THE New Zealand Herald AND DAILY SOUTHERN CROSS. SATURDAY, MARCH 10, 1923. MENTAL MALADIES.

New Zealand Herald, Volume LX, Issue 18345, 10 March 1923, Page 8

THE New Zealand Herald AND DAILY SOUTHERN CROSS. SATURDAY, MARCH 10, 1923. MENTAL MALADIES.

There is published to-day a letter by Dr. Beattie, Superintendent of the Auckland Mental Hospital, dealing with the treatment of incipient or "borderland" insanity. It raises points of great public interest. There is a widespread belief that, although present-day treatment of mental disease is vastly superior to that of earlier times, it is still far from perfect. To believe this is not to bring a wholesale charge of incompetence or inefficiency against the management of institutions devoted to the treatment of mental maladies, nor even against the efficiency of any one of them in particular. There is nevertheless need for serious review of the whole position. The war, which left a painful aftermath of mental disorders, has served to call attention to both their increase and their possibilities of cure ; and the accelerated pace of modern civilian life has, no less than war, taught the necessity for rational treatment of irrationality. This is not the con- '' cern of professional experts only. The psychological discoveries of Freud, Adler, Jung, and their followers, have turned the reading public into students of mental processestyros very often, but students nevertheless, and disinclined to leave mental pathology entirely to the specialist. The public opinion that displaced the cruel madhouse with the asylum, and later pressed for mental hospitals in which even the safety of the public counted for less than the good of the patients, is now demanding that curative means shall be extended to include the "borderland" cases. Dr. Beattie's suggestion that these should be dealt with in the general hospitals will satisfy neither the authorities of those hospitals nor the public. The staffs of those hospitals must be specialists in physical disorders ; and to add to their duties the care of patients suffering from incipient insanity is to make unreasonable demands on them. To associate, in however small a degree, the physically ill with the mentally excitable or depressed is calculated to jeopardise both ministries of healing : those weak in body should not be exposed to terrors that nearness of the mentally unsound would mean, and the mentally afflicted should be spared the sombre influence that massed sickness brings. Special institutions for the accommodation and treatment of the incipiently insane are inevitable in a wise system of therapeutics.

It is undeniable that there are countless cases of insanity that are curable, and that the prevailing system of dealing with the whole problem fails to do the best for them. Some mental hospitals are even yet places of detention rather than places of cure; and there is urgent need for institutions to deal with cases of insanity that are but slightly removed from mental health. What proportion of cases falls within this category is perhaps not easy to fix ; but there is good authority for fairly definite statements. Dr. Beattie's declaration that insanity has never been defined, and in the present state of our knowledge never can be defined, is hardly relevant. It ignores the fact that a definition sufficiently precise for practical purposes obtains. In "borderland" cases a similar practical precision is not impossible, and its application by medical and legal authorities presents no greater difficulty. Indeed, since early cure rather than indefinite confinement is in vipw, it may be claimed that the decision as* to need for treatment would be beset with less grave conseauences and so be more easily reached. The possibilities of effecting a cure in mental maladies are much greater than was ence thought. Victims if melancholia, aflthongh liable to selfdestruction, may be restored to ! eventual health, in some instances I ranidly. Acute mania, such as is ! produced by alcoholic poisoning, is not incurable. Puerneral mania has an early recoverable stage. All alienists to-day agree that the old- j time regard of these and many other I mental disorders was needlessly ! pessimistic. They ailso agree, and in this they share an increasing public opinion, that there is a large class of early mental cases that ought not to be sent to asylums or public mental hospitals at all, or, i if sent there, should not be treated in comnanv with cases of more advanced disorder. They should be i deailt with in suitable homes, separ- \- ate from asylums, and their treat- i ment should be based upon • an expectation of complete cure. What" happens is often vastly different. i They are inadequately segregated \ from incurables. Differential treatment is denied them. They are treated as incurable— so are made incurable. The chief condition of many a cure, that of the patient's hopefulness, is ruthlessly removed. So we get what Sir Henry Maudsley called, with illuminating frankness, " asylummade lunatics." Until more rational provision is made for these cases, there will be a large toll of mental wrecks made bv clumsy and inhuman handling of them: needless pain wiill be inflicted and avoidable expense to the State will be incurred. Dr. Beattie contends that vast expenditure will be necessary to deal with "borderland" cases. , But leaving alone for a moment any! higher considr- tion than that of the balance-sheet, there is a large saving, of which he loses sight, in the cure of incipient insanity : every patient cured lessens the cost of ; mental hospitals and adds to the } earning and taxraving capacity of the community. It may be safely! conieotii'-ed that such " a savin*' would outweigh all cost. Even if. it did not. is humanitarian work to be shirked on that account !

Proof of the need for this task is. j convincingly abundant. The literature J

of the subject grows with every year. Among the chief defects of England's asylum system, Dr. Montagu Lomax, author of " Experiences of an Asylum Doctor," a book that created a deep public impression some months ago, has included " the absence of any provision for the treatment of incipient insanity." He has declared that the recovery-rate is stationary and even showing signs of going down. Yet something has been done by private philanthropy, as in the instance of what Dr. Lomax calls "such admirable institutions as that founded by the late Sir Ernest Cassel at Penhurst. He urges the extension of the "voluntary boarder" system worked with success in Scotland and operating in England's private asylums. His criticism has passed on to constructive suggestion : "restful surroundings, good food, fresh air, sympathetic and kindly treatment, good nursing, and wise medical aid are the most hopeful means." The formula sounds simple ; but in it are involved all essential things. They include competent superintendents, trained in applied psychology, adequate and intelligent staffs, suitable homes, complete segregation of different classes of patients and differential treatment adapted to individual cases, an environment of hopefulness and good cheer, and such a graduation of liberty as will restore the self-confidence of the patients. The formula's employment in State institutions, as well as private mental sanatoria, is greatly desirable In this way some real advance in solving what Dr. Beattie rightly calls "a knotty problem" may be made. It ought to be attempted. To dismiss the subject with a gesture of despair is unworthy of a civilised people. I