A REVIEW OF RECENT WORK AND PROGRESS IN THE FIELD OF PSYCHOLOGY.
Fellow-Members.-As Chairman of the Section of Mental and Nervous Diseases, it becomes my duty to present an address before this Society, giving a review of the work accomplished during the past twelve months, together with the general trend of interest and progress in the field of psychology.
The work accomplished by this bureau may be summarized by presenting the following list of articles relating to mental and nervous diseases, together with the names of their authors:.
“Progress in the Care of the Insane and the Development of the Hospital Idea in the Treatment of Mental Invalids,” Dr. Selden H. Talcott, Chairman, Middletown, N.Y.
“Puerperal Insanity,” Dr. A.P. Williamson, Minneapolis, Minn. .
“Statistical Facts Relative to Insanity and its Treatment,” Dr. George Allen, Middletown, N.Y.
“The Care of the Insane,” Dr. C. Spencer Kinney. Middletown, N.Y.
“Clinical Instruction to Medical Students in State Hospitals for the Insane,” Dr. N. Emmons Paine, West Newton, Mass.
“The Causes of an Increase n Melancholia,” Dr. William M. Butler, Brooklyn, N.Y.
“The Octave in Nature and in Man as a Key to Psychology.” Dr. J.D. Duck, Cincinnati, O.
“Mental Depressions and the influence of the California Climate Thereon,” Dr. H.R. Arndt, San Diego, Cal.
In considering these papers we conclude that during the past three years there has been a marked tendency to an increase in that form of insanity known as melancholia,,and due, we believe, to the effects of la grippe when complicated with Allopathic treatment.
We also find that operative surgery is having an influence upon the mental condition of woman which should receive close scrutiny and careful investigation.
Again, we note that the influence of climate and of diet and of social surroundings are most marked either in the production or prevention of that most dreaded of all diseases-insanity.
The various phases of mental disorder, together with their causes, and the conditions under which they most flourish or decline, have been discussed by the writers already named. Hence, we shall devote the brief space of time allotted to us for a bureau address to a consideration of the general progress which has been made toward an understanding of the nature of insanity, and likewise shall seek to consider the most modern method of treating this malady, and attach to this dissertation a few tabulated statements showing the results attained. It may be interesting to some of your to know that the history of the care and treatment of the insane may be divided into four great epochs:.
1. The epoch of absolute neglect, when these sick people were outcasts from society and compelled to live in forests and in caves. This was their condition when the Great Physician of Galilee began His work of healing the nations.
2. The epoch of the dungeon, the chain, the strong cord and the whip. This was the epoch when the insane were treated as the worst of criminals, and that treatment still constitutes one of the horrors of the Dark Ages.
3. The epoch of the asylum, where the insane were held “in custody,” and made to feel constantly a sense of imprisonment; but their confinement was carried on in substantial and imposing buildings, and the insane were kept in comfortable rooms, and given sufficient food, and clad in warm raiment, and, generally, they were afforded such comforts as seemed necessary in the dim light of a dawning perception of the needs of this strange class of human beings.
4. The epoch of the hospital. In this latter epoch the fact that the insane are sick people suffering with brain disease, and needing medical as well as physical care, was fully disclosed by the discovery of modern science. This epoch is very recent in its origin. Although Pinel struck many shackles from the limbs of the insane one hundred years ago, and although at that time Samuel Hahnemann taught the doctrine of kindness to the insane, it was but recently that insanity was considered so much of a physical disease as to require hospital treatment in every sense of the word.
I think it may be truthfully stated that during the past twenty years greater progress has been made in the acquirement of a correct knowledge of brain and mind diseases, and in treating them successfully upon the hospital plan, than ever before.
It took nearly eighteen hundred years of a Christian era to so far develop the human understanding as to inspire Pinel with sufficient confidence in the law of kindness to strike shackles from the limbs of maniacs. It has taken, since his day, a hundred years of persistent teaching to change the dungeon into the asylum and the asylum into the hospital. The “Hospital Idea” may be said to have been practically recognized only during the past few years. Even now its recognition is but partial, but its beneficence must, we think, speedily be acknowledged by the charitable and sympathetic masses of philanthropists.
The cave treatment that belonged to the Healer of Gennesareth, and the dungeon treatment which forms a part of the horrors of the Dark Ages, have passed away, and we have now to consider only asylum care and hospital treatment for the insane.
Let us consider now the difference between an asylum and a hospital. An asylum is a place of custody where the insane, dangerous to themselves or others, may be confined for safety of the community as well as that of the individual. A hospital is a place for the treatment of the insane, and where cures are effected if possible. The asylum is associated with strong walls and barred windows and heavy doors and generally prison-like and custodial attachments. The asylum, in its old-time purpose, is constructed upon the “safe in some quarters, looked upon a s a being who is almost, if not quite, as dangerous to humanity as the most hardened and reckless criminal. Hence, close custody has been the allotment awarded to him by judicial proceedings or, at least, judicial approval.
The “Hospital Idea” recognizes the board and conclusive fact that the insane man is suffering with an actual physical disease. The lunatic is now looked upon as a person suffering with some pathological state of the cerebral mass-pathological either by organic change of the brain tissues, or by functional disturbances within the cranium, or by reflex irritation of the cerebrum through the influence of disease located in some other organ of the body.
The fact that the brain of the insane man is diseased having been recognized,. it would seem, then, the most natural and logical conclusion arrive at that he should be favored with as skilful, and scientific, and thorough hospital care as a person afflicted with nay other form of disease in any part of the body; and yet, when we come to advocate and recommend hospital treatment for the insane, we are forced likewise to consider the necessity for depriving the individual of his personal liberty.
In the minds of many, this personal liberty of the individual is sacred, and should not be infringed upon except by the most solemn sanction of the law. While we do not hesitate to consign small-pox cases to the pest-house, and typhus and cholera cases to the hospital for infections diseases without a judicial commitment in each individual case, we recoil from the idea of placing an insane patient in a hospital against his will, unless a commitment is made out in the most elaborate form by two qualified examiners in lunacy, and their certificate must receive judicial approval by a judge of a court of record before the commitment of the sick man can safely be commenced.
In the State of New York, a legal commitment of an insane man to a hospital for treatment provides for the following:.
(1) Medical examination by two duly qualified physicians, and a certification of the result.
(2) Judicial approval of the certificate by a judge of a court of record.
(3) Approval or disapproval of these judicially approved papers by the State Commission in Lunacy.
Here is formidable array of legal measures to be complied with before the lunatic can receive continued treatment in a hospital. Here is an instance where the medical care of the sick is wrenched from the hands of physicians, and the necessity for curative measures may be either approved or denied by a non- medical judge, or a commission that is non-medical by a two- thirds majority.
Why should legal proceedings interfere with the prompt and careful application of medical measures in behalf of the sick? I suppose that one reason to be assigned is this: Insanity is not a contagious disease; if it were then legal interference would be considered unnecessary. Neither a trail by jury, nor a judicial approval, is required when the disposal of a small-pox case is in question. if it were, how many unvaccinated juries or judges would be willing to try the case? No one seems anxious to impanel a jury to diagnose a case of cholera or typhus fever! Ad Editha’s burglar said, regarding noise: “It isn’t considered ‘healthy in the profession”.
