I WITNESSED a wonder and a marvel! A marvel of modern science and psychiatry in the hands of highly skilled physicians who transformed a young mother from a delusional, acutely disturbed state, completely unable to control her mental processes, to a stable member of society able to return home and take her place in her former important role.

        There are thousands of people in our country today who are mentally ill and who have not been given the care and chance to become rehabilitated by being hospitalized. The young mother was made well because her husband was persuaded to have her taken to a hospital shortly after her mental collapse.

        At first her husband was reluctant to have her enter the hospital, because like the majority of persons, his notion was that "once you get into a mental hospital you'll never get out."

        This is an unjust stigma which has been attached to mental hospitals and to other institutions that care for the mentally sick. So long as these benighted ideas exist in the public mind, relatives of the mentally ill will not feel free to bring them into a qualified hospital for treatment. Too few of us realize that the mind can become sick just as easily as the heart, liver, kidneys, or any other organ of the body. The foolish stigma persists that it is a disgrace to admit that a relative suffers from a mental disease and has been institutionalized.

        This young mother was not the only case I followed during the more than six months I observed on and off at a mental hospital.

        The term "shock" as used here does not mean the production of pain, fright, startling, or sudden emotional responses. The term came into use because of certain features resembling what for many years has been called "surgical shock." Even when electricity is used, the person does not feel the shock.

        Since the shock treatments began, an amazingly high percentage of mentally ill people in varying degrees have left hospitals better than when they were admitted. There have been recurrences, of course, and some patients have had to return for further treatment. But by and large, the patients, once through with the prescribed treatment, have regained a place in society, and again have become integrated with their former environments.

        WHEN the superintendent of the hospital asked me if I would be interested in making a study of insulin and electro shock therapy as applied to mentally ill patients, I had apprehensions that I might not be able to watch the pain in others during the process of the treatments.

        I thought of them in terms of shock such as comes from pain, fright, or sudden emotional disturbances. I soon discovered that patients experienced little or no pain from the shock treatments.

        One of the first shock treatments I witnessed was administered to this young mother, the wife of a hard-working farmer. Her five children were born at approximately thirteen-month intervals. Aside from caring for her children she assisted her husband with chores that are a part of dairying and poultry culture.

        It was impossible for the couple to hire a girl-of-all-work. Finally, the young mother broke under the strain of child-bearing, keeping house, and sharing hardships with her husband, who was farming alone an acreage that normally would require three or four men. She could not carry the load. Her confused mind and tired body completely gave way.

        When she was brought to the hospital, Mrs. C., as we shall call her, was difficult to handle. After her case had been diagnosed, she was given the insulin treatment. A half hour after the dosage, she became relaxed, probably for the first time in many months. From then on I followed her "reconversion" at regular intervals. Mrs. C. responded magnificently. At the thirty-fifth treatment her mind and reflexes were greatly improved.

        I received permission from the doctor to converse with Mrs. C. and to most of my questions she gave intelligent, well-thought-out answers.

"How are you feeling today?" I asked.

"I am fine. The doctor says I may go home soon. But I don't know how I ever got in this hospital. Doctor says I was very sick," she answered without hesitation or cloudiness of mind.

"If you keep on responding as you have in the past two weeks, you will be able to go home to your children and husband," the doctor told her, adding, "Who is coming to see you next Sunday?"

"My husband,"—this without hesitation.

"Who was at the hospital three Sundays ago?" he queried.

"My husband. May I go back home with him next Sunday?" she asked hopefully.

"If you improve as much in the next three weeks as you have in the past three, it is very likely that you may accompany your husband home," the doctor told her.

        After fifty treatments had been administered to Mrs. C., she was an entirely different person from the one who had been brought to the hospital. After a period of close observation she was allowed to return to her home, to all appearances entirely well. Whether the illness would recur, the doctors and attendants could not say. They did, however, give her a better-than-even chance of never having to return for further treatments if not subjected to the same rigorous life that was hers before coming to the hospital.

        TREATMENT of a mentally sick patient depends upon his particular type of illness, just as in physical ills the types of mental illnesses are many and varied. Sometimes treatment can be directed to eliminate causes of mental illness, in instances where certain toxic conditions and nutritional deficiences occur. Sometimes even though the cause is known, little can be done about it, as in cases where aging processes are the bases of the illness. In other cases, even though the exact cause is not known, enough is known so that beneficial treatment may be employed.

        Among the latter group are schizophrenia (so-called dementia praecox), manic-depressive psychoses, and involutional psychoses. None of these diseases is a single disease but contains several sub-groups. They comprise one third of all first-admission patients to mental hospitals. It is for these disorders that the so-called shock therapies are applied.

        In the insulin treatments the dosage is determined by the physician. Once in the blood stream, insulin causes a lowering in the blood sugar content with which the brain is continuously supplied. This results in a period of an hour or two of varying degrees of cloudiness of thought, stupor, and coma, depending on the amount of insulin given and the length of time it has acted when stupor and coma come; or various symptoms arise similar to those in surgical shock.

        During the time these are developing, trained nurses and attendants are constantly present watching for signs which tell exactly the state of the patient. Physicians are always available and remain constantly with the patient during the latter stages of the treatment.

        Ordinarily, a patient is allowed to remain in a light coma for about an hour and a half. Should the patient show evidence of impending danger, the treatment is terminated. If there is reason to terminate the treatment rapidly, dextrose is injected directly into an arm vein. This usually brings the patient out of the coma sufficiently so he can speak in one minute or even less. If there is no reason for rapid termination, sugar is passed into the stomach through a tube inserted in the nose and into the stomach. When sugar is given into the stomach, fifteen or twenty minutes are required to bring the patient out of the coma.

        There are many dangers associated with the insulin treatment, but by careful selection of patients to be treated and attention by those giving the treatments, these dangers are rather remote. At the hospital where I was an observer, over seventeen thousand individual treatments have been given without any known permanent ill effects. Some transient ill effects have occurred, but they have cleared up in rather a short time.

        Electro-shock therapy is used to replace metrazol, a drug injected into the veins. Time of shock is generally two tenths of a second, but it may vary from one tenth to four tenths of a second. A recording apparatus measures actual time and flow of current.

        It cannot be properly explained how either the insulin or the electrotherapy treatments act to improve the patient. Many physiological changes are known to occur. Some, those in the brain, are, without doubt, responsible for the improvement. Although neither of these treatments supplies all that is to be desired, both have given definite help to thousands of patients during the few years they have been used. What is more important, they have given physicians in the field new clues to work upon which in the future may bring greater help and even prevention of certain mental disorders.

        THE mental hospital is not primarily a custodial institution. The purpose of a mental hospital is to treat and restore mentally ill persons. An institution only becomes custodial when a patient is unable to be cured and rehabilitated. The degree of success any mental hospital will have in this endeavor is determined by three factors:

        (1) The facilities it has at its disposal. (2) The ability of its administration to organize and utilize those facilities. (3) The willingness of relatives to put away false pride and cooperate for the benefit of the patient.

        Certain types of mental illnesses cannot be cured by any treatment known today. These, however, are not without hope, as much knowledge is being gained throughout the world which gives evidence that some day these present incurables may also be given treatment that will be more adequate than at present. Even though a person cannot be cured of his illness, he is entitled in a civilized society to kind and sympathetic treatment.

        Ignorance of the public in general concerning mental diseases is one of the greatest impediments to care and treatment of the mentally sick, and one of the chief reasons for the apathy throughout the country in demanding adequate appropriations from state legislatures to secure competent personnel, research, and housing.

        It has been difficult to bring before the citizenry and elected representatives a different attitude on the importance of the work being carried on at mental hospitals. If public opinion is to be changed, people in general must be taught that the prime purpose of mental hospitals is to give mentally sick persons the care and treatment that best fit their individual needs.

        One of the troubles specialists have is in trying to enlighten the public to the need of institutionalizing those who need attention as soon as possible after a competent physician has diagnosed the case as a mental illness. 

        Those who need attention are deprived of institutional care or hidden away in homes by relatives so long that the unfortunate individuals, in a great many instances, cannot be helped.

        When the public has been enlightened on the work of rehabilitation of mentally ill persons and is convinced that it is not a disgrace to go voluntarily or to be sent by relatives and that mental hospitals are to cure and not to confine—only then will the stigma of placing a mentally sick person in an institution be lifted.