2. Insanity in Massachusetts
We have been favoured with the ” Fifth Annual Keport of the State Board of Health of Massachusetts,” and it is our intention briefly to draw our readers’ attention to that part of the report which has special reference to insanity in that State.
At the commencement of the chapter on Insanity, we are told that it is prominent in the State ” by its frequency and persistence,” and that ” if the persons who are attacked with this disorder are as promptly cared for as others when attacked with fever, dysentery, and pneumonia, eighty or ninety per cent, can be restored to health and usefulness.”
This account of the probability of recovery of patients in the State takes us by surprise, and seems quite contradictory to our own statistics of insanity. In England the probability of recovery is at the most thirty- three per cent., and we cannot help thinking that in preparing these returns of the recoveries an error must have been unwittingly made. The report goes on to tell us that, ” if neglected, the disease tends rapidly to fix itself upon the brain, and becomes more and more difficult to be removed.” Here we would draw attention to the fact that insanity, whether acute or chronic, is per se a disease of the brain or its membranes, and as a consequence the organ is functionally or organically disordered; however, we should be glad to be informed rather more clearly what is here meant, as it is contrary to all our accepted psychological doctrines. Insanity is as much a disease of the brain as pneumonia is a disease of the lungs; but we quite agree with the writer that it is most important to endeavour to treat the incubatory symptoms of insanity, and that much evil has resulted, and the treatment been rendered more difficult and obstinate, from failing to observe the precursory indications of mental disorder. The writer informs us that ” the period of the healing power varies with many circumstances and conditions?from a few days or weeks to many years.” Here, again, we must take exception to the views propounded. Insanity is never cured in a few days, and the cases referred to here, and supposed to have been cured in three days, could not have been pure cases of insanity.
It is rather a bold assertion for a writer on insanity to state generally that ” the disease is not immediately destructive to life,” and that ” some lunatics live five, some ten, others fifteen, and a few live forty and fifty years, while suffering from their mental malady.” I think here a little classification would have been desirable, for there are some varieties of insanity which must be regarded as immediately destructive to life.
The cost for supporting insane patients in the State of Massachusetts is at the rate of four dollars a week, and according to the statistics the average time required to restore a patient is twenty-six weeks.
The writer now passes on to consider minutely a comparison between what a lunatic, ast. 20, who recovers in the average number of weeks, will cost the State, or if not restored, what will be the loss to the State, provided he be of a certain age, and live a certain number of years, in comparison to what the said lunatic who recovers in the twenty-six weeks, and lives for the same number of years, earning so much as a labourer.
The subject is thus summed up : The cost and the profits of healing lunacy may thus be compared, in the cases of labourers becoming insane at twenty years:
Gain, present value of his future labour . . $2,665 37 Present value of the cost of his support, if not healed 2,121 00 Total saved and gained …. $4,786 37 Cost of healing . …… 134 00 Net gain $4,652 37”
On an average, a lunatic aged twenty not recovering would entail a loss of 4,786 dollars to the State, and if recovering a gain of 4,652 dollars.
The example given above has only reference to a common labourer, without trade or profession, who earns thirteen dollars a month, besides board, which costs three dollars a week. At the present time there are 3,300 persons of unsound mind in the State, whereas twenty years ago the number was 2,630, the proportion to the population being 1 in 1,357.
The chief causes for insanity enumerated are ” physical disorders and forms of vital depression,” which are supposed to originate out of perversions, excesses, abuses of the mental, moral and bodily powers, especially the appetite and lower passions.
With regard to the partial abolition of restraint in the State, a paper containing a number of questions has been issued and sent to the proprietors of our asylums, for their views on the subject.
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