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SPIRITUAL CARE OF THE INSANE
it, when the degree of their illness does not warrant compulsory
certification. Sometimes the motive is pure egotism, sometimes
it is sublime unselfishness. The curious thing is that economic
motives seldom loom very large, according to Wertham’s
experience. The Phipps Psychiatric Clinic is able to take the
economic situation of the family into consideration when
assessing its fees, and this fact may well have weighed Wertham’s
conclusions. In general the economic aspect of the matter must
not be neglected. Whether a patient receives treatment at a
private clinic or state hospital his stay there, especially if he has
been a wage-earner, can occasion his family great expense.
There can be little doubt that in many cases this factor weighs
heavily and accounts in part for the desire to secure the patient’s
discharge as soon as possible. Moreover, it is also evident that
very often the patient himself suffers anxiety at the economic
consequences of his hospitalisation.
The Risks of Premature Discharge
It is of some interest to notice which members of a patient’s
family show most initiative in securing discharge against
medical advice. Wertham finds that of the 193 cases
investigated 74 were released at the request of wife or husband, 34 at
the request of parents, 17 at the request of brothers or sisters;
and in 33 cases several members of a family acted jointly. Only
` in 10 cases did children seek the release of their parents.
What are the risks attending the release of a depressed patient
against medical advice? Wertham says they can be exaggerated.
No doubt they can. Nevertheless they are there, and relatives
should be aware of them when they make decisions that will
perhaps have unforeseen consequences for all concerned.
Depressed patients are often suicidal. The writer knows of at least
one case where a middle-aged man with marked suicidal
tendencies was placed under hospital care for his own protection.
After a few weeks his progress towards recovery appeared to be
so marked that his physician yielded to his desire to be sent
home. On arrival there he went straight to the bathroom, took a
razor and cut his throat. The strong inference is that, exercising
the amazing subtlety in guile of which some insane people are
capable, he actually simulated sanity in order to secure the
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