Library Collections: Document: Full Text

The humane treatment of the insane has tended to lessen the death-rate among them. Gathered together into institutions where the sanitation is good, as a rule, the food nourishing, and the care watchful and kindly, there is a larger quantity of life falling to the lot of the insane population than would formerly have come to them. Their numbers increase because each remains longer upon the scene.

Medical skill is learning to control many of the contagious diseases and acute fevers. The consequent prolongation of life, in the population as a whole, has tended to allow larger numbers of comparatively weak constitutions to come to the period of life when degeneration of the nervous or vascular system takes place. This is held to account in part, not only for the increase in the number of the insane, but also for the increased number of persons who die from cancer and from diseases of degeneration.

The climatic influence of the country, with sharp extremes of heat and cold, and the dry atmosphere permitting rapid evaporation from the body, is held by many physicians to tend to the unbalancing of the nervous system. Dr. Pliny Earle maintains that as civilization has advanced, and the habits of the race have been consequently modified, disease has left its strongholds in the fleshy and muscular tissues and at length seated itself in the nervous system.

The over-tension of modern life, which is spoken of by some as if it were wholly responsible for the increase in the number of the insane, has undoubtedly had much to do with the increase in insanity. Especially among the more highly organized individuals the burden which modern life puts upon the reasoning powers is out of all proportion to that which was placed upon them a few decades ago. We challenge custom, we question our instincts, we are sceptical where we used to have faith. In matters, for instance, such as the relation of man to the church, and of the sexes to each other, we now believe that reason should be constantly compelled to act. . We have put upon the minds of the present generation great burdens, which those minds are not sufficiently well developed and well organized to bear.

Another explanation that is frequently given is the great amount of foreign immigration, and the character of the immigrants. A certain, or rather an uncertain, number of paupers, lunatics, and imbeciles have undoubtedly been foisted upon us by Europe. Besides this, the complete change of conditions, climate, and associations might be expected to unsettle the minds of foreigners coining to this country. But the comparisons ordinarily made between native-born and foreign-born insane, without reference to sex or age distribution in the population, are entirely misleading.

Much lurid poetry and fiction have been produced, having for their basis the unjust commitment of sane persons as insane; and, on the other hand, many papers have been written by physicians and others showing the danger of allowing insane persons to be too long without asylum restraint, and of the injustice that comes from making it too difficult to secure judgment of insanity and subsequent commitment and detention. Undoubtedly the danger of the commitment of sane persons has been greatly overestimated. The Earl of Shaftesbury, who was chairman of the English Commission in Lunacy for fifty years, stated that though the number of certificates that had passed through their office was more than 185,000, there was not one person who was not shown by good prima facie evidence to be in need of care and treatment. Drs. Ordroneaux and Smith, who were State commissioners in New York from 1873 to 1888, stated, that, during the fifteen years of their term of service, no case of illegal detention had occurred in the State; and the inspector of Massachusetts hospitals made a similar statement in 1893.

In most instances there are two things to be decided: first, whether a person is legally insane and in need of asylum treatment or the control of a guardian, and second, whether or not he or his relatives should be compelled to support him.

In the United States there are four methods of commitment: by arraignment and trial without medical authority; by trial with medical examination; by physicians' declaration, the court merely registering the findings; by a regular commission. The decision as to sanity is primarily a medical question; the old method was to treat it as a legal one. The person "charged" with insanity was brought personally into court and tried before a jury. In a few States jury trial is still obligatory in all cases, and the presence of the patient at the trial is demanded. Although this system may be properly characterized as barbarous, there is at the same time a judicial element in the matter which requires that the cases should be passed upon by a court. The more progressive States provide that all commitments shall be recorded in the Court of Records, but that the testimony upon which the action is based shall for the most part be that of medical experts. It is necessary that adequate publicity should be provided for, that an adequate amount of expert testimony should determine the question of sanity, and that a court should protect the rights of the patient.