In advocating the establishment of separate pavilions for nervous and mental disease in direct association with the general hospitals, Dr. Bedford Pierce says:—
“At La Charité Hospital in Berlin, the visitor enters a small park, and Dr. Ziehen’s clinic is but one of many detached buildings devoted to special diseases. It is as easy and simple for the patient suffering in mind to get advice there as for another with eye and lung trouble.”
Let it be noted that none of these German patients, on returning to their relatives and friends, suffer from the stigma of having been to an asylum. In our country some of those same friends during the patient’s absence would often have been engaged in “sympathetically” spreading the news of the sufferer’s absence and his whereabouts to everybody in the district. To a certain type of mind there is a ghoulish fascination in gloating over the illnesses and afflictions of neighbours. Even though people addicted to such habits may salve their own consciences by exclaiming “poor fellow” at the end of their narrative, the effect of their conduct is none the less brutal and offensive. This is not the place for the discussion of so remarkable and important a phenomenon of social psychology. Nevertheless it plays a great part in the causation of the prevalent dread of treatment for mental disorder.
For many reasons the psychiatric clinic is not regarded by the public as a “lunatic” asylum. In the Giessen clinic in Germany, for instance, both nervous and mental diseases are treated. The patient afflicted with tremor or a paralysed finger visits this institution as well as the sufferer whose troubles if neglected might develop into mental disease. Difficult medico-legal cases resulting from such incidents as those arising from the claims by workmen and others for compensation after accident are sent to this clinic for observation and opinion. “Rest-Cures” and similar treatment are also carried out there. The official title of the institution, displayed at the entrance, is “Clinic for Mental and Nervous Diseases.” The institution is therefore regarded by most people in quite a different light from the asylum, and it is not spoken of by the general public with bated breath. One of us, while working in the laboratory of a German psychiatric clinic, was introduced to a visitor who made some remark about “when I was here.” To the question, “Were you on the staff, then?” the visitor answered quite naturally, “Oh no, I was here as a patient.”
With this experience may be contrasted another incident, this time from our own country. Delegates from a certain Board of Guardians paid a visit to the county asylum to inspect the arrangements made for the comfort of the inmates from their own district. In the next week’s local newspaper a report of the visit appeared in the form of the chief delegate’s speech at the subsequent board meeting. This report consisted of “funny” stories of the eccentricities of the patients the visitors had seen, and of the delusions from which some of the victims were suffering, with sufficient detail to enable many of the relatives, and possibly some of the friends, of these “lunatics” to identify the afflicted ones. The newspaper account of this humorous effort was punctuated at suitable intervals with “laughter.”
It is obviously not claimed that these two accounts are typical either of Germany or of England. But what is claimed is that of these two public attitudes the clinic system promotes the one, the “lunatic” asylum the other.
Before leaving the comparison of insanity with tuberculosis we must remind the reader of some other facts that are important in this connection. We have seen[56] that the scientific study of tuberculosis has materially modified the earlier views concerning its hereditary transmission. It is now held that tuberculosis is not inherited as such; but that a child of tuberculous parentage may begin life with a subnormal power of resistance to the disease and perhaps greater risk of exposure to infection. If later he develops the disease, it is traceable directly to his environment. The corollary is that if his environment be improved, and his body’s power of resistance increased meanwhile by all the means in our power, he has a considerable chance of living a life free from the disease. Thus the old pessimistic view is replaced by a distinctly optimistic one.
In the mental disorders that are indubitably traceable to organic disease of the central nervous system, heredity doubtless plays a great role. But two points should be remembered in this connection. First, among asylum patients the number of mental disorders which cannot, post-mortem, be traced to organic causes is very great as compared with those that can be so related. For example, of 1,325 patients received at the Burgholzi Central Asylum and University Psychiatric Clinic, Zürich, Dr. C. G. Jung states:—
“... in round figures a quarter of our insane patients show more or less clearly extensive changes and destruction of the brain, while three-fourths have a brain which seems to be generally unimpaired or at most exhibits such changes as give no explanation of the psychological disturbance.... We must take into account the fact that those mental diseases which show the most marked disturbances of the brain end in death; for this reason the chronic inmates of the asylum form its real population, and among them are some 70 to 80 per cent. of cases of dementia præcox, that is of patients in whom anatomical changes are practically non-existent.”[57]
In a great number of mental disorders our present knowledge of anatomy, physiology and pathology is of little help as a means of throwing any light upon the patient’s condition. While in no way attempting to belittle the magnificent work in these subjects during the past century, it should be pointed out that its very success has brought about, especially in this country, an unfortunate tendency to regard these methods as the only ones suitable for attacking the problems of insanity. But nothing is more certain than that in the psychoneuroses: hysteria, neurasthenia, psychasthenia and the rest, anatomical and physiological knowledge has not yet passed beyond the theoretical stage[58]. But it is equally indisputable—and the statistics of shell-shock cases have strengthened the evidence for this assertion—that the psychological mode of attack, the treatment of mental disorder by mental means, is now firmly established as a practical method.