The Two Cats
Review of Wisdom, Madness, and Folly. The Philosophy of a Lunatic. By John Custance. Foreword by Canon L. W. Grensted. (Pp. 254. 16s.) London: Victor Gollancz. 1951.
British Medical Journal, 2: 1263, 24 November 1951, p. 1263
The author does himself a serious injustice in giving his book the subtitle, "The Philosophy of a Lunatic." In fact he is not a lunatic, although he has had periods of lunacy - that is, typical and severe attacks of both mania and depression. He describes these episodes with clarity and feeling, so that they rank highly among the selfdescriptions of psychotic patients. For that reason alone the book is interesting to the psychiatrist, and should be interesting to others too. In his case not only were the depressive phases a kind of Hell, but the manic phases, as is much less common, seemed very near to Heaven. Mr. Custance is naturally a deeply religious man, and the psychological necessity arose to try to relate his abnormal experiences with his religion and philosophy. He feels that they have enriched his mental and spiritual life, and would not now be without them, despite the distress they caused. The philosophy to which he is led emphasizes the objective reality of his experiences, and is indeed a form of idealism. Suppose he were to see, he says, in a hallucination a cat sitting next to him, he would be unable to distinguish the hallucinatory cat from a real one, and for his psychophysical system the two would be the same. In his "Theory of Actuality" no difference is made.
Mr. Custance's philosophical system, which is quite sane, will make a strong appeal to those who are attracted to idealist philosophies, but it will not do as the basis for a scientific approach. The reconciliation which he has found it to give between religion and science would be a shaky one. The trouble is that, if others were to deal with Mr. Custance's two hypothetical experiences, normal visual perception and hallucination, as equivalent, they would make practical errors of considerable consequence. A very successful method of helping the chronically hallucinated patient to get by in ordinary life consists in teaching him to distinguish, perhaps by adventitious circumstances, the hallucinated from the real, and to react differently to them.
In one mental hospital Mr. Custance experienced, as he credibly claims, a degree of brutality from the male nurses which would be a disgrace to any decently run institution; and, it is said, the doctor to whom he complained turned a blind eye. This distressing history is confined to an appendix, which, however, should be carefully read by psychiatrists. Such affairs are increasingly less likely to occur as a therapeutic rather than a custodial attitude develops in mental institutions. What Mr. Custance has to say about the way in which sympathy or antipathy may be aroused in the psychotic patient by the attitude of his doctors is of real value. He has, in fact, many practical suggestions to offer, such as the provision of incentives in occupational therapy, which could well be considered by hospital psychiatrists.