We have noted two of the common obstacles which obstruct the path of the physician anxious to treat mental disorder: his own lack of training and, in not a few cases, his temperamental inclination to look exclusively for visible and tangible material evidence of disease. There is, moreover, at present another serious obstacle consisting in a widespread social convention. This is the unwritten law which commands a person to hide any troubles of a mental nature not only from his friends, but even from his doctor, though he may speak of his physical disabilities to everybody with unblushing frankness. Much could be written on this subject, but the inconsistency of the current attitude has been satirised with inimitable wit and humour by Samuel Butler.
His whimsical fancy has created a civilised country in which this convention does not exist; in which, in fact, the opposite belief obtains. In that land, while a man’s bodily ills are counted a disgrace, and not to be mentioned, his mental troubles are regarded as physical illness is with us. The name of that country is Erewhon. In Erewhon, we are told, physical illness is not only considered shameful but is punishable by imprisonment. Mental trouble, on the other hand, even irritability or bad temper, is regarded as illness requiring the attention of physicians, known as “straighteners.” And the consequences of this are that a man will dissimulate the existence of indigestion, giving out that he is being treated for dipsomania, while in answer to questions about his general condition another will quite freely and truthfully say that he is suffering from snappishness. We in England, says the explorer,
“never shrink from telling a doctor what is the matter with us merely through the fear that he will hurt us. We let him do his worst upon us and stand it without a murmur, because we are not scouted for being ill, and because we know that the doctor is doing his best to cure us and that he can judge our case better than we can; but we should conceal all illness if we were treated as the Erewhonians are when they have anything the matter with them; we should do the same as with moral and intellectual diseases—we should feign health with the most consummate art till we were found out....”
This convention inevitably influences the “straightener’s” attitude towards his patients, as we are told by the traveller in a description of an interview between his host and an Erewhonian doctor:—
“I was struck with the delicacy with which he avoided even the remotest semblance of inquiry after the physical well-being of his patient, though there was a certain yellowness about my host’s eyes which argued a bilious habit of body. To have taken notice of this would have been a gross breach of professional etiquette. I was told, however, that a straightener sometimes thinks it right to glance at the possibility of some slight physical disorder if he finds it important in order to assist him in his diagnosis; but the answers which he gets are generally untrue or evasive, and he forms his own conclusions upon the matter as well as he can. Sensible men have been known to say that the straightener should in strict confidence be told of every physical ailment that is likely to bear upon the case, but people are naturally shy of doing this, for they do not like lowering themselves in the opinion of the straightener, and his ignorance of medical science is supreme. I heard of one lady, indeed, who had the hardihood to confess that a furious outbreak of ill-humour and extravagant fancies for which she was seeking advice was possibly the result of indisposition. ‘You should resist that,’ said the straightener, in a kind, yet grave voice, ‘we can do nothing for the bodies of our patients; such matters are beyond our province, and I desire that I may hear no further particulars.’ The lady burst into tears and promised faithfully that she would never be unwell again.”
FOOTNOTES:
[50] Hart, op. cit., p. 7.
[51] Cf. Dr. Bedford Pierce’s statement, (op. cit., p. 43), “I have met persons otherwise level-headed who cannot be persuaded to enter the grounds of an asylum. Not infrequently all sorts of excuses are made to escape the duty of visiting a relative who is under care, and so real is the danger of neglect that the State has decreed that no order for reception shall be granted without an undertaking that the patient shall be visited at least every six months.”
[52] p. 5. The italics are ours.
[53] pp. 77 and 78.