A hundred years ago: The taint of insanity
The most interesting passage in Dr. Mercier's letter [to The Times] is a protest against the "stigma" commonly held to attach to mental maladies.
"If," writes Dr. Mercier, "a man becomes infected by the poison of typhoid fever, we do not consider that the attack of fever attaches to him a taint or stigma after his recovery, even though, at the height of the fever, he was delirious – that is to say, insane; but if he becomes infected by some other poison which produces delirium, without the physical symptoms of fever, then, after his recovery, he is tainted, he is stigmatised"; and this popular distinction seems to Dr Mercier an "ignorant and pernicious prejudice."
Popular prejudices on scientific subjects are, indeed, nearly always ignorant, and frequently pernicious; but the parallel which Dr Mercier draws with the view of removing this particular prejudice is not quite a fair one. When a patient recovers from typhoid, however delirious he may have been when the fever was at its height, there is, at any rate, no doubt about his recovery. The delirium obviously resulted from physical conditions which have obviously disappeared. The conditions, and the delirium, may, of course, recur as the result of a fresh infection; but the infection implies no antecedent mental abnormality, and leaves no permanent mental abnormality behind it.
We do not ask ourselves whether the patient is really cured, or wonder what he will be up to next. The case of the mental patient, properly so called, is different. His return to sanity is in many cases only apparent, or only temporary. Even alienists cannot be sure of distinguishing between the complete and actual and the apparent and partial cure. Their mistakes have often resulted in the release from asylums of homicidal maniacs, who have speedily resumed their homicidal practices. The public know that, and their knowledge is the rationale of the prejudice.
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The Enlightened View
It is a prejudice which, Dr. Mercier tells us, does not exist in some enlightened countries. He relates a story of a "well-known professional man" in the United States who spent some time in an asylum under treatment for mental derangement, and whose professional friends afterwards "entertained him at a banquet to celebrate his recovery."
We hope he had indeed recovered; but we have heard of a case in which a mental patient, discharged from an asylum as cured, refused an invitation to a similar congratulatory banquet on the ground that he was the moon, and had to shine that night. Until alienists are in a position to assure us that such stories not only are not, but cannot be, true, the popular prejudice is likely to remain ineradicable, whether it be pernicious or not; and, so long as that prejudice exists, the proposal to treat mental cases in general hospitals is impracticable.
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The Treatment of Mental Diseases
Another question on which there has been a good deal of discussion during the past month is the proposed provision of departments for mental diseases in general hospitals. The difficulties to be surmounted before such a measure can be taken with any useful result are well tabulated by Dr. Mercier, in his letter. The admission of insane patients to the general wards, he points out, would bring the hospitals under the Lunacy Acts, and "grave difficulties of administration would arise" in consequence.
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The Detention of Female Inebriates
The Press published in April some correspondence between the Clerk of the London County Council and the President of the Eugenics Education Society on the subject of the detention, in asylums, of irreclaimable female inebriates. It is urged with emphasis on the one side that such persons ought to be detained; it is urged with equal emphasis on the other side that it is not the business of the Municipality to detain them at the cost of the ratepayer.
The two propositions are not contradictory, and it is possible to accede to both of them. We have already given our support in principle to Sir James Crichton-Browne's contentions, and need not travel over that ground again. The proper deduction from his latest letter is not so much that the municipality of the metropolis is shirking its responsibilities as that legislation allocating the disputed responsibility is urgently required.
It is the "view" of the Council, according to Mr. Gomme, that the provision of accommodation for incorrigible drunkards is the duty not of the local but of the central government. He adds that the Home Secretary has never dissented from the "opinion" expressed. Very likely not. But the matter is surely not one in which it ought to be possible for "views" and "opinions" to be bandied in this way.
Whether the duty of taking charge of the incurable victims of alcoholism devolves upon the State or the Municipality is a detail of minor consequence. What is essential is that the State should either definitely accept the duty, or definitely assign it, and that it should be made impossible for one of the most important functions of government to remain unfulfilled, as the result of a quarrel about money and machinery.