SEX IN RELATION TO INSANITY.
The relative frequency of insanity in the sexes varies somewhat in
different countries and under the differing conditions of civilization.
There can be no doubt that under circumstances and surroundings adapted
equally to the maintenance of the health of both sexes, there would be as
little disease of brain in the one as in the other. The conditions of
life, however, nowhere exist bearing alike on both. While there are
certain hardships, exposures, and dangers to be endured by the male to
which the female is little liable, on the other hand there are many
unfavoring experiences growing out of the nature of her labor and duties
as arranged in modern civilization, as well as from the constitution of
her system, from which the male sex is exempt. While the male is more
often exposed to the inclemency of weather, the cold of winter and the
heat of summer; while he must endure the hardships of war by sea and land,
and the larger expenditure of physical force in the performance of his
labor; while he is much more liable to injury of the nervous system from
accidents arising in connection with his exposures in the larger sphere of
locomotion; on the other hand the female is much less favorably situated
in relation to the beneficial effects arising from living much in the open
air. The sphere of her activities is much more circumscribed, and the
larger portion of her time is passed in-doors, and often in an atmosphere
less favorable as to its hygienic conditions.
There are, however, certain physical conditions of the female sex which
are intimately connected with the sexual system, and which have been
supposed, by both lay and professional persons, to be closely allied, as
causes, to mental derangements, to which I desire to call attention for
the present. These will relate more especially to the unmarried.
In a general way the sexual system in the female exerts a much larger
influence on the whole physical and mental economy, than in the male. A
very intimate sympathy exists between it and both the stomach and the
brain. This becomes especially manifest at the period of puberty, and
continues until after the cessation of menstruation. The whole moral
nature appears to become changed, or rather it appears to come into
existence and activity when the child becomes a woman, and thereafter, for
thirty or thirty-five years, the whole person is largely affected one
fourth of the time by the functional activity of the pelvic organ.
The amount and quality of the blood, and its physiological effect upon the
vessels and cells of the brain, must largely depend upon the regularity
and perfect discharge of this function; and in the case of married women
the whole economy is subject to the large changes which come from
conception, pregnancy, child-birth, and lactation.
The cessation of menstruation must also, in most cases, be attended by
such changes as are of grave import: the calling into a larger activity
other organs of the body, especially the liver and the skin for the
purpose of eliminating those products of secondary metamorphosis which
before had passed from the system by the uterus; the consequent
disturbance of the circulation while this adjustment of functions is being
made; the increased amount of carbon left in the blood, and its effects
upon the brain;--every general practitioner of medicine has abundant
occasion to witness how great effects all these experiences produce upon
the nervous system; how excited or depressed, how irritable and nervous
and changeful the brain becomes from their influence upon it.
But in addition to these generally obvious effects, the gynaecologist has
occasion to observe other, and which he may regard as no less potent,
results of reflex influence on the brain from uterine disturbance of
other kinds, which more especially affect the unmarried class, which every
year becomes larger among all the older civilizations.
The condition of marriage is doubtless the normal one for both sexes, and,
as a rule, a larger degree of physical health is enjoyed by persons who
live in this relation. In no other is the discharge of the natural
functions of the sexual organs possible. As society is at present
constituted, however, more especially in the older civilizations, marriage
and its consequent responsibilities become more and more difficult, and
the female is the larger sufferer by a failure to consummate this
relation. All those instinctive yearnings for objects of affection and
love in the way of husband and children; all the outgoing of longing for
all that is implied in home, the care of it, and all connected with it;
with no one to cling to and depend upon in hours of sickness and trial;
the turning back, keeping down, and putting forever away into darkness all
those natural desires and passions which arise and tend to press forward
for recognition from time to time;--in short, the failure to develop and
bring into its mutual relation to other portions of the system this, which
is arranged and designed by nature to play so significant a part in the
female economy of life, can but tend in no small degree to cause a
somewhat abnormal condition and activity of the general nervous system.
Persons become nervous, capricious, irritable, and hysterical. A feeling
of lassitude and weariness results from any considerable physical effort,
and they are unable to endure the friction and annoyances of ordinary
daily life without much complaint. They feel badly without knowing why,
and are unable to long apply the mind to any particular task, or
persistently to carry forward any kind of employment. An experience of a
year or two, more or less, of this kind of nervous debility and suffering
generally lands many of these persons in the hands of the physician, and
no small number in those of the gynaecologist.
On examination there is frequently found to exist uterine derangement of
one kind or another: it may be congestion or a sub-acute inflammatory
condition of the neck of the uterus; in some cases there is endo-metritis,
or peri-metritis, abrasive ulceration attended with discharge, or there
may be displacement in the way of any of the flexions. Or again, there may
be defective, or irregular menstrual discharge, dysmenorrhoea, or
amenorrhoea. My impression is that some one of these various lesions of
the uterus will be found to exist in a large number of females who have
exhibited, for some time, such physical and mental conditions and symptoms
as have been detailed above.
Now, one of the inferences of the gynaecologist is likely to be, that the
uterine lesion, of whatever nature it may chance to be, is the cause of
the failure in mental and general health; that it is the "_fons et origo_"
whence has arisen the long train of nervous symptoms, and, doubtless, in
some cases this may be a correct inference; but in a vast majority of
cases my impression is that both the existing debility of the nervous
system and the uterine lesion are to be regarded as _consequences_, and
that neither is a cause of the other, but rather that they both result
mainly from a failure in the discharge of those functions which more
especially pertain to the sexual system, and a disregard of the laws of
health as to physical exercise.
But what I desire to specially note in this connection is, that these
symptoms or manifestations of nervous derangement are not those of
insanity, that they rarely pass over or develop into those of insanity.
There is prevalent, both among lay and professional persons, an idea that
a large number of females become insane, from the existence of some such
uterine conditions, or that these have a large influence in producing
insanity. My experience, however, points to an opposite conclusion. It is
rare to find any of the uterine lesions referred to existing among insane
women; and this is doubtless explicable for physiological reasons.
In almost all cases of acute insanity there exists a much larger amount of
mental activity than when the brain is in a normal condition. The
processes of thought go on during a larger number of hours every day, and
the period of sleep, in which there is a demand for a more limited supply
of blood in the brain, is correspondingly diminished. Then, again, the
character of mental operations is generally of much greater intensity;
impressions are more numerous, sensations are more vivid, and thoughts
press their way onward through the channels of nerve-cells and fibres of
the brain with greater rapidity and constancy.
Almost the whole force and energy of the nervous system appear to be
centred in the brain, and to supply the wear arising from such increased
activity of the brain, the system calls for a larger supply of blood in
this organ. It is therefore diverted from other portions, and there
results a diminished sensibility and activity especially of the sexual
system. In a large majority of these cases also, the monthly discharge
ceases to appear, and the sexual functions are in partial abeyance.
Now, in consequence of those changes which tend to occur in the vessels
and cells of the brain when a person becomes insane, if there were
existing any such functional uterine lesions as I have referred to, there
would at once arise a tendency to recovery from them; the monthly
congestions generally disappear, and such passive congestions as may have
long existed would also tend to pass away. An inflamed, or irritable, or
ulcerated neck would, in the absence of the usual physiological activities
of the organ, have a tendency toward recovery, except in some few rare
cases; and by the removal of congestions there would exist little if any
cause for displacements.
This may be said to be mere theory, but it happens to be certainly in
accordance with the experience of those psychologists who have studied the
tendencies and conditions of the uterus during periods of insanity. In an
experience extending over many years and embracing many cases, the number
of the above-named uterine diseases found by me could almost, if not
quite, be counted on my fingers.
While, therefore, such diseases of different kinds and degrees may, and
generally do, co-exist with general debility of the nervous system, they
are rarely found to be, and probably seldom are sufficient in themselves,
as causes of insanity, though they may sometimes be allied with other and
more potent influences in its production.
I may add that similar conditions of the female nervous system not
unfrequently arise among the married, when persons long live in the
relations of marriage, and yet without its natural results in the way of
a number of children, especially if, as is almost always the case,
improper measures are used to prevent the increase of the family.
I might in this place refer to another of those conditions of life
inherent in our civilization, which is unfavorable to the mental health of
the female sex, viz., the limited sphere of physical and mental
occupation, as compared with that of the male sex. So much, however, has
been written on this subject in its relations to and effects upon the
general welfare of women, and there appears to be so large a tendency on
the part of society, at least in this country, to admit her to any and
almost all such occupations as she may qualify herself to follow, that I
shall not refer to it further than to remark that, in so far as there may
exist a disposition on the part of women to avoid the care and
responsibility incident to home life and family, and, instead, to indulge
in physical inactivity; in so far as they avoid physical exercise in the
open air, and spend their hours of leisure in reading exciting novels, or
love-stories, whose heroes and heroines are generally of almost any other
kind of character than real, living, healthy, ones; in so far as they
avoid the conscientious discharge of those duties which devolve upon them
by virtue of their high mission as wives and mothers, and seek, instead,
to follow occupations or professions for which they cannot be best
qualified by reason of the nature, physiological activities, and duties of
their sex; in so far as they divert that nervous energy and physical
strength which is designed by nature to enable them to discharge the
sacred function of motherhood into other channels of activity, however
high and ennobling they may be,--in just so far are they deviating from
that great highway which leads to mental health and the highest interests
of humanity.
No aspirations of woman can ever reach so high and grand a sphere in the
activities of the world as that enshrined in the name of mother; and since
Nature has crowned her with this supremest function, all effort to forget
or change it, to belittle or push it aside for other more transitory
pleasures or missions, can only lead, in the end, to unhappiness and too
often to disease.