|
Main
- books.jibble.org
My Books
- IRC Hacks
Misc. Articles
- Meaning of Jibble
- M4 Su Doku
- Computer Scrapbooking
- Setting up Java
- Bootable Java
- Cookies in Java
- Dynamic Graphs
- Social Shakespeare
External Links
- Paul Mutton
- Jibble Photo Gallery
- Jibble Forums
- Google Landmarks
- Jibble Shop
- Free Books
- Intershot Ltd
|
books.jibble.org
Previous Page
| Next Page
Page 34
This brief survey indicates how, in the development of the work of the
institution, it required years of practical experience to show to the
Governors that, in order to secure for the patients the treatment which
the Asylum had been established to furnish, it was necessary to extend
the powers and duties of the physician so that he could control and
direct the internal management and discipline, and all the resources
for social as well as individual treatment. This extension was continued
until finally the present form of organization was adopted in which the
chief physician is also the chief executive officer of the institution.
This was, however, not fully accomplished until 1877. It is now
universally recognized that the physician must be the supreme head of
the organization, and all American institutions and most, if not all, of
those in other countries are now similarly organized.
In the early development of Bloomingdale Asylum, this extension of the
influence and authority of the physician is the outstanding medical
fact. It did away with division of responsibility and removed from
discussion the question of moral as distinct from medical treatment.
Thereafter a harmonious and effective application of all the resources
of the institution to the problems of the patients became more easily
and certainly possible. Since then, the resources for treatment directed
to the mind have been developed as steadily and fully as those required
for the treatment of physical conditions. The use of the organized
agencies which were regarded by the founders as the main reliance in
moral treatment, namely occupations, physical exercises and games,
diversion, social contacts, and enjoyment, and management of behavior
has been greatly extended, and specialized departments have been
created for their application with system and growing precision. Great
advances have also been made in the methods of examining the minds of
the patients and of determining the mental factors in their disorders
and the means of restoring their capacity for adjustment to healthy
thinking and acting. Psychiatry has been furnished with a body of
well-arranged facts, and with a technic which is not inferior in system
and precision to that of many other branches of medicine. In the study
and management of the minds of the patients the physician is thus
enabled to apply himself to the task as he does to any other medical
problem.
The advances in general medical science and practice have also
necessitated great elaboration of the resources for the study and
treatment of the physical condition of the patients. Instruments of
precision, laboratories, x-ray departments, dental and surgical
operating rooms, massage and hydrotherapy departments, facilities for
eye, throat, nose, and ear examinations and treatment, and all the other
means of determining disease processes and applying proper treatment
have been supplied and the methods and standards of modern clinical
medicine and surgery are utilized. It can now be clearly seen that it is
necessary to direct attention to the whole personality of the patient,
including his original physical and mental constitution, the physical as
well as the mental factors which may be operating to produce his
disorder, and the environmental conditions to which he has been and may
again be exposed. In the treatment of mental disorders it is necessary
to beware of what Pinel found to be the fault of the physicians and
medical authors of his time, who he says were more concerned with the
recommendation of a favorite remedy than with the natural history of the
disease, "as if," he says, "the treatment of every disease without
accurate knowledge of its symptoms involved in it neither danger nor
uncertainty," and he quotes the following maxim of Dr. Gault: "We cannot
cure diseases by the resources of art, if not previously acquainted with
their terminations, when left to the unassisted efforts of nature."
Exclusive attention to the physical condition and factors, or to the
mental condition and factors, or concentration on one theory or one form
of treatment to the exclusion of all others is sure to lead to neglect
of that careful general inquiry into the whole personality of the
patient, into the conditions out of which his disorder arose, and into
all the manageable factors in the situation which is so essential to
intelligent and effective treatment. Notwithstanding the great benefit
which has been derived from physical measures in the study and
treatment of mental disorders, and the well-founded hopes of greater
advances in this direction, the main task still continues to be what
Pinel calls the management of the mind. Experience and increasing
knowledge show that this is a task which can only be successfully
performed by the physician and by means of organized resources which are
under medical direction and control. The hospital for mental disorders
furnishes the means of providing social as well as individual treatment.
It is a medical mechanism and for its proper management and use it is
required of physicians that they accept the burden of much executive
work and give their attention to many subjects and activities that may
interfere seriously with what they have been taught to regard as more
strictly professional interests. Like Pinel, one must be willing to
forget the empty honor of one's titular distinction as a physician, and
do whatever may be necessary to make the institution a truly medical
agency for the healing of the sick. Considerable progress has been made
in developing executive assistants to relieve the physicians of much of
the administrative work which requires little or no medical supervision
and direction. Special provision for the training of such executives
has, however, received insufficient attention. This question might, with
great advantage, be taken up by the hospitals and colleges. Nothing
would add more to the quality of the service which the hospitals render
than to supplement the work of the physicians by that of well educated
and highly trained executive assistants who would themselves find an
extremely interesting and productive field for their efforts.
Previous Page
| Next Page
|
|