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Page 20
By the courtesy of Dr. Russell I have had an opportunity of seeing the
pamphlet in which are recorded the efforts of Mr. Thomas Eddy in the
year 1815 to move his colleagues to consider this matter.[13] The result
of those efforts was the establishment of an institution on Bloomingdale
Road.
Various changes followed until we arrived at the Bloomingdale Hospital
of to-day with its large and trained staff of medical officers, who,
while still recognizing the difficulties of the task, are imbued with a
hope of success which has arisen on a basis of wider knowledge, but
which was unknown to many of their predecessors. To have the opportunity
of joining with you in celebrating the big advance made a hundred years
ago, of exchanging ideas with you with regard to the difficulties which
still confront us, whether in America or in England, and which demand a
united effort on the part of all who are interested in the scientific
investigation of the subject, cannot fail to afford one the liveliest
satisfaction.
In the brief history of the Hospital prepared by Dr. Russell we find the
recommendations of another reformer, Dr. Earle, who in 1848 was
evidently still not satisfied with the treatment provided for the
sufferers from mental illness.
Both Mr. Eddy and Dr. Earle were influenced by their observation that
even in those suffering from mania much of their behavior could not be
described as irrational. If you will allow me I will quote a sentence of
two from each.
Mr. Eddy said: "It is to be observed that in most cases of insanity,
from whatever cause it may have arisen or to whatever it may have
proceeded, the patient possesses small remains of ratiocination and
self-command; and although they cannot be made sensible of the
irrationality of their conduct or opinions, yet they are generally aware
of those particulars for which the world considers them proper objects
of confinement." With reference to treatment Dr. Earle said: "The
primary object is to treat patients, so far as their condition will
possibly permit, as if they were still in the enjoyment of the healthy
exercise of their mental faculties."
To superficial observation these suggestions might well have appeared as
the phantasies of dreamers and perhaps at the present day their
importance is not always fully appreciated. Recent advances in
knowledge, however, have led us beyond the moral treatment recommended a
hundred years ago and have enabled us to see that a more important
truth underlay these suggestions.
We are all familiar with the frequent difficulty we encounter in our
efforts to discover the actual mental disturbance which is supposed to
exist in our patients. It is often a question of wit against wit as
between patient and doctor, and not infrequently a rational and
intelligent conversation may be maintained on an indifferent subject.
The fact too that the disturbance is so frequently only temporary
suggests that the loss of rational control is a less serious phenomenon
than was generally supposed and we know that the control can be
frequently restored by a period of rest or by a helpful stimulus. Quite
recently a patient who in hospital had been confused, undisciplined,
abusive, and threatening, was removed to a house of detention. The shock
of finding himself, as he said, amongst a lot of lunatics, led him to
face reality from a fresh point of view. He admitted that it had taught
him a lesson and when he revisited the hospital, if not entirely
grateful to us for the experience, he evidently bore no ill will.
But not only is it necessary to recognize what rational powers remain to
the patient, we must also inquire how much in their disturbed mental
activity can be considered a rational reaction to the stimuli which
have operated, and still may be operating, on them.
In connection with this I would suggest that there are two aspects to be
considered. First, what is the standard according to which we are to
judge them? Secondly, to what extent are the reactions of the patient
abnormal in kind to the driving stimulus? They may perhaps be reckoned
abnormal in degree, but, to what extent, if at all, are they abnormal in
kind?
It may be readily admitted that the behavior of those suffering from
mental illness offends against conventional usages and is anti-social.
It must also be recognized that amongst human beings living in
aggregates some conventional usages must be evolved and insisted on in
order to insure the greatest good of the greatest number. These usages
are regarded not merely as protective measures for the body corporate,
but they are also supposed to indicate a beneficial standard for the
individual. But such a standard being adopted, observation is liable to
be limited so much to results without sufficient attention being given
to the causes which had led to those results.
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