CHAPTER V.
Some Lessons of the War.
Are we, as a nation, doing all that we should for the mentally afflicted? This is the question—no less urgent and important now than it was a century ago—to which we call the serious attention of the reader.
It is no new discovery to recognise the immediate importance of its proper consideration, of the honest facing of the present conditions, and of the urgency for such reform as shall lead to an affirmative answer to our question. Already it has been the subject of considerable discussion in recent medical literature, and in the medical press numerous efforts have been made to bring it to the attention of the general public. In July, 1914, the Medico-Psychological Association of Great Britain and Ireland, a body composed chiefly of the medical officers of our asylums, issued the report of a special committee which had been appointed, in November, 1911, to consider the “status of Psychiatry as a profession in Great Britain and Ireland, and the reforms necessary in the education and conditions of service of assistant medical officers.” Unfortunately, within a few weeks of its publication, the outbreak of war prevented that discussion of the question which would otherwise assuredly have followed the publication of so momentous a statement. For in the report stress was laid on the “absence of proper provision for the early treatment of incipient and undeveloped cases of mental disorder,” on the lack of adequate “facilities for the study of psychiatry and for research” and upon “the unsatisfactory position of assistant medical officers” in the asylum service. Clearly the stressing of such points by a committee, thoroughly competent to form a judgment in such matters, compels a negative answer to our leading question. The report makes it perfectly clear that this country has grievously lagged behind most of the civilised nations in the treatment of mental disease.
Yet all attempts in the way of important and far-reaching reform have been frustrated, at least during times of peace, by a strange state of indifference and inertia and by lack of knowledge. Thus, even so recently as January 15th, 1916, the British Medical Journal was responsible for the statement “The only hope that our present knowledge of insanity permits us to entertain of appreciably diminishing the number of ‘first attacks’ lies in diminishing habitual and long enduring drunkenness and in diminishing the incidence of syphilis.”[74] This statement would have been sufficiently amazing if it had been made three years ago; but when the hospitals of Europe contain thousands of “first attacks” of insanity, which are definitely not due either to alcohol or syphilis, the only conclusion to be drawn is that its author must have been asleep since July, 1914, or have become so obsessed by a fixed idea as to be unable to see the plain lessons of the war. Syphilis, no doubt, is responsible for a considerable number of cases of insanity, and drink perhaps for some more[75]; but the incipient forms of mental disturbance which the anxieties and worries of warfare are causing ought to impress even the least thoughtful members of the community with the fact that similar causes are operative in peace as well as in war, and are responsible for a very large proportion of the cases of insanity. But—and this is still more important—it is precisely these cases which can be cured if diagnosed in their early stages, and treated properly. The chief hope of reducing the number of patients in the asylums for the insane lies in the recognition of this fact, and in acting on it by providing institutions where such incipient cases of mental disturbance can be treated rationally, and so saved from the fate of being sent into an asylum. We may refer the reader to p. [82] et seq., on which was given a short account of the success of these reforms. We reiterate some of the advantages of the clinic system—treatment of the patient without the necessity of the ordinary asylum associations and the consequent social stigma; and the considerable reduction in the number of patients requiring internment in asylums which has followed upon the establishment of the psychiatric clinic.
In this country insuperable obstacles in the way of this urgent reform have been raised by our distinctive national obstinacy, and our blind devotion to such catch-phrases as “the liberty of the subject,”—even when this involves the eventual incarceration of the patient whose liberty to escape treatment and to become insane, is the issue jealously defended. Now, however, the stress of war has compelled us to see matters in another light. The present war, which has been responsible for destroying so many illusions, has worked many wonders in the domain of medicine.
The rational and humane treatment of early cases of mental disturbance has now been inaugurated on precisely those lines which have been so long urged, with such little success, by the more far-seeing members of the medical profession.[76]
A good example of this reform is the splendid work now being carried out, at the Maghull Military Hospitals, near Liverpool, for officers and men, organised and superintended by Major R. G. Rows. The institutions are specially devoted to the treatment of soldiers suffering from “shock” and other psychoses. The success already achieved there is sufficient evidence of the great value of these special hospitals for the treatment of nervous and mental disorders in their early stages.
But if the lessons of the war are to be truly beneficial, much more extensive application must be made of these methods, not only for our soldiers now, but also for our civilian population for all time. We have before us the practical experience of those countries which have undertaken this great experiment in preventive medicine, yet apart from the encouraging results of its treatment practised in our special military hospitals, its present position in this country is only too accurately described in the report to which we have referred. With few exceptions[77] “the subject (of mental disease) is left severely alone.”[78] Our arm-chair writers direct their attention to safer subjects, such as eugenics, for example, and here they can be happy in feeling they are on secure ground, because they are aware that their neighbour knows little more about it than they do. Or they inspire reports, and I quote a sentence from a recent report as a contrast to the encouraging sound of the word ‘recovering.’[79]
In the Standard newspaper a few days ago, (i.e., in 1914) there was a reference to a report issued by the London County Council in which one paragraph began with the statement, ‘Once a lunatic, always a lunatic.’ This is the message sent in this country to our sufferers, a message as brutal as it is unjustifiable. Again, in the Standard of February 11th in the year of grace 1913, there appeared the statement that ‘the Camberwell Guardians have issued instructions that the use of “anklets” on violent lunatics in their institutions is to be discontinued.’
With reference to the dictum “Once a lunatic always a lunatic” we should like to call attention to another statement in this report. “The fact that, even under the present conditions of delayed treatment, about 33 per cent. of those admitted to the asylums of England and Wales are discharged recovered, demonstrates that the feelings of helplessness and hopelessness, with which such illnesses are usually regarded, are by no means justified. The evidence of many authorities who have had practical experience of the value of treatment during the incipient stages of the illness, shows conclusively that the exercise of scientific care during the early phases of mental disorder would save many from such a complete breakdown as would necessitate certification and removal to an asylum. In all other branches of medicine facilities for dealing with disease in its initial stages are recognised as indispensable and therefore the Committee regard it as essential that, in the large centres of population at any rate, means should be provided to obviate the delay that now exists in providing adequate treatment for mental disorders. It is, therefore, recommended that psychiatric clinics should be established.”[80]