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The problem of mental illness
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T H E P R O B L E M OF MENTAL I L L N E S S By THOMAS H. B. GLADSTONE, M.B., B.S., D.P.M. MR. PRESIDENT, LADIES AND GENTLEMEN,
THE subject which we have to discuss to-day is of very great importance since mental illness is so much on the increase, particularly in this country and in the United States. I t is one which concerns us particularly as homceopaths because there is no homceopathic institution in this country to deal with such cases. This means that if we have a mental patient who is so bad that he cannot be looked after at home, we are obliged to surrender him to the tender mercies of the orthodox practitioner and are unable to go on treating him homceopathically. The whole environment and social circumstances under which peopl 9 are treated for mental illnesses are badly in need of reform. Many of you have probably seen the vast barrack-like institutions often housing from 1,000 to 3,000 patients. Within these places mild and recent cases are often herded together with chronic incurable patients. The wards are usually all locked and there is a clash of keys whenever a doctor or nurse enters, which emphasizes the sense of imprisonment. There is a terrible sense of frustration, boredom and aimlessness in the existence of the inmates. Many spend the whole day walking aimlessly up and down and give one the impression of animals shut up in a zoo or fish swimming aimlessly up and down in an aquarium, rather than human beings. Frequently also one finds the wrong type of nurses ~n such institutions. The male nurses are often men who have served their term in the Regular A r m y and, finding nothing better to do on release therefrom, they have taken up this type of nursing. On the other hand, one does see a better type of nurse in these institutions. Nevertheless, there is room for improvement, as instanced by the following experience I had when working in a mental hospital A nurse developed a method of treating a somewhat troublesome patient by simply keeping him sitting on a small chair. Whenever he tried to rise from it he was pushed back on to the chair ! That had been going on for about twenty years. Imagine the effect of it on the mentality of the patient. In fact, I would go so far as to say that the chronic mental patient is often a product of the modern type of mental hospital. The most hopeful factor in treatment, so far, is the occupational therapy department, though the occupations are still very limited : woodwork foI male patients and probably only knitting and needlework for the female patients. There should be the inclusion of artistic occupations: weaving, painting, pottery, gardening and so on, all of which would help to direct the attention of the patients away from themselves and really train their will-power. Most of those who axe mentally ill have little will to do anything whatever. Then there is the harmful effect of the hierarchy which generally exists in these institutions: the medical superintendent on a pedestal, so to speak; under him the assistant medical practitioners; and then the nurses and, finally, the patients. Between those groups there is no actual contact, from a co-operative point of view ; they are each completely isolated the one from the other. I n any mental home of the future it would be beneficial for all responsible for the treatment of the patients to meet together and co-operate to a greater extent than is now the case. There should be weekly meetings in which doctors and nurses can discuss the patients individually and consider the difficulties the patients have and the best means of coping with them. Again, very much smaller units would be beneficial. We shall never achieve any really satisfactory results in huge baxrack-iike buildings containing anything up to
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3,000 patients all herded together. About 100 patients would be the ideal maximum, The attitude towards the patients themselves will have to change. Too often they are regarded as just strange animals, or as outcasts rejected by society. That has a very bad effect on mental patients, especially those on the border-line. There is need for the development of a much more social atmosphere in which such patients can be received and helped. Unfortunately, some nurses seeing the terrible symptoms of mental illnesses fear that the same sort of thing may exist within themselves, and in order to protect themselves from it they treat their patients as if they were beings of a different species. I believe the modern educational system brings about mental illness; the system of competitive examinations and intellectual cramming is very much to blame for a great deal of mental illness which develops later in life. I t is quite common to find schizophrenics who have had a brilliant school career. One of the worst cases I saw in a mental hospital was a youth who had been a brilliant young architect. Being brilliant when at school their intellects have been forced and they have had to pay for that later in life. There has been an endeavour to prevent this happening by not allowing young students to take the school leaving certificate or matriculation at too early an age, but there are still examinations for the ll-year-olds as a result of the passing of which children are accepted either for a general or technical type of education. Because of that the schools and the parents are always urging on the children to swot for the examination. I t seems too often to be forgotten that a child can only absorb that which is suitable for its own age ; in fact, the child recapitulates the history of humanity itself, in that only certain subjects are suitable at certain ages. Every school should have a homceopathic doctor attached to it, because signs of mental illness can often be recognized during the school age, and if there is a school doctor who is co-operating with the teachers he is frequently able to give them advice which m a y prevent trouble occurring later. One final point. So many mental illnesses show themselves at a time when a young man or young woma n is reaching the age when he or she should leave home. Often there is an overbearing father or mother responsible for the state of mind of the young individual ; in other words, responsible for the mental illness of son or daughter. If one can only remove the young people from the home surroundings and atmosphere it is often possible to help them to avoid a complete breakdown. This is especially the case under existing housing conditions when even after marriage young people are often forced to remain at home for lack of a house. A hostel to which these young people could go and in which they could develop their own personalities would be useful. At present mental therapy is in rather a bad way. Usually a patient entering a mental hospitaI is at once put under the influence of some narcotic drug, as a matter of routine. Generally, the patient is put to bed, given the narcotic, and kept in bed for months. While that procedure provides an opportunity for physical examination of the patient, it does not help to improve or alleviate the mental condition. Another form of therapy is that of psycho-analysis. Nearly all mental hospitals in these days have some sort of Freudian psychoanalyst attached to them. As long as that is the case there will be another stumbling block to any real therapy of the patient. In the first place, the psycho-analysis is founded upon preposterous ideas of the mental life of the child, ideas for which no proof has ever been offered but which have been upheld as a sort of religion. If it were a mere question of theory it would not matter so much, but the practice of psycho-analysis has a bad effect on the patients because they are thereby taught to believe that all their troubles are dim to shock received in early childhood. The search for the shock continues for years and years, and 5a
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sometimes one meets with patients who have been psycho-analysed for eight years in am effort to discover whatever it is that is supposed to have occurred in their childhood. Even if some shock is discovered or an imaginary shock is invented b y the psycho-analyst, the patient, unfortunately, remains in the same state. Another bad effect of the psycho-analytical school is that it teaches patients to become tremendously absorbed in themselves, so that they are unable to take interest in anything or anybody except themselves. I managed to get one such patient to read The Times and give me an account of the foreign news each week as a means of attracting her attention away from her own troubles which had been all she could think of or talk about. Thirdly, the psycho-analysis often has a bad moral effect. A patient who had been psycho-analysed came to me because he was always getting into trouble through taking on a fresh secretary, divorcing his wife and marrying the secretary. This had happened three times and he was getting tired of it and was wondering if anything could be done to p r e v e n t iv. I found he had been taught by the Freudians that all his troubles were due to the fact that in his early childhood he had had a mother and a nannie. Because of this it had always become necessary for him to have two women attached to him. Once I got rid of this ridiculous idea he was able to arrest this process and settle down with his present wife. There is really no end to the absurdities attributed to children as a cause for mental trouble in l~ter life; one hears the most arrant rubbish. Leaving aside that particular sphere, the next thing which occurs to the mental patient is shock treatment which consists in giving a person artificial epileptic fits by passing electric currents through the forepart of the brain. This procedure developed from an attempt to treat schizophrenia, because it was known that epilepsy was rare in schizophrenics. I t was found that it did not deal with the schizophrenia at all, but arising from that it was discovered accidentally that the treatment had an effect on the mood of the patients ; that they became temporarily more elated and less depressed. That led to a wider application of shock therapy. I t is a destructive form of treatment which often does more harm than good. l~esults are only temporary and sooner or later further treatment becomes necessary, with the consequence that the patient is always going in and out of mental hospitals. The next stage is that the patient m a y have a leucotomy done on his brain, which is really an extension of the shock therapy ; the electrical shock damages the forepart of the brain, but leucotomy destroys the white matter altogether. While it is difficult to assess the results of this procedure, it is apparent that it seems to have a bad effect on the higher faculties of the patients. Those who have been suspicious and depressed may become absolutely carefree, but they do so by going their own way regardless of other people. I read an interesting record of the follow-up of some of these patients, and it was common for relatives to say that the patient did not seem to be the same individual ; that prior to the operation it had always been possible to appeal to his or her better nature, whereas following the operation there seemed to be no better self, and so on. It seems to me that those who are experimenting with this operation Scarcely know what they are doing. I do not propose to say much about the mental symptoms of homoeopathie drugs because you all know much more about that already. We all know the effects of drugs such as Belladonna, Hyoseyamus, Nux vomica, Ignatia, Aurum and Argentum nitricum. Hahnemann pointed out that in mental cases the physical symptoms are the most important in contrast to cases of physical illness, and I feel that we have come too much to regard mental illness as something t'o do with the brain, and only~he brain. We have to consider the whole body, to ~'onsider the mind as Connected with the entire body; not merely With the braitl; By ascertaining the cause of the disease of physical organs one m a y
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get to the bottom of the mental illness. I f it is possible to find the right therapy for the physical process, it will have a striking effect on the mental condition and symptoms. I remember a case in which a man had a series of minor strokes and was gradually becoming quite demented ; he was drowsy and somnolent and had all sorts of absurd ideas. I treated him homceopathically according to his mental symptoms without any great success. Then one day I was called to him because his wife thought he had pneumonia ; he had a high temperatm-e and seemed very ill indeed. I discovered that he really had acute cholecystitis. I gave him Chelidonium for that and from then onwards he began to recover. Though not yet completely well he is able to get up and about and his mental condition is very much improved, although I do not feel that he will ever be qiuite normal. I think some chronic processes which m a y have been going on in the gall-bladder accounted for his mental symptoms, and when he was given a medicament to suit that his mental illness improved. Another case was that of a man who had paranoia ; he thought he was being pursued by a gang, and he was quite wild, shouted at the top of his voice, and had strange religious delusions. On examination I found he had some signs in his lungs, and on the basis of that I gave him Phosphorus. If I had had to depend entirely on his mental symptoms I might not have chosen that drug ; at any rate, it seemed to bring about what his wife described as a mental revolution. He did not recover completely; he still is paranoic to a mild degree, but he did not have to enter a mental hospital and has lived a comparatively normal social life since the treatment. When it is necessary to treat the nervous system it m a y be useful to give medicines via the skin, because the latter is so closely related to the nervous system. That relationship has been recognized, to a certain extent, by orthodox practitioners because they used to treat tabes by the inunction of Mercury. That was found to be better than giving the drug by mouth. The rubbing of it into the skin produced the effect which they could not produce as a result of giving it by mouth. That is a matter in regard to which a good deal of experiment could be done. For instance, if Copper is rubbed over the part of the brain in which the centres controlling micturition are situated, it has a wonderful effect on a child with incontinence of urine. ] think these are the main points I wanted to bring to your notice.
DISCUSSION Dr. D. M. FOU~ISTER asked did Dr. Gladstone think that by changing the environment of a child with a tendency to schizophrenia it was really possible to prevent that arising sooner or later. Dr. GLADSTONE replied that if a child had a strong tendency to schizophrenia something would eventually come out, whatever the environment, but it might be possible to prevent it reaching such a point at which it became an actual mental illness. For instance, those with a " schizophrenic personality " did not necessarily actually become schizophrenic. He thought one could prevent schizophrenia completely if one could completely reform the present type of education. Dr. W. LEES TEMPLETON wished to thank Dr. Gladstone for his address but was sorry that it had been so depressing, perhaps too depressing he thought, though many of the criticisms were justified. He had hoped that Dr. Gladstone would have offered some constructive, ideas for the solution of this very important problem. He preferred to call it mental balance, for he thought that was how it should be considered, feeling that, if it were, something constructive might be obtained. If mental balance was the crux of the whole matter, what was it determined such balance ? We were all incipient homicides and suicides. All had similar 5B
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moments when we might be either. W h a t was it determined that we remained incipient ? Surely it was the result of m a n y factors. Some of the most highly educat.ed people broke down perhaps because of the type of education or its very nature. Not altogether training, for, again, all types from all classes, even including the medical profession, were to be found in mental institutions. There was the question of religious training. That, he felt, was of the utmost importance, and its present-day lack indeed might be one of the important factors in the increased incidence of mental disease throughout the world. It was rarely the big catastrophes of life which determined mental breakdown but rather the everyday affairs which the incipient mental patient was unable to tackle. Dr. Gladstone had criticized the atmosphere of many mental institutions, but his advocacy o f luxurious sanatoria, whilst ideal, was scarcely practical~ unless it was to be that the sane members of the population were to be saddled with an intolerable burden for the sake of the insane. (It used to be said that if one were to be a pauper it was always better to be an insane pauper !) But this led one up to the question of the value of shock methods of treatment which Dr. Gladstone said did more harm than good. He, Dr. Templeton, did not agree with this entirely. Viewed from the social angle, as, e.g., when penicillin and sulphonamide treatment was judged to be superior, not because it was the best method, not that it was even the method of cure, but that it rendered the patient non-infectious to his fellows. Shock therapy in many cases made it possible for the " impossible " patient to recover so far that he could be nursed at home. From the social angle that was, of course, important, but was it all-important ? Leucotomy also was of similar value. I t was stated that in the chronic states of melancholia there was a one-way tract along which the " depressed " complexes ran. Cut the tract and the chanees were that the depression would be rendered invisible. This he felt was one reason why such chronic states (and here he would include epilepsy) were not amenable to treatment, especially homceopathie treatment. There was a one-way tract which had beeome " the permanent way ", and only something violent or mechanical would be of any value. I t was a etude method, but it worked. Dr. Gladstone had criticized the discipline in mental hospitals. B u t surely he would admit that with a disturbed mind, an unbalanced mind, discipline was not only necessary, but was actually a form of treatment. He can recollect being called to a patient (sent out on trial) who every day was ehasing his relations round the house. When he arrived he, Dr. Templeton, simply snapped his fingers and said, " Into bed " , and he went like a lamb, recognizing the voiee of the master ! Was this to be deprecated ? He for one did not think so. Obviously the undisciplined mind must be disciplined not by force or eruelty, of course, but as at school, by training. Here he wanted to mention the danger of modern cramming methods for scholarships. This was liable to cause breakdowns, and though he was no believer in the ultramodern method of allowing the child to do only what it wanted to do, there were limits even to this. Given a balanced child, balanced because the home atmosphere and training were good, many of the alleged causes did no harm at all. Often the alleged cause was only the last straw. Dr. Templeton agreed with Dr. Gladstone's plea for more occupational therapy. He had studied a series of schizophrenies and not one of them was a manual worker. All were of the white collar class and of the semi-educated pseudo-intellectual type. No one was really trained for anything. He wondered if this too (for the trend again is away from manual training and oecupations), was responsible in part for the increase in mental disease. But he did not like the suggestion about hostels. Most individuals liked privacy and should have the ch0iee at any rate. He for one did not like the
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communal life, but of course some did. He felt that those who liked it were less self-reliant. The other type was more self-sufficient. Bug apart from early training, as far as treatment was concerned he felt t h a t one must get the ease early ; for once the one-way tract was established it was nearly impossible to alter the trend. We all had our successes in the early case. One recently, a. religious mania, which if he had not improved quickly would most certainly have required institutional care. He was driving his wife and family to despair. He did not sleep, and no one else did either: He had a peculiar symptom " that he himself was Christ ". Cannabis indica is the drug which has this in the Repertory. I t was given in the 6th potency and in a week he returned quite relaxed, quite sane, and asked if he might return to work. Another, a woman in a most desperate state, actfvely suicidal. Her husband had been three years in hospital with war wounds. She had been left with the full responsibilityof the home and children. He was coming home the next week. She could not face him in this state of mind. She looked pathetic, trembling all over as if in fear. " Trembling as if afraid " he found a very useful clue to Opium. Opium she got (a 3 0 ) a n d returned all smiles and so grateful. I n conclusion, Dr. Templeton hoped that Dr. Gladstone in his reply would give some positive recommendations for the maintenance of mental health and balance. Dr. LAURENCE, referring to the question of sepsis, cited the case of a man who had been under treatment by various specialists for some two years for melancholia, which had become serious and acute for the last six months. The removal of a mouthful of septic teeth affected a complete cure in about six weeks. The effect of septic teeth on the mind was often more marked than their effect on rheumatism. What was Dr. Gladstone's experience of ansesthesia in producing a relapse in schizophrenic eases ? Dr. Laurence believed that it sometimes pushed the patients over the borderline again, as he had seen it happen once or twice. There was no question that shock treatment apparently shortened some cases of mental illness--at least the patients seemed to recover more quickly. Dr. LE HUNTE COOPER expressed his gratitude to Dr. Gladstone for his very interesting paper, and for calling attention to the shortcomings of the mental institutions at present existing in this country. His reference to the urgent necessity for such an institution, in which Homoeol0athy would take front rank in the treatment of these eases, was of the greatest possible importance. His, Dr. Cooper's, experience had convinced him that the number of mental cases in England would very greatly decrease if Hom0eopathy were more universally employed, and those eases which had to be dealt with in such institutions would have a far better chance of recovery if their maladies were dealt with on homceopathie lhles. I n commenting on the shortcomings of our present mental institutions, it was only fair to point out the immense handicaps these establishments were struggling against. To obtain a suffieieney of trained staff and nurses is impossible, and it is a matter for wonder that they are able to deal with the patients as well as they do. The difference between the old-fashioned, and homceopathie, methods of dealing with mental conditions was very dearly illustrated by a personal experience of his own. Some years previously, he had been asked by a family, which was then feeling its way towards Homceopathy, to visit a distant mental institution on account of a young girl rel0t~ve of theirs, suffering from schizophrenia, who had been treated at that institution for a considerable time. He found that the eondition arose, in the first instance, from mental strain continuing over several previous years, and was ushered in by sudden collapse and violenee, necessitating restraint in an appropriately furnished room, this being subsequently necessary from time to time.
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The mental symptoms chiefly took a form of religious derangement in the first instance, with semi-religious delusions. There were occasional attacks of rigidity and staring into space, often lasting an hour or more, together with loss of interest in life, and an occasional resort to bad language, but never with loss of temper. This girl had been so very tenderly brought up, and well educated, and was of so refined and gentle a nature, that it was a matter of the greatest surprise that she could have ever heard such language. These occasional lapses into Billingsgate " were similar to that which occurs in patients of equally refined dispositions when under the influence of a general anaesthetic. She was much troubled with voices ", which at times compelled her to do, and say, certain things which she had no power to resist. The absurdity of some of these orders was illustrated by one of them directing her to stand on a window-sill, some three or four feet from the ground, and throw herself back on to her bed. That she did this without any evidence of injury whatsoever was very remarkable, in that she fell flat on her back on to a mattress, b y no means soft, and with no springs beneath it. W h y she did not develop any evidence of a severely jarred spine was to him a baffling mystery. The worry and fear caused by the imaginary voices were a constant source of distresstoher. The continuance of this sort of existence in time produced a condition of apathy, with slow cerebration, rendering it most difficult to obtain answers to questions asked. She often showed complete indifference to the existence of anybody in the room, and her relations stated that she frequently did not recognize them, and even when she apparently did so, she would take little or no notice of them. During her m a n y months' residence at the institution she had been treated by insulin shock " on two occasions, each for about eight weeks, without any improvement. The two medical men in charge of the home both expressed their emphatic opinions that the case was hopeless, as everything possible had been tried. One good thing which had been done, and of which the speaker greatly approved, was the regulating of the bowels at the commencement of the case, it being a well-known fact that the majority of such patients are found, when admitted to such institutions, to be the victims of intense constipation; this causing auto-intoxication over a period of years, which he considered a most potent contributory cause of mental derangement. The senior of the two medical men offered it as his opinion that the one and only possible hope of improving the patient's condition lay in the operation of leucotomy. As he, Dr. Cooper, could not recommend such a procedure, and as her relatives refused to entertain the idea, he, Dr. Cooper, had an independent personal interview with each of the medical men, and put it tothemindividually that, as they had come to the end of their tether, and considered that nothing but rest and attention to the general health was possible in the future, t h e y might possibly entertain the idea of homceopathic treatment being tried. In making this suggestion he had been prepared for possible objections being raised, but not for the evidence of shock " produced in each of them b y such a proposal. They both showed great consternation, and vehemently proclaimed the impossibility of any such measure being attempted: Nor would they, for a moment, take the risk " of departing from the traditions of the establishment, and of employing a treatment of which they had had no previous experience. He then suggested that they might regard it as an experiment ", from which no possible harm could come. I t would consist merely in the exhibition of a remedy, the physiological action of which they were familiar with, and which would be given in intermittent doses at varying intervals, and so highly diluted that they would probably discount the possibility of its having any effect whatever, either deleterious or beneficial. "
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They, however, remained adamant in their decision, and it was agreed that the patient would simply be left at rest, with simple attention to hygiene, and no specific treatment, Thus, having a clear field at last, he introduced a unit dose of Hyos. 30 into some lemonade the patient was taking, and awaited results ! A possible slight increase in excitement, and general disturbance, seemed to follow, but not sufficient to have any real significance. Similar doses were administered, at from seven to ten days intervals, and after the fourth dose the patient began to show signs of taking some notice of her surroundings, the tenth dose being followed by a return of interest in life generally, with enquiries as to her absent friends and, for the first time, showing evident pleasure in the trees, flowers and scenery generally, outside her window. Next came a drive in a car, the country scenes filling her with an ecstasy of delight. All the old symptoms completely left her, and when the two medical men were asked to make a thorough examination of the case for their unbiased opinion, they gave it as one of " complete recovery ". During the successive years, from that time to this, this patient has continued absolutely mentally normal. Dr. C. O. KENNEDY said that during his period in the Royal London Homceopathic Hospital three patients had become delirious during the night. All had been treated hom0eopathically, but the strain for the medical and nursing staff and other patients had been very considerable. One was treated with Stramonium with little effect ; indeed, the patient was worse the second night. Hyoscyamus did not relieve him, although it was clinically indicated. I t was only on the third night after repertorization that Rhus tox. had been prescribed, with good effect. What was one supposed to do in such cases ? How long was it justifiable to allow a patient to continue in such a condition ? Narcosis would allow peace for other ill patients with greater certainty, at least for beginners. Another patient had come in suffering from poisoning and he had just laid in bed week after week taking no notice of anybody ; he reluctantly took the food as it was given him ; it was impossible to get any history from him ; he had not responded to any remedy and had made two suicidal attempts. In consequence, the patient had to be transferred to one of the observation wards of the L.C.C. He was now back at work, whether due to his experience in the observation ward or not the speaker could not say. Could Dr. Gladstone give some guidance for the approach to such cases ? Dr. Gladstone had Said that the psycho-analytical approach tended to make patients introspective. The speaker suggested that homceopathie case-taking might also make patients introspective, especially if it were repeated. He had in mind one or two patients who were definitely introspective, probably due to this. Dr. L. R. TWENTYMANsaid he would like to add a little to the pessimism about which Dr. Templeton had been so disturbed. He believed it true to say that of every twenty people in the United States of America one spent part of his or her life in an asylum. That seemed a serious state of affairs when one considered that for every one of those people there were probably several relatives who probably did not go into an asylum. So that one wondered where to draw the line between the sane and the insane. I t did not seem that the problem could be treated apart from the whole nature of present-day civilization, and he welcomed the fact that Dr. Gladstone had raised that issue. I t was obviously one which could be solved by producing more and more homes for the mentally sick and more people to look after them, otherwise there would be a civilization which was itself a lunatic asylum. Dr. Gladstone had mentioned some extremely interesting cases: for instance, that in which a patient with cholecystitis recovered as a result of the use of Chelidonium. There was possibly a somewhat different interpretation
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of that case. Was it the Chelidonium or was it actually the appearance of the cholecystitis which was therapeutic ? There were so many instances in one's experience in which a crisis during illness somehow seemed to enable the patient to come through and enter into a new period of their life. Possibly very often the appearance of an illness such as cholecystitis meant that either the mental illness had worked down into the gall-bladder, liver or whatever organ it might be, or the appearance of that inflammation had changed the forces and enabled the personality to be differently related to the organism. I t was important that Dr. Gladstone had drawn attention to the mind, or soul, or whatever one likes to call it, in relation to the different organs of the body and not simply to the brain. Illness or local pathological changes in various organs should be much more closely considered a n d s t u d i e d from the point of view of the different type of mental disturbance which came with them. A book published by a homceopath during the last century had a most stimulating title, The Human Body and its Connection with Man, in which book the author, James Wilkinson, discussed the various organs of the body and their complexity and relation to the different faculties and qualities of man. Finally, the Speaker expressed gratitude to Dr. Gladstone for drawing attention to that deeper problem in relation to man's experience in subjective life, from the point of view of the whole of the bodily organs rather than of the one called the brain. The PRESIDENT felt that the audience were indebted to Dr. Gladstone for calling attention to institutional defects. While he was speaking there had come to mind the l~udolf Steiner school about which some present knew and which seemed to be making great progress in this country. Some little while ago Dr. Koenig had lectured to the Faculty on the work being carried on for the mentally defective child, and anyone with experience of the Rudolf Steiner system could not fail to be impressed by the institutional and practical therapy employed in dealing with those children. I t was rather striking that educational bodies had been forced to recognize those institutions for the treatment of their mentally defective children and that they had actually contributed to the funds, so that children from various districts were being sent to those schools. Certainly some of the work produced by those so-called mental defect cases was above that which many considered the average in music or in art. i t seemed that the Rudolf Steiner school had found something that was lacking in the ordinary mental institutions in this country. The President had, he said, been interested in the case of cholecystitis and also in the fact that Dr. Gladstone had stated that Hahnemann had drawn attention to the point that in marked mental cases the physical symptom was important--rather the reverse of the general view. I t seemed, according to Dr. Gladstone, that when dealing with a mental case the physical symptoms became of prime importance. The work on the nosodes showed that it was possible to relate organisms to mental conditions. In the past, certain types of temperament had been associated with certain organs: the liver with melancholia and so on. The relation between the organs of the body and mental illness had been recogifized long ago. Dr. Templeton had asked how one was to retain mental balance, which came back to the whole problem of heredity and environment. Which was the more important factor ? Personally he thought them both important. When children were brought up in the same environment and were subjected to some particular shock in the home, one child would show quite characteristic mental symptoms while the other would show none. Therefore, there must be something inherent in the child which had been brought out by the factor which was common to all children. Thus both factors were important. " The voice of the master " was important when dealing with mental patients. During the 1914-18 war he had had a colleague in a mental institution who, when any case came in, gave the patient large doses of hyoscine b y
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injection, as he had found that it only needed one injection to keep them quiet ; the patients had such terrible nightmares, delusions and disturbance from that one injection that it was only necessary to go into the ward and hold up the syringe to quieten them. The voice of the master was certainly heard there. Dr. Kennedy had been disappointed because a case in which he had given hyoscyamus had not responded as he thought it should. I t was well to keep in mind that what one ordinarily would, from the homceopathie standpoint, consider a massive dose might be regarded as the optimum dose in a particular case. At any rate he had had an experience of seeing an alcoholic maniac and wishing he had had some hyoscine hydrobrom., but he had with him nothing of the kind. So he went to his homceopathic ease and gave the man two granules of Hyoscyamus 30 in sterile water by injection and got the most startling result'. The patient quietened down and went to sleep--the reverse of Dr. Kennedy's experience. Taking it on the whole, the paper had been discussed from many angles, which was exactly what was hoped for. Dr. GLADSTOI~Eregretted that he had seemed depressing. I-Ie felt that he had given a slightly one-sided picture with the object of arousing interest in what went on in these days when there was a tendency to acquiesce a little too much in the orthodox school. In a recent number of the British Medical Journal the author of an article stated that he had been doing research on fibrositic disease of the breast and confessed that he had removed both breasts from six of his patients who complained of pain there, and that the pain had afterwards appeared somewhere else in the body. I-Ie had performed that operation on six patients and there was no sense of having acted wrongly. There seemed a need for an awakening as to what happened in that way. Leucotomy could make a patient completely demented, and yet there was a tendency to keep on doing that operation in the early eases. Apparently in another hospital cases of anorexia nervosa had been treated by leucotomy ! Depressing he might have been, but it really was necessary to fac~ facts. It was qui~e right to say that the whole tendency of modern civilization, the background of religion, and so o11, was of great importance. A speaker had touched on the question of the relation of mental patients to the normal individuals, from the point of view of how much it cost the normal person to have to take care of those who were abnormal. I t was an important aspect of the problem. If asylums were run on wrong principles they resulted in a chronic mental hospital population, and that would be even more expensive than treating the patients on sounder lines. I t was a matter of dealing with those who fell below the general level, whether through mental defect, mental disorder or criminality. Of course it would, be wrong if so much were done for those folk that what should be done for the normal person became neglected. On the other hand, it was an important task for humanity to try to bring those sufferers back ir~to the general community, a task for which certain types of individual would be willing to make sacrifices in order to carry it out. The importance of the work which had been described by Dr. Koenig could not be over-estimated, for if difficult children were.neglected they might cause a good deal of trouble. One had only to think of ttitler--a mental case which had ended in the gaining of power and causing an enormous convulsion. As to anmsthetics, they upset the whole relationship of the body and soul, and could certainly bring on mental illnesses. Many women who had had anmsthetics in childbirth became mentally ill as a result of this. Dr. Gladstone added that when he was at a general hospital in the East End a cleaner there had a gastric ulcer and the surgeon did a gastroscopy as a result of which the woman became acutely depressed and had to go into a mental hospital. I t was discovered that she had been there before, had recovered and then worked for five or six years in the hospital ; having had the gastroscopy, she had had to be
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sent back to the mental hospital. Operations and aneesthetics were undoubtedly dangerous for people who have a tendency to mental illness. Dr. Gladstone could not agree that shock treatment shortened mental illness ; he thought it prolonged it. I t actually replaced one set of symptoms by another. Patients recovered from the one illness as a result of the shock, but they had to return and have further treatment. The longer the treatment the greater the damage to the brain, so that they ultimately became intellectually very feeble. He thought Dr. Kennedy's experience was due to the fact that it was sometimes necessary to choose the remedy for a mental case on the physical symptoms and not the mentals. Apparently he chose it on the strong mentals, and it was not effective. If he had looked more at the physical symptoms of the patients he might have found the right remedy. The PRESIDENT said that Dr. Gladstone's mention of anorexia nervosa had called to his mind that recently a colleague at a clinical evening at the Scottish Branch of the Faculty had given details of a case. A girl of 16 had been the round of all the hospitals and had finally been dismissed as being beyond the power of recovery. The girl had come to the notice of Dr. Gladstone Robertson who psycho-analysed the ease. The girl could not keep anything down at all. Some time after Dr. Robertson had analysed the case the mother came to him and asked him to see her daughter again, and the girl said : " I have been thinking : if you get m y mother to take back my father I will not be sick again ". Dr. Robertson then saw the mother and heard her story : that she married quite young ; she did not love her husband ; she had had nine children ; she had become " f e d up " because he began to go to public houses and she eventually turned him out of the house and told him not to come back again. IIe had been absent for a number of ye0rs. I t appeared that he had arrived a few weeks previously and wanted to be taken back again and the woman had again turned him out. That corresponded with the actual date when" her daughter started being sick. On going into the girl's history Dr. Robertson found that at 12 years of age she had had a similar attack. That was when the father had been turned out of the house. Then the sickness had passed over. When the girl, who" was now 16, had had explained to her the hardships her mother had suffered, she had said : " It's all right, Mother ; don't take him back and I won't be sick again ", and she was not ! All the other children in that family had been exposed to the same circumstances, but that girl was the only one who had put up that particular symptom. There was no doubt that psychological shock had had something t o do with her condition, but there was another factor : the psychological shock had so upset her biochemical balance that she became ill. There was clearly some relationship between mental and physical conditions. Dr. Gladstone had said that the psycho-analysis laid stress on the mental health of the child, and in this cormection the President recalled that in regard to constipation of children the psycho-analyst had offered the explanation that the child was constipated because his fmces was his only possession; that during the day the nurses or the mothers took everything away from him and he was therefore going to hold on to his fmces. That was the cause of the constipation ! He could hardly accept such explanation. Finally, the President expressed indebtedness to Dr. Gladstone for his interesting paper and thanks to all who had joined in the discussion.
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T H E P R O B L E M OF MENTAL I L L N E S S By THOMAS H. B. GLADSTONE, M.B., B.S., D.P.M. MR. PRESIDENT, LADIES AND GENTLEMEN,
THE subject which we have to discuss to-day is of very great importance since mental illness is so much on the increase, particularly in this country and in the United States. I t is one which concerns us particularly as homceopaths because there is no homceopathic institution in this country to deal with such cases. This means that if we have a mental patient who is so bad that he cannot be looked after at home, we are obliged to surrender him to the tender mercies of the orthodox practitioner and are unable to go on treating him homceopathically. The whole environment and social circumstances under which peopl 9 are treated for mental illnesses are badly in need of reform. Many of you have probably seen the vast barrack-like institutions often housing from 1,000 to 3,000 patients. Within these places mild and recent cases are often herded together with chronic incurable patients. The wards are usually all locked and there is a clash of keys whenever a doctor or nurse enters, which emphasizes the sense of imprisonment. There is a terrible sense of frustration, boredom and aimlessness in the existence of the inmates. Many spend the whole day walking aimlessly up and down and give one the impression of animals shut up in a zoo or fish swimming aimlessly up and down in an aquarium, rather than human beings. Frequently also one finds the wrong type of nurses ~n such institutions. The male nurses are often men who have served their term in the Regular A r m y and, finding nothing better to do on release therefrom, they have taken up this type of nursing. On the other hand, one does see a better type of nurse in these institutions. Nevertheless, there is room for improvement, as instanced by the following experience I had when working in a mental hospital A nurse developed a method of treating a somewhat troublesome patient by simply keeping him sitting on a small chair. Whenever he tried to rise from it he was pushed back on to the chair ! That had been going on for about twenty years. Imagine the effect of it on the mentality of the patient. In fact, I would go so far as to say that the chronic mental patient is often a product of the modern type of mental hospital. The most hopeful factor in treatment, so far, is the occupational therapy department, though the occupations are still very limited : woodwork foI male patients and probably only knitting and needlework for the female patients. There should be the inclusion of artistic occupations: weaving, painting, pottery, gardening and so on, all of which would help to direct the attention of the patients away from themselves and really train their will-power. Most of those who axe mentally ill have little will to do anything whatever. Then there is the harmful effect of the hierarchy which generally exists in these institutions: the medical superintendent on a pedestal, so to speak; under him the assistant medical practitioners; and then the nurses and, finally, the patients. Between those groups there is no actual contact, from a co-operative point of view ; they are each completely isolated the one from the other. I n any mental home of the future it would be beneficial for all responsible for the treatment of the patients to meet together and co-operate to a greater extent than is now the case. There should be weekly meetings in which doctors and nurses can discuss the patients individually and consider the difficulties the patients have and the best means of coping with them. Again, very much smaller units would be beneficial. We shall never achieve any really satisfactory results in huge baxrack-iike buildings containing anything up to
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3,000 patients all herded together. About 100 patients would be the ideal maximum, The attitude towards the patients themselves will have to change. Too often they are regarded as just strange animals, or as outcasts rejected by society. That has a very bad effect on mental patients, especially those on the border-line. There is need for the development of a much more social atmosphere in which such patients can be received and helped. Unfortunately, some nurses seeing the terrible symptoms of mental illnesses fear that the same sort of thing may exist within themselves, and in order to protect themselves from it they treat their patients as if they were beings of a different species. I believe the modern educational system brings about mental illness; the system of competitive examinations and intellectual cramming is very much to blame for a great deal of mental illness which develops later in life. I t is quite common to find schizophrenics who have had a brilliant school career. One of the worst cases I saw in a mental hospital was a youth who had been a brilliant young architect. Being brilliant when at school their intellects have been forced and they have had to pay for that later in life. There has been an endeavour to prevent this happening by not allowing young students to take the school leaving certificate or matriculation at too early an age, but there are still examinations for the ll-year-olds as a result of the passing of which children are accepted either for a general or technical type of education. Because of that the schools and the parents are always urging on the children to swot for the examination. I t seems too often to be forgotten that a child can only absorb that which is suitable for its own age ; in fact, the child recapitulates the history of humanity itself, in that only certain subjects are suitable at certain ages. Every school should have a homceopathic doctor attached to it, because signs of mental illness can often be recognized during the school age, and if there is a school doctor who is co-operating with the teachers he is frequently able to give them advice which m a y prevent trouble occurring later. One final point. So many mental illnesses show themselves at a time when a young man or young woma n is reaching the age when he or she should leave home. Often there is an overbearing father or mother responsible for the state of mind of the young individual ; in other words, responsible for the mental illness of son or daughter. If one can only remove the young people from the home surroundings and atmosphere it is often possible to help them to avoid a complete breakdown. This is especially the case under existing housing conditions when even after marriage young people are often forced to remain at home for lack of a house. A hostel to which these young people could go and in which they could develop their own personalities would be useful. At present mental therapy is in rather a bad way. Usually a patient entering a mental hospitaI is at once put under the influence of some narcotic drug, as a matter of routine. Generally, the patient is put to bed, given the narcotic, and kept in bed for months. While that procedure provides an opportunity for physical examination of the patient, it does not help to improve or alleviate the mental condition. Another form of therapy is that of psycho-analysis. Nearly all mental hospitals in these days have some sort of Freudian psychoanalyst attached to them. As long as that is the case there will be another stumbling block to any real therapy of the patient. In the first place, the psycho-analysis is founded upon preposterous ideas of the mental life of the child, ideas for which no proof has ever been offered but which have been upheld as a sort of religion. If it were a mere question of theory it would not matter so much, but the practice of psycho-analysis has a bad effect on the patients because they are thereby taught to believe that all their troubles are dim to shock received in early childhood. The search for the shock continues for years and years, and 5a
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sometimes one meets with patients who have been psycho-analysed for eight years in am effort to discover whatever it is that is supposed to have occurred in their childhood. Even if some shock is discovered or an imaginary shock is invented b y the psycho-analyst, the patient, unfortunately, remains in the same state. Another bad effect of the psycho-analytical school is that it teaches patients to become tremendously absorbed in themselves, so that they are unable to take interest in anything or anybody except themselves. I managed to get one such patient to read The Times and give me an account of the foreign news each week as a means of attracting her attention away from her own troubles which had been all she could think of or talk about. Thirdly, the psycho-analysis often has a bad moral effect. A patient who had been psycho-analysed came to me because he was always getting into trouble through taking on a fresh secretary, divorcing his wife and marrying the secretary. This had happened three times and he was getting tired of it and was wondering if anything could be done to p r e v e n t iv. I found he had been taught by the Freudians that all his troubles were due to the fact that in his early childhood he had had a mother and a nannie. Because of this it had always become necessary for him to have two women attached to him. Once I got rid of this ridiculous idea he was able to arrest this process and settle down with his present wife. There is really no end to the absurdities attributed to children as a cause for mental trouble in l~ter life; one hears the most arrant rubbish. Leaving aside that particular sphere, the next thing which occurs to the mental patient is shock treatment which consists in giving a person artificial epileptic fits by passing electric currents through the forepart of the brain. This procedure developed from an attempt to treat schizophrenia, because it was known that epilepsy was rare in schizophrenics. I t was found that it did not deal with the schizophrenia at all, but arising from that it was discovered accidentally that the treatment had an effect on the mood of the patients ; that they became temporarily more elated and less depressed. That led to a wider application of shock therapy. I t is a destructive form of treatment which often does more harm than good. l~esults are only temporary and sooner or later further treatment becomes necessary, with the consequence that the patient is always going in and out of mental hospitals. The next stage is that the patient m a y have a leucotomy done on his brain, which is really an extension of the shock therapy ; the electrical shock damages the forepart of the brain, but leucotomy destroys the white matter altogether. While it is difficult to assess the results of this procedure, it is apparent that it seems to have a bad effect on the higher faculties of the patients. Those who have been suspicious and depressed may become absolutely carefree, but they do so by going their own way regardless of other people. I read an interesting record of the follow-up of some of these patients, and it was common for relatives to say that the patient did not seem to be the same individual ; that prior to the operation it had always been possible to appeal to his or her better nature, whereas following the operation there seemed to be no better self, and so on. It seems to me that those who are experimenting with this operation Scarcely know what they are doing. I do not propose to say much about the mental symptoms of homoeopathie drugs because you all know much more about that already. We all know the effects of drugs such as Belladonna, Hyoseyamus, Nux vomica, Ignatia, Aurum and Argentum nitricum. Hahnemann pointed out that in mental cases the physical symptoms are the most important in contrast to cases of physical illness, and I feel that we have come too much to regard mental illness as something t'o do with the brain, and only~he brain. We have to consider the whole body, to ~'onsider the mind as Connected with the entire body; not merely With the braitl; By ascertaining the cause of the disease of physical organs one m a y
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get to the bottom of the mental illness. I f it is possible to find the right therapy for the physical process, it will have a striking effect on the mental condition and symptoms. I remember a case in which a man had a series of minor strokes and was gradually becoming quite demented ; he was drowsy and somnolent and had all sorts of absurd ideas. I treated him homceopathically according to his mental symptoms without any great success. Then one day I was called to him because his wife thought he had pneumonia ; he had a high temperatm-e and seemed very ill indeed. I discovered that he really had acute cholecystitis. I gave him Chelidonium for that and from then onwards he began to recover. Though not yet completely well he is able to get up and about and his mental condition is very much improved, although I do not feel that he will ever be qiuite normal. I think some chronic processes which m a y have been going on in the gall-bladder accounted for his mental symptoms, and when he was given a medicament to suit that his mental illness improved. Another case was that of a man who had paranoia ; he thought he was being pursued by a gang, and he was quite wild, shouted at the top of his voice, and had strange religious delusions. On examination I found he had some signs in his lungs, and on the basis of that I gave him Phosphorus. If I had had to depend entirely on his mental symptoms I might not have chosen that drug ; at any rate, it seemed to bring about what his wife described as a mental revolution. He did not recover completely; he still is paranoic to a mild degree, but he did not have to enter a mental hospital and has lived a comparatively normal social life since the treatment. When it is necessary to treat the nervous system it m a y be useful to give medicines via the skin, because the latter is so closely related to the nervous system. That relationship has been recognized, to a certain extent, by orthodox practitioners because they used to treat tabes by the inunction of Mercury. That was found to be better than giving the drug by mouth. The rubbing of it into the skin produced the effect which they could not produce as a result of giving it by mouth. That is a matter in regard to which a good deal of experiment could be done. For instance, if Copper is rubbed over the part of the brain in which the centres controlling micturition are situated, it has a wonderful effect on a child with incontinence of urine. ] think these are the main points I wanted to bring to your notice.
DISCUSSION Dr. D. M. FOU~ISTER asked did Dr. Gladstone think that by changing the environment of a child with a tendency to schizophrenia it was really possible to prevent that arising sooner or later. Dr. GLADSTONE replied that if a child had a strong tendency to schizophrenia something would eventually come out, whatever the environment, but it might be possible to prevent it reaching such a point at which it became an actual mental illness. For instance, those with a " schizophrenic personality " did not necessarily actually become schizophrenic. He thought one could prevent schizophrenia completely if one could completely reform the present type of education. Dr. W. LEES TEMPLETON wished to thank Dr. Gladstone for his address but was sorry that it had been so depressing, perhaps too depressing he thought, though many of the criticisms were justified. He had hoped that Dr. Gladstone would have offered some constructive, ideas for the solution of this very important problem. He preferred to call it mental balance, for he thought that was how it should be considered, feeling that, if it were, something constructive might be obtained. If mental balance was the crux of the whole matter, what was it determined such balance ? We were all incipient homicides and suicides. All had similar 5B
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moments when we might be either. W h a t was it determined that we remained incipient ? Surely it was the result of m a n y factors. Some of the most highly educat.ed people broke down perhaps because of the type of education or its very nature. Not altogether training, for, again, all types from all classes, even including the medical profession, were to be found in mental institutions. There was the question of religious training. That, he felt, was of the utmost importance, and its present-day lack indeed might be one of the important factors in the increased incidence of mental disease throughout the world. It was rarely the big catastrophes of life which determined mental breakdown but rather the everyday affairs which the incipient mental patient was unable to tackle. Dr. Gladstone had criticized the atmosphere of many mental institutions, but his advocacy o f luxurious sanatoria, whilst ideal, was scarcely practical~ unless it was to be that the sane members of the population were to be saddled with an intolerable burden for the sake of the insane. (It used to be said that if one were to be a pauper it was always better to be an insane pauper !) But this led one up to the question of the value of shock methods of treatment which Dr. Gladstone said did more harm than good. He, Dr. Templeton, did not agree with this entirely. Viewed from the social angle, as, e.g., when penicillin and sulphonamide treatment was judged to be superior, not because it was the best method, not that it was even the method of cure, but that it rendered the patient non-infectious to his fellows. Shock therapy in many cases made it possible for the " impossible " patient to recover so far that he could be nursed at home. From the social angle that was, of course, important, but was it all-important ? Leucotomy also was of similar value. I t was stated that in the chronic states of melancholia there was a one-way tract along which the " depressed " complexes ran. Cut the tract and the chanees were that the depression would be rendered invisible. This he felt was one reason why such chronic states (and here he would include epilepsy) were not amenable to treatment, especially homceopathie treatment. There was a one-way tract which had beeome " the permanent way ", and only something violent or mechanical would be of any value. I t was a etude method, but it worked. Dr. Gladstone had criticized the discipline in mental hospitals. B u t surely he would admit that with a disturbed mind, an unbalanced mind, discipline was not only necessary, but was actually a form of treatment. He can recollect being called to a patient (sent out on trial) who every day was ehasing his relations round the house. When he arrived he, Dr. Templeton, simply snapped his fingers and said, " Into bed " , and he went like a lamb, recognizing the voiee of the master ! Was this to be deprecated ? He for one did not think so. Obviously the undisciplined mind must be disciplined not by force or eruelty, of course, but as at school, by training. Here he wanted to mention the danger of modern cramming methods for scholarships. This was liable to cause breakdowns, and though he was no believer in the ultramodern method of allowing the child to do only what it wanted to do, there were limits even to this. Given a balanced child, balanced because the home atmosphere and training were good, many of the alleged causes did no harm at all. Often the alleged cause was only the last straw. Dr. Templeton agreed with Dr. Gladstone's plea for more occupational therapy. He had studied a series of schizophrenies and not one of them was a manual worker. All were of the white collar class and of the semi-educated pseudo-intellectual type. No one was really trained for anything. He wondered if this too (for the trend again is away from manual training and oecupations), was responsible in part for the increase in mental disease. But he did not like the suggestion about hostels. Most individuals liked privacy and should have the ch0iee at any rate. He for one did not like the
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communal life, but of course some did. He felt that those who liked it were less self-reliant. The other type was more self-sufficient. Bug apart from early training, as far as treatment was concerned he felt t h a t one must get the ease early ; for once the one-way tract was established it was nearly impossible to alter the trend. We all had our successes in the early case. One recently, a. religious mania, which if he had not improved quickly would most certainly have required institutional care. He was driving his wife and family to despair. He did not sleep, and no one else did either: He had a peculiar symptom " that he himself was Christ ". Cannabis indica is the drug which has this in the Repertory. I t was given in the 6th potency and in a week he returned quite relaxed, quite sane, and asked if he might return to work. Another, a woman in a most desperate state, actfvely suicidal. Her husband had been three years in hospital with war wounds. She had been left with the full responsibilityof the home and children. He was coming home the next week. She could not face him in this state of mind. She looked pathetic, trembling all over as if in fear. " Trembling as if afraid " he found a very useful clue to Opium. Opium she got (a 3 0 ) a n d returned all smiles and so grateful. I n conclusion, Dr. Templeton hoped that Dr. Gladstone in his reply would give some positive recommendations for the maintenance of mental health and balance. Dr. LAURENCE, referring to the question of sepsis, cited the case of a man who had been under treatment by various specialists for some two years for melancholia, which had become serious and acute for the last six months. The removal of a mouthful of septic teeth affected a complete cure in about six weeks. The effect of septic teeth on the mind was often more marked than their effect on rheumatism. What was Dr. Gladstone's experience of ansesthesia in producing a relapse in schizophrenic eases ? Dr. Laurence believed that it sometimes pushed the patients over the borderline again, as he had seen it happen once or twice. There was no question that shock treatment apparently shortened some cases of mental illness--at least the patients seemed to recover more quickly. Dr. LE HUNTE COOPER expressed his gratitude to Dr. Gladstone for his very interesting paper, and for calling attention to the shortcomings of the mental institutions at present existing in this country. His reference to the urgent necessity for such an institution, in which Homoeol0athy would take front rank in the treatment of these eases, was of the greatest possible importance. His, Dr. Cooper's, experience had convinced him that the number of mental cases in England would very greatly decrease if Hom0eopathy were more universally employed, and those eases which had to be dealt with in such institutions would have a far better chance of recovery if their maladies were dealt with on homceopathie lhles. I n commenting on the shortcomings of our present mental institutions, it was only fair to point out the immense handicaps these establishments were struggling against. To obtain a suffieieney of trained staff and nurses is impossible, and it is a matter for wonder that they are able to deal with the patients as well as they do. The difference between the old-fashioned, and homceopathie, methods of dealing with mental conditions was very dearly illustrated by a personal experience of his own. Some years previously, he had been asked by a family, which was then feeling its way towards Homceopathy, to visit a distant mental institution on account of a young girl rel0t~ve of theirs, suffering from schizophrenia, who had been treated at that institution for a considerable time. He found that the eondition arose, in the first instance, from mental strain continuing over several previous years, and was ushered in by sudden collapse and violenee, necessitating restraint in an appropriately furnished room, this being subsequently necessary from time to time.
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The mental symptoms chiefly took a form of religious derangement in the first instance, with semi-religious delusions. There were occasional attacks of rigidity and staring into space, often lasting an hour or more, together with loss of interest in life, and an occasional resort to bad language, but never with loss of temper. This girl had been so very tenderly brought up, and well educated, and was of so refined and gentle a nature, that it was a matter of the greatest surprise that she could have ever heard such language. These occasional lapses into Billingsgate " were similar to that which occurs in patients of equally refined dispositions when under the influence of a general anaesthetic. She was much troubled with voices ", which at times compelled her to do, and say, certain things which she had no power to resist. The absurdity of some of these orders was illustrated by one of them directing her to stand on a window-sill, some three or four feet from the ground, and throw herself back on to her bed. That she did this without any evidence of injury whatsoever was very remarkable, in that she fell flat on her back on to a mattress, b y no means soft, and with no springs beneath it. W h y she did not develop any evidence of a severely jarred spine was to him a baffling mystery. The worry and fear caused by the imaginary voices were a constant source of distresstoher. The continuance of this sort of existence in time produced a condition of apathy, with slow cerebration, rendering it most difficult to obtain answers to questions asked. She often showed complete indifference to the existence of anybody in the room, and her relations stated that she frequently did not recognize them, and even when she apparently did so, she would take little or no notice of them. During her m a n y months' residence at the institution she had been treated by insulin shock " on two occasions, each for about eight weeks, without any improvement. The two medical men in charge of the home both expressed their emphatic opinions that the case was hopeless, as everything possible had been tried. One good thing which had been done, and of which the speaker greatly approved, was the regulating of the bowels at the commencement of the case, it being a well-known fact that the majority of such patients are found, when admitted to such institutions, to be the victims of intense constipation; this causing auto-intoxication over a period of years, which he considered a most potent contributory cause of mental derangement. The senior of the two medical men offered it as his opinion that the one and only possible hope of improving the patient's condition lay in the operation of leucotomy. As he, Dr. Cooper, could not recommend such a procedure, and as her relatives refused to entertain the idea, he, Dr. Cooper, had an independent personal interview with each of the medical men, and put it tothemindividually that, as they had come to the end of their tether, and considered that nothing but rest and attention to the general health was possible in the future, t h e y might possibly entertain the idea of homceopathic treatment being tried. In making this suggestion he had been prepared for possible objections being raised, but not for the evidence of shock " produced in each of them b y such a proposal. They both showed great consternation, and vehemently proclaimed the impossibility of any such measure being attempted: Nor would they, for a moment, take the risk " of departing from the traditions of the establishment, and of employing a treatment of which they had had no previous experience. He then suggested that they might regard it as an experiment ", from which no possible harm could come. I t would consist merely in the exhibition of a remedy, the physiological action of which they were familiar with, and which would be given in intermittent doses at varying intervals, and so highly diluted that they would probably discount the possibility of its having any effect whatever, either deleterious or beneficial. "
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They, however, remained adamant in their decision, and it was agreed that the patient would simply be left at rest, with simple attention to hygiene, and no specific treatment, Thus, having a clear field at last, he introduced a unit dose of Hyos. 30 into some lemonade the patient was taking, and awaited results ! A possible slight increase in excitement, and general disturbance, seemed to follow, but not sufficient to have any real significance. Similar doses were administered, at from seven to ten days intervals, and after the fourth dose the patient began to show signs of taking some notice of her surroundings, the tenth dose being followed by a return of interest in life generally, with enquiries as to her absent friends and, for the first time, showing evident pleasure in the trees, flowers and scenery generally, outside her window. Next came a drive in a car, the country scenes filling her with an ecstasy of delight. All the old symptoms completely left her, and when the two medical men were asked to make a thorough examination of the case for their unbiased opinion, they gave it as one of " complete recovery ". During the successive years, from that time to this, this patient has continued absolutely mentally normal. Dr. C. O. KENNEDY said that during his period in the Royal London Homceopathic Hospital three patients had become delirious during the night. All had been treated hom0eopathically, but the strain for the medical and nursing staff and other patients had been very considerable. One was treated with Stramonium with little effect ; indeed, the patient was worse the second night. Hyoscyamus did not relieve him, although it was clinically indicated. I t was only on the third night after repertorization that Rhus tox. had been prescribed, with good effect. What was one supposed to do in such cases ? How long was it justifiable to allow a patient to continue in such a condition ? Narcosis would allow peace for other ill patients with greater certainty, at least for beginners. Another patient had come in suffering from poisoning and he had just laid in bed week after week taking no notice of anybody ; he reluctantly took the food as it was given him ; it was impossible to get any history from him ; he had not responded to any remedy and had made two suicidal attempts. In consequence, the patient had to be transferred to one of the observation wards of the L.C.C. He was now back at work, whether due to his experience in the observation ward or not the speaker could not say. Could Dr. Gladstone give some guidance for the approach to such cases ? Dr. Gladstone had Said that the psycho-analytical approach tended to make patients introspective. The speaker suggested that homceopathie case-taking might also make patients introspective, especially if it were repeated. He had in mind one or two patients who were definitely introspective, probably due to this. Dr. L. R. TWENTYMANsaid he would like to add a little to the pessimism about which Dr. Templeton had been so disturbed. He believed it true to say that of every twenty people in the United States of America one spent part of his or her life in an asylum. That seemed a serious state of affairs when one considered that for every one of those people there were probably several relatives who probably did not go into an asylum. So that one wondered where to draw the line between the sane and the insane. I t did not seem that the problem could be treated apart from the whole nature of present-day civilization, and he welcomed the fact that Dr. Gladstone had raised that issue. I t was obviously one which could be solved by producing more and more homes for the mentally sick and more people to look after them, otherwise there would be a civilization which was itself a lunatic asylum. Dr. Gladstone had mentioned some extremely interesting cases: for instance, that in which a patient with cholecystitis recovered as a result of the use of Chelidonium. There was possibly a somewhat different interpretation
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of that case. Was it the Chelidonium or was it actually the appearance of the cholecystitis which was therapeutic ? There were so many instances in one's experience in which a crisis during illness somehow seemed to enable the patient to come through and enter into a new period of their life. Possibly very often the appearance of an illness such as cholecystitis meant that either the mental illness had worked down into the gall-bladder, liver or whatever organ it might be, or the appearance of that inflammation had changed the forces and enabled the personality to be differently related to the organism. I t was important that Dr. Gladstone had drawn attention to the mind, or soul, or whatever one likes to call it, in relation to the different organs of the body and not simply to the brain. Illness or local pathological changes in various organs should be much more closely considered a n d s t u d i e d from the point of view of the different type of mental disturbance which came with them. A book published by a homceopath during the last century had a most stimulating title, The Human Body and its Connection with Man, in which book the author, James Wilkinson, discussed the various organs of the body and their complexity and relation to the different faculties and qualities of man. Finally, the Speaker expressed gratitude to Dr. Gladstone for drawing attention to that deeper problem in relation to man's experience in subjective life, from the point of view of the whole of the bodily organs rather than of the one called the brain. The PRESIDENT felt that the audience were indebted to Dr. Gladstone for calling attention to institutional defects. While he was speaking there had come to mind the l~udolf Steiner school about which some present knew and which seemed to be making great progress in this country. Some little while ago Dr. Koenig had lectured to the Faculty on the work being carried on for the mentally defective child, and anyone with experience of the Rudolf Steiner system could not fail to be impressed by the institutional and practical therapy employed in dealing with those children. I t was rather striking that educational bodies had been forced to recognize those institutions for the treatment of their mentally defective children and that they had actually contributed to the funds, so that children from various districts were being sent to those schools. Certainly some of the work produced by those so-called mental defect cases was above that which many considered the average in music or in art. i t seemed that the Rudolf Steiner school had found something that was lacking in the ordinary mental institutions in this country. The President had, he said, been interested in the case of cholecystitis and also in the fact that Dr. Gladstone had stated that Hahnemann had drawn attention to the point that in marked mental cases the physical symptom was important--rather the reverse of the general view. I t seemed, according to Dr. Gladstone, that when dealing with a mental case the physical symptoms became of prime importance. The work on the nosodes showed that it was possible to relate organisms to mental conditions. In the past, certain types of temperament had been associated with certain organs: the liver with melancholia and so on. The relation between the organs of the body and mental illness had been recogifized long ago. Dr. Templeton had asked how one was to retain mental balance, which came back to the whole problem of heredity and environment. Which was the more important factor ? Personally he thought them both important. When children were brought up in the same environment and were subjected to some particular shock in the home, one child would show quite characteristic mental symptoms while the other would show none. Therefore, there must be something inherent in the child which had been brought out by the factor which was common to all children. Thus both factors were important. " The voice of the master " was important when dealing with mental patients. During the 1914-18 war he had had a colleague in a mental institution who, when any case came in, gave the patient large doses of hyoscine b y
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injection, as he had found that it only needed one injection to keep them quiet ; the patients had such terrible nightmares, delusions and disturbance from that one injection that it was only necessary to go into the ward and hold up the syringe to quieten them. The voice of the master was certainly heard there. Dr. Kennedy had been disappointed because a case in which he had given hyoscyamus had not responded as he thought it should. I t was well to keep in mind that what one ordinarily would, from the homceopathie standpoint, consider a massive dose might be regarded as the optimum dose in a particular case. At any rate he had had an experience of seeing an alcoholic maniac and wishing he had had some hyoscine hydrobrom., but he had with him nothing of the kind. So he went to his homceopathic ease and gave the man two granules of Hyoscyamus 30 in sterile water by injection and got the most startling result'. The patient quietened down and went to sleep--the reverse of Dr. Kennedy's experience. Taking it on the whole, the paper had been discussed from many angles, which was exactly what was hoped for. Dr. GLADSTOI~Eregretted that he had seemed depressing. I-Ie felt that he had given a slightly one-sided picture with the object of arousing interest in what went on in these days when there was a tendency to acquiesce a little too much in the orthodox school. In a recent number of the British Medical Journal the author of an article stated that he had been doing research on fibrositic disease of the breast and confessed that he had removed both breasts from six of his patients who complained of pain there, and that the pain had afterwards appeared somewhere else in the body. I-Ie had performed that operation on six patients and there was no sense of having acted wrongly. There seemed a need for an awakening as to what happened in that way. Leucotomy could make a patient completely demented, and yet there was a tendency to keep on doing that operation in the early eases. Apparently in another hospital cases of anorexia nervosa had been treated by leucotomy ! Depressing he might have been, but it really was necessary to fac~ facts. It was qui~e right to say that the whole tendency of modern civilization, the background of religion, and so o11, was of great importance. A speaker had touched on the question of the relation of mental patients to the normal individuals, from the point of view of how much it cost the normal person to have to take care of those who were abnormal. I t was an important aspect of the problem. If asylums were run on wrong principles they resulted in a chronic mental hospital population, and that would be even more expensive than treating the patients on sounder lines. I t was a matter of dealing with those who fell below the general level, whether through mental defect, mental disorder or criminality. Of course it would, be wrong if so much were done for those folk that what should be done for the normal person became neglected. On the other hand, it was an important task for humanity to try to bring those sufferers back ir~to the general community, a task for which certain types of individual would be willing to make sacrifices in order to carry it out. The importance of the work which had been described by Dr. Koenig could not be over-estimated, for if difficult children were.neglected they might cause a good deal of trouble. One had only to think of ttitler--a mental case which had ended in the gaining of power and causing an enormous convulsion. As to anmsthetics, they upset the whole relationship of the body and soul, and could certainly bring on mental illnesses. Many women who had had anmsthetics in childbirth became mentally ill as a result of this. Dr. Gladstone added that when he was at a general hospital in the East End a cleaner there had a gastric ulcer and the surgeon did a gastroscopy as a result of which the woman became acutely depressed and had to go into a mental hospital. I t was discovered that she had been there before, had recovered and then worked for five or six years in the hospital ; having had the gastroscopy, she had had to be
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sent back to the mental hospital. Operations and aneesthetics were undoubtedly dangerous for people who have a tendency to mental illness. Dr. Gladstone could not agree that shock treatment shortened mental illness ; he thought it prolonged it. I t actually replaced one set of symptoms by another. Patients recovered from the one illness as a result of the shock, but they had to return and have further treatment. The longer the treatment the greater the damage to the brain, so that they ultimately became intellectually very feeble. He thought Dr. Kennedy's experience was due to the fact that it was sometimes necessary to choose the remedy for a mental case on the physical symptoms and not the mentals. Apparently he chose it on the strong mentals, and it was not effective. If he had looked more at the physical symptoms of the patients he might have found the right remedy. The PRESIDENT said that Dr. Gladstone's mention of anorexia nervosa had called to his mind that recently a colleague at a clinical evening at the Scottish Branch of the Faculty had given details of a case. A girl of 16 had been the round of all the hospitals and had finally been dismissed as being beyond the power of recovery. The girl had come to the notice of Dr. Gladstone Robertson who psycho-analysed the ease. The girl could not keep anything down at all. Some time after Dr. Robertson had analysed the case the mother came to him and asked him to see her daughter again, and the girl said : " I have been thinking : if you get m y mother to take back my father I will not be sick again ". Dr. Robertson then saw the mother and heard her story : that she married quite young ; she did not love her husband ; she had had nine children ; she had become " f e d up " because he began to go to public houses and she eventually turned him out of the house and told him not to come back again. IIe had been absent for a number of ye0rs. I t appeared that he had arrived a few weeks previously and wanted to be taken back again and the woman had again turned him out. That corresponded with the actual date when" her daughter started being sick. On going into the girl's history Dr. Robertson found that at 12 years of age she had had a similar attack. That was when the father had been turned out of the house. Then the sickness had passed over. When the girl, who" was now 16, had had explained to her the hardships her mother had suffered, she had said : " It's all right, Mother ; don't take him back and I won't be sick again ", and she was not ! All the other children in that family had been exposed to the same circumstances, but that girl was the only one who had put up that particular symptom. There was no doubt that psychological shock had had something t o do with her condition, but there was another factor : the psychological shock had so upset her biochemical balance that she became ill. There was clearly some relationship between mental and physical conditions. Dr. Gladstone had said that the psycho-analysis laid stress on the mental health of the child, and in this cormection the President recalled that in regard to constipation of children the psycho-analyst had offered the explanation that the child was constipated because his fmces was his only possession; that during the day the nurses or the mothers took everything away from him and he was therefore going to hold on to his fmces. That was the cause of the constipation ! He could hardly accept such explanation. Finally, the President expressed indebtedness to Dr. Gladstone for his interesting paper and thanks to all who had joined in the discussion.