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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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At the end of five years this experiment in the therapeutics of mental medicine is thought worthy of a report to the National Conference of Charities and Correction. Facts and experience have accumulated to justify a statement as to whether an actual advance has been made in the most difficult and least understood department of practice; or whether, as is unfortunately too often the case in medicine, as well as in dress, a fashion has been introduced to indulge a passing fancy.


From February 18, 1902, the day of the first admission, to February 28, 1907, one thousand and thirty-one patients have entered this building. Of these five hundred and ninety-six have returned to their homes recovered or improved, three hundred and sixteen have remained stationary, and eighty-six have died. Two hundred and forty-five have been transferred to institutions for the insane; of these one hundred and twenty-six were sent to Pavilion F for detention during the legal proceedings, and one hundred and eighteen were committed after a period of observation. It thus appears that nine hundred and five patients have been under treatment without legal process, one hundred and eighteen of whom it became necessary to commit later to institutions for the insane.


If this special provision for the treatment of the mentally deranged had not been made in the Albany Hospital, then these nine hundred and five patients would either have had to be improperly treated at home, or would have been committed after a probably harmful development of the disease. It is impossible to judge how many have been saved from an unnecessary commitment.


A glance at the table shows that every form of mental alienation or defect has been represented. With reference to personal mental responsibility patients may be divided into three groups; first, those who know what they are doing, and enter the hospital for treatment; second, those who do not know what they are doing, and are brought to the hospital; third, those who know what they are doing, and decline to enter or remain in an institution.


In the first group are cases of neurasthenia, hysteria, hypochondria, melancholia, mania, light grades of dementia, some forms of drug addiction and alcoholism, and physical diseases with incidental mental symptoms. These patients are capable of making their wants known, of protecting themselves against injustice or neglect, and of enforcing any obligation of care or treatment assumed by the physician or hospital.


The second group includes, primarily, cases of delirium or stupor, and secondly, cases of feeble-mindedness, either native, as in idiocy or imbecility, or acquired, as in advanced dementia, the late stages of paresis, and old age. Delirium and stupor are mental states due to acute and profound changes in physical conditions, the pathological substratum of which is exhaustion and toxemia. The cases are critical and often fatal. They can rarely be treated at home, should not be committed to an institution for the insane, and require prompt and energetic measures, such as a general hospital may give. The question of improper motive or unauthorized interference is no more pertinent than when a patient unconscious from the uremia of Bright's disease is plunged unceremoniously into a bath. The mental enfeeblement of advanced dementia, paresis, and old age, gives opportunity to designing persons, and care should be exercised by the custodians of these helpless patients' to protect them from injustice. When property interests are involved it is wise that legal cognizance be taken of their incompetency.


In the third group are cases of early paresis and of delusional insanity. The experience of Pavilion F has shown that the confines of a small building are too limited for the characteristic restlessness and magniloquence of paresis. Delusional insanity is always a most troublesome condition. Any form of opposition, detention, or restriction is resented, and indeed the determination of the delusion may be difficult, particularly when marital infidelity or domestic infelicity is the basis of the disturbance. Husbands with quarrelsome wives, wives with intemperate husbands, children with degenerate parents, parents with disobedient children, occasionally look to the hospital for relief. Inasmuch as the management of such patients involves the question of custody rather than treatment, and restrictive measures are appropriately decided by the courts, the hospital refrains from engaging in these disputes.


It should not be forgotten that insanity is disease, and that the determination by a court of the treatment of disease is illogical. A few patients in incipient stages, less than twenty-five per cent, and probably not more than ten per cent, fail to recognize the morbid origin of their abnormal thought and action, and decline the remedy. They become a menace to themselves or others, and are subject to legal measures because they are unsafe, violate law and order, and render themselves liable to restraint. They constitute one class for whom supervision is necessary. Another group of patients are those who do not recover and need the good offices of the court, not however for the safety of their neighbors, but because they are left, after the active disease has subsided, with a mental scar, a defect in intelligence, and are incompetent to carry on independently the duties of life, to mingle in society, or to support or protect themselves in the struggle for existence. They are the demented, or mentally enfeebled, comprising the bulk of the State hospital population, a rapidly increasing number who are a helpless burden. It is right that provision for them be under the jurisdiction of the State, in the interest of both the State and its beneficiaries.

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