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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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Page 72:


What is responsible for the development of the brutal attendant and his continued existence?


In the first place, not only do locks and bars protect men mean enough to abuse the helpless, the sense of security itself really inspires them to wicked deeds. And this feeling of security is strengthened by the knowledge that chance witnesses can but rarely testify convincingly in a court of law. Being removed from the restraining influence of sane eyes, the attendant does not fear to abuse, or (the vicious type) even sometimes to kill a patient. At the worst he sees no greater penalty in store for him than the loss of his position. The chance of arrest and trial is so remote as to escape consideration; and a trial has few terrors for such attendants as are arrested, for acquittal is almost certain. Indeed, on those rare occasions when attendants happen to be indicted for murder or manslaughter, the public generally gives them the benefit of the doubt, assuming that their work is highly dangerous, and arguing that the occasional sacrifice of the life of an insane patient is unavoidable, therefore justifiable. In this the public is in error, for, though the work in question may be, and at times is, harassing, it is, by no means, peculiarly hazardous. The number of unprovoked attacks made upon attendants by insane patients is, in fact, small, and would become almost negligible were all patients treated kindly from the moment of commitment.


But can we put all the blame on attendants for assaulting patients when the management shows no aggressive disposition to protect the latter? Such indifference is far more reprehensible than the cowardly conduct of ill-paid men, the majority of whom have had few advantages of education. The professional thug-attendant who, when a fellow-attendant is assaulting a patient, deliberately turns his back so that he may say, if ever questioned, that he saw no assault, is, in my opinion, less deserving of censure than those doctors who, knowing that brutality is common in their institution, weakly resign themselves to what they call "conditions."


Much of the suffering among the insane to-day is, in my opinion, due to the giving of too much authority to assistant physicians. Many of them, especially the young and inexperienced, are not to be trusted implicitly. Or, if they are to be given almost absolute authority over the patients in wards assigned to their care, let the superintendent exercise his authority to set aside any order which he may deem inexpedient or unjust. All superintendents have such authority. What I wish to emphasize is that they too often fail to exercise it. As a result of their laxness, or timidity -- a timidity perhaps inspired by a misconception of the ethics of their profession -- the helpless patient is permitted unnecessarily to suffer; and, I regret to record, frequently is this suffering of the patient due to what seems a selfish desire of the superintendent to preserve peace in his official family -- the medical staff. Official peace at such a price amounts to crime. (14)

(14) Of course there is much to be said in favor of giving a high degree of authority to an assistant physician, -- provided his commanding officer, the superintendent, be a man whose own standard of efficiency is so high that he will, perforce, support his co-workers in their efforts to produce the best results. Thus a young physician, instead of having, at the very beginning of his career, all ambition and initiative ground out of him by that sodden and fatal sort of hospital routine into which he is so often forced to sink, will have an opportunity to develop into a man of capacity and increased usefulness.


But quite as culpable as lax discipline is the selfish desire on the part of doctors in authority to escape annoying investigations. When it does happen that they cannot avoid reporting felonious assaults or suspected murders to the proper authorities, their action, I regret to say, is too often in mere self-defense, and not from a righteous desire to protect their patients. Knowing that the battered and mutilated condition of the corpse, or a living victim of abuse, for that matter, will arouse suspicion on the part of the relatives of the victim, those in authority sometimes take the initiative in order to "save their face." In making this assertion I am well within the bounds of charity and truth, and the conduct of this type of doctor at the subsequent trial invariably is such as to support my contention. This behavior is quite human; for, let it be borne in mind that almost every honest investigation into these suspicious deaths reveals a greater or less degree -- sometimes a criminal degree -- of neglect on the part of the doctors themselves. If cornered at last by an aroused public opinion they are too ready to shift the responsibility upon the ignorant and untrained attendants whose brutality is but the reflex of the doctors' indifference, neglect, or cowardice. But this is the last resort. Usually they will first equivocate to the verge of deliberate falsehood. They will outrun the public by giving the benefit of all doubts to the attendants. Not to do so would in many cases cause the accused to turn on them and reveal conditions they would prefer to hide. Human nature, like Nature herself, is influenced by immutable laws. Self-interest is apt to kill one's higher feelings. To fight the fight of the oppressed, the outraged, the dead, too frequently forces one to abandon a chosen career. Therefore, the still voice of a timid conscience whispers (in a perverted sense): "Let the dead bury their dead."

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