THE RÔLE OF MEDICAL ADMINISTRATION IN PSYCHIATRIC HOSPITAL TREATMENT

The inadequacy of the present provision for hospital treatment of the mentally ill has been widely broadcast, and a growing demand for provision to conform with modern understanding of requirements may be anticipated. It will naturally be expected that the psychiatrists and their organizations will assume responsibility and leadership in propounding and activating the principles, plans, and standards to be followed. As long ago as the eighteenth century, an eminent medical teacher, in a lecture, "On the Passions," explained to his students that "this care of the human mind belongs to us. It is the most noble branch of our office..... Our art will not be consummately perfect, till it can render men, not only robust, but as ingenious and as good as possible" (20). A special obligation rests upon those psychiatrists who by training and experience are particularly qualified in psychiatric hospital administration and practice. Their position and the work they are engaged in are characterized by a recent medical author as follows: "The 700,000 patients in institutions are of course the central problem of psychiatry. The care and study of these patients is the professional occupation of a serious and devoted band of psychiatrists who man the medical staffs of the mental hospitals of the country. These physicians and the body of medical and psychological knowledge which they represent are the basis of psychiatry" (21). It should be realized that psychiatry is not merely a branch or outgrowth of general medicine. While mental illness was receiving no adequate attention in medical education and in general medical and nursing practice, it was in the institutions that opportunities were available for the observations and experience on which the fundamentals of psychiatry are based. Now that the scope of psychiatric understanding, study, and practice has been extended far beyond the confines of the institutions, psychiatry is enriching the resources of general medicine, and is gradually being incorporated into the general body of medical knowledge and practice, which may thus perhaps become "consummately perfect." In psychiatry, however, evidences of illness and methods of examination and treatment which have heretofore had no definite place in general medical thought and practice are the major considerations. It is essential, therefore, that hospitals for the mentally ill be definitely psychiatric. All the resources of general medicine and surgery should indeed be available, and much advance in supplying these has been made in the psychiatric hospitals. In future hospital planning and in endeavors to modernize the present hospitals, however, it seems important that the special requirements of psychiatric service should be the primary consideration. Some compromises with economic considerations and prevailing views and standards may be, for a long time, unavoidable. If, however, correct principles and standards and their relation to the objects to be accomplished are clearly explained and persistently advocated, they will frequently, and eventually always, be followed. The statements of correct policies, principles, practices, and standards which The American Psychiatric Association has, from time to time, formulated and adopted for the guidance of its members and the public have been generally accepted as authoritative. In view of the increasing interest, pressing need, and of what may ere long be a pressing demand for more adequate hospital provision, consideration might perhaps be given to revising and extending some of these statements. The program of the 1948 annual meeting of the Association contained at least six papers which indicated the place and value of medical authority and direction in the administration of the hospital as an effective instrument of treatment and rehabilitation(22). It might perhaps be advantageous to assemble such papers in the program of one session, and to publish them collectively in one number of the JOURNAL. Also, the establishment of a section of the Association on "Psychiatric Hospitals" might contribute to quickening and increasing interest and understanding of the nature and importance of administration as an integral part of the medical service.