LETTERS TO THE EDITOR. - -
" BEHIND THE SHUT DOOR."
[To the Editor of the SPECTATOR.] SIR,—I have read with great interest your review of Behind the Shut Door and the leader it inspired, which have stimulated
me to draw attention to certain phases of. this . controversy. I have always been amazed at the stupendous apathy of the lay mind with regard to lunacy, which rr^ v be expressed in the following aphorism, "once a lunatic—always a lunatic." This mental attitude, I regret to say, is shared by a large number of my own profession, with the lamentable result that of all the classes of suffering people, less is done for those mentally disordered than for those afflicted with any other form of illness, for lunacy is just as much a disease—or rather a combination of diseases—as is cancer. How many hundreds of thousands of pounds are bequeathed and spent in stimu- lating cancer research, how few hundreds in studying the causes of morbid mental processes ?
So apathetic is the public to the cause of the lunatic that, as you state, nearly every lunatic asylum, be it public or private, is woefully understaffed and in nine cases out of ten the Medical Officer is himself imbued with the " nothing-can- be-done " spirit, and his energies, such as they are, are dis- seminated over so many cases that individual treatment is practically non-existent.
Now, lunacy is not a disease per se, but in every case a symptom of an underlying condition. In a small number of cases this is obvious, and gross structural damage to the brain Inevitably renders the case hopeless. In a far larger number the mental symptoms are due to bio-chemical changes in the body producing malnutrition and rendering the sufferer less able to stand mental stresses, and as each patient's reaction depends on the violence of the stress and the stability of the brain, a poisoned brain renders him the more likely to exhibit mental symptoms. Heredity is also an important factor in deter- mining the fall of the balance.
It is for this class of case that such an enormous amount can be done by research. The bacteriologist, the chemist, the psycho-therapist all have their functions and large possibilities, but how rarely are they called in and, how little research is done. The greatest advance in this direction is the bequest of the late Dr. Maudsley and the opening of the Maudsley Hospital.
This letter presents three pleas : First, to those who have the money, to endow research scholarships in the causation of mental disorders, in order to stimulate interest in a huge tract of unexplored country of which only the fringes have been touched as yet and into which only Sir Frederick Mott has made any serious inroad. Secondly, to those in authority, to insist on a more complete course of instruction in lunacy at the Medical Schools instead of the short course of lectures and demonstrations, which is all that is required now. Finally, for the establishment of Clinics for the treatment . of early cases of mental disorder—the so-called borderline cases— prevention being in lunacy, as in other things, both better and easier than cure.—I am, Sir, &c., DESMOND MACMANUS.
142 Ebury Street, S.W.1.
[We regard the plea for better training in the lunacy side of Pathology as of very special importance. The law places terrific powers in the hands of medical men, and yet, as Dr. MacManus shows us, it does not see to it that they have a training which will fit them for their duties.—En. Spectator.]
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