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A Mind That Found Itself: An Autobiography

Creator: Clifford Whittingham Beers (author)
Date: 1910
Publisher: Longmans, Green, and Co., New York
Source: Available at selected libraries

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BY J. MONTGOMERY MOSHER, M.D. Attending Specialist in Mental Diseases, Albany Hospital, Albany, N. Y. -Reprinted from the Proceedings.-


ON the sixth of December, 1899, seven physicians of Albany, New York, petitioned the board of supervisors of the county to erect a "building for the temporary care of insane patients," directing attention to the fact that "the process of commitment to a hospital for the insane is complicated and often requires several days, during which time the patient may be protected by his friends as best they can, or, in event of active manifestations of insanity, endangering himself or others, be placed in the jail." The petition was favorably considered and a law was enacted appropriating eighteen thousand dollars "for the construction and furnishing of a reception pavilion in connection with the Albany Hospital, for the detention and care of persons afflicted with nervous and mental disorders." The Albany Hospital is a private corporation, under the administration of a board of governors, elected annually by subscribers, built on land granted by the city, and providing wards for the care of both private and public patients. The erection of the so-called "Reception Pavilion" was contingent upon "a contract between the Albany Hospital and the County of Albany, that the said hospital will maintain and manage the said pavilion, and will agree to receive and accept for detention or treatment in said pavilion, all public patients' from this county or any of the cities or towns thereof, upon the same terms as public patients are received and cared for from the various towns of this county, at such hospital."


The conditions leading to this action were particularly painful. The insane of the State of New York are maintained by a State law. The State is divided into hospital districts, Albany being in the district of the Hudson River State Hospital at Poughkeepsie, distant seventy-five miles. There was no opportunity for the treatment of a case of insanity other than by a commitment to this hospital. The commitment is a complicated legal process, consisting of a petition by any person with whom the patient may reside, by the nearest available relative or by a proper public official, annexed to the certificate by two qualified physicians, of an examination to have been made jointly within ten days before the granting of an order, and to contain a statement of "the facts and circumstances upon which the judgment of the physicians is based, and show that the condition of the person is such as to require care and treatment in an institution for the care, custody and treatment of the insane." The petition and certificate, properly verified, constitute the application, notice of which "shall be served personally, at least one day before making such application, upon the person alleged to be insane." If the judge to whom such application is made is "satisfied that the alleged insane person is insane," he may "issue an order for the commitment of such person," or he may, "in his discretion, require other proofs."


A later amendment to this law provides for "emergency cases," who need "immediate care and treatment," or who are "dangerously insane," and may be received in an institution upon the certificate of lunacy and petition for five days pending the judicial order.


In brief, a patient who is suffering from disease of the mind, the most threatening calamity of life, must be so far advanced in the disease and so disordered in action or in speech as to satisfy a lay tribunal of the necessity or justification of the forcible deprivation of his liberty, must be told that he is "insane," must be "adjudged insane," and "committed" by a court to an institution for the insane, before he can receive the treatment best adapted to the restoration of his health.


In so far as the "Insanity Law" of New York relates to the care, custody or protection of the insane, it is definite and effective; but as an obstacle to the prompt early treatment of mental disease, it must be regarded as a medical barbarism. This discrimination against the mental patient places him in a different light than the sufferer from a physical ailment, although the pathological processes are more delicate and intricate and demand the most painstaking consideration. It is impossible to conceive of a patient with pneumonia or a broken leg applying to a court of law for medical or surgical care, but such is the necessity of a mental case.


The man who has overtaxed his nervous system suffers first from insomnia. Insomnia is a manifestation of irritability, which is the earliest expression of exhaustion. It indicates that the excessive momentum of the work of the day is carried into the night, and that normal relaxation and recuperation do not follow. The train of thought is beyond voluntary control, and this automatic mental activity soon continues throughout the day and night. The patient states that his thoughts are "running away with him." He is also conscious of inability to concentrate his attention, which, as a layman, he usually describes as loss of memory. This mental unrest early becomes a source of anxiety, and the attempt is unfortunately made to obtain relief by sedatives; the overshadowing symptom of irritability is treated and the underlying pathological state of exhaustion ignored. The result is disaster. The use of debilitating drugs upon an already depleted organism intensifies the condition, interferes with function, obstructs the secretions, prevents metabolism, and the products of decomposition accumulate as poisons, to add their damaging effects. Strange thoughts and fancies fill the mind of the patient, of the extraordinary character of which he is partially or at times fully conscious, and of which he is willing to accept an explanation. This is the point of progress of the ailment which has been described as the "borderland of insanity." It is the true psychological moment at which a misstep may precipitate disaster, and proper treatment may avert a long and dangerous illness. The family look upon the patient with apprehension and with awe. The actions, manner and characteristics of one dearly beloved are changing and his companions are not educated to the interpretation or management of the altered personality. Evasion, indirection, deception, falsehood, contradiction, chiding and even violence, bewilder the patient, intensify his irritability and confirm his doubts, when the simple truth, a frank revelation to him of the morbid origin of his fancies -- the only source of mental relief -- is almost never spoken. They appreciate the mental disorder, its threatening aspect and possibilities, but stand in awe of the formidable judicial declaration of insanity. The opprobrium attached to a confession of mental obliquity weighs more heavily than the desire, for relief. Delay and mismanagement follow until the patient, delirious and desperate, has committed some offence against the law, or has become flagrantly incompetent, when, often too late, he is placed in the hands of physicians who understand his condition and are trained in the use of therapeutic measures for relief.

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