A REVIEW OF RECENT WORK AND PROGRESS IN THE FIELD OF PSYCHOLOGY.
BY SELDEN H. TALCOTT. M.D., MIDDLETOWN, N.Y., CHAIRMAN.
Fellow-Members.-As Chairman of the Section of Mental and Nervous Diseases, it becomes my duty to present an address before this Society, giving a review of the work accomplished during the past twelve months, together with the general trend of interest and progress in the field of psychology.
The work accomplished by this bureau may be summarized by presenting the following list of articles relating to mental and nervous diseases, together with the names of their authors:.
“Progress in the Care of the Insane and the Development of the Hospital Idea in the Treatment of Mental Invalids,” Dr. Selden H. Talcott, Chairman, Middletown, N.Y.
“Puerperal Insanity,” Dr. A.P. Williamson, Minneapolis, Minn. .
“Statistical Facts Relative to Insanity and its Treatment,” Dr. George Allen, Middletown, N.Y.
“The Care of the Insane,” Dr. C. Spencer Kinney. Middletown, N.Y.
“Clinical Instruction to Medical Students in State Hospitals for the Insane,” Dr. N. Emmons Paine, West Newton, Mass.
“The Causes of an Increase n Melancholia,” Dr. William M. Butler, Brooklyn, N.Y.
“The Octave in Nature and in Man as a Key to Psychology.” Dr. J.D. Duck, Cincinnati, O.
“Mental Depressions and the influence of the California Climate Thereon,” Dr. H.R. Arndt, San Diego, Cal.
In considering these papers we conclude that during the past three years there has been a marked tendency to an increase in that form of insanity known as melancholia,,and due, we believe, to the effects of la grippe when complicated with Allopathic treatment.
We also find that operative surgery is having an influence upon the mental condition of woman which should receive close scrutiny and careful investigation.
Again, we note that the influence of climate and of diet and of social surroundings are most marked either in the production or prevention of that most dreaded of all diseases-insanity.
The various phases of mental disorder, together with their causes, and the conditions under which they most flourish or decline, have been discussed by the writers already named. Hence, we shall devote the brief space of time allotted to us for a bureau address to a consideration of the general progress which has been made toward an understanding of the nature of insanity, and likewise shall seek to consider the most modern method of treating this malady, and attach to this dissertation a few tabulated statements showing the results attained. It may be interesting to some of your to know that the history of the care and treatment of the insane may be divided into four great epochs:.
1. The epoch of absolute neglect, when these sick people were outcasts from society and compelled to live in forests and in caves. This was their condition when the Great Physician of Galilee began His work of healing the nations.
2. The epoch of the dungeon, the chain, the strong cord and the whip. This was the epoch when the insane were treated as the worst of criminals, and that treatment still constitutes one of the horrors of the Dark Ages.
3. The epoch of the asylum, where the insane were held “in custody,” and made to feel constantly a sense of imprisonment; but their confinement was carried on in substantial and imposing buildings, and the insane were kept in comfortable rooms, and given sufficient food, and clad in warm raiment, and, generally, they were afforded such comforts as seemed necessary in the dim light of a dawning perception of the needs of this strange class of human beings.
4. The epoch of the hospital. In this latter epoch the fact that the insane are sick people suffering with brain disease, and needing medical as well as physical care, was fully disclosed by the discovery of modern science. This epoch is very recent in its origin. Although Pinel struck many shackles from the limbs of the insane one hundred years ago, and although at that time Samuel Hahnemann taught the doctrine of kindness to the insane, it was but recently that insanity was considered so much of a physical disease as to require hospital treatment in every sense of the word.
I think it may be truthfully stated that during the past twenty years greater progress has been made in the acquirement of a correct knowledge of brain and mind diseases, and in treating them successfully upon the hospital plan, than ever before.
It took nearly eighteen hundred years of a Christian era to so far develop the human understanding as to inspire Pinel with sufficient confidence in the law of kindness to strike shackles from the limbs of maniacs. It has taken, since his day, a hundred years of persistent teaching to change the dungeon into the asylum and the asylum into the hospital. The “Hospital Idea” may be said to have been practically recognized only during the past few years. Even now its recognition is but partial, but its beneficence must, we think, speedily be acknowledged by the charitable and sympathetic masses of philanthropists.
The cave treatment that belonged to the Healer of Gennesareth, and the dungeon treatment which forms a part of the horrors of the Dark Ages, have passed away, and we have now to consider only asylum care and hospital treatment for the insane.
Let us consider now the difference between an asylum and a hospital. An asylum is a place of custody where the insane, dangerous to themselves or others, may be confined for safety of the community as well as that of the individual. A hospital is a place for the treatment of the insane, and where cures are effected if possible. The asylum is associated with strong walls and barred windows and heavy doors and generally prison-like and custodial attachments. The asylum, in its old-time purpose, is constructed upon the “safe in some quarters, looked upon a s a being who is almost, if not quite, as dangerous to humanity as the most hardened and reckless criminal. Hence, close custody has been the allotment awarded to him by judicial proceedings or, at least, judicial approval.
The “Hospital Idea” recognizes the board and conclusive fact that the insane man is suffering with an actual physical disease. The lunatic is now looked upon as a person suffering with some pathological state of the cerebral mass-pathological either by organic change of the brain tissues, or by functional disturbances within the cranium, or by reflex irritation of the cerebrum through the influence of disease located in some other organ of the body.
The fact that the brain of the insane man is diseased having been recognized,. it would seem, then, the most natural and logical conclusion arrive at that he should be favored with as skilful, and scientific, and thorough hospital care as a person afflicted with nay other form of disease in any part of the body; and yet, when we come to advocate and recommend hospital treatment for the insane, we are forced likewise to consider the necessity for depriving the individual of his personal liberty.
In the minds of many, this personal liberty of the individual is sacred, and should not be infringed upon except by the most solemn sanction of the law. While we do not hesitate to consign small-pox cases to the pest-house, and typhus and cholera cases to the hospital for infections diseases without a judicial commitment in each individual case, we recoil from the idea of placing an insane patient in a hospital against his will, unless a commitment is made out in the most elaborate form by two qualified examiners in lunacy, and their certificate must receive judicial approval by a judge of a court of record before the commitment of the sick man can safely be commenced.
In the State of New York, a legal commitment of an insane man to a hospital for treatment provides for the following:.
(1) Medical examination by two duly qualified physicians, and a certification of the result.
(2) Judicial approval of the certificate by a judge of a court of record.
(3) Approval or disapproval of these judicially approved papers by the State Commission in Lunacy.
Here is formidable array of legal measures to be complied with before the lunatic can receive continued treatment in a hospital. Here is an instance where the medical care of the sick is wrenched from the hands of physicians, and the necessity for curative measures may be either approved or denied by a non- medical judge, or a commission that is non-medical by a two- thirds majority.
Why should legal proceedings interfere with the prompt and careful application of medical measures in behalf of the sick? I suppose that one reason to be assigned is this: Insanity is not a contagious disease; if it were then legal interference would be considered unnecessary. Neither a trail by jury, nor a judicial approval, is required when the disposal of a small-pox case is in question. if it were, how many unvaccinated juries or judges would be willing to try the case? No one seems anxious to impanel a jury to diagnose a case of cholera or typhus fever! Ad Editha’s burglar said, regarding noise: “It isn’t considered ‘healthy in the profession”.
Now these legal measures, which are required before curative treatment for the insane can be applied, are not taken for the purpose of promoting the interests of lunatics, but they are deemed necessary for the purpose of preventing the incarceration of people who are alleged to be sane, rather than insane. The whole drift and tenor, and tendency of legal commitment of the insane, is against the interest of those who are sick and in need of treatment. The whole trend of legal commitment is toward the protection of the sane to the neglect and injury of the insane.
Under the present forms of legal commitment the lunatic is examined, and probed, and tortured, and ignominiously guillotined in soul before the public gaze, and is branded as a “lunatic” all over his dome of thought before he can be allowed to receive treatment in a hospital for the insane.
Is there any place on earth where the physician is allowed to be the sole judge of the necessities of the sick insane? We may answer, in the affirmative, that in the freest of all republican countries, Norway-the “Land of the Midnight Sun”-the highest and noblest yet simplest form of commitment is to be found. There, the family physician is called to examine the patient, and if it is his opinion that the case needs asylum treatment, he makes an informal, unsworn to, and unapproved certificate to that effect, and the patient, armed with this certificate, and without any legal hindrances or restrictions whatever, is admitted to a Norwegian asylum for treatment and cure.
Dr. Lindboe, the distinguished psychologist in charge of the State Asylum for the Insane at Gaustad, near Christiana, Norway, told me, presently, that this method was entirely satisfactory, and that no evil results ever followed the practice which obtained in that country in behalf of the insane. [In Scandinavia, the physician must study medicine for ten years before he can be licensed to practice; but he is then permitted to perform his medical duty without interference by the laity or by another learned profession.
In this country we should compel our students to continue their college courses for eight or ten years, and then physicians should be allowed to care for their patients without without the specious and unwarranted approval or disapproval of those who may be rich in legal lore but ignorant of the compound intricacies of physical and mental pathology.
The physician should be thoroughly educated, and then he should be free in action,a nd should have supreme and unhindered authority in the care and disposition of invalids who may be suffering with either physical or mental disease.
Commitment of the insane for treatment in a state hospital should be made as easy as possible or necessary for the sick, and it should be, in my judgment, entirely upon medical authority. There is no good reason for supposing that the family physician will send his patient to a hospital for treatment, thus robbing himself of fees, so long as the case can be safely and properly cared for at home.
And even through insanity may continue for an indefinite time, we believe that the insane may safely be sent to hospitals for treatment without judicial approval, because these institutions are now examined and watched over by disinterested boards of trustees, commissions in lunacy, and the people at large; and those in immediate charge of these hospitals have every interest to discharge their patients cured or relieved, as soon as possible, in order to make a favorable showing to the community which holds them responsible for their work.
Not only should commitments be made easy, but voluntary admissions should be permitted. It is a recognized and accepted axiom among alienists that early treatment for the insane is the most successful. Many victims of insanity have recognized at the outset their oncoming mental disasters, and have sought by vague personal efforts to avert them.
Hence we urge, as a means to the end, that victims of incipient insanity may receive early treatment in accordance with their own wishes; legal enactments whereby the doors of our state hospitals in all the States may be readily opened for those who desire, even voluntarily, to enter them for treatment. If you would cure the largest possible percentage of the insane, thus keeping the community as free from insanity as possible, you must grant the privilege of easy and voluntary admissions to our state institutions to all the victims of mental disorder.
If men and women could be permitted to freely and voluntarily avail themselves of hospital treatment in the early stages of their disease, they would come to accept such benefits more readily, they would recover more rapidly, the usefulness of the hospital would be enhanced, and the apparent disgrace now attached to enforced and involuntary treatment would, to a large extent, be removed. State hospitals for the insane should be as free for the admission of patients needing treatment for mental disease as are other hospitals for the admission of those affected with general or special diseases.
Such freedom of entry and egress (for the voluntary patient may depart when the pleases) to and from our state hospitals is in accordance with the spirit which pervades the Constitution of the United States, and is in closest harmony with that memorable assertion contained in the Declaration of Independence: “We hold these truths to be self-evident; that all men are created equal (that is, with equal privileges); that they are endowed by their Creator with certain inalienable rights; that among these are life, liberty, and the pursuit of happiness”.
In maintaining integrity of freedom in one’s life, in acquiring full exercise of liberty, and in engaging in the pursuit of happiness, nothing can be more important than that priceless privilege of entering a hospital when sick i body or mind without let or hindrance from any source whatever.
It is wrong, unjust, unconstitutional to stamp the name of a disease, held to abhorrence and feared as a disgrace through all time, upon the forehead of an individual who, without the stamp, is willing to avail himself of every possible opportunity for treatment and cure. Individual rights and aggregate interests are infringed upon by unnecessary legal commitments. Let us have laws which shall grant the admission of voluntary patients to our state hospitals, and let commitments be restricted simply and solely, as the law originally designed, to those who must be confined against their wills for the proper protection of themselves and the community.
Again, if any of the insane are to be considered as the wards of the State, let all be treated alike and fairly. That is, if the State assumes wardship over the pauper and indigent insane, let the Common wealth also assume charge and wardship over those who ave both life and property to protect.
Insanity is a disease which renders its victim absolutely helpless. Under its visitation he can protect neither his life nor his property. Legal wardship implies protection of those who are unable to care for themselves, and who have both life an property at stake. This is the case when a guardian is appointed to take charge of the life and property of a minor.
We claim that the insane who have both life and property should be doubly the wards of the State, on account of their helplessness, on account of the interests involved, and on account of the fact that the insane with property are always more or less liable to become the easy prey of designing individuals. While we believe that all the insane should enjoy, if they or their friends so elect, the benefits of wardship from the State, we are also willing to admit that principle of freedom of choice which enables an insane man to go to a private asylum for treatment if he or his friends prefer that method of care.
It is claimed by some that the asylums of Europe are in many respects superior to the asylums of the United States. If we can find n the institutions of the East anything better than that which is now established here, we should certainly seek to monopolize it. In France and Belgium and North Germany and Sweden and Scotland we find institutions for the insane where all classes, both poor and rich, can be admitted, and where voluntary patients are received as well as the involuntary.
We should seek to acquire the best from every source, and then bend all our energies to the making of such improvements as shall conduce not only to the comfort of the inmates, but to exemplification of hospital treatment for the purpose of curing the largest possible percentage of the insane.
During the past few years the asylums in the State of New York have been converted, by legal enactments, into “State Hospitals.” More than that, these institutions have been transformed in many particulars. The rooms and wards and parlors have been renovated and decorated and supplied with comfortable and easy furniture.
Soft lounges and cushioned reclining chairs have taken the place of hard wooden benches; here floors have been relieved by bright and cheerful carpets; the casements and the walls have been garnished with curtains and pictures; the windows have been made larger and more numerous, and thus more light has been let into the dark and gloomy corners of the buildings; the dingy walls have been painted and frescoed and beautiful with harmonious tints; large rooms have been fitted up for hospitals where the best and softest of beds are prepared for the reception of weak and exhausted patients.
The grounds of our public institutions have been made beautiful with trees, and shrubs and plants and gaily-colored flowers which, from balsamic for the stimulation and delectation of the sick. Heavy iron guards have been removed, and light wire screens, for simple purposes of protection, have been substituted; trained nurses, with helpful hands and sympathetic hearts, have taken the place of grim visaged and hard-souled keepers; smiles have ruled out frowns, and the soft folds of snow-white cloth have been substituted as all that is needful in place of the old-time and harsher restraints of leather and wood and iron.
In this general improvement the matter of diet has been carefully studied, and it has been found that a generous and varied, carefully-prepared and daintily-served bill of fare is far better and more fruitful of curative results than the plain, hard, unattractive prison fare of the past. Hot milk is the beneficent substitute for cold potatoes!.
The Hospital Idea seeks to monopolize everything that can be inspired or suggested by the spirit of kindness and sympathy, and it seeks to embody in the line of practical utility everything that can be acquired in behalf of the sick by intelligent human thought or action. The Hospital Idea embraces al that is known in sanitary science as applied to the protection of human life; it embraces all that is known of diet as applied to restoration of impaired physical energy, and it embraces the education and training of nurses, whose nightly vigils are to supplement the daily visits of the physician.
The Hospital Idea is a tropic as vast as ocean depths, as magnificent as mountain peaks, as enduring as are the experiences of sin and sorrow among men. Its application is the last and grandest work of the philanthropist, and a sure forerunner of the millennial dawn. God hasten the day when this Hospital Idea shall be exemplified in the care of every victim of mental disease within the borders of all the nations of the earth.
They cry of the ages is for universal, not limited or restricted, liberty; the cry of humanity’s heart is for universal brotherhood; the cry of those who sit in darkness is: “Let in the light of universal truth;” the cry of man’s soul is for universal knowledge and everlasting life; and the cry of the suffering sick, while life lasts on earth, is that the spirit of sympathy and the hand of charity may encompass and help universally, and without limitation of class, all those who have been bereft of the use of their reason, and who need the generous protection and the ample wardship of the State.
We know present a few tables showing the results attained in the State Hospital at Middletown, where the patients are afforded not only the physical comforts of life-the bright and beautiful surroundings of architectural buildings, sanitary resources and artistic grounds, and where trained nurses minister constantly to the necessities of the sick-but also where strict Homoeopathic treatment constantly and uniformly prevails. In presenting these statistics we make a modest contrast of our work with the work of institutions where Homoeopathic treatment does not, as yet, prevail.