MENTAL DISORDERS

Evening Post, Volume CIX, Issue 124, 29 May 1925, Page 7

MENTAL DISORDERS

THE TRUE TREATMENT

"CHIEFLY MORAL AND

HUMANE"

STATEMENT BY SIR TRUBY KING.

A member of the "Post" staff called on Sir Truby King at his office yesterday, and asked his opinion concerning some professional and other statements which have just appeared in Dunedin and Auckland papers with reference to improvement and further' development of our mental hospital institutions and service; • for example:—

Contention (1): "Modern knowledge demands a proper system of classification. Sufferers from Acute Melancholia ought certainly to be distinguished and separated. They are the sort of persons who commit suicide. They cannot be - received into general hospitals, because they might jump out of a window. Yet they are proper hospital cases, and, as such, cureable." "AN ABSURD STATEMENT" Sir Truby King: "It is difficult to account for .'a Dunedin physician uf high standing' publishing such an ' absurd statement. By far the most frequent and dangerous form of 'acute melancholia' is delirium tremens—a condition in which the patient is not only liable to commit suicide, but in which there is a grave risk of homicide. Yet delirium tremens patients are almost invariably treated in general hospitals; and could not in any case be committed to a mental hospital until the proper legal formalities had been gone through. NEW OUT-PATIENT CLINIC "Under the new scheme these cases will still be taken, as they now are, to the general hospital for examination and ' temporary lodgment at least. But the effect of the new outpatient clinic, conducted conjointly by doctors drawn from general mental hospitals, will tend in the direction of promoting the provision of more suitable quarters for such patients during their necessary sojourn in the general hospitals, besides causing some of the subjects of delirium tremens whose symptoms do not clear iip on eliminating the alcohol from their systems, to be sent sooner to mental hospitals for appropriate treatment there. "Dr. Wilson, medical superintendent of the Wellington General "Hospital, was the first to welcome and proclaim the' advance it would be to the general hospitals to have' a. mental specialist regularly , attending their institution.

AN OBVIOUS DUTY

"It need scarcely be said that whenever' the medical staff of a mental hospital has to deal with a patient suffering from bodily illness of a puzzling character, on which light may be thrown by an outside physician or surgeon, it is their obvious duty to call for such aid, in consultation, with a view to ensuring a correct diagnosis and suitable treatment.

STAFFING SYSTEM

Contention (2): "The staffing (of the mental hospitals) under the existing system is wholly insufficient for proper oversight. No man should have more than 40 insane persons under his care."

Sir. Truby King:, "This is at least five times the average proportion of doctors to patients that there is aiiy ■use employing in our New Zealand institutions. "

"In Great. Britain a very large proportion of the class of people who remain in our mental hospitals would either be kept in pborhouses or' boarded in villages, where people are so hardup that they are glad to cko" out a living by looking'after harmless demented persons in'their own homes. :

MAJORITY OF INMATES

"All over the world the vast majority of the - inmates of mental hospitals are chronic secondary dements. Many of these are' very far from mindless, but they have reached a stage of organicand incurable niental deficiency which makes them incapable of resuming ordinary free life and responsibilities. Indeed, secondary dementia has been well described as 'the tomb of the mind—the bourne whence no errant intellect returns.' Sir Thomas Clouston once said, ■Insanity might be defined as a tendency to dementia,' because almost every insane person who does not recover within a year or two becomes a secondary dement. Our mental hospitals are filled with such people, and they have teen accumulating for the last 50 years—they sometimes remain half a century in an asylum. Over 90 per cent, of the inmates of mental hospitals might be classed as 'incurable chronic dements'; and it is safe to say that we never have in the whole of our mental hospitals more than 200 cureable patients. I should say that the average recovery rate in England is not more than 33 per cent, of admissions, if subsequent remission (often within a year or two) is taken into account.. The admissions to our four main asylums average under, 250 a year; and if recovery.is to take place at all, this generally occurs well within the first twelve months, beyond which time special treatment is rarely of much use.

"In view of these facts, it is absurd to suggest that a staff of 100 doctors could 'occupy themselves with useful work in the Mental Hospital Department. One. additional doctor to the present standard allowance at each of the main ' institutions would certainly suffice.

TREATMENT IN GENERAL HOSPITALS

Contention (3). —"That it would be a great advantage to mental patients to be treated in ; general hospitals, and that outside practitioners should be appointed to pay routine regular visits to mental hospitals."

Sir Truby King : "In my opinion, neither of these contentions is generally correct. Occasionally a mental case needs temporary rest in led; but this can be given equally well, generally better, in a suitable cottage at a menial hospital or seaside sanatorium, than in the^ ward of a general hospital. "Both the above suggestions are well answered by the authoritative stale* ment made on this subject by the wisest and most level-licaded authority of our time—Dr. Sir Clifford .AllbulV P.C., Regius Professor of Physic,. Cambridge University, Commissioner in Lunacy, 1889-92: When asked by tlVe Londdii County Council for bis mature convictions as ■to the desirability of so-called 'hospitalisation of Hie insane,' when this very problem was under consideration many years'ago, he said :— VIEWS OF SIR CLIFFORD ALLBUTT "1 think," said Dr. Allbut, "the.first thing to do } s i n .g ot „;,) of some of t))(> connotations which the word 'Hospital' brings in. [do not mean to say that the word is not a good one, and- should nob be used, but. it brings in the idea that you want something "like a hospital for the treatment of the bodily sick. '

'1 think the two classes of iustitu-

lions should be entirely' different, especially in their system of organisation and that it is very important that ono should get rid of any idea that such un institution as you arc contemplating should be anything like the St Geoi-"c's Hospital or the London. Hospital, or such hospitals for the sick in our towns. The treatment of lunacy does not appear to me—l am open to correction —to be very much a matter of drugs or pharmaceutics That medicines may be of the utmost possible importance, and that they may be employed at times with the greatest possible advantage no one, of course would deny; but that they are.usually of primary importance, or that they are the treatment for mental disease, is, I think, not true. INFLUENCE OF THE STAFF "I think the true treatment is chiefly moral and humane, and not very much in the direction of drugs. I therefore think that the management of the place —and. under management .I. include all the amenities ot the place, as well as the mere stewarding of the house-the personal qualities of the medical - superintendent the personal qualities of every member of the medical and nursing staff is, really the cure. ■ • '

HOSPITAL AND MENTAL HOSPITAL

th^Hr f "I r-17 L°ndon h0s Pital rirf,.? xf «»*«*.la somewhat of this nature- The physician comes -at, .say, 2 o clock M , th e aftcnjoon. He goes round with the- house-physician, and he examines the patients, who are. usually n bed, and endeavours to ascertain the bodily complaint, for which he.prescribes mechanical appliances or drugs, and a special dietary; and those directions can be fully carried out by the house-phy-sician or house-surgeon. - "Now, I do not see much similarity in that to the treatment of the insane. When the physician goes into an asylum he finds a person not in bed—a person who is open to all the influences of exercise and fresh air, and many, of the pleasures and diversions of life. Those are indeed, part of the physician's treak ment. The patient, in nine cases out of ten, is not especially in need of drugs His dietary may need some adjustment, but it is not a matter of primary importance, and it would in most cases be the wholesome dietary of the average Englishman or Englishwoman. "Therefore, it appears to me that all those things which a visiting physician does in a London hospital you would have very little place for. "But what it does appear to me that there is place for, and what is, indeed, of cardinal importance, is the intimate personal relation between the superintendent and his staff, and the individual patient—the study of the patient's character and peculiarities, the ascertainment of his fears "and his delusions, his dreads, his suspicions, what are his hallucinations, and everything .of that kind; and then the dealing, as tenderhearted, open' minded, sympathetic, humane people, with those mental conditions, as mind with mind. That system, you see, makes • your superintendent everything, and, subject to him, makes your staff everything also.

THE TRUE MEDICINE

-'.'The superintendent is your medicine; the staff is your medicine; the nurses are your medicine; your conservatory and your entertainments, your birds, your garden, and your farm are your medicines; and these things cannot be prescribed by visiting physicians. , "I may say, in order to illustrate what I mean, that a.visiting system was onco in force at Wakefield. We have there a. very able, much-respected physician, Dr.' Wright, who is now, I think, the last remaining of the members of the visiting staff, which, on.this principle,' was attached to.the last asylum at Wakefield, oi which I have- been a managing justice for some years. Dr... Wright is in every respect tv highly competent man and.his reputation in Wakefield and elsewhere stands very high. "Dr. Wright has continued his visits to tho asylum, I think I should not bo wrong in saying, up to the present moment—at any rate, until quite recently. Kow I have observed this, and I know Dr. Wright has felt it himself, and I know the medical superintendents havo felt it—that the part which can bo played by a gentleman coming for an hour or two into the wards, every day it may be, and making medical.suggestions about the patients or' even making .moral suggestions, is such a very, very small part of the medical care of the insane, that, although his personal character and abilities will ensure for him a respectful hearing, he will retain no ascendancy. "You must have a most capable superintendent—a man of special endowments and of special knowledge, and you must place upon him every responsibility; and in this case he, whatever the courtesy of his bearing may he, will not be. interfered with." .