to intelligent medical treatment and sympathetic nursing care which have been substituted for the old methods of neglect, restraint and cruel authority.

The modern hospital which has for its purpose the care and treatment of the mentally ill, has a staff of physicians who are specialists, a staff of nurses who are intelligent and trained in the care of mental disorders, beautiful and costly buildings with bright wards, dining rooms, living rooms and sun parlors, all made more cheerful and attractive by rugs, window hangings, pictures, books, plants, birds and musical instruments; laboratories for research, clinical, histological, psychological and X-Ray; departments of electrotherapy, hydrotherapy, mechanotherapy and occupation therapy; gymnasium, swimming pool, amusement hall, chapel, library, conservatories and centres of recreation and industry, golf links, ball fields, tennis courts, gardens, sewing rooms, shops, laundry, etc., many windows without guards and doors which are not locked, and large numbers of patients permitted to walk about the grounds unattended.

Here is provided for these patients not only a hospital, but all the features of community life which are essential to the development and maintenance of health, an environment which is especially adapted to their needs, where they are under the direct supervision of those who understand them and appreciate their condition, and know their limitations. Is it to be wondered at that mental hospitals today, even the largest public institutions have an atmosphere of cheerfulness, industry and contentment?

REFERENCES

"Insanity," Encyclopædia Britannica, art.

"The Origin and Growth of the Healing Art," Berdoe. "Institutional Care of the Insane," Hurd.

"Life of Dorothea Lynde Dix,” Tiffany.

CHAPTER III

SOME LEGAL ASPECTS OF MENTAL DISORDER

Insanity, meaning "unsoundness," is a term applied by the courts of law to conditions of mental derangement, and has been adopted generally to include all forms of mental illness. It is, therefore, a legal and social term and not a medical one. From the medical standpoint no definition of insanity is possible, for a person mentally ill may be entirely competent according to the Statutes which provide that the test of competency is the person's fitness to attend to the ordinary common affairs of life. The mental activity may be perverted or disordered in only one particular field, or limited to a single subject as shown by the impulse to do certain acts or by a particular delusion, and at the same time the patient may be quite capable of transacting business and be rational in all other ways.

It is only when mental disease disables socially, when the individual is unable to adequately cope with his environment and is incapable of making the ordinary adjustments in domestic, social and business relations, or commits an illegal act that the question of insanity is raised and his responsibility must be determined.

Responsibility has been held by the courts to mean that "the person is able beyond doubt to comprehend the nature and consequences of his acts, and has sufficient power of will to overcome impulses to commit crime."

While by far the largest number of individuals showing mental aberration are not in hospitals, and do not become really mentally sick, there are many whose symptoms are so severe that sequestration is indicated. Some of these patients have no insight or understanding of their real

condition and refuse treatment and resist admission to hospital; or if they enter voluntarily, will after a few hours or a few days refuse to remain longer and demand their release. Even though the patient may be a danger to himself and a menace to others the physicians and hospital authorities cannot detain him against his will, for under the Constitution no citizen can be deprived of his liberty and the control of his property without due process of law. In order to safeguard and protect the patient as well as promote the welfare of society, commitment or restraint by law is provided.

Commitment regulations are prescribed by Statute and the jurisdiction and procedure vary in the different states. These regulations provide in general that some relative, friend or person who assumes the responsibility of the detention makes formal application for the commitment of the patient. A time and place are fixed for the hearing and notice is given to the patient who has the privilege of appearing and contesting the proceedings. Some states require that notice shall be sent to the next of kin, although the interests of the relatives are at all times secondary to those of the patient. At the hearing the magistrate or other person or persons who may be authorized by law to act in that capacity, receives as evidence the testimony or the sworn certificate of two qualified physicians who have examined the patient, and if he is present he may be questioned. The usual evidence is that "the acts, declarations and conduct of the person are inconsistent with his previous character and habits." If this is proven by the evidence, a judgment of mental aberration or insanity is given, and the patient being a proper person to be taken charge of and detained for care and treatment," is committed under seal to a hospital which treats mental diseases. It remains for the physician to determine what form of mental disease he is suffering from, whether the condition is temporary or permanent, curable or incurable, and to prescribe such measures of treatment as will cure or improve his condition and so make

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him again returnable to society, or if his illness is of too long duration, or if the prognosis is unfavorable or grave, and offers little hope of a return to mental health, to at least bring to the patient's aid such scientific study and measures of treatment as will tend to make the rest of his life as natural and happy as possible.

An individual adjudged insane is held under the law to be incapable of assuming the responsibility of his acts, and is barred from becoming a party to a contract, acting as the executor of a will, and from making a valid will of his own. He is, however, held responsible for his debts and may inherit property. One of the duties of the nurse who has the care of patients mentally ill is to see that they do not sign documents or papers presented to them by relatives or clever and scheming persons without the full knowledge and consent of the physician.

The term of commitment is not decreed by the court but is to be determined solely by the condition of the patient. Whenever a patient or any member of his family, or other person directly interested, believes that he is unjustly and unlawfully detained, he may make application for release either by complaint or request in writing. In the judgment of the court a writ of habeas corpus may be issued to the person who holds the patient in custody, commanding him to produce the body of the patient at a certain time and place. The physician and frequently the nurse are required as witnesses and sometimes the nurse's daily notes and records concerning the patient are introduced as evidence.

When the physicians are convinced that the patient has recovered from his illness sufficiently to again take his place in society he is paroled or discharged. In the states where parole is in force the patient is placed in the custody of his family or some other responsible party for a definite period, during which he reports to the physician at stated intervals, and is visited in his home or place of employment by the social worker. In the event of recurring illness he may be returned to the hospital under the former commitment,

and further proceedings are unnecessary. At the expiration of the term of parole, if his condition is favorable he is discharged from the hospital and the commitment is no longer in force.

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Largely as a result of the mental hygiene movement and the campaign of publicity in relation to mental diseases the attitude of people has been changing, for they are learning that there are many forms and degrees of mental illness, and that a large proportion of those who are ill are harmless. The revulsion of feeling, shame and disgrace which were formerly aroused by and too often associated with the old terms "lunatic," crazy," and even "insane, insane," are no longer evident when ignorance has been displaced by knowledge of the true nature of mental disease, and a new terminology approved in medicine has replaced the old. The prejudice against mental hospitals which was formed and fostered by the horrors of the old asylums is also broken down as soon as people become familiar with the presentday hospital for mental patients where kindness, patience and sympathy as well as scientific measures of treatment, are now the chief factors in alleviating and curing diseases of the mind.

While legal denial of full liberty may be necessary in some cases, it is undoubtedly true that the mistake is still being made of requiring legal proceedings far too often, for it has been proven repeatedly that the majority of patients will willingly remain in hospital. In ever-increasing numbers these patients are voluntarily asking admission to hospitals and it is good to record that the unnecessary efforts to protect the "legal rights" of the patients are being less and less frequently made, and proceedings which brought into publicity the condition and suffering of the patient, as well as the anguish of the family and friends, are avoided, and the patient is not needlessly adjudged insane and stigmatized. The nurse is in a peculiarly advantageous position to help combat the force of tradition and overcome prejudice against mental hospitals which is no longer justified, and to dis