REMARKS. DEDICATION OF CLIFTON T. PERKINS
STATE HOSPITAL

JESSUPS
May 2, 1961

With the opening of the Clifton T. Perkins State Hospital, there
has been inaugurated for the first time in Maryland an organized
program of psychiatric treatment for a long-neglected, little-understood
group of patients classified under the harsh title of "criminal insane. "

Most of these patients have come to our doors because they have
committed offenses against society and have been found by the courts
to be "not guilty by reason of insanity. " This catch-all phrase, which
puzzles the courts as well as psychiatrists, had its origin more than
a century and a quarter ago, when the unfortunate Daniel McNaghten
shot and killed the private secretary of Sir Robert Peel, mistaking him
for Sir Robert. The medical evidence indicated that McNaghten suf-
fered under the delusion that his enemies were ever plotting against
him in such a way that he lost control over his acts and lost "preception
between right and wrong. " That test of criminal responsibility stands
in effect today, although it is unsatisfactory to psychiatrists and lawyers
alike.

Consequently, our mental hospitals have had thrust upon them the
problem of how to deal with sick individuals who, for their own sake and
for the sake of society, have to be held in restraint. Mental hospital
buildings and programs are not planned around restraint. Advancing
psychiatric concepts call for more freedom for the individual under-
going psychiatric treatment. The fortress type of hospital buildings, in
use when the McNaghten Rule was laid down, have been replaced
by buildings that permit patients to be free to move about as psy-
chiatric treatment concepts changed over the years. Buildings and pro-
grams planned about freedom of movement and ready access to the
community are not structured to provide the services required for the
patient who, under a sentence of a court of law, must be confined
and restricted while under treatment. Such diverse types of patients
cannot be successfully treated in the same hospital setting. Up to now,
the problem has been met with makeshift measures. Attempts were
made to reconstruct existing buildings to meet security needs, but
these proved to be inadequate, failing to provide both the necessary
protection and sufficient opportunity for medical or psychiatric treat-
ment. Patients segregated in these areas had fewer chances for re-

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