Mental Diseases. A Public Health Problem
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Book Reviews. :Author: James V. May, M.D., with a
preface by Thomas W. Salmon, M.D., Boston. Richard G. Badger, 1922. Demy 8vo., pp. 544. Price $5.00.
One concluded the reading of this book with a feeling of regret that none of our standard British works on psychiatry and allied subjects have been written from the point of view of mental hygiene in its widest application.
We say mental hygiene although Dr May names his treatise “Mental Diseases: A Public Health Problem” yet, strictly speaking, it is the mental aspect of public health he deals with.
Mental hygiene is a big subject and enters into all problems affecting communal life. Thus physicians, judges and magistrates, social and philanthropic workers, legislators and municipal governors, ministers of religion, educationalists, political economists, leaders of labour, and others in the course of their ordinary professional, social, and pol itical activities have either to deal with the insane or with problems involving mental efficiency and inefficiency. A knowledge of the aetiology and forms of mental disorders, methods of care and treatment, the prevalence of insanity and mental deficiency and their effect on the social cosmos is vital to a clear and practical understanding of these problems and this Dr. May attempts to convey in the book befoxe us.
It is thus no ordinary text-book of insanity written for the instruction and guidance of practitioners and students. It is at once an education and an appeal, a historical retrospect and a vivid presentation of the present position. He designs to speak to a large and increasing audience on a subject the importance of which is becoming more and more recognised by the public generally.
The appearance of Dr May’s book is opportune, and though it will be most appreciated by American readers, the greater part of it is of general psychiatrial interest. Althoug we can bear comparison with America in j domain of psychology and psychology medicine, we have more to learn from tn country in the matter of organised welfare an other social work which has been taken nP there more seriously. The movement in tn country is virile and the workers enthusiast10 but it is still capable of much expansion 111 many directions.
It is not our purpose, neither is there spaC^ for it, to write a critical digest of Dr Hay book; we must content ourselves with description of the ground it covers. Part ? is devoted to General Considerations, aD, Part II. to the Psychoses. Part I. will be 0 most interest to welfare workers. The open ing chapter is on the “Social and EconcmlC Importance of Mental Diseases.’’ Arguments and statistics are adduced to show that “^e intimate relation between mental disease alcohol, ignorance, poverty, prostitution* criminality, mental defect, etc., suggests social and economic problems of far reaching importance, each one meriting separate an special consideration.” Much depends up?n psychiatry for the solution. The next chapters treat of the ‘ ‘Evolution of the Modern Mental Hospital’’ and the ‘ ‘Organi2^* tion and Functions of State HospitalsThere will be general agreement with tbe statement that their field of influence extends far beyond the hospital walls. Out-patient work, aftercare, social research are matters now recognised to be matters of vital imp01^* ance. After a largely medical chapter on the “Hospital Treatment of Mental Disease, Dr May sketches the “Development of the Psychopathic Hospital.” America founded its first “Maudsley” at Boston in 1912. * fate had not willed otherwise the institution just inaugurated at Denmark Hill might have opened the same day. An inspiring chapter on “The Mental Hygiene Movement” followsAlthough each chapter of Part I. is in itseli a finished essay yet there is a certain continuity subject-matter and interest, and a development along historical lines which enables one tQ readi ly fo llow the author. Thus successive ^apters on “Aetiology of Mental Diseases, ‘Immigration and Mental Diseases,” “Men^1 Diseases and Criminal Responsibility,” The Psychiatry of the War,” “EndoCrinology/’ naturally lead to a dissertation “The Modern Progress of Psychiatry.” &rt I. concludes with “The Classification of Cental Diseases.”
In Part II. the main psychosts are Presented chieflv historically and descriptivey* American statistics are freely quoted and m>ne of these chapters will be found difficult by ay readers; while practitioners and students ^ill find there facts of great interest which ^?uld otherwise need searching for, far and *ide.
In conclusion Dr May is to be congratu^ted upon a most readable and informative b??k which can be wholeheartedly commended. J. R. Lord. ^ ? La Methode Decroly . By Mile. Amelie Hamakle, collaboratrice du Dr. Decroly a Bruxelles. 6 frs. suisses. * L’education des Enfants Anormaux (2nd edition). By Mile. Alice Descoeudres. 4.75 frs. suisses. ‘ Le developpement de l’enfant de 2 a 7 ans. By Alice Descoeudres. 7.50 frs. suisses. These three French Books of special interest 0 those concerned with education, particulary that of the subnormal child., are published ^^etachaux and Niestle, Neucliatel. The first by an ardent admirer of Decroly suffers somewhat from a lack of perspective. . e niethod cannot claim to any great original1 y > though in many ways it makes new uses of precepts such as the Herbartian, observa,!?n> association and expression, while correlais regarded as a new principle.
The method should ensure intelligent, active children if properly used under perfect c?nditions, but, unlike some excellent modern methods, teachers must use the whole, and not adaptations. There are a good many little suggestive ideas and it seems an excellent plan for the author to describe the method, then to give an example of the working.
The training of the defective child, so long neglected by writers, has of recent years become a more popular subject. The work of Mile. Descoeudres shows a surprising ignorance of the writings of English and American educators (or even of Phillipe et Boncours whose useful little book bears an annoyingly similar title) but thorough acquaintance with both literature and education of France, Belgium and Germany.
This book covers a wide field of things pertaining to Special Schools, training and aftercare, but it is particularly on account of the ideas for apparatus work and games that the book will be valued. It is full of practical suggestions for gaining and keeping the attention of the slow-witted as well as the scatter-brain. It shows teachers how to present clear associations by means of active repetitions.
The games are delightful, but they vary considerably in difficulty, and the examples cited show wide differences in capacity. This is certainly a book which should be in every Special School, and it is to be hoped that an English translation may be forthcoming. The observation of little children has a real bearing on the education of those whose bodies are bigger though their minds are young. Mile. Descoeudres has brought skilled observation to this work, but one cannot help feeling that she has propounded her theories and then sought evidence to prove them. Two points strike our British minds. Are the poorer children innately more generous than the richer ones? This would require far wider proofs than those that the writer gives. Tests carried out during the chance meeting with a strange child in the park may be extremely interesting, but not conclusive evidence. This is a delightful book and thoroughly interesting in its freshness. M.F.B.
The Problem of Population. By Harold Cox, Editor of the ‘ ‘Edinburgh Review.’’ 198 pp. Jonathan Cape. London. 6s. net. Mr. Harold Cox has given us in this work an extraordinarily clear, concise, and convincing argument as to the controversies under discussion to-day relating to the problem of population. It is a book which is especially timely and which demands the serious consideration of all those responsible for or interested in social welfare. The book is in the main devoted to the discussion of the economic problems arising from the inevitable problem of population, which is itself succinctly stated and supported by overwhelming arithmetical argument. There is no escape from the arithmetical necessity that the rate of growth of any population must be reduced as the volume of that population increases, and if we are to achieve this end we are faced with a Scylla and Charybdis, a choice between an increase of the death-rate or a decrease of the birth-rate. We are shown that the overgrowth of population is the most persistent cause of war and that in any large population a low birth-rate is a necessary condition of racial progress.
The only way out of the dilemma is found to lie in a wholesale adoption of the practice of birth control and a widespread dissemination amongst the masses of the knowledge relating to contraceptive measures, for “the only practicable method of getting rid of the evil of slum life … is to persuade the slum dwellers to refrain from continually refilling the slums.” It is further held that all defectives must be eliminated and that steps must be taken to prevent them from reproducing their kind, for which purpose sterilisation is strongly advocated. The autb? however does not give us any reason to belief that he sufficiently realises the practi ^ difficulties involved in the application sterilisation to mental defectives, and it is this point that must join issue with him. he himself recognises, “in the case of perso1 so mentally deficient that they could not eVel1 give consent to the operation, the question does not arise, for in any case it would p^? bably be necessary to keep these persons una permanent restraint.” We would point 0 also that even in the case of mental defectiveS who would be able to give assent there ^ large group for whom permanent restrai would still be necessary on account of the social failings and anti-social propensity5’ and that amongst the remainder the difficulty which would arise in the actual diagnosis an selection of cases?difficulties which in t]1 opinion of the experts in mental deficit j cannot be lightly brushed aside?raise very considerably doubts as to whether the stern sation of mental defectives is a practical pr? position. Moreover the author does not p?in out the important fact that not only are the# some cases of mental defect which are no transmissible but that the majority of cases o mental defect are the children of parents, though being ‘ ‘carriers’’ of the defect are to all outward appearances perfectly normal, and * we are to produce any appreciable results ^ should have to deal with the “carriers” an apply sterilisation to about 10% of the popu lation.
We are grateful for the last chapter on t?e ethics of birth control, in which the basis ? the creed which condemns the deliberate limitation of births is fearlessly examined an shown to be full of inconsistencies. E. Prideaux
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