Experiences of an Asylum Doctor with Suggestions for Asylum and Lunacy Law Reform
- Author:
Book Reviews.
- Auhtor:
Montague Lomax
M.R.C.S. (Lond.), George Allen and Unwin. 1921. Pp.256. 12s. 6d.
This remarkable book which has been pub- ished during this year, apparently contains a tailed description of the life experienced by f:Judical officer in one of our asylums. That j*e book has given much food for thought, here can be no denial, but before accepting j*e lurid details?for in many ways indeed , ey are morbidly lurid?we would like to how the credentials of the writer and also the rue motive for such a deliberate indictment of asylum administration. Dr. Lomax states hat he dedicates the book to all the “insane Poor in sympathy with their sufferings and in he hope of alleviating their hardships.” ?^nis book is so inscribed by the author, but reading it through we notice that very tie is mentioned with regard to any protest ?h the part of Dr. Lomax by reporting any ^vils and abuses to the authorities during his ehure of office, which apparently dates back o those dark days of the Great War. It is obvious that during those trying times, when Very few if any organisations could have successfully withstood the scrutiny of an over- ^ealous critic, although Dr. Lomax was pain- ty aware of all these alleged facts, it seems a great pity he did not take an earlier oppor- tunity of openly protesting and publishing r?ad his criticisms and suggestions for re- ?rm. we accept the statement that Dr. 0rQax has been a lifelong student of Psychol- ?gy 5 but one must remember that theory with- out the leavening effect of matured experience, more often than not enters into conflict with actual practice and it is extremely fortunate hat this indictment is not made by a medical *han of matured asylum experience, for Dr. Fornax frankly confesses that his experience institutional work covers a short period of “out two years. This condemnatory attack ?ft asylum administration is of so bold a char- acter that after reading the book we are left 111 a state of wonderment as to whether such a state of affairs so gloomily described can actually exist at the present day, as in various passages the descriptions of the conditions savour of medieval prison life.
The book contains an Introduction with twelve chapters and very fully covers the ground necessary for a detailed and critical survey in support of his views. We notice with pleasure that the writer pins great faith to the teachings of the late Dr. Charles Mercier, whom we always acknowledge as having been a brilliant psychologist, a master of logic, and a prominent and shining light in the field of psychological medicine. In these twelve chapters, Dr. Lomax in an honest and frank manner describes his experiences and he does not fear to criticise severely any defect which in his opinion requires reform. In this way, everything appertaining to the life of an individual, whether a member of the staff or a patient, comes in for its share of critical ob- servation. The construction of the asylum building, the unhygienic wards, the lack of facilities for hospital treatment, the clothing and comfort of the patients, the weak points in the medical and nursing administration are all carefully reviewed by Dr. Lomax and one would be doing him an injustice by refusing to accept his interesting and descriptive account. On the other hand we feel that if similar unsatisfactory conditions do not exist generally in other institutions, it is somewhat unfair on the part of the writer to assume that the vivid descriptions of his experiences are typical of those obtaining at other institutions for the reception and care of the insane.
On carefully reading this book we are con- fronted with so many problems which require detailed discussion that it is impossible to deal with them in a short review. No doubt those who have been associated with asylum life for any appreciable length of time, will realise the difficulties which arise in caring for and treating large numbers of unfortunate patients, whose disordered minds and erratic conduct necessitate somewhat different treat- ment to that meted out in general hospitals, and here arises one of the greatest problems for those who administer the provisions of the Lunacy Act. It is the inability of those responsible to indulge patients with greater individual attention and treatment, owing to the fact that it would require an enormous medical and nursing staff to carry out such generous treatment amongst two or three thousand patients, who are for the most part, difficult to handle owing to their varying moods. The presumably curable patient, we feel sure, receives every sympathetic consider- ation, but the patient who is either a menace to himself or to others, must of necessity be treated with rigid discipline. In any case, we are certain that this book which Dr. Lomax has written, with apparently honest aim, must receive serious attention, both from the pub- lic and from the authorities who are respon- sible. We consider that no stone should be left unturned in investigating such a serious charge and we look to the immediate future for a searching enquiry into the whole question and the result to be published broadcast.
We must acknowledge however, that isolated instances of ill-treatment and neglect have occurred in institutions, but we know that in all cases, when possible, the offenders have been promptly brought to justice. That there is a need for reform in Lunacy Act administra- tion, there can be no doubt, but this remodel- ling must be carried out by those who are experienced and are well versed with the diffi- culties and dangers which arise in dealing with mental patients. There is no branch of medi- cine into which the emotions enter more strongly, and it is well known that often singu- larly unhappy results are brought about by well-meaning but misguided actions of the inexperienced enthusiast.
It is a regretable and even lamentable fact that a certain section of the Press should have so eagerly selected and published the sensa- tional element of the story, as it has come to our knowledge that a considerable amount of anxiety and unhappiness has arisen in the mind of those who are unfortunate enough to possess friends or relatives under care in insti- tutions for the insane. We must remember that there are always two sides to every ques- tion and for the present we are contenting our minds with a feeling that such evils and abuses recorded in this book, do not faithfully repre- sent the actual uncoloured and unvarnished state of affairs which one usually meets with in asylum life. Although Dr. Lomax may be considered iconoclastic in his attack by some of the older school of administrators, yet most of us cannot fail to welcome the practical sug- gestions for the establishment of an “Ideal Asylum” built and administrated on the Villa system?a scheme which is by no means new and which has, for some time, been actual practice abroad. We feel it must be the wish of all those concerned with the wel- fare of the insane, to see antiquated buildings and archaical methods of administration swept away and if Dr. Lomax’s book will even stir the feelings of those responsible for the carrying out of such reform, it will indeed have achieved some object.
RECENT AMERICAN TESTS.
(1) The Terman Group Test of Mental Ability, Specimen Set, London. G. Harrap & Co., 2s. nett. (2) The Otis Group Intelligence Scale, Specimen Set, London. G. G. Harrap & Co., 3s. 6d. nett. (3) Specimen Set of the Courtis Standard Practice Tests, London. G. G- Harrap & Co., 5s. nett.
A large amount of literature concerned with mental testing is now reaching this country from America. During the recent European War, the scheme for examining, by psycho- logical methods applied on a large scale, re- cruits for the American Army gave an enor- mous stimulus to work in this direction. To test large masses of men upon a uniform basis it was necessary to construct tests of ability which could be applied to the examinees, not orally and individually, but by means of written examination papers to large numbers working simultaneously in groups. Hitherto, most tests of intelligence, as for example the Binet Simon scale, have been applicable to one individual only at a time. It was, we believe, the work in this country, at Oxford and at Liverpool, that first showed, by care- fully obtained co-efficients of correlation, that group testing could be quite as efficient and trustworthy as individual testing. Somewhat upon the lines of the earlier Army Tests the “National Scale” was con- structed for use in American schools; and noW the “Terman” and “Otis” “Group Tests” have been drawn up and published.
Here again the type of problem and of material adopted for the tests is very largely identical 111 its general nature with that previously used for testing American recruits. . The Terman series is designed in the first ^stance for use in the upper classes of primary schools and beyond. A brief set of directions f?r giving the tests and scoring the results accompanies the test sheets.
No tables of normal standards of perform- ances are given. The writer states that what the teacher and principal most need to know is how the pupils of a given school or class differ from one another. The test gives Us this information without reference to norms.”
The Otis Group Intelligence Scale contains a primary as well as an advanced examination. The former consists mainly of pictures, and is suitable for use with illiterate adults, or with children so young or backward that they cannot read.
The Courtis Tests have a different object. Both in England and America scientific testing of arithmetic has shown that, particu- larly among older pupils, there is an unex- pected amount of inaccuracy in the fundamen- tals of calculation?in simple adding, sub- tracting, multiplying, and dividing. To im- prove both speed and accuracy of simple Calculation, a course of intensive drill, care- fully adjusted in amount, nature, and diffi- culty to the capacities of individual children, ls the simplest and most important means. % the aid of such drill the Courtis Tests claim to enable the teacher to bring the backward Pupil up to the standard in the several opera- tions in a minimum amount of time.
All three schemes of testing are American in f?rm and origin. The wording, indeed, has evidently been revised to render the tests aPplicable as far as possible for use in Eng- land; but such revision and re-standardisa- tion requires months, and even years, of care- ful statistical investigation, before it can be accepted as satisfactory. In the Otis Manual some of the tables are still given in terms of American “grades,” instead of English “standards”; and it is hardly likely that age- n?rms obtained in America can hold good without considerable adjustment to children Working in British schools. Here, therefore, ls a fruitful field for research in this country.
*t would be interesting, for example, to discover how far, and with what modifica- tions, the simpler or primary examination contained in such test manuals would be use- ful in the hands of teachers in England for a first rough diagnosis of backward or defective children. C.B.
“Abnormal Psychology and its Educa- tional Applications.” By Frank Watts, M.A. Published by George Allen & Unwin, Ltd. 7s. 6d. net. pp. 191 One of the main difficulties met with by the teacher,?especially the young teacher?to- day is undoubtedly to be found in the attempt to establish a clear relationship between the findings of modern psychology and the prac- tice of the classroom. Only too often the question “What use can we make of all this knowledge?” meets with no adequate answer with the result that classroom practice suffers in spite of the best intentions.
This fact is in itself sufficient to make Mr. Watts’ book “Abnormal Psychology and its Educational Applications” a very welcome addition to educational literature, and the welcome becomes the warmer as we realise the admirable way in which the task is fulfilled. Taking the modern study of abnormal psychol- ogy under three of its main aspects, viz.,? the psychology of the crowd, psychopathology and the development of personality, and the psychology of the defective mind?Mr. Watts shows in a clear and concise way how the main facts revealed by them can be applied to the teaching of children?both normal and abnor- mal?in school.
A brief historical survey of the literature on each point affords suggestions for further reading on the subject, while of special interest to the teacher of the defective will be the sound criticism of the Montessori method and the many practical suggestions for train- ing subnormals to be found in the last chapter. The book is undoubtedly one which should be read by all teachers. It is short, admirably clear, and most valuable in its suggestions.
L.G.F. “Abnormal Psychology.” By Isador H. Coriat. Kegan, Paul. 10s. 6d. net. The dramatic character of the war neuroses and the frequency of those tragic cases, mis- 94 STUDIES IN MENTAL INEFFICIENCY. named “shell-shock,” aroused a strong curio- sity among the intelligent public in the whole question of Abnormal Psychology. Dr. Coriat’s book is not one of the many written in answer to this demand for it dates from 1910. Much of his material is consequently out of date?(the case of the multiple person- ality, Miss Beauchamp, has for example been presented ad nauseam in the last fifteen years) ?and some valuable recent work was of course not available to him.
The work is a study of “dissociation or the splitting of the mind,” and an attempt is made to explain all abnormal mental pheno- mena from this standpoint. The first part deals mainly with investigation of the sub- conscious by means of studies of well-known ?indeed hackneyed?examples of automatic writing, multiple personality, lost memory and dreams; the second part with diseases of the subconscious, e.g., hysteria, psyclias- thenia, neurasthenia, etc. The scheme is quite a good one and indeed a certain amount of useful information is conveyed, but mainly, one notes, by means of copious quotations from famous authorities such as Janet, Macdougal, James, Freud, Putnam. The author’s own style is so vague and turgid and his use of scientific terms so slovenly that it is often difficult to make out his meaning. “The student of diseased conditions,” he writes, “looks upon the subconscious as a derange- ment of certain functions of the nervous system; to one interested in the functions themselves, the subconscious means an in- ability to reproduce at will the images of past experiences.” The bewilderment induced by this passage deepens as one reads on.
A word must be said on the author’s treat- ment of psycho-analysis as he is expressly claimed as an expert in the publishers’ notice on the wrapper. The subject is certainly often mentioned in the text but it is impossible to imagine that the author has ever read his own quotations from Freud. The Freudian theories of the development of the emotions, and the importance of the affections of the child are practically ignored and appear un- known to the author. His treatment of dreams is farcical. Further, Dr. Coriat’s so-called analyses of his own patients (by free association, hypnosis or dreams), end where a real analyst would begin, for he is triumphant and satisfied if he discovers some incident associated with a symptom, and regards it as the root cause of the whole disease. Thus a very severe case of hysteria is attributed to the fact that the young woman patient one night heard her sisters quarreling in the next room* Three days later her fits began! This lS magnificent but it is not psycho-analysis and we feel that the publishers owe the public an apology for that wrapper.
For the lay reader who wishes to have a clear understanding of the abnormal mind Dr? Bernard Hart’s lucid and simple little book on the “Psychology of Insanity,” and M ss Barbara Low’s “Psycho-Analysis,” are still without rivals. L .D .F.
Psyche. A Quarterly Review of Psychology in relation to Education, Psycho-Analy* sis, Industry, Religion, Social and Per- sonal Relationships, Aesthetics, Psychi- cal Research, etc. (Incorporating The Psyche Research Quarterly). Kegan, Paul, Trench & Trubner & Co., Ltd. Price 5s. net.
If the first numbers of the new series of this magazine is an indication of what we may look for in the future, there can be no doubt that it will cover a very large field, and it should therefore appeal to a wide public. The first number includes articles on The Interpretation of Dreams, The Psychology of Exploration, Scientists and Psychical Re- search, The Homing Instincts in Dogs, Sleep, The National Institute of Industrial Psychol- ogy, First Steps in Psychology and?which the readers of our paper will probably find the most interesting?on Criminal Responsibility by Dr. E. Prideaux. This suggestive and thoughtful contribution, deals with a parti- cularly difficult subject involving as it does the psychological, medical and legal aspects of crime, and indicating the lines on which a solution of some of our present difficulties may be arrived at, thus giving us hope for the future.
It may be objected that the wide range of subjects covered in this publication tend to make the treatment of some of them very slight, but for the person who has no time for reading the more highly specialised periodicals STUDIES IN MENTAL INEFFICIENCY. 95 ere is considerable interest to be derived getting a bird’s eye view of many aspects the important psychological problems which are to-day receiving so much attention. Dreams and Day Dreams of a Delin- quent Girl. By Cyril Burt.
These are two papers specially reprinted ?m ‘ ‘The Journal of Experimental Pedagogy and Training College Record.” They con- ^lst> as the title indicates, of a detailed account of the writer’s analysis of a concrete ?ase “which is recorded for the purpose o ustrating the nature of the technique of Psycho-analysis, and drawing attention to e chief generalisations which its use has Suggested.
The case described is one specially chosen on acc?unt of its comparative simplicity and the ^ay it exemplifies, within a narrow compass, most of the commoner facts and crucial inferences upon which psycho-analysis is The subject of the analysis?a girl of 16? ^as brought to the writer with the supposition ^ lat her unsatisfactory behaviour must be due Cental abnormality. She was a domestic ^ervant and her alleged delinquencies included sleeping out, pilfering and persistent 0venliness in her work. Her mother was a *espectable woman, but the father was said to e dishonest and a heavy drinker, and had not J^ed with the family for years. Although ?re was a record of backwardness at school, billet Simon Test revealed a mental age of JO ?
? j and in certain practical tests she aPpeared distinctly above the average of her s?cial class. It was therefore at once made Manifest that her delinquent behaviour could n?t be attributed to “menta deficiency” Properly so-called, and that it was her T^racter and not her intelligence that landed psychological examination.
the first paper two dreams and their a^alysis are recorded in detail. The shortness this notice precludes any account of the Process; suffice it to say that it involved the Reconstruction largely by the patient herself? 0 her early emotional history and the origin ? her later aberrations of conduct, this in its ri1 resulting in the furnishing of a working exPSanation of those aberrations, revealing them as the “irrational outcome of thwarted emotional tendencies” dating back to earliest childhood and common to all mankind.
“With her dreams thus analysed and her past thus reconstructed the girl herself came to understand as she had never before under- stood, or troubled to understand, the real aim and origin of her caprices.” What then the writer asks, here touching the vital issue of the matter, was the effect upon the child? The answer is of profound interest and shall be quoted in full:?
“The main delinquency?namely, pilfer- ing, together with the general attitude behind it of antagonism to society, dis- appeared entirely. From the date on which these dreams were finally analysed she never, so far as I have been able to ascertain, stole, or was suspected of stealing. In other respects, indeed, as I shall note in another connection, her conduct was not entirely satis- fying. Nor do I believe that the analysis and its immediate consequences were by any means the sole factors contributory to this partial reform. Yet one fact seems sure. Before the analysis her misdemeanours seemed inexplicable, alike to those who knew the girl and to the girl herself. After the analysis they became intelligible, and suddenly and finally ceased.”
The second paper contains an analysis of a characteristic “step-mother” day dream of the same patient, which is then discussed as an illustrative type of the persistent fantasies of childhood. This paper should be of special interest to teachers as it throws light upon certain problems of mentality and behaviour which are met with in every class room. The writer concludes with a reference to the analogy between the “step-mother” type of fantasy with which he has dealt and the traditional myths and legends embodied in popular fairy tales, “the day dreams of a people.” Upon this aspect of the subject he proposes to concentrate in a subsequent paper.
“School Hygiene.” A Quarterly Review for Educationalists and Doctors. Adlard & Son & West Newman, Ltd., 23, Bartholomew Close, E.C.I. Price 1/6 per copy.
The August number of “School Hygiene” 96 STUDIES IN MENTAL INEFFICIENCY. contains an interesting article by Dr. F. C. Shrubsall, Medical Officer to the London County Council Education Committee, on “The Ascertainment of Mental Defect.” It describes in some detail, for the guidance of School Medical Officers, the factors which should be taken into account in examining a child alleged to be mentally defective, and the Mental Tests which experience has proved to be of most value for the purpose.
The subject of classification is dealt with and various illustrative tables are given. The writer concludes with a timely re- minder to the Certifying Officer of the influ- ence of environment which must, he urges, in cases of moral delinquency always be taken into account, and “unless he feels that under a similar environment and with a similar upbringing he would have acted very different- ly he will be slow in assessing the responsi- bility of his fellows.”
The paper has been reprinted as a separate pamphlet and copies can be obtained from the publishers of the review.
The October number of “The British Journal of Inebriety” (Balliere, Tindall & Cox, 2s. 6d. net.) contains two articles of special interest to workers amongst mental defectives, viz.: “Alcoholism and Mental Defect” by W. A. Potts, M.A., M.D., and ‘ ‘Conclusions based on Results of a Statistical Inquiry on the Prevalence of Alcoholic Intem- perance in the families of Mentally Defective School Children,” by Robert Hughes, M.B., M.P.C., School Medical Officer, Stoke-on- Trent . PMC5109156
Bibliography
- Reference type:
Journal Article
- Record-number:
17218
Year: 1921 Title: Reviews of Recent Books Journal: Studies in mental inefficiency Volume: 2 Issue: 4 Pages: 91-96 Date: 1921/10// Short-title: Reviews of Recent Books Alternate Journal: Stud Ment Ineffic
Accession-number: PMC5109156 Name-of-database: PubMed Central Language: eng Copyright:Attachment:
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