THRALDOM OF INSANITY

Wanganui Chronicle, Volume LXXXII, Issue 19443, 31 October 1925, Page 6

THRALDOM OF INSANITY

VISIT TO NEW ZEALAND MENTAL HOSPITALS HOW THE STATE BUILDS UP HUMAN WRECKAGE PLEASANT VILLAS REPLACE THE OLD GRIM WALLS. (Written by for the “Matanra Ensign.”) , “Madhouses.” “lunatic asylums.” “mental hospitals”—these are the three terms which, in that order, have been applicable to institutions set up for the treatment of the insane. Each of them describes a period in the history of such treatment: the “madhouse” was quite an apt designation for the establishment of from, say, 1250 to 1790 A.D.; from that year on “lunatic asylum” is the best appellation, certain reforms having by then been instituted; and gradually throughout the 19th century those reforms were multiplied and came into general application, bringing with them drastic changes in public regard of the insane and their treatment, until to-day we in New Zealand possess eight institutions (seven run by the State and one privately) whose rightful designation is “mental hospitals”—with pronounced emphasis on the word "hospital”

Many of our people have quite a wrong notion regarding mental hospitals. They picture griin wards and equally grim warders; padded cells with raving inmates frothing at the mouth: cages whose steel bars are continuously shaken by wild-eved men; rhains. manacles, and all the etceteras. A recent t isit to Porirua (Wellington) and Avondale (Auckland), the two big mental hospitals in the North Island, quickly dispelled all such ideas.

A Mixed Multitude. Porirua Mental Hospital at present contains between 1200 and 1300 patients, their ages ranging from early childhood to up among the 90’s, and their distempers including almost every form that can impair the mental facul- ! ties—hereditary and congenial, melan- • cholia and a host of other agencies, while among the inmates can be found a large number whose only mental limitation is senile decay.

To think of visiting such a place foi the first time brings a feeling of depression and a fortifying of oneself against the pathetic sights' and sounds to be encountered. There’s no need. As Dr. Tisard (superintendent) conducts one from the railway station to the “big house,” the way lies through pleasant paths, well kept, and bordered by trees and shrubbery. The Only Blot. Tn the opinion of Dr. Tisard and all his colleagues at our mental hospitals, the “big house”, is the only blot—it’s a blot on the landscape, and equally a blot on the hospital system. Tn the old days of the “ madhouse,” and to a lesser degree during th'* period of the °lunatic asylum,” the main idea in dealing with the insane was to get them out of public view, place them where severe restrain (those were the days of the iron collar, the leg-irons. land the strait-jacket), and so to confine them that a minimum staff could control and feed the lot. Such was the British tradition which Now Zealand inherited, and under that tradition the great prison-like piles of stone and steel were reared. In such places clissification and segregation were impossible, study of the various (and varying) mihds of the patients was out of the question, and as a consequence the title of “madhouse” was fully merited. The grotesque contortions of an epileptic patient frightened his fellow-patients into panic worse than ever, while the. same epileptic during his periods of sanity chafed at the company of the blithering idiots and victims of delusions with whom he was housed.

Now all is changed. The “big house” still has its uses, for in it are the administrative officers, the infirmary, the indoor recreation and industrial departments. The refractory wards also are here, and in those wards only docs the visitor find a survival of the old order. There are the prison bars, there the curtailed liberty, there the constant supervision, the ( only place where language and looks I are inclined to raise the visitor’s hair. ! The refractory ward, however, is gradually becoming depeopled. for the hairraising patient is made the subject of

special study, special diet, special treatment generally. One can readily understand how, under the old regime, every patient was a- refractory—4iis very surroundings and companions drove him to it, either permanently or intermittently, and the ever-present iron bars and iron rules were as necessary as they were repulsive. The refractory is now A Negligible Quantity. For the most part the patients “would eat out of your hand”; in bygone days they would eat hand and all! They have changed as the system of treatment has changed; they can find the relation of cause and effect increasingly as wisdom in the same direction has come to those who handle and nurture them.

The Porirua Mental Hospital covers a large tract of land, and its whole expanse is chequered with agricultural plots, pastoral areas, industrial workshops and what not, with villas dotted about. Of these villas, the largest at present in occupation is “Ra-uta,” where are housed amid pleasant surroundings about 150 patients of both sexes, these being mild and convalescent cases. Another beautiful place is “Vailima,” a modernised house of 11 r*oms, and here the visitor is impressed by th ewealth of floral growth add by the appearance of facilities for tennis and other recreations to be enjoyed by the wealth of floral growth and substantial structures either ready or nearing readiness for occupation, the ■whole scheme having as its objective the classification and judicious treatment of the unfortunate folk whose reason has become unhinged.

These places are all remote from one another, and are significant of the discovery (comparatively modern) that the causes and cures of insanity are all remote. Once the whole catalogue was bulked as “madness”; now our experts have shown us that brain affections are as varied as bodily afflictions, and courses of treatment are equally dissimilar. Once the patients also were baulked, now they are so housed that personal contact with each individual is possible to the specialists who study and guard their interests.

Paitents Hived Off If a man is feeble and inert in mind, it is not good that he should be subject to the exacting demands of the o her m'an who imagines himself the Crown Prince of Timbuctoo—it is bad for both parties, and not conducive to iue Healing of either. In like fashion, the man whose one desire is to cut his own or somebody else’s throat must be kept from means of doing it, but that is no valid reason why his neighbour who is “just a bit simple, you know,” should, be deprived of his knife and fork. And so it has come to pass that the feeble-minded are hived off to pleasures and tasks within their mental copipass, the Princes of Timbuctoo are installed in their own palaces, the would-be suicides are not allowed to handle edged tools, the simpletons live their simple life together. Visualise that, and you sec one great agency for the bettering and often the curing of the patients. Of those four patients only the man who is chasing blood needs restraint and iron bars; but the old system put the bars around all, and inevitably they eventually all needed them, or died. Work a Great Tool Work is another great tool in the hands of our mental hospital authorities, and thus we find the patients employed, singly or in drafts, at all sorts of tasks in and around the villas or far afield on one of the agricultural plots. The objective of the staff in this matter is twofold; first, the work has to be done by some agency in order to make the estate in a measure reproductive, and the patients can in many instances do it quite as well as outside labour; secondly, it has been found that the employment of a patient’s brain and brawn is a fine medicine, relieving the tedium, “tak-

him out of himself,” and giving meh mental and physical exercise as helps him wonderfully on tho road to a measure of sanity.

Thus we find the patients tending Hie orchards, gardens, cereal and other field cro).s, milking tho herd of over 50 fine Ayshiroa, seeing to the pigs, poultry, horses and other stock. Their life is free, healthy, and untrammelled by any sign of fences or walls.. Such patients enjoy full parole, and so long as they are on hand for meals, treatment and rest, they may in the interim employ their time as fancy mny dictate. Usually their fancy dictates work.

Those Who Need Restraint Returning to the “big house,” one sees how complete is the science of guarding from harm those less fortunate patients who need restraint. Nobody can get far without a key, for most doors are locked. The idea of incarceration, however, is removed as far as possible, and the fastened door is tn ensure proper classification rather than to prevent violence. As a matter of fact, mental hospital patients arc not violent or dangerous; even in tho refractory ward one sees them commingly freely, and it is but seldom that one patient threatens another or any member of the staff. The supervision is constant here, of course, and one may be treated to a flow of “language” in passing, but thkr speaking generally, is all there is to it.' Environment Excellent The one-time cells are now com pletely transformed, and in their place ono sees neat, airy bedrooms, in most cases showing tokens of the natural grace and refinement of their occu pants. For the better-class patients (mentally better, that is) there are big dc'-’intories containing, perhaps, 50 be/,s while for epilept'Cs and others liai'-'e to self-inflic .e.I damage the special precautions include beds made up on the floor, the toilet utensils in these cases being of stout rubber.

Fresh air, beautiful surroundings, healthy diet, multiplied interests — these have been among the chief slogans of Sir Truby King and the late Dr. Hay as cures for the curable, and all are amply evident at both Porirua. and Avondale. The “big house” Js still there, of course, against the wish of everybody; but we must not forget that the “big house” represents a mightly lot of money, and its removal to the scrap-heap must necessarily be a very gradual process. In Sir Maui Pomare the mental hospital authorities have found a Minister after their own heart, for among his various degrees is that, of Doctor of Medicine, and his expert knowledge has meant active sympathy in every move for the betterment of the patients. At Auckland The superintendent of tho Avondale Mental Hospital is Dr. T. G. Gray, an Aberdonian who, hiving gained expert ence in the Land o’ Cakes, Brough J it with him and applied it at Stoke (Nelson) and Seacliffo (Dunedin) ere he found his present niche at Avondale. Dr. Tisard, of Poriru'a, came from Colny Hatch, England, and hand Dr. Gray appear to be of like mind in their ideal of making tho New Zealand institutions as different as possible from the bad old conditions in England and Scotland. Dr. Grtiy chafes at tho presence of the “big house,” and looks forward eagerly to its displacement by the villa system. He already has some very fine villas at Avondale, but is anxious to see them multiplied. “Let us have villas,” he said with all the force of an enthusiast, “and 90 per cent of the dread of these places will vanish. The villa system allows for complete freedom, complete segragation, complete classification, complete treatment, complete rest, complete industry, complete dietary —and those are the things our patients need. The old conditions made a madman madder. Put a. person, sane or insane, behind steel bars, and the first thing he or she wants to do is to break them. Possibly it was

restriction that made the forbidden fruit so desirable to Eve. Anyhow, it has worked out that way with tall her descendants.”

Results have borne out Dr. Gray’s contentions. At Avondale he has practically 1100 patients under his control, and over the expanse of 183 acres a large proportion of these are classified in various villas with but a modicum of supervision. For example, 1 was present—was invited to become a guest, too?— while a party of 131 patients enjoyed dinner with an appetite whetted by a forenoon’s work on the farm. All of these men are on full parole, and within the limits of their mental capacity are able and conscientious workers. Their table manners might not pass without comment at the Hotel Cecil, but thev’re a very happy family. Jarring Notes Eliminated. The term “happy family” well describes most of the wards, in fact. Such is the classification worked out by the superintendent and his staff that all jarring notes have been eliminated as /ar as possible. All told, the staff at Avondale consists of 83 ladies and 70 men. These relative numbers—more ladies than men—at first seem out of proportion, seeing there are more male patients than female. But the numbers are quite all right. Dr Gray explains that “chivalry is not dead, even among the insane,” and he has found that fully 60 per cent, of male patients are more tractable and make greater progress under lady nurses than under male attendants. Such a statement from such an authority gives rather a jolt to the old popular notion that insane people arc violent and need the attention of muscular men. Gracious Tactfulness. Sister I. D. Brand is matron at Avondale, and probably the gracious tactfulness of this lady and her big

bevy of helpers has a lot to do with the reversal noted. Another agency for curative good is constant personal touch with patients. It was a real pleasure to see the calming effect produced in a patient by the touch of the superintendent’s hand on his shoulder or a reassuring word from the nurse. During 1924 nearly 100 patients left Avondale as cured, and one cannot help attributing a big measure of this success to the methods outlined. The Villa System. In the villa system—which seems destined to become generally adopted as the finances of the country permit—we have a complete answer to the agitation for a “half-way” house and some special institution for “border-line” cases. As explained by Drs Tisard and Gray, a system of villas provides for both of these; “and,” added Dr Gray, “with this modern scheme you have not only, a half-way house, but a quarter-way house, a three-quarter-way house, and a house for each stage of severity, all administered from the one centre, and doing our job much more effectively without increase in running costs.” When all is said and done, that is precisely what the country is after —to get the job effectively done—and it is good to know that such an ideal is being so well and so generally pursued. At the end of last year the patients in the Dominion’s mental hospitals numbered 5131 (2873 males and 2258 females), but these cannot all be classed as insane, for among them are a large proportion coming under the heading of “senility,” whoso only men ta.l affection is the burden of years. The number of patients is certainly large, but it is pleasing to learn that the percentage of population is not becoming any greater. Some of us had thought that our neurotic and jazzy conditions were bound to lead to madness, but if that is so, a good many of us have eluded capture up to date. —J.H.