Extracts from Henderson and Gillespie's A Text-Book of Psychiatry
1927 edition p.36:
While psychopathic parents tend to have psychopathic children, and
while the bulk of evidence is in favour of earlier onset of mental illness
among descendants, the view
previously held that familial
"degeneracy"
was inevitably progressive was unnecessarily gloomy; and there is evidence
that Nature tends to mend, rather than to end, a psychotic strain. A
familial tainting of psychoneuroses, of insanity, and of
apoplexy, does not
necessarily constitute a bad heredity
1927 edition p.405:
Neurasthenia This syndrome was at one time much more commonly
mentioned in the literature than it is now. Beard first described it in
1880, and Beard's neurasthenia became such a popular diagnosis that by 1894
Muller was able to furnish a bibliography of fourteen pages. In modern days
neurasthenia is rarely seen in pure form. This pure form consists in
complaints of mental and physical fatigue, associated with sensations of
pressure in the head, poor memory, inability to concentrate, irritability
of temper, increased reflexes, poor sleep and various aches and pains (A.
Meyer)
1927 edition p.485:
If, as a result of his examination, the doctor is convinced that mental
hospital treatment is the best method of dealing with the patient, he can
advise the relatives (and perhaps also the patient) that there are two
methods of procedure:
This method requires in Scotland that the patient himself shall sign two
letters, one addressed to the Board of Control, the other to the medical
superintendent of the institution to which he wishes to go, saying that he
wants to place himself under care and treatment as a voluntary boarder. No
other formality is necessary. In England only one form has to be signed,
namely that addressed to the medical superintendent.
This is the method of choice, and every patient who is capable of
appreciating the significance of such a letter should be given the
opportunity to do so.
In England a voluntary patient can leave the hospital on giving twenty-four
hours' notice of his desire to do so, whereas in Scotland three days'
written application can be insisted on.
If a patient has been admitted on a voluntary basis, and insists on leaving
even though he is obviously still ill, he should never be certified in the
mental hospital. He [p.486] should be allowed to leave in the care of his
friends, and, if necessary, his friends can have him certified and
returned. If a patient comes voluntarily, and is then certified later in
the institution, his trust in the institution and its officials is so
shaken that treatment is a matter of the greatest difficulty.
In England the voluntary method applies only to private patients. In
Scotland it applies not only to private patients, but to certain of the
rate-aided institutions whose committees have been wise enough to see the
humanity and usefulness of such a plan of treatment.
A voluntary patient retains his civic rights, can sign cheques and legal
documents, and advise in the management of his affairs. This form of
admission is being used more frequently, and in the Royal Asylums of
Scotland 50 per cent of the admissions are now voluntary patients.
If the patient refuses to sign the voluntary application, some other way
must be sought, and two main points must be considered carefully before
certification is proceeded with:
1. The medical man and relatives may believe that mental hospital treatment
would be best, but the social and economic circumstances may be such that
certification as a person of unsound mind may not be advisable. A
compromise has to be effected either by employing specially trained nurses
in the patient's own house or by removal to a nursing home.
The deliria associated with any toxic or infective-exhaustive process, mild
affective states, psychoses associated with senility, and certain paranoid
states are examples of groups of cases technically of unsound mind, yet
able to be cared for satisfactorily under outside conditions.
Apart from the purely medical side, the social and economic circumstances
are often deciding factors for and against certification. Certification is
desirable where no adequate accommodation at home or in a special nursing
home is available, or where money is a consideration. Certification is
unnecessary where adequate arrangements for treatment can be made outside
of mental hospitals, and undesirable where the patient occupies an
important public position, e.g. director of company, partnership, etc.
2. It may be impossible to certify the patient owing to the
[p.487] fact that he is thoroughly on his guard, and has sufficient
understanding to enable him to rise to the occasion. In such instances,
although the statements of the patient's relatives may be convincing in
themselves, there may not be sufficient direct evidence to justify
certification, e.g. in hypomanics, paranoiacs, alcoholics and epileptics.
It is not justifiable to certify a patient while in an epileptic fit, or
while under the influence of alcohol, as these may be merely episodes.
When the doctor has satisfied himself fully regarding the good faith of
those concerned, and when he feels that the patient has had every possible
chance under the best circumstances, he is justified, without further
delay, in recommending mental hospital treatment under certificates. The
tendency is to delay such treatment far too long. The doctor must explain
clearly to the relatives his reasons for advising it, and must inform them
that his certificate is only one part of the formality, and that it is of
no value unless the nearest relative is willing to sign the petition,
which, along with the medical certificates, has to be placed before the
legal authority for sanction. The law in England differs from that in
Scotland. In England the law differs regarding the certification of private
and parochial patients respectively, in that the private patient requires
two medical certificates, the parochial patient only one. In Scotland no
such distinction is made, every patient, private or parochial, requiring
two medical certificates.
Andrew Roberts likes to hear from users:"A bad stock", as
Mott says "is one where are found a large number of members
exhibiting various forms of degeneracy besides insanity, e.g. feeble-
mindedness, epilepsy, criminality, pauperism, inebriety; in fact a low
standard, mental and physical, in stem and branches of the family tree, the
further growth of which should be cut off"
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