Now these legal measures, which are required before curative treatment for the insane can be applied, are not taken for the purpose of promoting the interests of lunatics, but they are deemed necessary for the purpose of preventing the incarceration of people who are alleged to be sane, rather than insane. The whole drift and tenor, and tendency of legal commitment of the insane, is against the interest of those who are sick and in need of treatment. The whole trend of legal commitment is toward the protection of the sane to the neglect and injury of the insane.
Under the present forms of legal commitment the lunatic is examined, and probed, and tortured, and ignominiously guillotined in soul before the public gaze, and is branded as a “lunatic” all over his dome of thought before he can be allowed to receive treatment in a hospital for the insane.
Is there any place on earth where the physician is allowed to be the sole judge of the necessities of the sick insane? We may answer, in the affirmative, that in the freest of all republican countries, Norway-the “Land of the Midnight Sun”-the highest and noblest yet simplest form of commitment is to be found. There, the family physician is called to examine the patient, and if it is his opinion that the case needs asylum treatment, he makes an informal, unsworn to, and unapproved certificate to that effect, and the patient, armed with this certificate, and without any legal hindrances or restrictions whatever, is admitted to a Norwegian asylum for treatment and cure.
Dr. Lindboe, the distinguished psychologist in charge of the State Asylum for the Insane at Gaustad, near Christiana, Norway, told me, presently, that this method was entirely satisfactory, and that no evil results ever followed the practice which obtained in that country in behalf of the insane. [In Scandinavia, the physician must study medicine for ten years before he can be licensed to practice; but he is then permitted to perform his medical duty without interference by the laity or by another learned profession.
In this country we should compel our students to continue their college courses for eight or ten years, and then physicians should be allowed to care for their patients without without the specious and unwarranted approval or disapproval of those who may be rich in legal lore but ignorant of the compound intricacies of physical and mental pathology.
The physician should be thoroughly educated, and then he should be free in action,a nd should have supreme and unhindered authority in the care and disposition of invalids who may be suffering with either physical or mental disease.
Commitment of the insane for treatment in a state hospital should be made as easy as possible or necessary for the sick, and it should be, in my judgment, entirely upon medical authority. There is no good reason for supposing that the family physician will send his patient to a hospital for treatment, thus robbing himself of fees, so long as the case can be safely and properly cared for at home.
And even through insanity may continue for an indefinite time, we believe that the insane may safely be sent to hospitals for treatment without judicial approval, because these institutions are now examined and watched over by disinterested boards of trustees, commissions in lunacy, and the people at large; and those in immediate charge of these hospitals have every interest to discharge their patients cured or relieved, as soon as possible, in order to make a favorable showing to the community which holds them responsible for their work.
Not only should commitments be made easy, but voluntary admissions should be permitted. It is a recognized and accepted axiom among alienists that early treatment for the insane is the most successful. Many victims of insanity have recognized at the outset their oncoming mental disasters, and have sought by vague personal efforts to avert them.
Hence we urge, as a means to the end, that victims of incipient insanity may receive early treatment in accordance with their own wishes; legal enactments whereby the doors of our state hospitals in all the States may be readily opened for those who desire, even voluntarily, to enter them for treatment. If you would cure the largest possible percentage of the insane, thus keeping the community as free from insanity as possible, you must grant the privilege of easy and voluntary admissions to our state institutions to all the victims of mental disorder.
If men and women could be permitted to freely and voluntarily avail themselves of hospital treatment in the early stages of their disease, they would come to accept such benefits more readily, they would recover more rapidly, the usefulness of the hospital would be enhanced, and the apparent disgrace now attached to enforced and involuntary treatment would, to a large extent, be removed. State hospitals for the insane should be as free for the admission of patients needing treatment for mental disease as are other hospitals for the admission of those affected with general or special diseases.
Such freedom of entry and egress (for the voluntary patient may depart when the pleases) to and from our state hospitals is in accordance with the spirit which pervades the Constitution of the United States, and is in closest harmony with that memorable assertion contained in the Declaration of Independence: “We hold these truths to be self-evident; that all men are created equal (that is, with equal privileges); that they are endowed by their Creator with certain inalienable rights; that among these are life, liberty, and the pursuit of happiness”.
In maintaining integrity of freedom in one’s life, in acquiring full exercise of liberty, and in engaging in the pursuit of happiness, nothing can be more important than that priceless privilege of entering a hospital when sick i body or mind without let or hindrance from any source whatever.
It is wrong, unjust, unconstitutional to stamp the name of a disease, held to abhorrence and feared as a disgrace through all time, upon the forehead of an individual who, without the stamp, is willing to avail himself of every possible opportunity for treatment and cure. Individual rights and aggregate interests are infringed upon by unnecessary legal commitments. Let us have laws which shall grant the admission of voluntary patients to our state hospitals, and let commitments be restricted simply and solely, as the law originally designed, to those who must be confined against their wills for the proper protection of themselves and the community.
Again, if any of the insane are to be considered as the wards of the State, let all be treated alike and fairly. That is, if the State assumes wardship over the pauper and indigent insane, let the Common wealth also assume charge and wardship over those who ave both life and property to protect.
Insanity is a disease which renders its victim absolutely helpless. Under its visitation he can protect neither his life nor his property. Legal wardship implies protection of those who are unable to care for themselves, and who have both life an property at stake. This is the case when a guardian is appointed to take charge of the life and property of a minor.
We claim that the insane who have both life and property should be doubly the wards of the State, on account of their helplessness, on account of the interests involved, and on account of the fact that the insane with property are always more or less liable to become the easy prey of designing individuals. While we believe that all the insane should enjoy, if they or their friends so elect, the benefits of wardship from the State, we are also willing to admit that principle of freedom of choice which enables an insane man to go to a private asylum for treatment if he or his friends prefer that method of care.
It is claimed by some that the asylums of Europe are in many respects superior to the asylums of the United States. If we can find n the institutions of the East anything better than that which is now established here, we should certainly seek to monopolize it. In France and Belgium and North Germany and Sweden and Scotland we find institutions for the insane where all classes, both poor and rich, can be admitted, and where voluntary patients are received as well as the involuntary.
We should seek to acquire the best from every source, and then bend all our energies to the making of such improvements as shall conduce not only to the comfort of the inmates, but to exemplification of hospital treatment for the purpose of curing the largest possible percentage of the insane.
During the past few years the asylums in the State of New York have been converted, by legal enactments, into “State Hospitals.” More than that, these institutions have been transformed in many particulars. The rooms and wards and parlors have been renovated and decorated and supplied with comfortable and easy furniture.
Soft lounges and cushioned reclining chairs have taken the place of hard wooden benches; here floors have been relieved by bright and cheerful carpets; the casements and the walls have been garnished with curtains and pictures; the windows have been made larger and more numerous, and thus more light has been let into the dark and gloomy corners of the buildings; the dingy walls have been painted and frescoed and beautiful with harmonious tints; large rooms have been fitted up for hospitals where the best and softest of beds are prepared for the reception of weak and exhausted patients.
