INSANITY AND CIVILIZATION.
Information in reference to the character of the diseases which formerly
existed among the aborigines of North America, or among uncivilized
peoples of other countries, in the past, is both meagre and indefinite.
Legends concerning widespread epidemics of some forms of disease,
especially the yellow fever and small-pox, among those tribes which
formerly lived on the territory which now constitutes New England, have
been handed down, and there must have occurred cases of insanity, to a
greater or less extent, among all savage nations, arising from injuries to
some portion of the nervous system; but, for the most part, those
conditions and experiences of life which appear to predispose or excite
the nervous system into diseased action, were probably absent.
Those who were born with weakened or defective organizations, either
physical or mental, would, under the exposed conditions and the rude
experiences of uncivilized life, hardly attain to adult age, even if they
were not intentionally left to perish, so that the vast majority of those
who did arrive at those periods of life during which insanity generally
manifests itself, would probably possess such nervous organizations as
would be little liable to become insane.
Their modes of living, also, being for the most part in the open air, and
without excessive labor or exertion, except on occasions, and during short
periods; and living in comparative freedom concerning those uncertainties
of business and property which exist so generally among some classes, and
even nations, under the conditions of civilized life; having few needs,
and those of such a nature as to be easily supplied, would all be
unfavorable to the development of insanity.
Again, uncivilized persons have but little sensitiveness, and are easily
satisfied in reference to that long range of sentiment and feeling which
holds so large a sway, and wields so strong an influence, in the lives of
their brethern and sisters in civilized life; and, moreover, experience
few of the annoyances, disappointments, and vexations which result from
the habits and customs of our forms of domestic and business conditions.
Yet it appears to be a humiliating admission to make, that, with all the
increase of mental power and range of thought, with acquired power over
the forces of nature, with ability to convert the hidden treasures and
forces of nature, into the means of supplying wants and ministering to
comfort, and, with the vast storehouse of mental wealth which comes into
the possession of mankind through the influences of civilization, there
should, somehow, necessarily come with them, greater liability to such a
calamity as insanity. This is, however, but one of many evils which
invariably come into existence under the changed relations and
circumstances of life, not only while passing from the habits of
uncivilized life to those of a high state of civilization, but especially
while living in the latter condition.
It is exceedingly difficult to differentiate, and accurately state in few
words, what is signified by either insanity or civilization. Both are
terms, the general signification of which, for practical purposes, is
supposed to be well enough understood, but when we are called upon to give
a clear and at the same time a fully comprehensive definition of them,
there is much difficulty in doing it.
As has been very clearly shown by Dr. Arthur Mitchell,[2] civilizations
may differ in different countries, as well as at different periods of time
in the same country; they may be old or new, high or low, one thing in
this century, and another in the next. That of the ancient Greek certainly
differed widely from that of the Roman, while both differed largely from
the European civilization of the present time.
In one view of the subject, that which regards it as something separate
and distinct from those unfavorable conditions which always accompany its
progress, we may say that _civilization may be considered as the measure
of perfection reached by society as a whole, toward living in harmony with
its environments, in a civil condition_.
But, inasmuch as no civilization has yet appeared among any people, so far
as we know, or is soon likely to appear, free from those imperfections
which affect even large numbers, some other more practical idea of its
character will be necessary. For my present purpose it may be considered
as _the sum of results, which follow from the total of activities in
operation among any people, while living under those conditions which
always have pertained to civil life_.
These results will vary even largely from one period of time to another,
and will be partly good and partly bad. Indeed, I think it will be found
that, in the degree in which nations have passed from those conditions
which pertain to life in the savage state, upward toward those which
abound in civilized life, in that measure has the sum total of diseased
conditions, in both body and mind, increased; in this measure have there
resulted degenerations of nerve element, and consequent failure to attain
to and live in harmony with those artificial arrangements and conditions
with which society in the civil state has, thus far in its history,
uniformly surrounded itself.
In other words, while man has largely gained in some directions; while his
mind has become more active and far-reaching in its range of thought, and
many-sided in its activities; while the comforts and luxuries of life have
become many times larger, by abandoning those conditions of life which
pertain to the savage state, and assuming others of a vastly higher and
more complex nature, yet, thus far in his history, he has not succeeded in
surrounding society by such regulations, and in securing obedience to such
laws, as will suffice to preserve and retain the health and strength of
body which existed while in the savage state, except among the few.
That many of the conditions pertaining to modern civilization prove to be
highly conducive to physical diseases, needs hardly to be said, and that
they are no less productive of insanity and other diseases of the nervous
system, will be evident from some considerations to be alluded to in
connection with this discussion.
1. At first thought it might appear that the development and extension of
civilization, which carries with it so many and great advantages in many
other respects, should also be favorable to mental health. It is a law of
the human system that the various organs become strong and maintain a high
standard of health, only while under a considerable degree of activity,
and this is especially true of the muscular and nervous systems.
Inactivity and disuse tend toward degeneration, therefore, such
circumstances and surroundings of life as will conduce to harmonious
activity of these organs and parts, would, _ceteris paribus_, be most
favorable to health.
Now the various portions and faculties of the human brain are brought into
a state of full development and activity only under the conditions and
influences of civilization; all of those higher and finer manifestations
of thought, sentiment, and feeling, which pertain only to man; the
satisfaction which comes from the results of mental activities both in
relation to mechanics, education, governments, and the social amenities;
the increase of strength pertaining to thought, and consequent
self-reliance, and ability to rise above the adverse circumstances and
experiences of life; freedom from the conditions of uncertain and limited
supply, with attainment of those of a fairly certain and abundant
character; the results which come from travel, and intercourse with
persons of other nationalities; from trade, commerce, and intellectual
pursuits; together with the possession of knowledge, which is power,--all
come only from the conditions and influences of civilization, and should
rather have a tendency to confirm and make strong mental health.
And this would undoubtedly be the result, if these were all, or indeed
mainly, the effects attendant on living under the influences of
civilization.
But, unfortunately, these are only some of the beneficent results of this
change. Other influences, customs, and practices, and those of a character
highly adverse to the maintenance of healthy mentality, have also come
into operation, to a greater or less extent, and are especially potent in
modern civilization.
With the increase of mental activity alluded to, there have come into a
fuller range of activity those portions of the brain which are concerned
with thought, and which, in the narrow limits and simple conditions before
experienced, had been comparatively inactive. Consequently, a larger
supply of blood has been summoned to these parts of the brain to repair
the loss incurred by this increased activity. This change and consequent
disturbance in the relative blood-supply, as between the brain and other
parts of the system, would be of little importance if sufficient care be
exercised that it comes in the right degree, and does not cause too great
activity in the organ of the mind; indeed, there might be expected
favorable results from a larger exercise of function, or at least not
unfavorable ones.
In the experience of modern times, however, this has not proved to be the
case. With the measure of mental power and scope which attends the change,
there has been a large tendency to over-stimulate the intellectual
faculties, which has been aided and thought to be necessary, in
consequence of the immense competitions and business activities of modern
civilization.
This tendency to stimulation has been manifest even to a much larger
extent than formerly, first, in the matter of education. The new
conditions and employments of life, rendered prominent by some of the
discoveries which pertain to science, agriculture, commerce, and the
general conduct of business pursuits, have developed requirements on the
part of those who are called upon to conduct them, which have been
heretofore unknown. To meet these requirements it has been thought
necessary to pursue such courses of education, and to present such special
incentives to study on the part of the young, by the use of prizes and
grades of scholarship, and public exhibitions, as will bring into
operation the largest possible activity, and secure the highest discipline
of the brain, even at a very early period of life. At this time all the
forces of vitality and physical growth are in the fullest activity, so
that the strain comes upon the brain at the period when it has the least
of ability to bear it, and at expense to other portions of the system.
And again, in the use of stimulants, especially alcohol, in some of its
forms, and tobacco, during the period of growth and early manhood. The use
of these substances, as well as the subject of education, in their effects
upon the nervous system, will be discussed more fully in future chapters,
and are only mentioned, in this connection, as causes of nerve
degeneration, which have come into operation more fully through the
influence of modern civilization.
2. One of the conditions of savage life, is that of _a community of
interests and supplies_, to a large extent. Families and tribes seek for
and possess supplies in common; the weaker depend upon the strong, and the
strong aid the weak, so that when privations, from failure in the chase
and other causes, may come, they affect all together, and generally in
like degree. The passion of avarice is in a latent state; those who are
strong do not thrive at the expense of those who are less so, while the
latter depend upon aid from the former. Wealth and poverty and such
distinctions as arise from these civil conditions are unknown.
Under the conditions and customs which pertain to civilized life, how
great the contrast! All, or nearly all, is changed. Individuality appears
at once. Each and every person, or family, is expected to rely upon his,
or its, individual effort for success in obtaining such things as are
necessary to comfort and well-being. In this he stands, in a large sense,
isolated, and fails, or succeeds, by himself, alone, or with his family.
In other words, _community of interests_, except in some very indefinite
and limited measure, is lost sight of, and swallowed up in those of the
individual. In the conduct of life, the strong are almost sure, not only
to neglect the weak, but often to tyrannize over them; they become selfish
and not unfrequently covetous, and require much for little. The
distinctions and conditions of society incident to wealth and poverty,
knowledge and ignorance, appear, and the latter too often surrounds its
unfortunate victim with such hardships and exposure, as tend rapidly, in
too many cases, toward bodily and mental disease.
In this way the struggle incident to the conditions of civilized life,
becomes tenfold greater than in savage life, for one portion of the
community, and in this struggle, the weaker ones, sooner or later, tend
toward the wall. The strong become stronger from the very conditions and
influences which surround them, while the weak tend to become weaker, and
many are almost sure to fall by the way. Ignorance, poverty, and unhealth
are long-time companions, and lean strongly toward immortality.
Under the complicated conditions and antagonizing interests of
civilization, the strong make the laws and establish the customs, which
become obligatory upon all alike, and these will invariably be of such a
character as will, in the long run, discriminate in their own favor. This
has been apparent in all the older civilizations, especially in reference
to the tenure of land; so that, _once owned, always owned_, might be
considered as the law. Land, once in possession, continues in families for
long generations, or indefinitely, unless it revert to the government. In
either case its resources in ameliorating the conditions of the poor, and
ministering to the productive wealth of the country, are greatly
diminished, while under the influence and laws of a larger community of
interests, it could be made productive toward the support and comfort of
thousands who now live and die in poverty, want, and ignorance, and who,
all their lives, from infancy to death, are in those circumstances of
privation which render them specially liable to disease of mind.
But not only in respect of land does the tendency to unequal conditions
manifest itself; it becomes apparent in reference to property in nearly
all its other forms. In the conduct of commerce, manufactures, trade and
exchange, in government itself, there exist vast ranges of opportunity
unknown to savage life, for the strong to triumph over the weak: To him
that hath shall be given, and he shall have an abundance, while from him
that hath not shall be taken away even that which he appeareth to have.
The rich have an abundance and surfeit, while the poor become poorer, and
suffer for the requisites wherewith to become strong, or even to remain in
physical health. To the one class pertain all those conditions which serve
to invigorate and strengthen, while to the other pertain the opposite
ones. To the one belongs abundance in the way of food, clothing, shelter,
warmth, pure air, change, and education, while to the other pertain
privation, insufficiency of food, impure air, overwork, ignorance, and a
never-ending monotony and drudgery of life.
And in the history of the world, thus far, there has never appeared any
high states of civilization without these unequal and inharmonious
developments. No peoples have as yet ever learned the art of living under
the conditions of civilization without them; no peoples have ever passed
from the community of interests and possessions, which exists so largely
in savage life, up to those conditions which pertain to civil life, except
with attendant results similar to those already indicated; and these
results are plainly those which tend largely toward the development of
mental disease.
If the views presented in the preceding chapter and also in this, in
reference to the tendency of insanity to increase, and which statistics
appear to confirm, are correct, we perceive at once how important, in
relation to both political economy and the future health and happiness of
society, becomes the problem of this disease.
As a subject of science and philanthropy, it has for some years engaged
the study and interest of many who have been desirous more fully to
understand its bearing in both these respects; but in the no distant
future, it will become the disease of paramount importance and interest to
legislators and political economists; and as there exist reasons for
supposing that, under the changing conditions of our modern civilization,
it will more surely tend to invade the homes of many who have heretofore
been exempt, and will in the future even more surely than in the past,
affect all ranks and conditions of society, the increasing importance of
making its causes a subject of investigation, and of endeavoring to
prevent its increase, even in a limited degree, becomes at once apparent.
It may be remarked at the outset that many of the _exciting_ causes of
insanity are uncontrollable. We can do little, or nothing, toward changing
or modifying the demands which are made upon us by the business operations
of the present; nor toward modifying those great activities which are so
loudly calling for development and conduct in life; we cannot do much
toward changing the unequal conditions which pertain so largely in
relation to property, occupations, and modes of living; or in avoiding the
sufferings which result from the bereavements and disappointed
expectations of life; we cannot, nor is it desirable, in all respects, if
we could, do much to promote community of interests in property. But it is
important to bear in mind that, after all, the prime condition of insanity
lies, to a large extent, back of these exciting causes. Thousands have
passed through such conditions and experiences, have suffered from
disappointment and failure in respect to their plans and purposes; have
endured exposures and hardships all their lives; all, without becoming
insane, and thousands more will continue to do so in the future. It is
evident, therefore, that there must exist back of these experiences, a
state of the nervous system which renders it susceptible of the disease.
This, it is, which is the prime factor in the problem of insanity; and it
becomes of the first importance to discover, so far as we may be able to
do so, in what this predisposing tendency may consist, or, at least in
what ways, or through the operation of what causes, it more especially
tends to come into existence and operation to so large an extent at the
present time, and by what means it maybe avoided.
In this study we are proceeding along the same road we follow in
investigations concerning other diseases. In a philosophical sense, there
lies back of all manifestation of diseased action, an antecedent
condition, which is the soil from which morbid actions spring. There exist
the scrofulous, the phthisical, the gouty, the rheumatic diatheses, and,
hence, the question of heredity is of the utmost importance in reference
to many forms of disease.
"To many intents and purposes, we are born one generation at least, and
generally more, before we come into the world. The soil whence the
protoplasm of our grandfathers was formed, has a large significance in
reference to ourselves. We limp, because they were gouty; we groan with
rheumatic pains, because they slept in damp rooms; the neuralgic twinges
of their fifth pair of nerves extend over into ours. The acid of the
grapes, which our fathers ate, has acted on the enamel of our bicuspids
and molars. That intangible tendency to weakness, to unhealth, so
indefinable, so delicate, so inappreciable to our senses, is yet the
mightiest factor in our being, and measures the amount of our physical
pains and sufferings with a greater delicacy than we have been wont to
think. It is the match, which needs only to be rubbed,--or the tinder
waiting for the spark,--or the acid for the alkali.
On no other theory are we able to explain the effects, or absence of
effect, from the exciting causes of disease. For instance: in one case
cold produces neuralgia, in another rheumatism, in another pneumonia, in
yet another bronchitis, and in the fifth person no morbid action at all.
Now in these several persons there must have existed a primary or induced
condition of the several parts affected, of such a nature, that a common
cause, acting upon all alike, yet produced widely different results.
"Again, two persons may be exposed to the same atmospheric conditions, or
be brought within a similar miasmatic influence, resulting in the one case
in fever; in the other, in nothing. The miasm or poison was doubtless
present in both systems alike, and, perhaps, in similar quantity, and yet
in one case with no appreciable effect, and in the other, creating an
illness which may continue for weeks or months. It is evident that there
must have been, in the last case, a condition of the system which rendered
the action of the miasm possible, and without which, it would have been
entirely, or nearly, inert. In fact, strictly speaking, this cause, or
antecedent condition, is rather a part of the disease itself, and cannot,
in fairness, be separated from it. For, if disease be abnormal action,
either in the structure or function of an organ, whether sufficient to be
recognized or not, subjectively or objectively, then this weakness,
inherited or acquired, becomes the chief factor, and those changes, which
are sufficiently gross to be observed by our senses, and which we are
accustomed to term disease, are only the remaining factors of it."[3]
I apply the same course of reasoning in relation to _that necessarily
antecedent condition of the brain_, which renders it especially liable to
become diseased through the operation of those ordinary exciting causes,
which, to a greater or less extent, surround the lives of all persons, and
which we term _the Insane Diathesis_. It becomes necessary, therefore, to
study this peculiar condition of the brain, first, as to its _nature_,
and, second, as to some of those _causes_ which tend especially to create
it.