CARE OF THE STATE

Southland Times, Issue 19290, 8 July 1924, Page 5

CARE OF THE STATE

MENTAL DEGENERATES THEIR TREATMENT AND CURE COMMITTEE OF INQUIRY AT DUNEDIN. (Per United Press Association.) DUNEDIN, July 7. The Committee of Inquiry into mental defectives and sexual offenders sat in Dunedin again this morning. COMPLETE RE-ORGANISATION NEEDED. Dr. Marshall Macdonald said it was impossible to consider the disposal of the feeble minded without going into the question of re-organisation of the whole of the machinery for dealing with the insane, because, in his opinion, it was in this Dominion ineffective and inadequate. Most of the mental hospitals were not suited for the purpose. They were overcrowded and understaffed with medical men, and it was not possible to carry out proper classification. He would like to point out that the most urgent need at present was that of provision for border line cases. There should I be special hospitals with specially trained physicians and with trained nurses for the treatment of such class of case as acute melancholia. That class of case was essentially a culpable one, because stich cases were suicidal. They could not be kept in general hospitals and even in Seacliff, where very praiseworthy efforts had been made to treat voluntary cases in what was known as the cottage. Acute melancholia had to be placed in the main building. TRAINED PHYSICIANS ESSENTIAL. Dr Macdonald said he would like to emphasise the importance of training medical graduates in mental diseases. That principle was recognised in all modern medical schools. In New Zealand training in mental diseases was limited to one week spent in Seacliff where they saw cases of gross and advanced mental disease. Students received practically no training in the early diagnosis and treatment of mental conditions. With regard to sexual offenders against women and children, Dr Macdonald said he thought they should be segregated. He was not in favour of compulsory operation in these cases. It would be all right where the patient was willing to be operated on, but he would not recommend compulsory operation, for two reasons. One reason was that an operator could not forsee the result of his operation. If death or insanity were to result, a Judge or Magistrate would hesitate about recommending such a procedure. Again his other reason was that castration or sterilisation would not be an effective remedy. Dr Macdonald went on to give a case in his experience to show that castration had not had the desired effect. He supposed there were about 1 or 2 per cent, of the children born in New Zealand mentally deficient. No one was sure of the figures, but he thought there were about 400 children who were mentally deficient born annually in the Dominion. About quarter of those were low grade imbeciles and found their way ultimately into the mental hospitals. For these he would have no hesitation in recommending sterilisation. That was an operation short of desexing the patient. It would not be absolutely preventative, but would be fairly satisfactory. Dr Macdonald thought that the most effective way of dealing with higher grade imbeciles would be to notification by school teachers and by social workers. These children could be collected and placed in a special school like that in Otekaike. He did not regard alcohol per se as a common cause of insanity, he would rather say that alcoholism was one of the symptoms of neuropathic inheritance. About 10 per cent, of the feeble minded, said Dr Macdonald, became delinquents. That was 2 per cent, of the general population, and 10 per cent, of the prison population. Dr Macdonald said he was utterly opposed to the teaching of sex questions in schools. It would likely result in more harm to the teacher than in good to the children. The duty of instructing children in these matters rested with the parents. BORDERLINE CASES. Dr Kenneth Ross stressed the need for an institution apart from a mental hospital to house borderline cases. This would relieve Seacliff and allow proper treatment to be given there, and proper classification of the acutely insane. The feeble minded were divided in two types—idiots and imbeciles. The latter were divided into two classes, low and high grade imbeciles. The lower grade was not of much danger to the community, but the higher grade provided persons who committed petty crimes, and prostitutes. High grade imbeciles were often difficult to recognise, and often they were not found out until the/ reached the Police Court or until the girl became pregnant. He suggested the establishment of a mental clinic. In reply to a question, Dr Ross said that he thought the only thing for sexual perverts was absolute and permanent segregation. NEUROSIS. Dr Stuart Moore said that there appeared to be no proper provision at present for the care and treatment of such cases as aimless thieves. It would be more economical to the community if such cases were permanently segregated and studied by psychological and other methods with a view to cure and more or less complete liberty. The ordinary school carriculum tended to produce neurosis in some subnormal children and so rendered them less able than would otherwise be the case to fight their way .in the world. The subnormal might suffer from neurosis. That could be alienated or even cured by psycho analysis or some other method. There was danger of normal children suffering from neurosis being regarded as subnormal, or even in severe cases, as mental defectives. The same was true of adults. Neurosis was one of the most crippling ailments to which humanity was liable. It was not curable by suggestion, but was often curable by psycho analysis. Further research wae needed to determine exactly what conditions were hereditary. Neurosis which was apt to be mistaken for feeble mindedness or sub-normality might appear to be hereditary, when in fact it was transmitted largely, if not wholly, by the presence in environment of the child of neurotic parents. Further research was needed to determine the best treatment of people who were unfitted mentally to run their own lives successfully. The best method of treatment of feeble mindedness and of neurosis which was apt to stimulate and also apt to be associated with abnormal intelligence, was prevention. That involved : (1) Prevention of venereal diseases, and their efficient treatment. (2) Improvement in the environment of the young by the development of proper methods of, and provision for treatment of borderline cases of insanity of brief duration, alcoholism or drug addiction (which was usually either neurosis or psychosis), and of neurosis. (3) The prevention of goitre, which if allowed to develop, would give us a crop of cretins. (4) Voluntary sterilisation should be offered to the feeble minded and sub-normal, but the sanction of the operation should be in the hands of a Judge or on advice of medical experts. The general principles on which the recommendation should be carried out should be carefully considered and determined only after careful study. FURTHER RESEARCH. Further research was needed. (1) To determine what conditions were hereditary.

(2) To understand psychology and the

treatment (a) of alcholic, (b) of neurotic, (c) of morally defective and of sexual perverts. Medical students should receive much more thorough instructions in psychiatry. They should receive also a course of lectures by a medical man who was a psychologist in normal and abnormal psychology. At present medical students became qualified with almost no instruction in sex matters. Sexual perversion was quite a different problem from that of mental degeneration, and he thought it altogther misleading in consideration of either of these two subjects to have them bracketed together. Sexual perversion, if severe, was difficult to cure, but was sometimes curable by psycho analysis. A tendency to it, or perversion itself, was often overcome by the patient by the development of curable but maybe severe neurosis. He did not think that castration was likely to cure. Deterrent treatment must be retained, but the study and treatment of these people should be offered to them, at any rate to selected cases, while they were undergoing deterrent treatment. CAUSE OF SUB-NORMALITY. In the prevention of the sub normal, he believed that proper care of the mother during pregnancy and the early years of her children’s infancy was a factor of some importance. The common practice which prevailed of mothers consuming impoverished foods during pregnancy and lactation must be regarded as a source of sub-norm-ality in children, and this was a fairly simple problem to deal with. Alexander McMurray Paterson gave evidence based, on his experiences in the care of boys in Scotland, Australia and New Zealand. Lengthy evidence was given by Miss Ralston, matron of the Caversham Industrial School, who quoted a large number of cases of feeble minded girls who had come under her notice. She expressed a desire that her evidence should not be published. The Committee will leave to-morrow morning for Christchurch, where further evidence will be taken, and where several institutions will be inspected. Then it will proceed to Nelson to inspect the special school and will afterwards go to Wellington to take final evidence.