MENTAL HOSPITALS.

Dominion, Volume 1, Issue 307, 21 September 1908, Page 2

MENTAL HOSPITALS.

• «■ STINCINC CRITICISM FROM DR. LEVIfJCE. SOME REFORMS SUGGESTED. A certain amount of public interest has been aroused in the mental hospitals of tho Dominion as tho result of. the recent debate in the House on matters connected with their overcrowded state owing to the increase of insanity, as well as by the presentation of the annual report of the Inspcctor-General. (Dr. Hay); and, knowing that Dr. Levinge, for many years medical 'superintendent •at Sunnyside, retains great interest in all questions affecting our mental hospitals, and that' his views on such questions carry weight with the public generally, a representative of the Christchurch "Truth" inten •icwcd him on matters arising out of the debate and the report. The Question, of Classification. ' I noticed in reading tho report of the delate in the House, if debate it can bo calicd, ..Dr. Levinge remarked, "that mcnibeis raised the question of classification —a question that they always raise. Tliev appear to ■ think that they have done their duty with regard to criticising tho report if they complain about the classification. It is just a- cry that has been got no and raised by members in order to make it'appear that they are interested in the' subject; but, as ■a matter of fact, they know little or nothing about it, and probably think less. The classification in air public-mental hospitals is more or less the, same, arid must, of necessity, be on the same lines! It depends almost entirely on tho mental conditions, tho conduct,_ behaviour, and-habits generally, of the patients. _ In short, that is the only basis of classification except as regards the sick or very old or very young patients; these cannot bo associated with rough and violent cases, and'for. .that reason'they are treated'apart in the ; infirmary ward unless .there are sufficient of them to justify a separate ward. Refractory. ■ cases are always treated by themselves oil account of their, habits and conduct; chronic cases are similarly dealt with, anil no exception need be taken to the classification of'these classes.

"The chief objection to the present classification is the association of the' old, feeble people and the children 'with tlie more recent or acute cases; that can only bo met b'y making proper provision for that particular class, and that provision, in _my judgment, should be' made in connection with tho. general hospitals at : the chief centres. Such provision has been made on the Continent ot Europe, in England, and elsewhere, to a very large extent of recent years, 'and' has been 'found highly successful. Why tho Government should seek to perpetuate'an,antiquated system and discredited policy by having these wards in connection with the mental hospitals' seems difficult to understand „ in. view of tho more enlightened, practice of the present day. This is'a matter which I have been advocating for years past, aud if Ministers or members of Parliament could witness the anguish—and that is about tho only word, that adequately, expresses it —that I have so vory _ frequently seen on the part of near relatives on learning that their relation is had to go to the mental hospital which till recently was the 'lunatic asylum,' it would probably move even their sympathy.' A mental ward, or a detached block;, at Sunnysioe, for instance, under the direction of. tho I'.udical officers there, would still be 'Surnjsida and would still have attached to it the stigma that attaches to Sunnyside. Comparatively few patients would be sent to such wards,' but would be kept at homo as at present until the disease becomes advanced and confirmed and tho difficulty of cure, would remain''as great and tlio chances of recovery correspondingly loss. , In fact, no attempt is being made to grapple , with insanity, in its early stages, and until that is done we cannot liopo to cheek its increase. At present, people won't send their relatives to .a mental hospital jf they can help it, .preferring to keep thfc'ni 'But 1 if there were wards at the general hospitals the same reluctance would,"not' exist, and. insanity 'in 'its earlier stages could be dealt with before the disease reached .a' stage at which it Is■ much less •amenable' to treatment. ! ■ '!' : '

"I was very much interested in Dr: Hay's report,", continued Dr. Levingc, ■ "and read with pleasure his very careful mid interesting analysis of .the statistics of the population of ' .the mental hospitals of- the Dominion. He certainly puts those statistics in a much moro interesting light than'they have been put in any previous report. ' I Was in hopes, however, that Dr. Hay, being young and more in touch with the progress and advances made in psychiatric medicine at Home, would have endeavoured to press the reform to which I have referred—the establishment of wards for incipient mental disease at the general hospitals, where there ; would be a greater opportunity of such cases receiving that special individual attention which is so essential and,which can be given, better- than in an institution'where there is necessarily; moro routine. Prevention of the Increase of Insanity. "I was disappointed with Dr. Hay's rather cursory dismissal of the.question of sterilisation, a matter that. was recently advocated by Dr: Beattie, mcdibal superintendent of the Auckland Mental Hospital, and othors, and by myself several years ago. Although itmight bo. premature at present to propose sterilisation, Dr. Hay could very well take a lead in the direction, of ventilating and forcing attention to the. subject more fully than' he does, and lay before the public the risks and dangers of imprudent marriages, the wrongs. to posterity so often involved, and the necessity for adopting some measures to check the increase of the mentally, diseased. It is all very well to talk about 'keeping the cradles full, but a great deal should depend on the material in the cradles. The absence of control and of' responsibility is a very marked characteristic of the insane and thus these are the very peoplo who are apt to keep the cradles full without any check whatever. Whereas, formerly, it was a question of tho survival of the fittest and of the weaklings going .under, it .appears to me moro than ever necessary, now that the unfit are being coddled in many, ways, to put some check on their propagation. I have no desire to'belittle the work of the worthy agencies that are seeking, and successfully, to ameliorate the lot .of/the weaklings, but at the same time prevention is better than cure, and should not be forgotten. - Unless something is done in the direction I have indicated, the race is bound to degenerate, and, in my opinion, there is quite as much, if not more need for some organisation' or society to look after the interests of theinsano and cognate . questions than ' of any other class, for individuals and responsible relatives, for obvious reasons, fight shy of the subject, and thus members of Parliament and Governments do not. move. Unfulfilled Premises. . "Another matter worthy of note ■ is tho fact that, though references liave appeared in the Governor's speeches on several occasions to a promised amendment of tho Act, nothing has been done. The Hon. W. HallJones, when he was Minister in charge of Mental Hospitals, intimated that lie would have tho Act amended, and invited suggestions and recommendations from the medical superintendents with that object, but though ho returned from his, visit to England witli much to say regarding what he had seen at Home, and all the reforms ho was going to introduce, tho only alteration made by him was the changing of the name of the institutions to mental hospitals, which I had long advocated. Tho Act is still the 'Lunacy Act,' the inmates of mental hospitals are still 'lunatics' according to it, the forin and mode of committal are tho same, and, as . regards insanity statistics, they are still'included in those of the gaols, so that- tho mentally afflicted are classified in the crimi--nal statistics. ( I commend the question of classification in .this. direction to members of Parliament and to our so-called 'humanist' Government. The Mode of Committal.' "Can any greater indignity, wrong,, or inhumanity v be imagined than the present mode of committa.l of a mentally sick person to a hospital, in that ho should bo

dragged to Court liv the police, hustled , from one room to another for medical ex- ; animation , aud inspection by., a magistrate \ there, as if lie .wan guilty' of some grievous 1 offence, cross-questioned, "'often-'more or less .i publicly, about all sorts of personal and pri- j vatft affairs —to , which his relatives, or friends, if lie has any present, are' 'also-'sub-jected, often, too, in his presence, after ho ; has,vperhaps, spent some.hours or days in i the police cells or Lyttelton Gaol. Is it any wonder thn.t relatives dread-and shun this ordeal, and seek to postpone it to the . ; very last, only facing it because, they fear. some calamity, or," perhaps, after such" haa'' s ■' already taken place. | "Thero is,. moreover, ..no proper room :.'or.ii-. ! ;' place set n.part at our local-Court for such j medical examination, which has to bo conducted anywhere available- under, the most ' difficult circumstances and often,. I fear, in I a-.very perfunctory manner. i ' "It may well bo asked: Is this possible.at the present day, and is it compatible with our boasted humanity? The late Dr. MacGrcgor advocated in one of his reports that a room should be provided elsewhere than at the Court where such cases ■ could bo examined and dealt with, but our 'humanist*'-" Government has not been able, apparently, to see its way to the expense. "It is perfectly monstrous to require ,a ,- ' person so afflicted and his relatives to go to the Court for criminals for, the purpose of being admitted to a hospital for the :'■ sick. , "True, tho magistrate, on representation j being made to him, will sometimes go to the patient's home for the purpose of committing V--' :: him to a mental hospital, but this, I think, is ' far from being the rule, and, as I said before, relatives dread the ordeal more, perhaps, than anything else connected with the' question.' '"If magisterial committal is necessary at ■ all at the present day it should be in some' ' more decent, humane, and private manner, • " but L hold that it should and . could bo abolished, in many cases at least, by. admission to a mental ward at a general hospital ill" the first instance. Another grievous indignity often inflicted on the relatives is in being required'by .the Act to' lay and swear an ■'information''do daring their relative to be a .' luna.tic '- (hated vi word) for tho purpose of committal to a men-'. tal hospital, and can it be wondered that" l ' they shirk this also as. long as possible. . ■"V.- . ' But what need to multiply instances' of. ■ ' such barbarities, or what, good ?—for I. fear -v the amending Act so long promised will have - to wait yet longer in'order that members, i'i paid by the year for doing the work required ;.L of-them, are in-too great a. hurry to look . after that £300. per annum to prolong the.. ': session, which, we have been told will closo • .early in October, for such a minor,considera- $ tion as the amendment of tho.' Lunacy' ■Act.-, "I trust, however, that a promise. for- itsj--,. :early amendment will lie extracted from each candidate at tho hustings by'sonie-organisa-. i • tion interested in the subject!, " , ' How to Effect Reforms. , " The Government must be aware of the 1 reluctance felt l by . relatives of' the ' mentally afflicted to move in., the matter of needed rei • , forms' of the present system of dealing with' ; these in the early, stages of insanity; Ministers and members . must know that these - people feel that if they moved in such mat..tors they would have the stigma of insanity. attached to themselves and' their relations. Advantage has been taken of this state of V affairs to allow matters to. remain as they ■: have always been. It soems to mo that" no- : thing will be done in the direction indicated unless steps are taken by some organised ;■ social reform body such as the Canterbury. • • Women's Institute, or some of the labour or-;y; ganisations, or bodies controlling votes. 1 I < 'have_:\vitnessed. many very painful and dis- / tressing scenes, and I suppose that every doctor. ill' this city : has witnessed similar;", , scenes, when relatives.have, been told, that those they hold dear must-be sent to. Sunny? side.. The possibility of insanity developing ■. ■■ in relatives is not seriously considered by i most people,, but such are living in a fool's paradise, for often those least expected are ~ soroly smitten, and it is not always a question of heredity. There are many other conditions that aro potent in bringing it about; thus tho question should .'interest alj. lam 'a very great.believer:-in.,the transmission of insanity by heredity, and I do not think that. half the cases of heredity are_accountod for,-.., because frequently it is, impossible to get -any*', family ;history,,.and what the medical,,man ~i; 3 might regard as a strong neurotic tendency.. may have, no/significance'in the eyes of.thei. j layman'.'/This is, further'proof'of the neces-. sity for wards for the . treatment of incipient /■ mental disease at the general hospitals,, and ; ,j; ' for tho establishment of a department in con- .... . nectkm with such wards ' for the outdoor-; treatment of the neuroscfe, as, elsewhere. ■; J Necessity for Private Mental Hospitals. "Another great wanj; is the .-provision of private mental hospitals. Previously I have not spoken on this subject because I feared that it might be thought that.l'-Svas speak- ' ing in my own interests; but I have now no, desiro and no intention of establishing, a pri*, vate mental hospital, and therefore myad-i' . vocacy of the. necessity for such, institutions .;' cannot be-misunderstood. I hold that-.it is r, perfectly, monstrous that, patients froin all : over -tlie Dominion, whose friends or relatives' do not- wish them, to go.into" a publio .'; institution, should have to go to Dunedin . ■for. treatment, and that'the.Government will' ; only, allow one private mental'hospital which, moreover, is at the. extreme end of the Do- i minion. A large number of medical men .in this city and - elsewhero. have spokeai to me about the great' wrong that Is, done by the . •: present. state, of affairs.' When I resigned',-,, froin the, Suniiyside Mental .Hospital I ap-. . plied for permission to equip a'private. hospital in this city, but I never gotVany. an- , swcr .to my! conimuuication, except-:iiotifica--tion' that' it would bo considered... Subse?. -. i quently, tho then Minister (Mr. Hajl : Jones) told me that he had sanctioned the application, and that it had been approved by Cabinet; yet I have not got any official reply to this.day., I know-that at least one rh other'medical man of- 'special :experience.:-.fJ mado a similar: application,_ and that it wasrefused.- The only, conclusion--I. can draw.; from these facts is that the' Government, or • ; some individual, has no desire to interfere i with tho existing monopoly. Consequently,- ■> people all over the Dominion are ; put to tin- " necessarv expense in sending their • relatives , .; a long clistanco for treatment in. a private institution, where they . can but rarely visit ;v.; them. At tho same time, the Government ,-.i ; is practically winking at breaches.of the lawin taking no steps, to, prevent patients bev >, ing .treated in unlicensed homes, as is..well known to the Department, biit it will only ■•..< act when some scandal, such as occurred : in ..: Christelrar'ch a few years ago, compels,,them ... to take action to appease publio opinion."