Medicine
The mad gardener
John Linklater
An old lady was battered to death in her home in Liberty Hall Road, Addlestone, Surrey, on July 23 after her husband had been released from psychiatric care for weekend leave, thus adding one more gruesome story to a saga of events nowadays all too common to the daily press. An inquiry is to be held and blame, or absence of blame, apportioned. Some.reguladons will no doubt be re-written or re-phrased to satisfy public demand that action should be seen to be taken, and the incident will then be closed.
Comment on incidents of this nature appears to be equally divided between those who are ready to blame the psychiatrist for his failure to protect the public and those, like the International Commission for Human Rights, who believe that a patient should be free to enter and leave a psychiatric hospital at will unless he has actually already committed a crime for which imprisonment would otherwise be appropriate.
There has been much talk recently of the civil rights of mental patients, as if civil rights existed as an inalienable, unconditional, entity which descends upon the human being at conception. In fact, civil rights form part of a two way contract which includes not only rights but also civil duties. When a man is no longer capable of carrying out his duties or fulfilling his obligations, then he forfeits for the time being a just claim upon his full rights.
The do-good organisations which stress the civil rights of a man whose judgement may be so gravely impaired that he is likely to become a law breaker, forget that he is restrained not only to protect the public, but also to protect him from the consequences of his own actions. Like most organisations which exist ostensibly to protect minority groups at the expense of the nation as a whole, they loudly and perhaps unwittingly advocate a policy which ultimately gives that minority group a favoured position with respect to the rest of society. A dele gation from such an organisation is reported in the press es having been able to carry out an in spection of SevereIls Hospital near Colchester where they interviewed patients. Such patients would not easily have been able to grasp that the delegation did not possess any official medical status and it is ironical that the basic right of patients to privacy was denied in the very act of subjecting them to an interview without true, free consent.
With considerable press and television support, such vociferous bodies create an atmosphere in which a psychiatrist who would previously have detained a man of unsound mind as a potential public danger, and therefore a danger to himself, nowadays tends to fall into line and, reflecting what he feels to be the climate of public opinion, allows the patient his freedom from restraint. In doing so, of course, he denies the rights of the public at large, to be fully protected from the insane.
In addition to external pressure,. psychiatrists also find themselves subjected to government pressure to reduce the overcrowding in psychiatric and subnormal hospitals by discharging patients, and thus making a somewhat rosier picture of the statistical returns. Senior government officials have recently drawn attention to the well-know fact that subnormal long-stay patients still have less varied food, worse accommodation and less medical attention than patients in acute wards. It is presumably intended either to spend more of our national resources in this direction or else to expand subnormal hospitals into acute psychiatric wards and to discharge as many acute psychiatric patients as possible.
Perhaps the death of the old lady of Liberty Hall Road was due to a combination of factors of which the most important was, neither the decision of a psychiatrist, nor an undue regard for the'supposed rights of one man at the expense of those of his fellows, but rather a widespread national loss of aim. The philosophy that underlies the rules of conduct in a western civilisation is based upon the Christian doctrine of duty and obligation and the ultimate equality of all men in the eyes of God. This has been extended to include the ideal of equality of opportunity, but it was never written that there would be an equal distribution of this world's goods to • all men. Commonsense dictates that if we were all doomed to have control over an equal share of good regardless of our value to the community, then humanity itself would ultimately lapse into the lethargy of entropy. It may be that the overt rejection of the Christian doctrine without any clear, coherent or integrated philosophy to replace it, is probably the reason for which we find ourselves in such a messy, middle-road, miasma of seeking to please all, and satisfying none.
We should be sorry for the subnormal and the insane and do our best to prevent subnormality and cure insanity but it is unrealistic to treat the psychopath, the psychotic and the demented under psychiatric care as if they were rational citizens free to come and go as they pleased in an agreeable holiday hotel. It is equally unrealistic to redirect yet more of our overstrained medical resources, including occupational therapy and education, to an unfortunate soul who may not even know what time of day it is, or whether it is day or night, and who is happiest if he is merely amply fed and warm and clean. This is sentimentalism of the worst order and a shocking waste of skills, wished on us by noisy, do-good, pressure groups.
It is rather like the Parable of the Mad Gardener who cut the -tops from the tallest of his delphiniums because they were too tall and stood out too brightly, and planted beds of dandelion, fat hen, twitch and ground-elder in order that they too should have equal rights and who, finally, before being dispossessed of his garden, had begun to mix and scramble all the seeds from all his plants and sow them at one ounce to one square yard, everywhere, in a crazily perverted sense of equal shares and fair play for all.
It may be that the subtle offshoots of dialectical materialism have confused us all with pseudoscientific explanations as to the meaning of life, so that many worthy medical men no longer adhere to the ancient beliefs of their fathers and find themselves easily led on by a chain of plausible arguments which end when a maniac is turned loose upon the public in the name of natural justice and equality.
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