Insanity and the Lunacy Law
- Author:
William Wood, M.D,
F.R.C.P., &c. J. & A. Churchill; London, 1879.
Dr Wood, in his brochure, has come forward to assist the efforts of those “who are endeavouring to combat the pieju ices of the public against private asylums. His arguments, are m accord with the views which have from time to time been ado- cated in this Journal. It is especially appropriate at this moment, when the most absurd and unjustifiable accusations have been brought against the proprietors of private asylums, and it is high time that they should unite?not as tiades unionists?but as a body of professional gentlemen ready and able to vindicate their honour and integrity, which have been challenged by ignorant and sensational writers for the daily press. On the subject of the necessity of early treatment in cases of insanity, all alienists will endorse the following remarks of Dr. Wood
” Relatives often refuse to believe that the somewhat altered tone of mind in a friend betokens serious trouble, notwithstand- ing they are told so by skilled observers ; they cannot believe that so slight a change can need so stringent a measure as removal to an asylum; they wait irresolutely, till suddenly aroused to the gravity of the situation by some startling mani- festation of insanity, and then the opportunity for improvement may be remotely postponed, if it have not gone beyond recall. In a case which came under my notice, certain members of a gentleman’s family could not be induced to believe that profuse expenditure, far beyond what had been usual with him, was the first sign of the onset of mental disorder, until he gave an order for a gun the barrels of which were to be of solid gold ” The liberty of the subject is supposed to include that full liberty of action which is claimed for one who has proved that he is unable to take care of himself, even though it may involve the ruin of all belonging to him as well as of himself. Thus the case is allowed to go on unchecked, until the patient has com- mitted some very irrational act which establishes his mental unsoundness beyond question ; too late in many cases to arrest the malady, now deeply rooted in his system; too late, more- over in many instances to prevent irreparable injury to his relatives. In such cases?and there are many of them?the patient’s well-being and the family’s well-being alike demand early interference and control; too often blind, unreasoning prejudice against restraint steps in to effect the ruin of both, because, in a certain sense, the patient is not dangerous to him- self or others ” It cannot be too earnestly insisted 011 as of the greatest importance that the popular prejudice against asylums should be in no way encouraged by the legislature ; but it is of still greater importance that nothing should be done which tends to disturb and unsettle the patient’s mind whilst under treatment to shake his confidence in his medical attendant, or give him the idea that the law looks with suspicion upon the control to which ? he is subjected. As it cannot be disputed that it is well for insane persons that they should submit to the guidance of others, and that the control which they are unable to exercise of them- selves should be exercised for them by others, it is essential that those who are entrusted with this power should be suppoiced, and that those who have to submit to it should be encouraged to believe that they are in the hands of friends, who will do them justice ” One of the recommendations of the Select Committee is altogether opposed to this view. I refer to a paragraph in their report in which it is proposed that in all the principal rooms of every asylum a notice shall be put up, stating that any patient is at liberty at any time to write to the Commissioners ” To some, the imperfect cooking of a potato would be es- teemed almost of sufficient importance to address the Commis- sioners ; at any rate, it may be said that scarcely a day passes in an asylum of any size where the threat of an appeal to the Com- missioners is not heard. A suggestion that it is necessary to encourage these appeals on account of the probable injustice they are likely to experience at the hands of their legal guardians, would have no advantage to counterbalance the very prejudicial effect it must necessarily have on the minds of many whose chief ailment is perhaps that they are under delu- sions as to the injury inflicted upon them by their friends and others ” Whilst speaking of the question of signing the order, I may call attention to one regulation in connection with it which is not unfrequently attended by very great inconvenience. In consequence of one particular case, in which an officer in the army had signed an order for placing a relative under control, not having seen him for a long time, but accepting the respon- sibility as a positive duty which, in liis judgment, he could not with propriety avoid, it was enacted that no person should sign an order who had not seen the patient within a month. This restriction, really valueless as a safeguard, sometimes necessitates a very long journey, for it may be an ailing or aged relative ; or it may render it unavoidable to employ some person to represent the relatives who, as in one case which occurred within my knowledge, were resident in a distant colony.”
Every proprietor of an asylum will agree in the justness of the following remarks as to the inconvenience often arising from no provision having been made in the Lunacy Acts for applying the income of a patient for his own or his family’s use, without a commission. We have known an instance where, in consequence of a patient not being able to sign a document, a relative was subject to great privations. Dr Wood observes : ” Under the present system great inconvenience arises from the fact that there is no provision made for obtaining and applying the income of an insane patient for the maintenance of himself and his family without a commission. If the income be derived from Government securities or any other investments which require the signature of the investor, it will not be paid to any other person, and the family may be put to great stress to live, while the expense of a commission if opposed by the patient might swallow up a large portion of the property. It seems reasonable on every ground that some such provision should be made, and the income rendered readily accessible for maintenance. The suggestion of the Select Committee to transfer to the Court of Chancery the administration of pro- perty of those unfit to manage their affairs, would not be desirable in recent cases, and in many it would be too costly.” As one means of diminishing the popular prejudice against asylums, Dr Wood suggests the adoption of a new word for those institutions. The course was recommended in the Journal of Psychological Medicine more than twenty years ago. He suggests the word “Sanatorium.” We think “Hospitals for Nervous Diseases,” or some similar title, would be more appro- priate.
Dr Wood rebuts the insulting accusation which has been made against the proprietors of asylums with reference to their detaining patients longer than is necessary for their recovery. He says:?” Unworthy motives are not attributed to the surgeon who prolongs his attendance on a patient who has broken his leg, and who thinks it his duty to watch and guard against imprudent and premature use of the limb though the bone has united. Why should not a physician in charge of an insane person, and why should not the friends of a patient have the same measure of justice, meted out to them as is without hesi- tation accorded to the surgeon? A case, illustrating the neces- sity of caution, lately occurred in which a highly accomplished gentlewoman, who had for several years continued in the same uniform state of mental depression, began to take an interest on what was going on around her; I soon saw reason to fear that a condition was threatening which not unfrequently hap- pens on the occurrence of a sudden change from what had gone on for years, viz. the establishment of a condition the extreme opposite of that which had hitherto prevailed. My warnings were regarded by the friends as over-cautious. Ex- travagant acts, taking the form of acknowledgments for services rendered during the prolonged period of depression were con- sidered as the natural expressions of gratitude, and the friends considered it their duty to remove the control which up to that time had been maintained over her. The result was most lamentable, the excitement of the life she now led was wearing her out, but she retained sufficient consciousness to appreciate her helplessness, and having escaped from her attendant, pre- sented herself for re-admission in a far worse state than she had ever been before, with small hope of ultimate restoration.” We are at a loss to understand why Dr Wood should have dragged in the name of the unfortunate Mr. Dodwell as an example of a form of insanity. He is evidently but very imperfectly acquainted with the particulars of the case, and is entirely mistaken in his interpretation of the facts which have come to our knowledge. Dr Wood thinks that the act of firing a blank cartridge at a judge is a sufficient reason for separating the poor man from his family for life. We would refer Dr Wood to an article on Mr. Dodwell in the current number of this Journal which we hope will induce him to alter his opinion.
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