<http://books.google.co.uk/books?id=l-oRAAAAYAAJ&printsec=frontcover&dq=Medical+Inquiries+and+Observations+upon+the+Diseases+of+the+Mind&source=bl&ots=L6DW8TZof8&sig=JPsgnUSiYMPwNW9Ycw4SXIgbNAU&hl=en&ei=sSTWS4yCJZT20gScrsXeDQ&sa=X&oi=book_result&ct=result&resnum=3&ved=0CA8Q6AEwAg#v=onepage&q&f=false>
Medical Inquiries and Observations upon the Diseases of the Mind by Dr.
Benjaman Rush and the version provided for free by the wonderful people
at Google is from 1835.
There's a short section on the moon and mania which prompted the
previous blog post below but the interesting stuff is always going to be
in the treatments. (from around P170 onwards)
There's some other really interesting stuff that makes for food for
thought. A treatment protocol for mania and an interesting contrast to
modern evidence-based clinical guidelines.
1. "The first thing to be done [in the case of mania], to accomplish
these purposes, is to remove the patient from his family and from the
society of persons whom he has been accustomed to command, to a place
where he will be prevented from injuring himself....(snip).......The
effect of thus depriving a madman of his libety has sometimes been of
the most salutary nature by suddenly creating a new current of ideas as
well as by the depression it produces in his mind." This seems sensible.
In a time when the mad were truly regarded as repulsive and sub-human
many doctor's wouldn't have looked their patients in the eye properly,
preferring instead to treat them like a slave or an animal.
2. This starts with "A second means of securing a deranged patient's
obedience to the physician should be by his voice." Its a long way off
from the state of dialogue between doctor's and patients, advocacy and
involvement we see today. However I suspect that some mental health
professionals even today would prefer obedience in their patients.
3. A stern expression is useful.
4. The conduct of physicans must be dignified. No jokes - laughing at
them or with them - ever.
5. Be truthful. I can really understand the value of this. There is
nothing worse than being deranged and being lied to. The anger in that
state, the heighten sense of justice, the madness, whatever, gets much
worse when I'm lied to. It is worst when coming from a doctor.
6. A physican should treat the mad with respect. This is actually
progressive thinking 200 years ago. Its about humanity and its about
remaining human - remaining the person you are before the madness. In
the rest of the passage he goes on to say "The great advantage which
private madhouses have over public hospitals is derived chiefly from
their conforming to this principle in human nature which the highest
grade of madness is seldom able to eradicate." The principle he's
talking about is being able to retain that life and that sense of self
that comes through our routine lives: the plates we eat off; the
familiar objectsl the habits we have.
7. The encouragement of kindness as a tool for the physican to gain
their patients trust. His example was the offering of....fruit cake.
Its actually not a bad list. Not great but for an American doctor 200
years ago its exceptional thinking. Dr. Benjaman Rush was an exceptional
man and his Wikipedia page has more of his great deeds
(http://en.wikipedia.org/wiki/Benjamin_Rush).
But he also advocated treatments that today would be considered
inhumane. This was actually how I stumbled across this book in a search
for some of psychiatry's misdemeanours. Instead I found something
interesting and with a degree of humanity in a book I assumed was to be
riddled with horrors.
There are horrors. I've gotten to the part where I read about
"tranquiizers" except they're an alternative to the "strait waistcoat"
and "mad shirts" used at the time. It's a confinement chair where the
individual is strapped down during their mania. A horrible treatment.
No comments:
Post a Comment