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PASTORAL PSYCHOLOGY
follow the physician’s advice. In some cases he may have
knowledge of the patient’s background and environment that
will weigh the judgment of the physician about whether or not
a patient can safely be left at large.
An American physician, F. I. Wertham,*! has compiled from
statistical and other material made available to him at the
the Henry Phipps Psychiatric Clinic of the Johns Hopkins
Hospital some most illuminating information about the attitude
of relatives to mentally diseased people.
During a period of eight years from 1918 to 1926, 2,758
persons received hospital treatment for longer or shorter periods.
Of these, 193 people—99 men and 94 women—were released
at the insistence of relatives against the advice of the physicians.
If we confine our interest to those patients suffering from
depressive psychoses, where religious broodings and delusions
most frequently occur as symptoms, it is notable that here is
found the highest percentage of releases against medical advice.
There are, of course, reasons for this. Manic patients are
usually very troublesome to their relatives while the depressed
arouse more compassion. Moreover, it is generally difficult for
the layman to realise that the slighter manifestations of
melancholia are of pathological significance. Again, the manic
patient usually adapts himself well to hospital life, while the
depressed person longs for home and can often convince his
friends that he will recover his happiness as soon as he gets there.
Wertham has very carefully analysed the influences that led
to the release of so many depressed patients against medical
advice. His findings are very striking. Out of 193 cases 47 were
released for a variety of reasons among which the attitude of the
family was the decisive factor. In 99 cases the family took the
initiative in demanding the patient’s release. In 10 cases the
family secured the patient’s discharge in defiance of his own
expressed wish to remain under hospital treatment. Thus in a
total of 146 out of 193 cases of depressed insanity the relatives
of the patient withdrew him from treatment against the advice
of the physicians who had him in their care.
There are, of course, many reasons why patients themselves
are unwilling to submit to hospital treatment, and may refuse
! “Discharges against Advice From a Psychiatric Hospital” (Mental Hygiene,
No. 3, 1929).
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