Insane Population Research Articles

Structural Racism in American Psychiatry and APA: Part 1

Structural Racism in American Psychiatry and APA: Part 1

Empathizing With the Criminally Insane

Arkham Asylum is home to some of popular culture's most notorious super villains. The neglect and inadequate care these villains receive mirrors a real-world context where mental illness is surrounded by stigma, misunderstanding, and poor rehabilitation rates. This study explores the less glossy niches between the action-packed button-mashing on the surface of a popular Batman video game Batman: Arkham Asylum. By pulling back the curtain over the routine treatment of Arkham Asylum's patients (also known as inmates), it presents a set of good practices for improving their care through more effective communication. Recorded audio interviews from the video game constitutes the foundation for this set of good practices tailored to the needs of the fictional facility. Narrative inquiry is used to pull these recommendations from the data. Based on narrative elements found in the data, this study recommends an empathy-driven and preventative approach to treating Gotham's criminally insane population.

The Front Comes Home: Returned Soldiers and Psychological Trauma in Australia during and after the First World War

This article uses the closed patient medical files from two large Sydney psychiatric hospitals to discuss ways in which the return of soldiers suffering mental illness, both during and after the First World War, impacted on Australian society. It argues that despite the intention of a ‘two tiered system designed to separate war trauma cases from a civilian insane population, this was not always adhered to and the results were often ad hoc. It further looks at resistance to, or acceptance of, medical diagnoses and treatment as well as issues that plagued some returned men well into the interwar years—violence, alcoholism, shame, and self-harm. While service in the war was deemed the cause of mental illness for some ex-soldiers, in many cases it was impossible to state with certainty that the war was the only cause.

7” long knife for 7 years in the duodenum: a rare case report and review of literature

Foreign body ingestion is a common occurrence both in sane and insane population. Quite a good number of interesting and unusual cases of foreign body ingestion has been reported in the surgical literature from time to time. Ingested foreign bodies varying widely in number, size and character, may travel through a distensible tube of comparatively small diameter causing mechanical insult to the intestinal wall without producing symptoms or permanent tissue damage. Accidental ingestion of the foreign body is by far the most common. Deliberate ingestion may result from an act of insanity, a dare, a habit or medicinal therapy. Retention of elongated or pointed objects in the duodenum is a frequent problem. Long, sharp, objects may perforate the duodenum and have been known to migrate widely in the abdomen. Early removal of such objects has been advised. This case forms rarity due to the fact that the 7 inches knife remained in the Duodenum for 07 long years without causing major catastrophe. From Medline as well as Medical library search we failed to find such a case report till date where the metallic foreign body has remained in the GIT for such a long time.

'A constant irritation to the townspeople'? Local, Regional and National Politics and London's County Asylums at Epsom

In 1908, The Times described London County Council's asylums near Epsom as ‘a constant irritation to the townspeople’. The article was specifically concerned with the patient walking parties that made their way into the town. This, and references to the site of the asylum, focused on the sense of imposition as local residents were forced to contend with London's insane population. As the ‘townspeople’ negotiated the impact of the asylums, the Urban District Council and Lord Rosebery, a former Prime Minister, were to play central roles. The aim of this article is to uncover the motivations of the Council and Rosebery and the roles that first the asylums and then their patients played in the development of their views. Ultimately, it will be argued that although the Council and Rosebery operated outside the management structure of London Asylums, they were able to instigate changes to the ways in which patients were managed.

Appendicitis in Private and Public Hospitals for the Insane

The excuse for a discussion on this physical affection in association with the insane mind is an attempt to prove by its rarity in county and county-borough asylums, asylums for idiots, mental hospitals and licensed houses of England and Wales, that it is preventable. In ten years from 1902 to 1911 there are recorded by the English Commissioners in Lunacy seventy-five deaths from appendicitis, typhlitis or perityphlitis, ascertained in the majority of cases by post-mortem examination, as having occurred among the insane population of the above institutions. and of the seventy-five deaths it would be instructive to know how many of these had the relics of this disease upon them or were suffering at the time of admission from acute or chronic symptoms. In making the statement that appendicitis is a rare malady in private and public hospitals for the insane, I do so with the support of several practitioners of psychiatry. Not only do these clinical observers give me their assistance, but further I have the help of the pathologist to the London County Asylum at Claybury who states, “I do not believe there has been a single case of appendicitis on the post-mortem table at Claybury since I have been pathologist. Consequently in more than 2000 post-mortems there has been no case.” In comparing the Claybury Hospital for the insane with two general hospitals, St. Bartholomew's and Guy's, we can make a valuable contrast. For instance, at St. Bartholomew's Hospital 1645 autopsies were made between 1909 and 1911, and of these, 69 were recognised as appendicitis. At Guy's Hospital in the year 1900, of the first 500 post-mortems 12 were recorded as cases of appendicular disease. As regards the proportion of cases of appendicitis to the number of admissions I find that at the same hospital in 1890 there were 8588 admissions. Of these admissions, 306 were subjects of appendicitis, 187 being under the care of surgeons, while 119 were under the care of physicians. The death-rate from appendicitis recorded in the Registrar-General's Report for 1909 shows a slight gradual increase from 1901 to 1909. Referring to other parts of the Kingdom in this investigation I find the statistical tables from the Lunacy Board of Scotland show that formerly deaths from appendicitis were usually returned as deaths from peritonitis, that appendicitis had no separate heading in the Board's tables of causes of death, and is not yet separately notified. If a case of appendicitis were returned it would be placed in the table of Diseases of Digestive System; but it has been ascertained that no death in a Scottish asylum has been returned during the past five years as due to appendicitis. Again the Blue Book of the Inspectors of Lunatics for Ireland in the issue for 1911 gives typhlitis grouped among the causes of death, but the table gives no return of the complaint for that year. and in the table there are only eleven cases of peritonitis. Likewise the Secretary of the Office of Lunatic Asylums, Dublin Castle, sends me the returns for typhlitis for the period 1902 to 1910 as follows: 1902, o; 1903, 1 male; 1904, o; 1905, 1 female; 1906, o; 1907, 1 male; 1908, 2, male and female; 1909, o; 1910, o—viz. five in all. and the cause was ascertained, except in one case, by post-mortem examination. With these figures for your guidance I would remark that in experimental research and statistical calculations, extreme care and accuracy should survive comment. But with the greatest attention and thoroughness that any of us can spend on the subject matter of a professional inquiry in medicine, exception will be sure to prove the rule.

The Housing of the Insane in Victoria, with special reference to Licensed Houses and Border-line Cases

When the Australasian Medical Congress met in Melbourne, in 1889, I dealt with “The Housing of the Insane in Victoria, with Special Relation to the Boarding-out System of Treatment.” Since then I have had ample opportunity of satisfying myself that such a method of caring for and treating the harmless insane is not suited to our colonial life. Much personal attention was given to this matter, and I was not satisfied with the results, the majority of the patients being in the care of officials of the various hospitals practically as servants. This was given a trial, as the official staff were practically the only applicants, not that I believed in the advisability of granting them patients. I ceased doing so, because it was evident the cases were taken for what could be got out of them, a circumstance which existed also with other applicants. This method of caring for our accumulated insane population being demonstrated unsuitable, we perforce fell back upon institutional accommodation for the chronic harmless cases.

Heredity in Relation to Mental Disease

In the following paper, dealing with the hereditary transmission of mental disease, my conclusions are based on a statistical review of 1200 cases of hereditary insanity admitted into the Cumberland and Westmorland Asylum during a period of thirty years (1865—1895). So far as I can ascertain, no analysis of such a large number of cases of hereditary insanity has hitherto been made by any one observer; there is, therefore, ground for the hope that results of value may accrue from such an investigation. One of the most important contributions to this subject is contained in a paper∗ by the late Dr. Hugh Grainger Stewart, which appeared in the Journal of Mental Science in 1864. That paper was based on the statistics of 447 hereditary cases admitted into the Crichton Royal Institution, Dumfries; the patients belonged mainly to the middle and upper classes of society, with a smaller number of pauper cases. The cases I propose to analyse were almost entirely paupers admitted from the general population of Cumberland and Westmorland. Private patients often come to an asylum from a considerable distance, and from beyond the limits of the district in which the asylum is situated; inferences drawn from the tabulation of such cases are scarcely likely to give so reliable a picture of the features of insanity in any district as when the cases analysed stand for almost the entire insane population of all the districts from which the patients come.

The Insane in Workhouses

Some time since, when moved to speak on behalf of the insane population of Irish Workhouses, I did not fully contemplate the many difficulties of the task before me; and now, when we are on the eve of promised legislative measures, it may seem unnecessary to enlarge on this subject, as it is to be presumed that the philanthropy which has urged the Executive to take up the cause of pauper lunatics in our Workhouses, has formulated a Bill embracing all that the heads of the Lunacy and Poor-Law Departments can suggest. Nevertheless, it may not be without effect to elicit from those present to-day, representing as they do the special knowledge of insanity in this kingdom—I may indeed say in Europe—some expressions of opinion on a subject which in one shape or another must have been presented to their observation in the course of their experience. In asking your attention I feel that the subject commands your sympathetic interest, as, of all others, you can fully realize the extent and malignity of the disease, and the urgency for suitable remedies.

The Propagation of Insanity and Allied Neuroses

For the past thirty years our insane population, as recorded in the annual Reports of the Commissioners in Lunacy, has steadily increased at the rate of over 1,500 a year, until in December, 1888, it had reached the alarming total of 84,340. Nor can even this large total be taken as at all fully representing the number of our insane. According to the census returns in 1871, the Commissioners' figures represented only 82·1 per cent., and in ‘81 only 86·5 per cent. of those returned as idiotic and insane; and when we remember that the census returns were made by fathers and heads of families more likely to under than overstate the numbers of afflicted in their households, we may venture to estimate that at present our insane population is fast approaching the enormous total of 100,000.

2. Dutch Retrospect

2. <i>Dutch Retrospect</i>

Presidential Address delivered at the Annual Meeting of the Medico-Psychological Association, July 25, 1889

Gentlemen,—I have chosen as the subject of this address a question which, though it is almost as old as the present system of treating the insane, has been revivified with so much vigour as to demand at our hands the close attention which we should feel bound to give to it had it been entirely new. I am about to offer you some remarks on what is called “Hospital treatment for recent and curable cases of insanity.” The reintroduction of this question is undoubtedly due to the necessity for the consideration of the great increase of the insane population; and it is appropriate in point of time; indeed, the time has been determined by the change in the composition of those bodies whose sanction and help are required for any new departure in this direction.

Insanity in British Guiana

From the short time at my disposal, and from not having beside me the complete records of the asylum, my remarks to-day must necessarily be more limited in their scope and desultory in their character than under other circumstances would have been the case. I must content myself with bringing before you, in a very general way, some facts relating to the proportion of insane amongst the different races and people which go to make up the much diversified population of British Guiana, and I may notice also a few of the more prominent forms of insanity seen in that colony. What I have to say may, I trust, possess sufficient novelty to be interesting, and may prove none the less suggestive, although its object be not to support any preconceived or pet theory. British Guiana, although a West Indian Colony, forms part of the mainland of the Continent of South America, and amongst its inhabitants is seen a diversity of races as great, if not greater, than in any other country of like extent. There are two large primary divisions into which the population may be separated, namely, those born in the colony—in local phraseology called creoles—and immigrants. In 1871, the date of the last census, the population of the country numbered 218,909, consisting of 103,775 creoles and 115,134 immigrants. Neither in these numbers nor in any subsequent calculations are the aboriginal Indians (bucks) included, who inhabit the interior of the Colony, and who do not supply any contingent to its known insane population. The first division or creoles comprises a very large population of blacks of fine negro blood, descendants of the local slaves of pre-liberation days and of black immigrants subsequently brought from Africa or the neighbouring West Indian islands. In this class are to be found the greatest number of the coloured people of mixed African and European extraction in various degrees of combination, with a few white creoles of pure European descent. Amongst the immigrants are included, firstly, the black and coloured people who have come from the other West Indian colonies, chiefly from Barbadoes; secondly, negroes born in Africa imported as free labourers, and who mostly belong to the West Coast tribes; thirdly, many East Indians (coolies) brought under indenture to work as labourers on the sugar estates; fourthly, a good number of Chinese, introduced for the most part under similar circumstances; fifthly, Portuguese who have come from Madeira and the Cape de Verde Islands; and, lastly, a comparatively small proportion of Europeans.

Insanity in British Guiana

From the short time at my disposal, and from not having beside me the complete records of the asylum, my remarks to-day must necessarily be more limited in their scope and desultory in their character than under other circumstances would have been the case. I must content myself with bringing before you, in a very general way, some facts relating to the proportion of insane amongst the different races and people which go to make up the much diversified population of British Guiana, and I may notice also a few of the more prominent forms of insanity seen in that colony. What I have to say may, I trust, possess sufficient novelty to be interesting, and may prove none the less suggestive, although its object be not to support any preconceived or pet theory. British Guiana, although a West Indian Colony, forms part of the mainland of the Continent of South America, and amongst its inhabitants is seen a diversity of races as great, if not greater, than in any other country of like extent. There are two large primary divisions into which the population may be separated, namely, those born in the colony—in local phraseology called creoles—and immigrants. In 1871, the date of the last census, the population of the country numbered 218,909, consisting of 103,775 creoles and 115,134 immigrants. Neither in these numbers nor in any subsequent calculations are the aboriginal Indians (bucks) included, who inhabit the interior of the Colony, and who do not supply any contingent to its known insane population. The first division or creoles comprises a very large population of blacks of fine negro blood, descendants of the local slaves of pre-liberation days and of black immigrants subsequently brought from Africa or the neighbouring West Indian islands. In this class are to be found the greatest number of the coloured people of mixed African and European extraction in various degrees of combination, with a few white creoles of pure European descent. Amongst the immigrants are included, firstly, the black and coloured people who have come from the other West Indian colonies, chiefly from Barbadoes; secondly, negroes born in Africa imported as free labourers, and who mostly belong to the West Coast tribes; thirdly, many East Indians (coolies) brought under indenture to work as labourers on the sugar estates; fourthly, a good number of Chinese, introduced for the most part under similar circumstances; fifthly, Portuguese who have come from Madeira and the Cape de Verde Islands; and, lastly, a comparatively small proportion of Europeans.

The Alleged Increase of Insanity

Six years ago I endeavoured to show, in a paper read before a quarterly meeting of the Medico-Psychological Association,∗ that there were not sufficient reasons to warrant the popular opinion, shared by some who had done more than accept a common notion without inquiry, that insanity was steadily increasing upon us year by year in this country; that, in fact, the undoubted great and rapid increase in the registered insane population of England was in the main to be attributed to other causes than an actual steady increase in the production of insanity. As the result of the enquiries, it seemed very uncertain whether we manufactured more madness now than formerly, but very certain that we take more care of, and know a great deal more about, the madness which we do manufacture. The conclusions reached were these:—

The Alleged Increase of Insanity

Six years ago I endeavoured to show, in a paper read before a quarterly meeting of the Medico-Psychological Association,∗ that there were not sufficient reasons to warrant the popular opinion, shared by some who had done more than accept a common notion without inquiry, that insanity was steadily increasing upon us year by year in this country; that, in fact, the undoubted great and rapid increase in the registered insane population of England was in the main to be attributed to other causes than an actual steady increase in the production of insanity. As the result of the enquiries, it seemed very uncertain whether we manufactured more madness now than formerly, but very certain that we take more care of, and know a great deal more about, the madness which we do manufacture.

On the Alleged Increase in Lunacy

Dr. Lockhart Robertson, in the April number of the “Journal of Mental Science,” raises the very interesting question whether the increase of late years in the registered number of the Insane in England and Wales represents an increase, real, or apparent only, in the amount of insanity amongst the population at large. After a laborious collection and study of the statistics relating to insanity, Dr. Robertson arrives at the conclusion that the increase is apparent rather than real—in other words, that the number of registered lunatics has largely increased, but that the amount of insanity amongst the population at large evidences a decline, particularly of late years. As a contribution to the study of this question, I venture to offer a few statistics referring to the insane population in the District of the County and City of Waterford.