ Dr. Sano inquired. Mr. John is the brother of an English physician, and was away in England to have some dental work done. He too has been in Gheel many years, — seventeen, — but he has improved enough to be able to make the journey to his brother unaccompanied.

In similar surroundings we found a tall, blue-eyed Englishman, who at once offered me cloth samples and proceeded to write down my measurements in a little book. ‘I hope the last suit was all right?’ he questioned anxiously, and his blue eyes shone with satisfaction when I told him it was. He goes freely about the town, always taking measurements, delivering imaginary suits, and being continually assured that they have proved satisfactory.

Here, too, was the prettiest, most exquisitely graceful Irish girl. As soon as she had heard us coming, she had run upstairs to adorn herself, to appear in a few minutes with her brown curls charmingly arranged, a flower at her belt, and tiny artificial ones wreathed about a cross she had hung from her throat. Such dainty ways and graces as she curtsied and smiled! Such a deliciously musical voice as she followed her fancies! An artist to her finger tips.

‘Yes, they came, Ina and Michael, and you did not keep it from me. Ina had flowers in her hair.’ Then suddenly, tragically breaking — ‘But why did she steal in at dawn and tear the clothes from me?’

I do not know how, but Dr. Sano quieted her. She had just passed a period in the Infirmary and he was watching her closely.

‘But I want to go and take care of your mother,’ she appealed to him. ‘I must take care of her.’

‘No, mother is quite all right there in Antwerp.’ He patted her shoulder.

‘Then your wife — I must take care of her.’

‘Yes, you can take care of her,’ he agreed, and she was happy again. ‘Bon jour!’ She tiptoed about me. ‘I will speak French with you,’ and she threw me an airy kiss.

How merciful, that space in which she still may circle and curtsy and run upstairs to adorn herself!

IV

I had lived many years close to a hospital for the insane and had become accustomed to the red-brick city set apart. But this was different. Here was no visible demarcation. Here the insane abide with the sane. Only the invisible border line, crossed and recrossed by the errant spirit. She talked of her flowers, then in a lightning flash was a planet away. He showed me a Gothic doorway, then he too was beyond my reach. I felt the ground slipping from under me. Here all was adumbration, evanescence — so many degrees of approach and retreat. Where, after all, was the border line? How insupportably poignant! How slight the mooring of any spirit! Yes, to succeed, this experiment demands the equable, unemotional Flemish temperament; a less equable one would fail.

These were all milder cases, whom a visitor would least disturb, but their relation to the household is typical. Everywhere I felt how truly at home they are. They are valued, almost revered guests, largely because they are a source of income, — because their work in the fields or the house is a distinct asset, — but also because from early centuries Gheel has considered it her religious duty to give hospitality to the insane. To-day the work is a state work, but the religious tradition still strongly persists.

And just here is the most dramatic aspect of this accomplishment. It traces its origin, not to some highly specialized modern laboratory, to recently developed experiment centres, but to faith in the power of a sixthcentury saint to cast out devils! There have been three stages in the development of this extraordinary community work: the first, or purely religious period, when the insane pilgrims who believed that through Saint Dimphna’s intercession they would be cured lived in cells adjunct to her Cathedral, and in families closely connected with it; the second, when they were grouped around a communal hospital; and the third or present period, dating from 1852, in which the State has entire supervision over them.

Tradition places the beginnings of the practice of housing the ‘possessed’ in this village of northern Belgium as early as the martyrdom of Saint Dimphna, in the sixth century. Historically it dates at least from the fourteenth century. When the cells adjoining the Cathedral proved insufficient to house the suppliants, families devoutly offered their rooms, and so the work spread. From the point of view of her achievement there is no more interesting saint in the whole Catholic calendar than Saint Dimphna.

Her story is beautifully carved on the altarpiece of the Cathedral. It represents her in the dim sixth century fleeing from Ireland and the pagan father who tried to force her to marry him. After long wanderings she and an aged confessor found themselves in the Campine, where they set up a chapel. There Dimphna’s days were filled with holy works, and love for her spread through the whole region. But the father relentlessly pursued her. One of his agents discovered a piece of Irish money in an Antwerp tavern. How had it come there? Why, they told him, the holy woman of the Campine had Irish money. And so they hunted her down. The incestuous demand was repeated, and again Dimphna repulsed her father. His soldiers assassinated the aged priest; he himself cut off his daughter’s head.

The carving shows him, with the devil that possessed him standing close behind. In the last panel the innocents crowd about the martyr, now Saint Dimphna. She who had power to resist her father’s devil would surely help them to free themselves of their own. A woman in epilepsy leans backward, the epilepsy devil escaping from her head. ‘That is as accurate a portrayal of a position in epilepsy as the one in Dr. Charcot’s office in Paris,’ Dr. Sano explained. The imbecile, the others in the foreground — all are remarkable. And so inevitably Saint Dimphna’s shrine became more and more a holy place of pilgrimage for the demented; and, as we have seen, the custom of offering them hospitality spread from the Cathedral outward.

Behind the present altar is the actual shrine, lifted aloft on carved supports. The exquisite silver châsse rests in the crypt below. Each May, after the procession of aliené pilgrims has marched three times around the nave, they must drop to their knees at the side of the shrine, and on their knees pass under it. If this feat is successfully accomplished, the innocent may hope to be cured. ‘Good medical sense too in that,’ Dr. Sano commented. ‘There is hope in such capacity to direct movement.’

Tradition reports wonderful cures in the name of Saint Dimphna. And wonderful cures are still wrought in Gheel. Here is no conflict between science and religion, for the last word of science repeats the early word of religion. To-day the city’s device might well present Religion and Science, hands clasped, welcoming the innocent.

We inspected the ancient cells, now kitchen and living quarters for Cathedral attendants, and passed into the churchyard by the lovely old door my guide of the morning had brought me to see.

‘You will find buried here, with the villagers, demented ones from Poland, from Czechoslovakia, from other far places,’ Dr. Sano pointed out, as we looked across the serried ranks of stones. ‘They mingled in life; here they are together in death.’

Then, just as my earlier guide had done, he suddenly wheeled swiftly about, and there again close behind us was the purple-clad figure. And again she glided noiselessly to a grave. As we passed through the gate I stood for a moment to watch her, immovable, a purple shadow against the gray stone.