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It conveys nothing to anyone's mind to say that the patient is queer; tell what he does or says that leads you to think he is queer, and let the physician draw his own inferences from the deeds or speeches. Write down, for example, that the patient talks as if answering voices that are imaginary; or that the patient brought an ax into the dining room and stood it against the table during the meal; or that he paraded up and down the lawn with a wreath of willow branches about his neck; in each case stating the actual fact. It is important to ascertain exactly what the patient's habits are, as to the use of alcoholic beverages, tobacco, and drugs (such as opium), and also as to sexual matters. To secure such information is extremely difficult, and the help of a close friend or companion will be necessary. After the mind begins to waver many a patient plunges into dissipation, though formerly a model of propriety.
The Causes of Insanity
The two great causes of insanity are heredity and stress or strain. Lunacy is not infrequent in children of epileptic, alcoholic, or insane parents, and those born of parents suffering from nervous disease frequently are in such condition that shock, intense emotion, dissipation, or exhausting diseases render them insane. Drinking alcoholic beverages is the most potent factor in the production of insanity. Mental strain, overwork, and worry come next. Adverse conditions, bereave
ment, business troubles, etc., rank third, equally with heredity. The arterial diseases of old age, epilepsy, childbirth (generally in the neurotic), change of life, fright and nervous shock, venereal diseases, sexual excesses or irregularities follow in the order named.
A Temperate, Virtuous Life the Best Preventive
To avoid insanity, therefore, one should lead a righteous, industrious, sensible life, preserve as much equanimity as possible, and be content with moderate pleasure and moderate success. In many cases, people who are neurotic from early youth are so placed that unusual demands are made upon them. Adversity brings necessity for overwork, duties are manifold, and responsibilities are heavy. In ignorance of the fact that they are on dangerous ground and driven by circumstances, they overwork, cut short their sleep, and, conscientiously pressing on, finally lose their mental balance and insanity is the result, a great calamity which is really no fault of theirs. Undoubtedly such is frequently the sad history; and for this reason, as well as for the general reason that the insane are simply ill, all insane should be cared for sympathetically. To consider the insane as constantly malevolent is a relic of the old-time, absurd belief that insane people were possessed of the devil." It is no disgrace to be insane, and the feeling of chagrin at discovering disease of the brain in a relative is another absurdity. Avoid
ance of insanity should be studied with as much devotion as avoidance of tuberculosis. Yet there should be no detraction from the fact that the heredity is strong. No one should be allowed to marry who has been insane, for the offspring of the insane are defective.
The tendency of the times is toward nervous and mental disorder. In the large cities the strain is too constant, the struggle is too keen, the pace is too swift. Haste to be rich, desire to appear rich, or ambition for social distinction has wrecked many a bright, strong intellect. This is the age of the greatest luxury the world has ever seen, and a large proportion of people in cities are living beyond their means, in the gratification of luxurious desires or the effort to appear as well as others. Stress and strain are voluntarily invited. Children are pushed in their studies and overloaded with too many subjects. Genius and insanity, worry and dementia, proceed among us hand in hand; the overwrought brain finally totters.
False Ideas Regarding Insanity
Curious ideas regarding insanity are common, and are apparently fostered by the reportorial writers of the daily papers. We read of people who are "insane on a subject." This is an impossibility. Many people can be drawn out and led into a betrayal of their mental condition only when a certain topic or idea is discussed. But although exhibiting their insane condition only
when this topic is broached, they are in no respect sane. Not every act of an insane man is an insane act, we must remember. Forgetfulness of this fact leads to errors in the superficial. You will hear people say that a certain person must be sane, because during a half day's companionship nothing astray was noticed. True, there may be a long period of self-control, or of absence of test; but occasional conduct will establish the fact of constant insanity. Again, we hear the expression : "He cannot be insane; there is too much method in such madness." The answer to this silly remark is that there is method in all madness except some epileptic insanity and terminal dementia. Insane people prepare careful plans, with all the details thoroughly considered, and perfect methods to escape from hospitals with the greatest cunning. One must never take it for granted that the insane person is so demented mentally as to be unable to appreciate what is said and done. One should never talk about the insane man in his presence, but should include him in the conversation as if sane, as a general rule, allaying his suspicions and avoiding antagonism. Do not agree with the delusions of an insane person, except so far as may be necessary to draw them out. Yet avoid argument over them. Simply do not agree, and do not strengthen them by appearing to share them. His food should be prepared for him, and his medicines administered to him as to any other sick person. His baths should be regularly taken.
A depressed patient should be very carefully watched. If the slightest suspicion of a suicidal impulse be present, the patient should never be left alone. Many a valuable life has been saved through the moral support of constant companionship; while we read very frequently of the death of an insane patient who sprang from a window during a brief period of relaxation of watchful care. Some people think it a protection to one insane to elicit from him a promise not to be depressed, and not to do anything wrong. One might as well secure a promise not to have a rise of temperature. The gloom of despondency and the suicidal impulse are as powerful as they are unwelcome and unsought; and the wretchedly unhappy patient cannot alone meet the issue and resist.
It is unreasonable to be offended by acts or speeches of an insane patient, to bear a grudge or expect an apology. Very frequently such a patient will turn savagely upon the nearest and dearest, and make cutting remarks and accusations or exhibit baseless contempt. All this conduct must be ignored and forgotten; for the unkind words of an unaccountable and really ill person should not be taken at all seriously.
Should a patient escape from home, it is the duty of the one in charge without hesitation to overtake him, and then accompany him or at least follow at a short distance. The nurse hould go with and stay with the patient, telephoning or telegraphing home when opportunity offers, and finally securing aid; he