CHAPTER IV.
Some General Considerations.
It is instructive to compare the public attitude towards insanity with that adopted in the case of another serious disease, tuberculosis.
There is nowadays a general conviction, not only amongst the medical profession but also amongst a large proportion of the educated public, that tuberculosis is a curable disease. It may exist in a mild and incipient form in many persons regarded as healthy, and, if properly treated in its early stages, with due regard not only to the actual disease in the bodily organism, but also to the healthy environment of the individual, it is almost certainly conquerable. Not many years ago, however, this happy belief did not obtain. A person “in consumption,” especially if “consumption was in the family,” was regarded as being in a very serious and almost hopeless condition. The patient, shielded from fresh air, inappropriately and insufficiently fed, often succumbed, supplying one more example to support the unscientific conception then prevalent of the inheritance of the disease. But such conditions are passing away. In our medical schools and hospitals special attention is paid to the diagnosis and treatment of early forms of tuberculosis; the importance of preventive measures is emphasised; the influence of the patient’s environment in favouring or combating the disease is explained; and the future medical practitioner is afforded frequent opportunities for personal investigation of tubercular patients. The old ideas about the “inheritance of consumption” are greatly modified. No longer is a patient’s disease explained as “in the family” and left at that. Preventive measures, early treatment, an attempt justly to appreciate the relative influence of heredity and environment are the watchwords of the modern medical attack upon tuberculosis.
If, however, we consider the attitude of the general public in this country towards the malady of insanity we find a mixture of ignorant superstition and exaggerated fear. From these there springs a tendency to ignore the painful subject until a case occurring too near home makes this ostrich-like policy untenable. The sufferer is removed to a “lunatic” asylum, neither himself nor his relatives being spared the gratuitous extra wrench to their feelings aroused by this name, which has long struck terror into the uneducated mind. He is taken away by the relieving officer of the district, often under the pretence of being given “a few weeks in a convalescent home at the sea-side,” and eventually finds himself under lock and key. Here, as is well known, he is treated with great kindness. Neither public money nor the exertions of the staff are stinted in the effort to render his lot as pleasant as possible—“the asylum to-day has become a model of comfort and orderliness.”[50] But the proportion of doctors to patients is on the average, one to 400, and it is exceedingly difficult to ensure that all patients, once inside the “lunatic” asylums, shall be regularly visited by friends from the outside world.[51] The attitude of the general public is not deliberately cruel, but it appears to be far more benevolent than it really is. The community treats the sufferer well, when, but not before, he has become a “lunatic.” It allows his delusions to become fixed, his eccentricities and undesirable acts to harden into habits, his moods of depression to permeate and cement together the whole of his life—and then interns him and treats him kindly for the rest of his life, but does not give him facilities for gratuitous treatment while he is still sane. That is the British procedure to-day.
Lest we should be accused of exaggeration, or worse, we will quote here from published articles and reports.
Dr. Bedford Pierce says:—
“Let me state in a few words the defects of our present system. At present, broadly speaking, no person unable to pay its cost can receive adequate treatment until he is certified as of unsound mind. This practically means that no special treatment is possible until he has utterly broken down, and is so seriously affected as to convince a magistrate that he is decidedly insane. No general hospital will receive such a patient; the public asylums are all closed to any one who begs for protection or treatment, for county asylums cannot receive voluntary boarders even when the cost of their maintenance is forthcoming.
Consequently there is no alternative but to apply to the Poor Law authorities, who, under certain circumstances, provide treatment for a period of two weeks in the workhouse infirmary. The whole system is radically wrong. When the wife of an artisan becomes depressed after confinement, surely it is cruel in the extreme to make her a pauper and send her to the workhouse infirmary, pending a decision as to whether she is insane or no. It is obvious in such a case that this course will not be adopted until the last possible moment, and consequently much valuable time is lost.
Every practitioner will be able to call to mind patients travelling steadily towards insanity in unfavourable surroundings. This question is brought even more prominently before consulting physicians, especially those interested in nervous and mental diseases.” (Op. cit., p. [42].)
In the words of the report of the Medico-Psychological Association:—