TREATING MENTAL CASES.

New Zealand Herald, Volume XLVIII, Issue 14753, 8 August 1911, Page 7

TREATING MENTAL CASES.

SOME OF THE DIFFICULTIES. 1. AUCKLAND METHODS. HOW CURES ARE EFFECTED. Tub Auckland Mental Hospital is just now e prominent in the public eye. In view of r this fact, interest attaches to the treatment i of patients as carried out there, and the , curative means adopted. These and other i- matters were inquired into by a Herald li representative upon the occasion of a ro- ,- cent visit, to the institution. In the course of a conversation with k the medical superintendent, Dr. R. M. Beattie, that gentleman stated that he 0 looked upon the thorough classification 1 of patients as being very necessary. He is - convinced also that they ought to bo under o the control of experienced nurses and ats tendants, who should be possessed of natuej ral qualifications for their positions. Fur--0 thermore, he considers that tho superint tendent of these nurses and attendants v should be enabled to devote as much time , as possible to individual cases. " Tho pub- , lie has to bear in mind," said the doctor, f "that insanity is not one disease, but a } whole encyclopaedia of diseases, and that f in dealing with patients one has to take 1 their particular cases largely into account, c as well as tho different temperaments of 1 individuals." He did not imply that ho 1 advocated treating the patients in separate ; wards, but ho favoured occasional indivit dual walks with the nurses or attendants, ; and so on. It is, he said, wonderful how 3 well some patients get on in the refractory . wards with an attendant in charge, who . go to pieces" in the general wards. ® Curative Methods Employed. j The average percentage of recoveries at the Auckland institution is between 40 per 5 cent, and 50 per cent. The curative methods now adopted, as compared with , these in vogue 20 years ago, reveal many i differences along humanitarian lines. A i good deal is effected by suggestion. Pa--3 tients will ask the superintendent or the 1 matron, " Will I get better?" Again and 1 again the plaintive query is put. In cases f where a cure is hoped for the reply is in- ; variably, " Yes, you will get better." I Later, the patients will Want a definite date put upon their return home. " Will I be able to leave by Christmas?" At firat they are told that it is probable, again •' that it is more than likely, lastly that it is certain. And usually, the definite promise once made, is carried out. Always a certain proportion of the mentally afflicted refuse to work., but these are fortu- ; nately in a minority, for it has been found that healthy work improves the physical condition, makes blood, and stimulates the nerves. Also it induces self-respect, and this, with , the other factors, largely assists in curing nr.'.ntal maladies. One cause of regret on the part of those who take charge of the patients is that very often they ara not brought to them at an early enough stage in the progress of their ailment. This, of course, is due to a natural feeling in the minds of the public and the medical profession against the early committal of mentally afflicted people to a mental hospital. ; Doctors remark that such a course puts a hallmark on a patient, and they will not send them in until they cannot help it. Only when the public can eradicate the impression from their minds that a stigma attaches to a person who is, or has been, confined in a mental hospital will the difficulty of dealing with the patients always considerable — lessened, because of the chronic condition in which a great many of them nowadays reach the hospital. In the new Bill now before Parliament is a clause providing for voluntary admission to such institutions, and it is thought , by experts .that, if carried, this mav help to some extent, though, probably, the number -who will voluntarily • consign themselves' to mental hospitals will be small. , Modern Treatment More Humane. As regards other methods of treatment 1 now in use at the . Auckland institution^jio ■ drugs are employed, save as occasional : sedative to the excitable. It was the prac--1 tice 20 years ago to use drugs more often, and also to exercise restraint more freely, ■ in the direction of long seclusion, straightjackets, and padded rooms. Nowadays, any 1 form of restraint is rarely used. The only j reception is > the canvas dress for patients 1 who are very destructive to their clothing. Padded cells are not any longer used as such, but merely as extra bedrooms, .when, as at present, overcrowded conditions necessitate it. Seclusion is never , lesorted to, j except in the , case of) extreme violence, and then only for a maximum period of five hours. If a patient quietens down before the expiry of that period hais released. . . . . , Seclusion means being placed in a single room with about; 1000 cubic feet of space, the door and shutter of the window closed. Ventilation is provided, * and the patient is given a mattress, a pillow, and blankets. Sometimes, after a surgical operation or injury, a patient is kept m a loose jacket to prevent interference on his part with the surgical dressing. . Tins very rarely happens, however, probably only two or three times a year. Dr. Beattie believes in the modern method of brief seclusion, his opinion being that physical ' health is injured by lengthy treatment of that sort. The whole, of the modern methods of treatment are based on the principle that the better the physical health the better the mental health. Patients Want Rousing. _ There, is just a doubt in the mind of Dr. Beattie as to whether the methods of treatment now adopted are not going too far in "a humanitarian direction. This view is important. In explaining how ho had arrived at it, the" medical superintendent said that during the past year he _ has been treating a fair number' of patients in the Wolfe Home for convalescents. His experience up to the present has been that - the patients there are not doing so well as . those in tho main hospital building. Tho Wolfe Home is in charge of a qualified hospital nurse, who also had seven years previous experience of mental cases'under Dr. Beattie. The Wolfe Homo is in every respectas the Herald representative was given an opportunity to sco for himself— like a private dwelling than a mental hospital. 'The patients are allowed much more freedom than those in tho general mental hospital across the road they are away from all noiso and excitement of any: kind; they have more outside recreation; somewhat better diet, and tho building is a great deal more hygienic. In spite of all these apparent advantages—and they are certainly intended as such—the Wolfe Home patients do not do so well as the others. Dr. Beattie attributes this to tho fact that he thinks the majority of mental patients, even in the, convalescent stage, improve more rapidly and get on better, amongst the bustle and excitement of the general 'institution. They have, more time at the "Wolfe Home to ood over their troubles, and not sufficient exci - *n *nt to keep them roused. "I am bound to say," remarked 'Dr. Beattie, " that it seems to mo the more humanitarian you are beyond a cer'tain stage the more y.jur cures go down. You have to rouse your patients and make them work. As a general rule, if a patient will not work ho will not get 'better." Some Difficult Cases. Concerning the difficulties of treatment, Dr. Beattie mentioned some sad instances of cases that cannot now, 1 or at any other time, bo cured. As an example, ho said that a woman might go to the institution as the result of a long period (often a matter of years) of worry and anxiety caused by a drunken husband, and a povertystricken home. She sinks into a state of melancholia as a rule, and when she is in the mental hospital, she begins to worry over her children, or to wonder what may be happening to them., She sees nothing before her , when she ift released but the same conditon of affairs that drove her in. Her worry continues, and nothing that can be ■ suggested or done has any effect upon

her mental condition. Her future outlook * remains always black. Probably the saddest cases that had to be dealt with are cases like —where the mother has 'been a devoted parent, and knows that her children may be either neglected or sent to a public institution. It has happened in such cases that a capable nurse, giving as much individual attention as possible, has done a great deal of good to the sufferer. But., too often, just as the patient has reached the verge of recovery, she suddenly realises the whole position again, and a rapid relapse sets in. Causes of Mental Disease. Tho causes of mental diseases treated , at the Auckland institution are many. Dr. Beattio states that alcohol unquestionably plays a very large part. Personally, he thinks that 20 per cent, to 25 per cent, of the insanity cases admitted to the Auckland institution are directly due to alcohol. How large a percentage is duo indirectly to this cause ho is not prepared to say. Alcoholics, again, sometimes have epileptical children, who become insane, and there is, besides, a greater tendency amongst alcoholics to have degenerate children than amongst tho sober members of the community. Heredity is tho second commonest cause of mental affliction. Dr. Beattie has tried frequently to estimate the percentage under this heading, but cannot arrive at any certainty owing to defective family histories. The percentage, however, is fairly large. In this connection the doctor stated that the father of a family of six or seven children committed suicido himself, whilst every one of tho children became patients at the mental hospital. Another case . quoted by Dr. Beattie raises a most disquieting point in connection with hereditary insanity. Last year ho discharged a malo and female patient at about, the same time. The two married, and at her first confinement the wifo again lost her reason, and is now, once more, an inmate of the asylum. ' 111-health is another cause of mental trouble, but, whilst nervous. breakdowns are frequently responsible the doctor combats the impression that neurasthenic persons become insane. Other causes are units for the most part, such as special shocks, frights, railway accidents, etc. As a general rule, however, Dr. Beattie finds . that strong brains do not break.