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However, this is not to say that because the aetiology of heart
disease is still not completely understood we should refrain from
using what knowledge has been accumulated for preventative
purposes.
Mental Illness
To judge by recent publicity, conditions in many mental hospitals
are far from ideal. Indeed, there is a marked contrast
between these and some of the country's penal institutions. In the
latter establishments, prisoners are afforded planned employment
and opportunities for vocational and cultural studies; indoor and
outdoor recreation is varied and well organised; smoking is permitted
and cells, although small for privacy, are used only for
sleeping. Compared with these, the facilities in many of our overcrowded
and understaffed mental hospitals seem somewhat stark.
That such an unglamorous task can attract a sufficiency of staff
and that they are able to overcome such adverse conditions is
ever a source of wonder. They warrant our wholehearted support
and unstinted admiration.
Fortunately, after a century or more of treatment based upon
isolation, modern psychiatry is reverting to an age-old method of
dealing with mental illness, namely, in the patient's home surroundings.
Removing psychotics from the normal environment has two
serious disadvantages not necessarily related to the disease process—(a)
it destroys the benevolent tolerance which develops in a
society accustomed to the presence of such people and (b) the
resulting alienation forces the patient into a vegetative existence
which, if discharge is ever to be considered, necessitates rehabilitation
involving a course of action which, despite the use of the most
modern methods, seldom repairs the damage arising from separation.
Moreover, the longer the period of isolation the less likely is
the patient to want to return to the community or to entertain any
plans for a future life in the outside world. Indeed, it is the
personal attitude of mind not only of the patient but also of the
close associates such as relatives, doctors, nurses, neighbours,
employers, etc., which is probably the largest single factor in
determining future prospects. It could well be argued that social
perhaps more than vocational rehabilitation is the basic need for
often the patient's "niche" in the home has been filled or forgotten
during the isolation period.
At a time when legislation is being considered for the transfer
of the responsibility for the education and training of the subnormal
from the Department of Health and Social Services to the
Ministry of Education and Science it is apposite to consider the