17 FEBRUARY 1923, Page 11

[To the Editor of the SPECTATOR.] Slit.,—The painful story of

an " Ex-Patient," which you published, surely must not be accepted as a complete state- ment of the facts. The incidents happened 35 years ago, and it is unlikely that the doctors and nurses concerned are available to give their testimony. In any case a satisfactory investigation, even if it were worth while, could hardly now be undertaken. Besides pleading for fair play and that no one, not even mental nurses, should be judged unheard, I should like to refer to the heading of the letter last week. Why is the door shut ? Why should not visitors be as welcome in a mental as in a general hospital and be permitted to see all that goes on ? The obstacle is not primarily with the mental hospital authorities, but arises from the demands of the public for privacy.

There is.here a conflict of interests. It is desirable that all hospitals should be open and there should be no concealment, and yet patients disturbed in mind have a right to reasonable privacy. Their relations demand it and the traditions of the medical and nursing professions respect this demand. It is recognized by law and the Commissioners of the Board of Control are sworn to secrecy. Where there is concealment there is risk of abuse. This is not merely a question of " private asylums," so-called, but the danger exists wherever• persons are detained, whether in nursing homes, the back parlours of private houses, or in public mental hospitals. So long as there is secrecy this risk appears inevitable, and the question arises whether it is not in the best interest of all parties that concealment of mental illness should be discouraged.

Long experience has shown me that relatives of patients make things worse by trying to hush up the facts. Their

trouble would be lightened if frankness were the usual attitude. Much misery is caused by trying to keep a skeleton in a cupboard, which, when brought to light, is nothing to be ashamed of. Mental affliction is, perhaps, the greatest trial that can befall a family. Come what may, occasions will arise when loved ones will have to be placed under care and perhaps detained. The natural dislike, of publicity and the possible damage to future prospects justify privacy, and yet the interests of the individual should give way to those of the community.

This is the problem as it occurs to me. Its solution is not easy and appears to depend upon the extent to which dis- interested service is forthcoming. The need is for personal service within the hospital and behind the door. I fear this will not be promoted by letters of the kind you have published. They create a prejudice against mental hospitals and sorely discourage the men and women now ministering to the needs of stricken humanity. Knowing as I do the devotion and self-sacrifice of mental nurses, I honour this branch of the nursing profession. We must not forget they undertake duties we shrink from attempting ourselves. Their work is onerous and often very difficult, and they are entitled to our