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The Philosophy of Restraint in the Management and Treatment of the Insane

  • Robert W. D. Cameron (a1)
Extract

Only since advancing science has demonstrated the true connection between mind and body, and dispelled the illusory fancies of metaphysicians, has a rational philosophy sprang up regarding the nature of mental processes. The study ot psychology having at length been placed on a proper basis and freed from the spiritualistic haze with which it has so long been shrouded, there is now great reason to hope that much may be accomplished in elucidating the various phenomena of mental disease. No study of insanity that is not founded on a physical basis can be of any real value in throwing light on the many phases of mental disorder, or in assisting to a knowledge of the proper method of treatment and management of the insane. Experience is beginning to teach that it is mere futility to regard mind, as the metaphysicians do, as a fixed entity, and endeavour by a process of analysis to arrive at a true conception of it. This can only be attained by commencing with the study of mind in its simplest manifestations, and tracing its various evolutions until it is presented to us in its most complex form. Although we have no actual knowledge of the human mind in its most primitive condition, it may be supposed, in accordance with the evolution theory, that man first emerged from the level of the lower animal life at the time when he ceased to live in a state of isolation, and to depend for subsistence entirely on individual exertion, his mental capacity having become so highly evolved as to induce him to form associations for the accomplishment of purposes which should redound to the advantage of himself and others. Association is essential to civilization and progress, and has its origin in a more or less complete self-surrender of the individual to what is advantageous to the common weal; for there can be no combination of men for the accomplishment of any purpose without its necessarily involving a curtailment of individual liberty and the imposition of restraint. “Inasmuch as a large part of the nature with which man has to come into some sort of harmony is not what we call physical nature, but human nature, it is plain that a main business of his life will be to adjust his relations to his kind. That he cannot help doing in the rudest form of primitive society; the control of his own passion from fear of the recalcitrant kick of his neighbour's passion is a solid foundation of a primitive sort of social feeling; but in a higher development of the social organism his relations as a social element become much more complex and special. Sympathy with his kind and well-doing for its welfare, direct or indirect, are the essential conditions of the existence and development of the more complex social organism.”∗ Abstract ideas such as right and wrong, mercy, justice, &c., are all the outcome of man's social intercourse with his fellows, and vary in their significance according to the complexity of the relations which exist between the different units of the social organism. They do not always have the same quantitative and qualitative value, and are devoid of meaning except when considered in connection with some social system. The same holds good with regard to insanity, no true conception of its nature being possible except when it is viewed from a social standpoint. When a man is born he becomes a unit of a social system in a higher or lower state of civilization, and is endowed with certain natural aptitudes to conform more or less completely to the essential conditions of that system. The degree to which he can discharge his functions as a social unit will depend entirely on his original mental capacity, or upon that as influenced by education, or modified by disease or injury. To my mind it would be a philosophical view of sanity to regard it as a relative condition, taking as its measure the degree to which the individual, by virtue of inherent qualities of mind, is fitted to conform to the essential conditions of the social system of which he forms an integral part. Most certain it is that no real separation can be made between sanity and insanity; the one merges into the other, and no line can be chalked out where all on the one side are sane and all on the other insane. Any attempt to do so must end in failure, and this should be borne in mind by those who from time to time formulate definitions of insanity purporting to attain to such a consummation. For practical purposes, I admit that a line, arbitrary though it be, must be drawn somewhere, and as the question has important bearings on subsequent remarks, I shall proceed to indicate my views as to where sanity may be considered to end and insanity begin. If the individual can conform generally to the essential requirements of the social organization of which he is a unit, he may, broadly speaking, and for all practical purposes, be regarded as sane. If he cannot so conform without the aid of exceptional restraint or the operations of the penal code, then I consider he may truly be regarded as insane.

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Maudsley's “Pathology of Mind,” p. 99.

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The British Journal of Psychiatry
  • ISSN: -
  • EISSN: 2514-9946
  • URL: /core/journals/the-british-journal-of-psychiatry
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The Philosophy of Restraint in the Management and Treatment of the Insane

  • Robert W. D. Cameron (a1)
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