Not Larger Asylums, But Fewer Commitments

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That is Solution of a Very Pressing Problem That Confronts the State, Says Charles B. Towns—Could Decrease Number of Inmates  One-Fourth

By Charles Willis Thompson [NY Times, December 26, 1915]

Instead of increasing the size and number of insane asylums, why not lessen the number of commitments?

Instead of more insane asylums, why not fewer lunatics?

In other words, are Governor Whitman and the other people who are appalled at the overcrowded condition of the State insane asylums, and who are proposing appropriations to enlarge them, approaching the thing from the wrong angle altogether? Charles B. Towns declares that they are, and that if they went at the problem from the other side, the asylums, instead of being overcrowded, would have room to spare.

By the method he proposes, he asserts, the number of persons committed as insane could be decreased at least one-fourth. If the statements he made to me are true, it inevitably follows that our present system not only sends to asylums people who do not need to go there, but actually creates lunatics, makes people permanently crazy who are only suffering from temporary delusions.

After that it will not be necessary to say that his line of argument is startling; but startling or not, he will have to be listened to, for he is an authority on the treatment of alcohol and drug habits. His argument rests on the fact that about one-third of the commitments to hospitals for the insane are cases with an alcoholic history back of them, and that even after a man’s mind has been disrupted by alcohol it is usually possible to restore him to sanity. If the cases caused by alcohol can be subtracted from the commitments, and he holds that most of them can, there will be no complaint of overcrowding and no demands for more and yet more asylums.

The remedy he proposes is definite and calls for State action. State action of some sort is admittedly necessary in view of the conditions disclosed. It is only a question of what kind of action it shall be. Build more asylums, is the answer given by everybody else; alter your committing system, and create one hospital for preventive treatment, and you will save the State money and men, is his answer. but before giving his remedy in his own words I shall give his arraignment of the existing system, the system that creates that very overcrowding which it is sought not to remedy, but to keep pace with.

“My suggestion to the Governor,” said Mr. Towns, when I asked him about Mr. Whitman’s reported intention to call on the Legislature to build an additional State hospital at Middletown, “is that instead of enlarging the facilities for the care of the insane he should propose to the Legislature definite measures for treating the whole subject in a larger and more scientific way.”

“The people who have hitherto had the say about the problem of insanity have just one principle: increase the facilities for taking care of the crazy without taking one step to find the cause of insanity and adopt preventive measures. That’s their training, the training of medical men, and prevents them from seeing the big side of the problem.”

“There is very little insanity in a country like Japan, where they do not use drugs, or like China, where they do not use alcoholic liquors. But in any country where the use of drugs or alcoholic stimulants is permitted you will find the same condition, though nowhere to so great an extent as here, except in England and Scotland. They don’t use drugs as much as we do, but they are eminent the world over for the use of alcohol.”

“Yet, although in this country the greatest individual contribution to the army of the insane is made by alcohol, nothing is done intelligently to stop the supply of maniacs. We go on jamming the asylums and can think of nothing better, when the jamming becomes too great, than to build some more. The State of New York, instead of increasing the facilities for the care of the insane, should lessen the crop of the insane.

“One of the biggest things that could be done would be to seek out the causes of insanity and begin an educational campaign with the medical profession.”

“The trouble begins with the lack of knowledge on the part of the general medical practitioner concerning the things which lead up to insanity. There is nothing in his medical college experience and there is nothing in his clinical experience to give him one particle of knowledge on the subject. What alcoholism and drug-using mean should be put before the medical profession in a definite and scientific way, and so that they will be able to render first aid.

“The first idea of the general practitioner when confronted with a victim of alcohol is to put him where he cannot get any liquor, believing that all that is necessary is to give him some form of sedative and some artificial stimulant. I am sorry to say that he sometimes resorts to the use of morphine, and many confirmed alcoholics have thus contracted the drug habit in addition. In cases of chronic alcoholism, where the patient is thus deprived of drink and dosed with sedatives and artificial stimulants, the physician in practically every instance will have delirium tremens on his hands. The trouble is that the situation is beyond him and he doesn’t know what to do with it.

“A woman in Asbury Park had an operation performed, and the doctor gave her drugs; she contracted the drug habit as a result; in desperation he tried to get her out of it by giving her alcohol, and she got the liquor habit. Her mother finally took her to a doctor in Baltimore; she was hysterical, and he gave her hyoscine. The physiological action of hyoscine is to produce delirium. To keep her quiet he gave it to her for five weeks. By that time she seemed to be insane, had delusions that she was being poisoned, but she was brought to me. I called up the Baltimore doctor on the telephone, and he said she was crazy and ought to be locked up. To all intents and purpose she was absolutely insane. After proper treatment she cleared up perfectly; she had simply been suffering from hyoscine poisoning.”

“The doctors know nothing but deprivation, and they do not know that within a few days the system of an alcoholic can be unpoisoned.”

“A man from Saranac Lake came to this city, in charge of a relative, on his way to take the Keeley cure. His family doctor had deprived him of liquor, and when he reached New York he naturally developed delirium tremens. They wouldn’t take him at the Keeley Institute, and he was taken first to an asylum at White Plains as insane and afterward to one near his home. He spent a year in these two institutions before he was discharged. It was his own friend and family physician who brought this calamity upon him; for if he had not been deprived of stimulants, and if he had had definite medical treatment in the beginning, he would not have had delirium tremens and the State of New York, by the way, would not have had the expense of caring for him for a year.”

“The conditions surrounding the commitment and treatment of the alcoholic in the city institutions are just as primitive as they were a hundred years ago. There is no more intelligence exercised at this time by the committing Magistrate than there ever was. Those brought before such Magistrates under the influence of drink meeting with reprimand, a fine, and on a reoccurrence, if they have no means, they are committed to the Island, and if they have, they are committed to private institutions for indefinite periods.”

“The committing Magistrate should be taught what are the proper courses for him to take in varying cases. To inflict a fine is a criminal absurdity. Fines should be abolished immediately.

“The first thing is to go into the man’s history, with the result of making an intelligent classification of his case. Those who have positions should be fitted to take up their work; if possible they should be restored to their places, and if not, other occupation should be found for them.

“The present method is simply to receive these cases in the medical wards of the city hospitals, where nothing definite is done; there is only an attempt to sober them up. Entrants are voluntary, and they are permitted to leave when they choose and come back any time they see fit.

“Even when people with means are sent to private institutions they are made life boarders wherever it is possible to do so. Under existing laws alcoholics of any class can be committed regularly by two physicians who are willing to state that the man is a chronic alcoholic and is irresponsible. He can be committed for any period up to a year, and even at the end of a year he can be held if it can be shown that he is still irresponsible in the opinion of all concerned.”

“With an intelligent handling of this problem not only would the State and municipality solve their biggest problem, but there would be a material lessening in the commitments to private institutions as well.”

“The present system enables relatives and friends of persons who drink to any extent to deprive them of their rights and liberty and the handling of their property. In the disturbed mental condition that results from drink persons are induced to consent to enter private institutions. No one should be permitted to sign away his liberty while in such a state, nor should he be committed.”

“The Judge should first be obliged to commit these persons first to a hospital for treatment, and they should not be taken to any public or private institution until this had been done. Not until the treatment has been completed is there a mental condition which will permit an intelligent diagnosis. It has been demonstrated that a patient can be thoroughly unpoisoned in from three to five days, and the diagnosis can then be made as to his physical and mental condition.”

“The last statement from Bellevue was that one-third of the patients admitted were alcoholics. And yet these patients, one-third of the whole, are the only ones that do not get definite and specific medical treatment.”

“Now, what the State of New York needs instead of more insane institutions is to set aside at least one institution where this kind of patient could receive curative and complete treatment. Instead of making life boarders of them, from two to four weeks at most would be all that would be needed to clear their systems and restore their minds.

“There should be a medical clearinghouse for all this type of cases in New York City.”

“The method of dealing with this individual at present makes him a permanent and worthless liability to society. Take him as he comes before the magistrate. ‘Have you ever been before me before?’ ‘Yes.’ ‘I remember you; this is the second or third time?’ ‘Yes.’ Then some member of his family says ‘Judge, I’ve done everything I could, but he will drink; it might do him good to send him away for awhile.’ And away he goes.

“That means his finish. Such colonization of these unfortunates should be resorted to only when the best authorities, after going carefully into every phase of his physical and mental condition, find that the man’s case is thoroughly hopeless. If that is not done, you will make his case hopeless whether it was so at first or not.”

“There are two types of these cases, the committed case and the voluntary patient. Where they are arrested and held by the courts, it is the policy to avoid giving drugs to the drug takers or drink to the drunkard. Something has to be done for the drug taker, but there is nothing that makes provision for any definite treatment of the alcoholic. It is the policy not to give him and alcoholic stimulants; the usual methods of artificial stimulation and sedatives are resorted to. Now, in cases of chronic alcoholism there is no form of artificial stimulation that will take the place of alcohol and that will avoid the consequences of deprivation.”

“What is the consequence of deprivation?” I asked.

“Delirium Tremens,” answered Mr. Towns; from which it appeared that the present method of treatment creates delirium tremens. Since permanent alcoholic insanity is usually the result of delirium tremens, it is apparent that the insanity too, is thus produced by the deprivation policy. He went on:

“If he lives through the delirium, he may be much weakened and have long periods of hallucination, and in the end, if this condition exists, he will become a subject for the insane institutions. He has received no definite treatment to eliminate the effect of stimulants and to remove the craving. His case has not been taken up in an individual way; there has been no classification, nothing positive has been done.”

“The policy consists in simply settling their nerves and trying to make them sleep; beyond that nothing is done at all. The law should be amended so that immediately upon admission to these thorough and definite treatment should be administered, and no commitment should be resorted to until that has been concluded; not until the system has been completely unpoisoned, which can be scientifically done.

“Those people who suffer from delusions that they are being persecuted, for instance—the first thing to do with them is not to send them to asylums, but to unpoison them. They should not be classified nor permanently committed until they have undergone radical treatment for the purpose of freeing their systems perfectly.”

“Excessive alcoholism sets up a physical depreciation. Simply to deprive the patient of alcohol brings about delirium and permanent mental lesions, unless something is done for him.”

“The present law provides that any confirmed drug users can obtain treatment in any State or municipal hospitals. The municipal authorities in the larger cities have provided such treatment. Bellevue increased its beds from two to fifty, and a like provision was made in the Metropolitan Hospital on the Island. But the officials of the State medical institutions sidestepped this responsibility by saying that the funds allotted to them sere for the care of the insane and not for the treatment of habits or addictions. So the man goes away; and if he does not die, but becomes insane through being deprived of his drug, then he is made eligible for treatment. And among confirmed drug users on or the other would be the result, in nine cases out of then.”

“The State of New York should provide at some central point a place not only for the drug taker, but for the alcoholic, who is the sickest man of all—a very much sicker man than the one who is taking morphine. No man can take up his case intelligently while he is under the influence of drink, and yet that is the very time he is always dealt with, when no proper diagnosis can be made of either his physical or mental condition. There are many places where there is no city hospital, and it is necessary for the State to provide it.”

“There is an inebriety farm at Warwick, but only those who fall into the hands of the courts can be committed there. The voluntary patient can go to Bellevue, and keep on going there until he gets blue in the face if he chooses. There could be one hospital in New York for the scientific treatment of all alcoholic patients, and if there was such an institution it would lessen the present expense of handling these patients enormously and at the same time it would set up some uniformity in care and treatment.”

“If this step were taken, and classification resorted to, it would mean that this overcrowded condition which affects the City of New York would be reduced about one-half. As it is, there is no uniformity of action on the part of the heads of the city departments in meeting this problem. The various institutions which accept such patients apply such treatment as they see fit.”

“With proper treatment and care, and classification, and with the State providing proper means for it, and the city doing the same, and with the Magistrates committing the patients in the first place to the hospital instead of to some place where the proper care cannot be given them, there would be easily a lessening of 25 per cent of the present number committed.”

“This is an appropriate time to raise this question, this time when the Governor is being asked to recommend new appropriations for caring for insane patients many of whom need never have been committed in the first place. Let the Governor do the big thing, not simply content himself with makeshifts. Let him approach the problem from the beginning instead of from the end. It is too big a subject, it bulks too large in the life of the State, to be dealt with in a small way. One of the best things he could do would be to seek conservative business advice from men who are not politically or otherwise interested in the matter.”

“I would like to tell the Governor that he doesn’t need any larger hospitals for the insane; that what is needed is to take up intelligently the chief contributing causes of insanity. At this time there does not exist, either at the place of commitment or elsewhere, any condition by which there can be any intelligent study, classification or elimination of this class of patients.”

“Boards of Health all over the country should make up their minds that this is one of the biggest problems they have to deal with, far bigger than any of the questions of contagion that occupy them so much. Until they do that, they will not be doing their full duty.”

“It is a problem much bigger than the case of the individual sufferers. All that crowed of humanity that cannot be helped under the present conditions are turned into hopeless cases, their families are being deprived of their livelihoods; those who might be saved or helped are being turned into derelicts.”

“The State must take care of them in one way or another; either at the farm, or the insane asylum, or the Morgue. The only question is which is the better place, the better way.”

“The employers, too, have a duty to perform. How many employers treat a victim of drink decently? Why not try to save him? I am going to call a meeting of the heads of big industrial concerns of this country together—I have already drafted the letter—with a view to discussing this problem with the, knowing that it is as big an economic problem as they have to face, and showing them that they can clean house and the way to do it.”

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