Lords Amendment: In page 2, line 46, after "life" insert
or of guarding himself against serious exploitation.
§ The Amendment makes clear that definitions of "severe subnormality" will cover people whose arrested or retarded development of mind is of such a degree or nature as to make them completely incapable of protecting themselves against serious exploitation. This is a matter which gave concern in the House as well as in another place. The intention is to make it abundantly clear that the more severely retarded of the patients at present classified as feeble-minded are intended to fall into the "severely subnormal" category.1687
That has always been our intention in the Bill, basing ourselves on paragraph 193 of the Report of the Royal Commission on the Law Relating to Mental Illness and Mental Deficiency, 1954–1957 which says:
The broad dividing line between the patients whom we call severely sub-normal and those whom we call psychopathic"—
which in the Commission's terminology, of course, includes subnormals—
comes in the middle ranges of what is now called feeble-mindedness … in some cases these patients … are incapable of living an independent life even if their intelligence quotient is, say, 60 or even higher, if they have other serious defects of personality in addition, resulting in a generally sub-normal personality which makes them incapable of managing their own lives or places them in serious danger of being taken advantage of by other people.
§ By this Amendment we have implemented the recommendations therein contained, and it should be a useful reinforcement of the phrase we have already in regard to incapability of living an independent life. Serious exploitation, as the House will appreciate, covers cases of the sexual exploitation of subnormal girls or women, and also, possibly, economic exploitation by an unscrupulous employer of a domestic servant or someone of that kind.
§ If a patient is incapable, as a child would be, of withstanding this kind of exploitation, he or she should come within the definition of "severely subnormal". But, before a severely subnormal patient can be detained for treatment in hospital, all the conditions of Clause 26 must be satisfied, and in particular the detention must be shown to be necessary in the interests of the patient's health or safety or for the protection of others.
§ Mr. Kenneth Robinson (St. Pancras, North)
I have every sympathy with the motive behind the Amendment, but I want to make two observations on the way in which it has been suggested. First, I should have thought that the original wording of the Bill included the danger of serious exploitation. In other words, if a severely subnormal person is in such danger it would be reasonable to show that he or she was incapable of leading an independent life.
My second point, briefly, is that the only purpose of the definitions is to provide for compulsory detention. I should have hoped that almost the entire range 1688 of severely subnormal patients in future will be informal patients. If somebody is in danger of serious exploitation of the kind described by the right hon. and learned Gentleman, that patient would obviously be better off under some kind of institutional or hospital care.
In a way we are putting a penalty on the victim of the exploitation, whereas if such exploitation takes place, I should have thought that the person guilty of the exploiting was the one to whom society ought to direct its attention and who ought to pay the penalty. In other words, whilst I am not against these people being given hospital or institutional care, it seems to me that to render them liable to compulsory care on the ground that they are subject to exploitation, is rather placing the emphasis in the wrong place. However, I believe that the motive behind the Amendment is sound, and I do think that in practice it will not lead to much difficulty, but I would like the Minister's observations on these two points.
§ Mr. Walker-Smith
With the consent of the House, Sir, I will make a short observation on the points raised by the hon. Member for St. Pancras, North (Mr. Robinson). On his first point, the position is that if what he said was true—and I am not dogmatic about this because we all know that none of us should ever be dogmatic about the legal effects of the words of a Statute—and if serious exploitation is included in the former wording, the Amendment will be valuable as a declaratory provision. If, on the other hand, it is not included, it is necessary as a substantive provision.
On his second point, I share the hon. Gentleman's hope that the majority of these people will be informal patients, but we must accept in this as in other cases that there is that residual category of case where we shall require the provisions of Part IV. I do not regard the provisions as penal, and I know the House does not: they are preventive in a sense but therapeutic in their main intention. What should be the attitude of society towards the exploiter is something which goes beyond the range of the Bill with which we are here concerned. I hope that explanation satisfies the hon. Gentleman.
§ Question put and agreed to.1689
§ Lords Amendment: In page 3, line 7, leave out: "of personality" and insert "or disability of mind".
§ 11.15 a.m.
§ This Amendment improves the provision which gave us all a great deal of concern over a period of time in the Committee stage in this House, that is to say, the important provision regarding the definition of the psycopath. In the definition of "psychopathic" in subsection (4) of this Clause this Amendment would substitute the phrase "persistent disorder or disability of mind", which is of course an echo of the definition of mental disorder itself, for "persistent disorder of personality".
§ It was suggested in another place that the word "mental" or "mind" should be imported into the description of the underlying disorder to emphasise that psychopathic disorder is a form of mental disorder. Anxiety had been expressed that if this were not made clear a diagnosis might conceivably be made without any symptoms other than persistently anti-social behaviour not necessarily linked to mental disorder.
§ I certainly agree that psychopathic disorder is a form of mental disorder. It is true, as I told the House earlier, that the patient's behaviour may well provide the main symptoms on which that diagnosis is based, but anti-social behaviour of the kind described in the later words of the definition is not in itself enough to establish the diagnosis unless the pattern of behaviour shows other abnormal features which indicate that it is the result of underlying mental disorder. We think that the introduction of the term "mind" instead of "personality" will help to make this clear and that is why we commend the Amendment to the House.
§ I said in Committee that I would go on thinking about the definition of psychopathic disorder when we were discussing it at length. This Amendment does not make a major change but I hope it goes a long way towards meeting the anxieties then expressed.
§ Dr. Edith Summerskill (Warrington)
If it would help the House and the Minister, I will tell him at this stage 1690 that this is the only Amendment about which I have serious misgivings, and it may be the only occasion on which I shall intervene during the passage of the Lords Amendments through this House.
I was surprised to hear the Minister say that he thinks the Amendment would be an improvement; indeed, he said that without any reservations. I would remind him of the Report of the Royal Commission on Mental Health, which gave the most serious consideration to the definition of a psychopath and psychopathic disorders. It is a matter which interests and concerns psychiatrists in all parts of the world, particularly the Western world, and it was precisely on this point that there was a difference of opinion. It was on this point that we had debates, and I would say with all due respect to the other place that we had at our disposal expertise of a kind that probably was not available to them because psychiatrists are busy men. They lent themselves on many occasions to the early discussions and they probably thought that this matter had been settled.
My misgivings arise from the fact that it is considered that the psychopath is the product of his environment. The Minister said that the mind and the mental condition must be injected into this question, but we cannot be dogmatic about this. There are still psychiatrists, many eminent men, as I have said, who believe that the psychopath is the product of his environment, which results in a persistent disorder of personality
It was said in another place that this Amendment simply shifted the emphasis. I regard that not only as a masterly under-statement but as much worse. The danger is that of affixing a label which the experts considered, but rejected in the interests of the psychopath. The Minister has suggested that this definition improves the Bill and is in the interests of the psychopath. But what all the psychiatrists, social workers and others concerned in the matter have tried not to do is to affix a label, which is what we are asked to do today.
I do not like to call another place a "back door" but I feel that this has been rather brought in by the back 1691 door while those at the front have departed on other business. They thought the job had been done, and they have dispersed. I would ask the Minister to look at the House today. It is extremely difficult to marshal one's forces on a Friday morning for what I regard as a mere debating point. There is no party issue here. I believe that hon. Members opposite would agree with some of my hon. Friends that it is better in a matter of this important kind where we are still being tentative in our approach—we cannot be dogmatic—to be guilty of sins of omission rather than sins of commission.
It could have been said in the early stages that the Royal Commission was very limited in its definition, and the definition in the Bill as it left this House was very limited precisely for that reason. It is a great mistake to say too much about something of which one knows very little. What the Minister has done today is to give his blessing to something which, I think, would have been better omitted. At any rate, no harm would have been done if it had been omitted, and I believe that it would have been better to have omitted it.
As I said, I cannot marshal my forces on a Friday morning, and all I want to do is to voice my misgivings at this stage and hope that when the Bill comes to be administered those who are responsible for administration will recognise that there has been a division of opinion in the highest circles on this point. Having said that, in no circumstances would I ask the House to divide.
§ Dr. Donald Johnson (Carlisle)
I do not think that I can follow the right hon. Lady the Member for Warrington (Dr. Summerskill) in the arguments that she has put forward. Indeed, I agree to a very considerable extent with what my right hon. and learned Friend has said, that this is an improvement. In fact, it has to some extent settled a number of doubts which I expressed during the Committee stage. I think it is essential if we are to exercise compulsory powers in a Mental Health Bill that we should have some tie-up with mind and mental illness. Nonetheless, I have certain reservations which I should like to express very briefly and, I think, 1692 without diverging too much into scholastic arguments.
We ought to try to be clear what we mean by "mind". One of the troubles of Measures dealing with this subject has been that a looseness of definition has crept in about "mind". "Mental illness" and "lunacy" were very clear terms at the time of the 1890 Act. Many of my correspondents in the last year or two have taken it upon themselves to quote Halsbury's Laws of England where, however imperfectly, there is some attempt to define lunacy, insanity and so forth. "Mind" was put into the 1890 Act with something of that kind in view. It was the same with the Mental Defectives Act. But we had a definition, which never came before Parliament but was entirely for psychiatric and psychological circles, that "defect of mind" was not necessarily "defect of intelligence". That is an entirely negative definition.
On the other hand, we have no positive definition to circumscribe what is meant by "mind" and "mental illness", and in the present age we seem to have given up the attempt to define it clearly and in the Bill have given the psychiatrists and the medical profession as a whole carte blanche to define what they mean by "mind" and "mental illness". They have been given very wide powers of interpretation indeed. Those of us who are anxious about the question of individual liberty hope that these powers and the trust which has been placed in the medical profession and the specialists will be honoured, and it is in that spirit that we support the Bill and endow these powers. Nonetheless, in the light of experience, I think that it is something which we shall have to watch, and we shall watch it, and if there are certain abuses we may have to raise the matter again. With those few words, I give my support to the Lords Amendment.
§ Mr. Somerville Hastings (Barking)
I do not think we have yet heard the last word about the definition of "psychopath" or "psychopathic disorder", but what we have to do in the Bill is to define the condition in terms which will be understood, not by a doctor or someone else skilled in the treatment of mental disease, but by those who are not doctors, by lawyers and other persons in the courts.
1693 In my view—here I differ from my right hon. Friend the Member for Warrington (Dr. Summerskill)—the Lords Amendment is a very definite improvement. It appears to me to do two things. It changes "disorder" to "disorder or disability," and it changes "personality" to "mind." I think both of those changes are desirable. It seems to me that the condition which we are trying to define may be not only a disorder but a disability—either a disorder or a disability. Certain psychopaths have a disability in appreciating many social customs. They fail to appreciate what is theirs and what is other people's. They fail to appreciate the undesirability of setting fire to odds and ends, and so on. It is not only a disorder. It is a disability, a lack of comprehension or power in certain directions, and this should be included as well.
The second change is also an advantage. When I think of "personality" I rather think of character—an unpleasant or disagreeable personality, or a lovable personality, and so on. The term "mind" seems to me to be much more all-embracing and to apply to much more of the individual. I believe the Amendment will make clearer, at any rate to the public, what I have in my mind in defining a psychopath or a psychopathic personality, and I am glad that the right hon. and learned Gentleman feels it desirable to accept the Lords Amendment.
§ Mr. K. Robinson
I am in the position—I do not know whether it is a happy or unhappy position—of disagreeing with the right hon. and learned Gentleman and at any rate the conclusions of my right hon. Friend the Member for Warrington (Dr. Summerskill), although I agree with very much of what my right hon. Friend said.
§ The Amendment is a tribute not so much to the good sense of the Minister and the Lord Chancellor and their advisers as to the persuasive eloquence of the noble Lady, Baroness Wootton of Abinger. Clearly, the arguments which she put forward very strongly in another place were directed towards narrowing the definition. Whatever this Amendment does, in my submission it does not narrow the definition. It adds the word "disability" to "disorder" and, unless 1694 "disability" and "disorder" are wholly tautologous, that must be an extension rather than a narrowing.
§ 11.30 a.m.
§ It then substitutes the word "mind" for the word "personality", and here, I think, is where we get into the realms of semantics if not into metaphysics, if we try to say what a doctor is going to regard as the difference between mind and personality. My hon. Friend the Member for Barking (Mr. Hastings) prefers it. He said that he thought "mind" was all-embracing but that "personality" rather meant character. The word "character" is not one that has been used and not one that has been substituted; it is, in fact, the word "personality", and I think that, in the last analysis, this Amendment makes no difference and will have no effect whatever on the working of the Bill.
§ If we are to have patients with psychopathic disorders compulsorily detained other than through the courts, it will be because doctors recognise what they consider to be a psychopath—someone who comes within the ambit of all "three legs" of the definition about which the right hon. and learned Gentleman spoke so convincingly during the Committee stage. I think that it makes no difference at all. If I had a preference, it would be slightly for the old wording, but do not let anyone think that the Amendment makes any substantial difference to the Bill as it left this place.
§ Mr. Walker-Smith
By leave of the House, I should like to make a short reference to the very interesting and diverse contributions which we have had on this matter. We approach it from the common standpoint that we have all regarded this as something of very real importance, very considerable difficulty, and something on which none of us would say that we are at the end of the road.
This is an emerging matter, and we shall go on learning about these matters as we go along. At any rate, for the time being, I think we have now achieved the best definition we can. I am sorry that it does not commend itself to the right hon. Lady the Member for Warrington (Dr. Summerskill), nor, altogether, to the hon. Member for St. Pancras, North (Mr. K. Robinson). I certainly expected to have his support—I 1695 was not so sure about the right hon. Lady—because of the misgivings, so eloquently and persuasively expressed in Committee, that conduct might bring a person within this definition, irrespective of his mental state. One of the advantages of this definition is that it is a safeguard against that, and that is probably part of its main practical value.
As the right hon. Lady said, this is certainly not a party matter, and I was very glad to have the support of the hon. Member for Barking (Mr. Hastings), with all his distinguished experience in this field. This Amendment, if my recollection serves, was moved in another place by a noble Lord, who not only sits on the Opposition benches but who, like the hon. Lady, has the advantage of medical qualifications.
I also think that we are very much in line with the Royal Commission, although the right hon. Lady rather doubted it, because it says in paragraph 190:Our second group comprises those patients suffering from a personality disorder which does not make them severely subnormal in the sense in which we apply this term to our third group, but which is recognised medically as a form of mental disorder resulting in abnormally aggressive or inadequate social behaviour.What we seek to do is to make it clear that this is within the ambit of mental disorder with which the Bill is trying to deal.
If I understood the hon. Lady aright, there was some thought in her mind, and I respect it if it was, that one did not lightly want to classify people as having a mental disorder if, in fact, they might not have if their state was fully understood.
I do not want to follow the hon. Member for St. Pancras, North into his semantics and metaphysics. One thing which we all hope will come out of this Bill—one particular piece of good, and we hope that much good will come from it—is that people will be able to be treated for mental or psychiatric disorder with no more sense of shame than attaches to treatment for a somatic disorder. That is the climate that we hope to achieve and which, we think, this Bill will create. I hope that the right hon. Lady will agree that we are being successful in doing that. I have had an 1696 impressive body of all-party support, and I hope that we may have the Amendment.
§ Question put and agreed to.
§ Subsequent Lords Amendments agreed to.