Human activity is always conservative, and the sphere of mental medicine is patently no exception to the rule. Since the reaction took place from the callous and barbarous treatment of the insane we have progressed far, and are rapidly tending to regard the mentally disordered individual from a similar point of view as the physical sufferer. The late war has brought the problem of mental disease vividly to the notice of the laity, the medical fraternity have been stimulated thereby to take greater interest in the subject, while even many psychologists and psychiatrists have through war clinical experience become more humanistic in their outlook upon the psychotic patient. Following upon the special provisions which were made for those who broke down mentally in the service, there is much discussion as to what alterations should be made with regard to the care for the insane, and more especially those who are in an incipient stage. That some adequate provision must be made for early care and treatment hardly requires pointing out, for its absence is perhaps the greatest defect in the existing organization. Any real advance, however, in this direction cannot take place until a fresh generation of psychiatrists have had the opportunity of being thoroughly trained to understand the genesis and pathology of those initial symptoms with which the average asylum physician of to-day would be more or less powerless to cope. We have arrived at the stage in which we have built huge caravanserais in which the insane have an environment which leaves little to be desired for this type of system. Is it not possible that we have lingered so long at this stage in a self-satisfied way that the conclusion is reached that little more can be done to alleviate the lives of those who have become mentally afflicted? Is this extreme measure of segregation away from society the ideal to be aimed at for the treatment or comfort of the patients? Is it also good for the social community? To a large extent at present so-called treatment merely means institutional confinement.
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