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INSANITY:
ITS CAUSES AND PREVENTION
BY HENRY PUTNAM STEARNS, M.D.
SUPERINTENDENT OF THE RETREAT FOR THE INSANE, HARTFORD, CONN.;
LECTURER ON INSANITY IN THE MEDICAL DEPARTMENT OF YALE COLLEGE,
ETC., ETC.
"It is the mynde that makes good or ill,
That maketh wretch or happie, rich or poore."
SPENSER--_Faerie Queene_, Book XI, Canto IX.
NEW YORK
G. P. PUTNAM'S SONS
27 & 29 WEST 23D STREET
1883
COPYRIGHT BY
G. P. PUTNAM'S SONS
1883
_Press of
G. P. Putnam's Sons
New York_
TO JOHN SIBBALD, M.D., F.R.S.E.,
COMMISSIONER IN LUNACY FOR SCOTLAND, IN PLEASANT
REMEMBRANCE OF A PORTION OF OUR STUDENT-LIFE
PASSED TOGETHER, THIS BOOK IS INSCRIBED
WITH SINCERE REGARD BY HIS FRIEND,
THE AUTHOR.
PREFACE.
It is something more than two years since I read a paper, entitled "The
Insane Diathesis," at a meeting of the Connecticut Medical Society. The
numerous requests received for copies of that article have led me to think
that something more in detail in relation to the prevention of insanity
might be desired by the reading public both lay and professional. Hence
this little book. It has not been written for specialists exclusively,
though it is hoped it will not prove wholly uninteresting to them, but
rather for those in the general practice of medicine, educators, and the
more intelligent lay members of society.
It has been written during odd snatches of time and with many
interruptions, so that there exists less uniformity of style than there
would otherwise be. Moreover, some of the subjects presented have been
discussed by me in papers which have already been published. These papers,
however, so far as they have been introduced into this work, have been
rewritten, and, it is thought, improved.
H. P. S.
HARTFORD, _Dec., 1882_.
CONTENTS.
CHAPTER I.
PRELIMINARY.
PAGE.
Increase of interest in the subject of insanity, resulting
from, first, more intelligent views concerning its nature; and,
second, the obligation to make provision for the care of the
insane in a larger measure than for other unfortunate classes--
Results in the way of hospitals--Asylum attendants--Change in
the modes of management, and care of the insane 3
CHAPTER II.
INCREASE OF INSANITY.
Indications which point to the probability of its increase in a
greater ratio than that of the population: (1) in relation to
the general conditions of society; (2) in occupations; (3) in
the character or tendency of disease--Increased demand for
hospitals for the insane not a conclusive evidence of increase
of insanity; other reasons exist for this--Improvements in
hospitals--The chronic as well as the acute insane now provided
for more generally than formerly--Accumulations in asylums--
Statistics--Those of England and Scotland--Their character and
import as presented in the yearly reports of the Boards of
Lunacy Commissioners 11
CHAPTER III.
INSANITY AND CIVILIZATION.
Prevalence of disease among savage nations--Conditions of life
not such as to produce insanity--Definitions of civilization--
Several conditions attending civilization combine to increase
diseases of the brain--Increase of brain activity--
Over-stimulation of the brain in schools and by the use of
alcoholic beverages--A community of interests exists in savage
life which is lost in civilized life--In the latter the strong
thrive at the expense of the weak--Monopolies in land and other
forms of property--Inference to be drawn from the tendency of
insanity to increase--The primary condition of insanity one of
the brain--Investigations should relate to the nature and
causes of this condition 33
CHAPTER IV.
THE INSANE DIATHESIS.
The _ideal_ human system--The _actual_ human system--Physical
and mental differences among persons in health--Periods during
which there exist considerable changes in the character of
mental action in the case of many persons while in a state of
health--Excitement and depression of mental activity--This
tendency to unstable activity of the nervous system may be
inherited or acquired--Illustrations from the effects of
over-exertion, "writer's cramp," chorea--A similar condition of
that portion of the brain which is concerned in mental
operations may exist--Illustrations--The effects of sudden
mental shocks and long-continued mental application--
Recapitulation--The condition which we term the Insane
Diathesis is the prime factor in the causation of insanity 53
CHAPTER V.
THE INFLUENCE OF EDUCATION.
The higher conception of education--The ordinary course pursued
in schools--Too many subjects studied at one time, and too
large a number of scholars under the supervision of one
teacher--Little opportunity to study individual characters and
tendencies--Numerous subjects of study tend to confuse the mind
rather than invigorate it--Illustrative cases--Teachers only in
part to blame--Courses pursued in colleges--The importance of
avoiding over-stimulation of any portion of the system in the
period of youth--Ball clubs; rowing clubs--A similar tendency
to over-stimulation of the brain in study prevalent in
England--Over-exertion in the use of the brain tends strongly
to create weakness and instability of action, and a condition
which may be transmitted to children 73
CHAPTER VI.
INDUSTRIAL EDUCATION.
Occupations of persons admitted to State asylums--Percentage of
those having no education in industry, or regular occupation--
Importance of industrial education to the brain--Difficulty of
obtaining it greater than formerly--Education of the brain has
taken the place of industrial education, and with unfavorable
results--The education of the schools does not qualify the mass
of people to earn a living: it tends rather to unfit them for
industrial labor--The interests of society require that the
largest number be educated to be self-supporting--To secure
this it is necessary to begin early in life--The same principles
apply to education for domestic labor 95
CHAPTER VII.
MORAL EDUCATION.
Examples of deficient moral education--It more especially
pertains to the influence of home and relates to obedience--
Respect and obedience toward persons in authority essential to
any efficient system--This must be learned in early life if at
all--Self-control essential to the growth of mental strength
and discipline--The tendencies in the modes of home and school
education 115
CHAPTER VIII.
HEREDITY.
Its importance as a factor in causing physical and mental
characteristics in families and nations--Illustrations--
Tendencies to morbid action, both mental and physical, may also
be transmitted--Insanity--Dipsomania--How may unfavorable
tendencies be avoided?--The influence of heredity acts toward
elimination of unfavorable tendencies when existing on one side
of the family--Importance of understanding this in relation to
marriage--Education may do much toward aiding in the removal of
unfavorable tendencies--Weak-minded children--Those born with
peculiarities of physical and mental constitutions 125
CHAPTER IX.
CONSANGUINEOUS MARRIAGES.
Different views in relation to the influence of consanguinity--
The customs of the ancient Egyptians, Syrians, and others--
Experiments in the inter-breeding of cattle--Popular
impressions as to its effects--Opposite views explained by
understanding the laws of heredity--Favorable as well as
unfavorable tendencies are increased--Hence unfavorable ones
may be eliminated 145
CHAPTER X.
ALCOHOL.
General considerations concerning its effects upon the nervous
system--Its use at the present time as compared with that of
the past--Society now reaping the effects of its use in the
past--Physiological effects of alcohol upon the system--
Experiments of Dr. Parkes and Count Wollowicz--Its effect upon
the action of the heart--Its effect upon the circulation of the
brain, the blood-vessels, and cells, resulting in a less
sensitive condition of these parts, and ultimately in organic
changes--Its effect upon the character of mind; upon the
electrical currents of the brain; upon other portions of the
body; upon the brains of children and young persons--The
alcoholic diathesis likely to be transmitted 153
CHAPTER XI.
TOBACCO.
Opposite views as to its general effects upon individuals--The
physiological effects upon the mucous membranes, the heart, and
the nervous system--Nicotin--Its elimination from the system by
the lungs, skin, and kidneys--Its effects those of a narcotic
and not of a stimulant--Its effects upon the brains of children
and young persons--The use of tobacco by children should be
forbidden by law--Its general effects upon society, socially
and politically, as presented by M. Fievee--It is not directly
responsible in any large degree for producing insanity--Creates
a diathesis which causes a diminution of intellectual and moral
power 173
CHAPTER XII.
SEX IN RELATION TO INSANITY.
Relative frequency of the occurrence of insanity in the sexes--
The sexual system in the female exerts a larger influence upon
the nervous system in certain ways than that of the male--
Sexual derangements dependent upon the debility of the nervous
system--They are generally _consequents_ and not causes of
nervous debility--Functional derangements of sexual organs rare
among the insane--A tendency to recovery in case they do
exist--Other conditions not favorable to mental health 187
CHAPTER XIII.
POVERTY.
Physical labor one of the largest promoters of health--Sudden
increase of wealth often results most unfavorably--Too constant
application to labor and household cares--A case illustrative--
In the contests of life the weaker go to the wall--They are
often surrounded by most unfavorable sanitary surroundings,
impure air, poor tenements--They become the psychological
windfalls of society--Have been and will continue to be
dependent when stricken down by disease 199
CHAPTER XIV.
RELIGION.
Influence of religious belief upon man--Not a cause of
insanity--Religious belief natural to man--It is found in all
nations--Man instinctively looks up to a Superior Power in
hours of suffering and need--He needs such a belief to sustain
and give hope--The laws of health and a religious life are in
harmony--A religious belief tends toward health--So long as the
present conditions of life exist, man will require its
sustaining influence 211
CHAPTER XV.
INSUFFICIENT SLEEP.
Conditions of the brain which are supposed to produce sleep--
Congested state of the blood-vessels--An anaemic state--
Suffering when a person is for any cause deprived of sleep--
Persons usually sleep too little rather than too much--
Physiological reasons why children require more sleep than
adults--They generally sleep too little, especially when living
in cities--The importance of sleep for the brain learned from
its universality in nature and especially from the functions of
other portions of the body--In this state it recuperates its
exhausted energies and stores them up for use when in a state
of activity--Inability to sleep a precursor of insanity 223
CHAPTER XVI.
CONCLUSION.
The primary causes of few diseases are fully understood--
Prevention of insanity must come mainly from education received
at home and in the school--Difficulties in the way of securing
any efficient preventive measures--Educational processes may be
improved in several ways: (1) by securing a larger degree of
_individuality_; (2) more attention to industrial education;
(3) more efficient home education--Changes in certain habits;
(1) in reference to the use of alcoholic beverages; (2) in the
use of tobacco; (3) the importance of longer periods of rest
and recreation; (4) improved sanitary surroundings in those
portions of cities occupied by the poor and laboring classes
of society--The importance of systematic measures toward the
prevention of insanity 237
CHAPTER I.
PRELIMINARY.
The subject of insanity, in its relation to both individuals and society,
is becoming of greater importance every year. A larger measure of interest
in relation to it has been manifest, not only in the writings of
specialists, who have made it a study, and the care of its subjects a
profession, but also in those of general practitioners of medicine and
philanthropists, who are ever seeking to improve the conditions of
society.
This results from two causes: 1, the change which has taken place in the
public mind in relation to the nature of the disease, it no longer being
regarded as something for which an individual is responsible in a larger
measure than for other diseases, or as entailing a stigma upon those who
are so unfortunate as to have experienced it, but rather a disease which
invades the brain in the same way that diseases of another character
affect other portions of the system, bearing with it neither more nor less
of responsibility or disgrace; 2, and, as a result in part from this
change, a more clear realization on the part of the public, that there
exists an obligation to make provision for care and treatment of those who
are deprived of reason, and consequently unable to care for themselves, to
a larger extent than for any other unfortunate class in the community.
The obligation resting upon the strong to provide for those who become
helpless from the effects of other forms of disease has long been
acknowledged, but it is only within recent times that this obligation
concerning those who become helpless from the effects of insanity has come
into general recognition. Now, however, it is readily conceded that this
unfortunate class appeals even more strongly for sympathy and aid than any
other, more especially by reason of the consequences which result to the
individual himself, as well as to his family, and the community in which
he resides.
The lower we descend in the scale of existence, the less importance does
the nervous system sustain in its relation to other systems of the entire
body; and conversely, the higher we rise in the scale, the larger
importance does it hold, until, in man, it reaches its highest relation,
crowning all the others, and making its possessor supreme in the world of
animal-life. When, however, disease invades the brain, and the individual
no longer holds sway over the purposes evolved from his mental
operations, he becomes the most helpless of creatures. Thought no longer
follows the dictation of the will; designs or plans, for the present and
future, are no longer possible. That intellectual power on which he so
much prided himself, and on which his highest happiness and usefulness
depended, has passed into darkness and confusion. Henceforth, if he is to
be cared for at all, or treated for the amelioration of disease, or for
recovery, it must be by friends on the ground of obligation, or by the
public, in virtue of that charity which is the growth of civilization and
religion.
Persons affected with other forms of disease may be cared for, in the most
part, at their own homes and by members of their own family better than
elsewhere, while the indirect influence of such care and surroundings is
often of much service in promoting both the happiness and the recovery of
the patient. But in the case of the insane the opposite is true: the
atmosphere of home and the care of friends are unfavorable conditions.
More often than otherwise, the disordered mind regards the oldest and
dearest friends as the worst enemies, while the circumstances of home and
scenes long familiar, are those which are the least calculated to improve
the mind.
In most other forms of disease, individuals may exercise their own
judgment or preferences in the selection of medical attendants, nurses,
and such appliances as may be thought necessary to comfort and recovery;
they more or less fully realize their own condition and requirements, are
capable, in some measure at least, of controlling their desires and
feelings, and of explaining their experiences, and are generally
influenced by such favorable indications as may arise in the progress of
their diseases.
But in the case of the insane all this is generally reversed. Individuals
have little or no judgment by which to be guided, as to those appliances
necessary for their care and treatment; they rarely recognize their
conditions fully enough to feel the necessity for doing any thing, beyond
yielding to those impulses which may be uppermost for the time being; they
are not generally capable of controlling their own feelings, restraining
their desires, or of intelligently realizing and describing their
condition, or of caring for themselves.
These conditions, so peculiar and opposite to those existing in many other
forms of disease, and the fact that even under favorable circumstances,
the vast majority of insane persons cannot be cared for in private homes,
except at greatest disadvantage to other members of the family as well as
themselves, renders it imperative for the highest interests of society,
that governments interpose and make provision for their care as wards of
the State, in a greater or less degree.
It appears to have been only within the last half century that this
obligation has become more fully recognized, and, in consequence, society
seems to be striving to make amends for past neglect. Hospitals and
asylums have been erected and equipped at large expense, and physicians,
selected with reference to experience and efficiency, have been placed in
the care of them. In some countries commissioners have been appointed
whose duty it becomes to see that kindness and sympathetic care take the
place of former neglect and cruelty; physicians and others, influenced by
professional and philanthropic motives, have been active in efforts to
secure measures for the most enlightened treatment and the most humane
care for these unfortunate members of society, so that, in process of
time, this charity has become one of the largest importance, affecting all
classes and conditions of society, and influencing, directly or
indirectly, every property-holder and every voter.
And, while it is a most melancholy truth that so large a number become
insane and dependent on society for care, yet the fact, that society is so
ready to recognize its obligation and respond so generously to it, appears
to be a cheering and hopeful indication. So far as it goes, it indicates
a diminution of selfishness and a growth of charity. It indicates that the
more humane, sympathetic, and finer qualities of character are having a
larger measure of influence in the tendencies of the present time.