concerned, though it might have been avoided had there existed a social agency, either as an adjunct to state hospitals or otherwise, to obtain suitable employment for such as could not readily find it of their own accord.

(b) Financial Relief to Families of Patients. The number of cases that had to be referred to a relief agency were not very large. Several families in which the father and wage-earner had been ill for a considerable time were already known to the United Hebrew Charities, the Jewish relief organization, and it was merely a question of referring the family for further financial assistance until the patient was discharged from the hospital and was able to reenter industry. Other families, unknown to any relief society, had to be taken under care while the wage-earner was confined in a hospital. Usually the relief given was either a subsidy to make up for an insufficient family income, or, where there were no wage-earners or relatives to call upon, the relief agency had to assume the full financial responsibility as best it could. Due to the understandable hesitancy on the part of recipients of financial relief to disclose the extent of the aid given them by the United Hebrew Charities, it was often impossible to obtain accurate facts concerning the amount of relief granted in particular cases. In the year 1919 the United Hebrew Charities spent on families of the insane 4 per cent or $12,400 of its total expenditure for relief. Of recent years there has been some agitation carried on to make the provisions of the law granting a pension to fatherless children who remain at home under the care of their mothers, applicable also to children whose fathers have been committed to a state hospital for the insane. Under the provisions of Chapter 700, Laws of 1920, the Legislature of New York provided that "a board of child welfare may in its discretion, grant an allowance to any dependent mother whose hubsand is an inmate in a state

institution for the insane." This law became effective

July 1, 1920.

(c) Dependent Children Committed to Orphan Asylums. Aside from the problem of financial relief of families in distress, there was the question of the disposition of minor children. The difficulty was most acute when the mother of young children was committed to a state hospital. The social service department in Bellevue Hospital helped to provide for and refer to proper agencies most of the children in need of being placed. Some of the ways used to dispose of such children properly are herewith enumerated, different methods having been found necessary in different circumstances. Children were boarded together with the father during the illness of the mother and until her discharge from the hospital; children were committed to the Hebrew Orphan Asylum, the Hebrew Sheltering Guardian Society and the Hebrew Infant Asylum, through the Department of Public Charities (now the Department of Public Welfare); the father paid neighbors to care for the children; boarding homes were found for the children, the father paying for their care; and children were taken in by relatives. The records of the Hebrew Orphan Asylum indicate that out of approximately 1,200 children, 12 per cent have been committed there because of insanity on the part of either parent; at the Hebrew Sheltering Guardian Society, with a population of about 525 children the percentage is 5.1; while of 350 infants at the Hebrew Infant Asylum 11.5 per cent are there because of insanity in one or both parents. In presenting the above facts regarding the social condition of paroled and discharged patients, the attempt has been merely to indicate what some of the problems are that beset families in which insanity overthrows the social or economic stability of the group. It was not intended that a detailed social study should be made of all the families

concerned, for such a task would not only require a great deal of space, but would also prove quite valueless, as practically all the salient points involved have already been brought out and mentioned. In the following chapter, in which individuals and families are studied in greater detail, the methods employed to meet the mental, physical, social and recreational problems that arise in families in which there is an insane person, are discussed at greater length.

XIII. RECREATIONAL OPPORTUNITIES

Very few, if any, of the patients and their relatives who were interviewed in making this study, realized the important part that proper forms of recreation could be made to play in the improvement and recovery of patients considered sufficiently well to be returned to their former environment. The attempt was made to obtain the facts pertaining to this particular phase of the problem as a whole by asking the following questions: What is being done to provide recreation for the patient; how does the patient spend his spare time; is there any improvement in the sociability of the patient since discharge from the hospital; what agency, if any, is helping the patient to readjust himself along recreational lines, and how; what needs for recreation are not being met. As a matter of fact, it was hardly worth while to ask any but the last question, for in nearly every instance there was a total lack of understanding and appreciation of the therapeutic value of proper forms of recreation. It was furthermore found that the needs of the patients were not being met, and that no agency was interested in helping such patients to grapple with their specific problems. Of the four divisions, namely, the mental, physical, social and recreational, the latter was discovered to be the most neglected field of service, one in which no effort was expended to help the patient.

The shortcomings of our present method of caring for the insane both within and without institutional walls have been more fully illustrated by the facts presented in this chapter. From what has preceded as well as from these facts, it has become apparent that certain adjuncts to the present state hospital system will have to be developed, ere it can be expected that persons adjudged insane and committed to state hospitals for the insane will receive the service and attention that they and their families require in order to return those mentally ill to normal society and to normal ways of living at the earliest possible time.

CHAPTER V

SOCIAL TREATMENT OF THE INSANE

1. INTRODUCTION

GROTIUS is reputed to have stated that "the care of the human mind is the noblest branch of medicine." Since his day we have come to realize that the care of the human mind, or rather of the insane and borderline cases of insanity, is not altogether a problem for the physician alone, but that other agents and forces in the community must either be called upon or brought into being in order to assist the medical men to meet this problem. This becomes apparent when considering the routine through which the average person who becomes mentally ill passes during the period of his illness.

Whenever a person becomes irrational, markedly depressed or excited, or shows anti-social tendencies which have their roots in the mental state of the individual, the immediate friends and relatives are quite likely to assume that some form of hospital care and treatment is needed. Usually the advice of the family physician is sought, and acting upon his suggestion or that of the police who are called in, the patient is transferred to the psychopathic ward of the general hospital in the community. Once there the patient is subjected to a mental examination and observation of his actions. If, at the end of a few days, a positive diagnosis is made and the patient is found to be insane in the legal sense of the word, he is committed to a state hospital were he remains until it is found advisable to parole [330

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