INSANITY
There is a very prevalent impression that religion is a common, even
rather frequent cause of insanity. This is founded on popular
experience. It has often been noted that not a few of the people who
go insane have delusions on religious subjects. It is also a very
common observation that those who are on the road to insanity and have
finally to be placed in an asylum have for some time been making
themselves conspicuous by their excessive practice of religious
observances of one kind or another. It is not surprising then that the
familiar fallacy _post hoc ergo propter hoc_, "after this therefore
the result of this", should have come to be applied in these cases,
and that religion should be set down as a prominent factor of mental
disease and perhaps one of the commonest causes of the condition.
Those who have given most study to the subject, however, know very
well that this conclusion is quite as unjustified by the facts of the
case as the corresponding one with regard to religion being a frequent
source of nervous diseases. We will discuss that in the chapter on
Nervous Diseases, and almost necessarily the closely related subject
of mental disturbances is touched on somewhat there. Of course it is
well understood that a great many of those who are on the road to such
mental alienation {206} as will eventually require their internment in
an asylum will give many external manifestations of religious
feelings, some of them exaggerated beyond reason, as perhaps the very
earliest striking symptom of their mental alienation. Religion, as we
said in the Introduction, is one of the most universal interests of
men. When people go insane, some interest will receive exaggerated
attention. The delusions of their insanity are dependent on what the
deepest interest of the individual was. If he was interested in money,
he will believe himself the richest or perhaps the poorest of men. If
he is interested in science, his delusions will be associated with
that subject. Delusions concerning some phase of science are probably
even more common in our day than those based on religion. Electricity
is the source of more delusions than anything else, though hypnotism
and telepathy and other sensationally exploited modes of so-called
psychology are a close second in this respect. If the patient has
recently suffered a severe loss by the death of a friend, sorrow will
be the central idea of his mental disturbance; if there has been a
disappointment in love, that will be the focus of his mental troubles;
if there has been a money loss, that disappointment will be the core
of the depression. Almost any human interest may thus become the root
of excitement or discouragement leading to mania or melancholia.
The Great War gave us some very interesting material as to mental as
well as nervous disease. In nothing was that more interesting than as
to the causes from which insanity develops. It might very well have
been expected that a great many people would break down under the
awful conditions in which they were placed during the war. For
instance Poland was fought over some six times, {207} and portions of
Austria overrun three times, and Servia was, between war and the
ravages of famine and disease, a veritable shambles of its people for
three or four years. It is easy to understand the awful states of
anxiety and solicitude and almost continuous terror to which the
inhabitants of Belgium, occupied by the Germans, were subjected,
particularly in the smaller places where they were utterly at the
mercy of the German officials whose one idea, fostered by their
military teaching, was that the end of the war would be brought about
or at least greatly hastened by a policy of frightfulness.
Literally many millions of people were subjected to conditions which
would seem to be impossible for human nature to stand for any length
of time, and yet they had to bear them continuously for four years or
more.
The records of the development of insanity among these people have
been rather carefully gathered, and they reveal the astounding fact
that the insanity rate was very little higher among all these intense
sufferers from the war than it would have been under the ordinary
conditions of civil life. Manifestly a certain number of persons had
the insanities which would have developed in them in later years
anticipated by the trials and the hardships of wartime conditions, but
only those suffered from insanity as a rule who might have been
expected to do so because their family or personal history revealed
tendencies in that direction which would almost surely have made
themselves manifest sooner or later even under the inevitable
vicissitudes of peace time.
What modern medicine has revealed to us is that apart from certain
infectious diseases which produce degeneration of the physical basis
of mind and the absorption of certain poisons--alcohol is a typical
example--which {208} cause a corresponding degeneration to the
infections, the supreme factor in insanity is the inheritance of a
predisposition to the affection. Two things have become perfectly
clear in the course of modern medical investigation, that insanity and
longevity run in families, and that there is almost no other basis on
which the two conditions may develop. Infections or intoxications in
the broad sense of the word may produce conditions to foster or impair
respectively either of them, but even they are of minor significance
compared to the original inheritance in either case.
Clouston, the well-known English authority on mental diseases, whose
opinion is founded on many years of personal observation, in his book
on "Unsoundness of Mind" [Footnote 6] has put the relationship
between religion and mental disease very clearly. He said: "It is true
that religion, touching as it does, in the most intense way the
emotional nature and the spiritual instincts of mankind, sometimes
appears to cause and is often mixed up with insanity. But in nearly
all such cases the brain of the individual was originally unstable,
specially emotional, oversensitive, hyperconscientious and often
somewhat weak in the intellectual and inhibitory faculties and, if
looked for, other causes will usually be found." He had said just
before, "To talk of 'religious insanity' as if it were a definite and
definable form is in my judgment a mistake."
[Footnote 6: Methuen, London, 1911. ]
So far from prayer--the principal exercise of religion, that is the
raising up of the mind to God, either in petition or in
resignation--unsettling people's minds, it has exactly the opposite
effect. Professor William James, whom most people are not inclined to
think of as likely to be an overstrenuous advocate of religion, in his
{209} well-known essay on "The Energies of Men" has a paragraph in
which he quotes from a physician who had had long experience in the
care of a great many insane and who did not hesitate to say that
prayer was a benefit and not in any sense of the word a detriment to
his patients.
"Doctor Thomas Hyslop, of the great West Riding Asylum in England,
said last year to the British Medical Association that the best
sleep-producing agent which his practice had revealed to him was
prayer. I say this, he added (I am sorry here that I must quote from
memory) purely as a medical man. The exercise of prayer, in those who
habitually exert it, must be regarded by us doctors as the most
adequate and normal of all the pacifiers of the mind and calmers of
the nerves."
It is recognized as a general rule in asylum practice that when
patients begin really to pray, a turn for the better has come in their
condition, and they are on the high road to recovery. This does not
mean, of course, noisy, wordy praying, but quiet raising of the mind
to God and acts of resignation to their condition so long as they may
be affected.
There is a very general impression among those who have had most to do
with the insane as well as among psychologists in general that
religion, instead of favoring the development of insanity, rather
inhibits it. Professor Muensterberg, in his "Psychotherapy" dwells
particularly on this. Almost needless to say Professor Muensterberg did
not wear the special favor of religion in the lists and was in no
sense her champion. He is proclaiming simply what he knows and feels
to be true.
A very curious reflection on the relations of religion and insanity is
to be found in the fact that the marked increase in the insane among
the population of all the {210} great modern civilized countries and
most striking among our own has come since the decay of religion and
the decrease of religious belief. The statistics of that increase in
the number of the insane are very startling to those who are not
familiar with the subject. During a single generation the number of
the insane in our institutions has increased to five times what it was
before in proportion to the population. There is no doubt that this is
due to some extent to the fact that people are much less ready to care
for their insane relatives outside of institutions than they were a
generation and especially two or three generations ago. We are much
less ready to make the personal sacrifices needed to keep our friends
at home, which is probably also due to the lowering of our religious
sense of obligation in the matter. Fortunately our insane asylums are
much better conducted than they were, and this has made people more
willing to confide their relatives to them. Giving all due allowance
for this, however, there has been an enormous increase in the number
of the insane. Such commonwealths as California and Massachusetts, in
which there are very large proportions of educated people, present the
highest increase in the number of the insane. There are certain
critical spirits who would say that it is our education without God
and without religion that has fostered this state of affairs, and that
it is particularly people of a certain limited intelligence who, when
overeducated, lose their faith, who are most prone to lose their
minds.
The most important single factor in insanity, not dependent on
constitution or heredity but on conduct, is that degeneration of the
brain which brings on paresis or general paralysis of the insane.
Taken by and large throughout the world generally, nearly one in five
of all {211} those who die in insane asylums die from this affection.
It is the result of an infection usually consequent upon sexual
immorality. The disease is inevitably fatal and once it begins it is
steadily progressive from the delusions of grandeur so common at the
beginning through various delusional states up to absolute dementia
and death, which usually takes place in a little more than three years
from the beginning of the disease; five years is a long time for a
patient to survive. Nothing has done so much to limit the occurrence
of this disease as religious influences, and it has increased to
become the modern scourge that it is just in proportion as religion
has lost its hold upon the mind of the rising generation. The disease
is particularly infrequent among clergymen, and while _lues_ from
which the disease develops may be contracted innocently, it is very
evident that a regular moral life such as is led under the sway of
religious principles is the best possible safeguard against the spread
of the disease.
After paresis the most serious form of acquired insanity in modern
life is that known as alcoholic insanity, due to excess in the taking
of spirituous liquors. It is not necessarily inevitable that a man who
frequently indulges to excess in alcoholic liquors will become insane
any more than that he will suffer from alcoholic neuritis, but a large
number of individuals prove susceptible to the toxic effects of
alcohol in these ways. There is an inherent liability in their brain
and nervous system to degenerate under the influence of alcohol acting
as a poison. This is an extremely common form of insanity, but almost
needless to say it occurs much less frequently in those who have any
religious principles than in those who are without them, because
religion protects from the excesses that predispose to these
conditions. Clergymen {212} very rarely suffer from them and though
occasionally clerical patients have developed alcoholic insanity or
alcoholic neuritis, these cases on careful investigation oftener
proved to be due to certain patent medicines which contained alcohol
in large percentage than to any direct consumption of spirituous
liquor.
Religion by its calming influence keeps a good many people who have
hereditary tendencies to insanity from developing outspoken symptoms
of the disease. Religious conviction has a definite efficacy in making
people humble instead of conceited, and this is an excellent factor
for preventing the tendency to insanity. Nearly always the preliminary
sign of insanity is an exaggeration of the _ego_ and a hint at least
of delusions of grandeur. People who overrate their importance are
often on the road to the asylum. Religion, by inculcating humility, at
least lessens this tendency and puts off developments that are
inevitable so that many more years of reasonable sanity are enjoyed
than would otherwise be the case.
Probably the worst thing in the world for those who have any inherited
tendency to disequilibration of mind is to have an occupation in life
which involves strains and stresses of emotion. The gambler, the
speculator, the man who risks his all on some attempt to make a great
deal of money, are much more prone to develop insanity than those who
have occupations in life at which they work from day to day for a
moderate wage, and who get their joy in life out of the fulfillment of
domestic duties. Almost needless to say religion has always
discouraged gambling and such speculation as resembles it very
closely, and the whole tendency of religious influence is to make
people so satisfied with their lot in life that they will not take the
risks which involve the {213} vehement mental emotions so likely to
disturb those with inherited predispositions toward irrationality.
Undoubtedly religion has in this way saved a great many men from
serious developments in mental alienation which might have come had
they felt themselves free to take up the riskier avocations in life
from which they were deterred by the feeling of religious disapproval.
After the tendency to exaggeration of the ego and delusions of
grandeur, the most common symptom of incipient insanity is delusion of
persecution. As regards this, once more, the religious feeling of
trust in Providence and the conviction that God will somehow take care
of them keeps many people from allowing their delusions of persecution
to manifest themselves so soon or so violently as would otherwise be
the case. Only comparatively rarely do religious minded people in the
midst of their delusions of persecution commit crimes, being deterred
therefrom by the underlying consciousness of the wrongness of their
acts in taking judgment on their persecutors into their own hands,
even though they may have yielded to a belief in their delusions. It
is true that a certain number of religious-minded people do commit
crime under the influence of delusions, but these are rarer than the
cases which occur in people who have never had any sense of religious
morality.
In a word religion has meant a very great deal for the limitation of
insanity and the tendency to it, for putting off its development and
giving patients years of sanity they might not otherwise have enjoyed,
and it has had a very definite effect in limiting the crimes
consequent upon insanity. It has a very marked tendency to create the
atmosphere of placid trust and confidence which means so much for the
preservation of sanity. Far from being {214} a provocative of
irrational tendencies it soothes patients' minds, prevents them from
running into such excesses of emotion as are dangerous for mental
balance, and it predisposes those who allow themselves to be deeply
influenced by it to live such quiet satisfied lives without inordinate
ambition and disordered desires as make for health of mind and body
during prolonged life.
It has often been said that religion unfortunately proved harmful to
insanity and the insane in the old medieval days, because
ecclesiastics, sometimes for the sake of the fees that they might
secure for exorcisms, taught very generally the doctrine that the
insane were possessed of the devil, and that the one thing to do for
them, besides exorcising the evil spirit, was to chain them up and
keep them in manacles in dungeons until there was assurance that they
had been released from the devil that had gained possession of them.
In spite of the fact that this is a rather common teaching in medical
books and is frequently asserted even by physicians and sometimes
indeed by specialists in nervous and mental diseases who are supposed
to know the subject on which they discourse, there is very little
foundation for this prevalent impression. Undoubtedly there was the
belief in the possibility of possession by the devil and some such
modern scientific minds as Alfred Russel Wallace and Professor Barrett
of Trinity College, Dublin, have reverted to that belief because of
their studies in spiritism and some of the curious results that follow
from overdevotion to the cult of spirits. There was, however, a very
definite recognition of the fact during the later Middle Ages that the
insane were just ailing persons who had to be taken care of, properly
treated, kept from hurting themselves or others, just as delirious
individuals {215} would have to be guarded, but who must be looked
upon as sick in mind, just as a number of people were sick in body and
with more than a hint that the bodily condition had more to do with
the insanity than anything else. I have discussed the subject at some
length in my volume on "Medieval Medicine" recently published in
London. [Footnote 7] Paul of Aegina wrote in the seventh century of
melancholy as a primary affection of the brain to be treated with
frequent baths and a wholesome and humid diet, together with suitable
exhilaration of mind and without any other remedy unless when from its
long continuance the offending humor is difficult to evacuate, in
which case we must have recourse to more complicated and powerful
plans of treatment. Paul was a very popular author much read in the
Middle Ages.
[Footnote 7: Black. 1920.]
The Church's view of the subject of insanity is very well expressed in
Bartholomew's Encyclopedia. This was a work written particularly for
the information of the clergymen of the time, in order to explain to
them all references in Scripture and to give them such details of
knowledge as were necessary for preaching and for the teaching of
their flocks. Bartholomew was very widely read and went through many
editions before printing, was put into print very early, and some of
the editions are among the greatest of bibliophilic treasures.
Bartholomew, usually called the Englishman--his Latin name of
_Bartholomaeus Anglicus_ is well known--boiled down all the knowledge
of insanity into a single paragraph. He has nothing at all to say of
possession by the devil, and his discussion of the whole subject of
madness is as modern as can be.
The causes of insanity which this clergyman writer {216} of the middle
of the thirteenth century enumerates are those which psychiatrists of
the present day are insisting on. The symptoms of infection,
considering the brevity of the passage, are very well and clearly
described, and the treatment suggested is the very latest in modern
practice and consists of improvement of nutrition and the diversion of
the insane. With all our supposed advance in knowledge no physician,
even of the twentieth century, could have expressed the whole subject
of insanity any better than Bartholomew did. This paragraph is a
complete refutation of the objections that the Church by its
insistence on diabolical possession as the principal cause of insanity
did a great deal of harm. Bartholomew said:
"Madness cometh sometime of passions of the soul, as of business and
of great thoughts, of sorrow and of too great study, and of dread:
sometimes of the biting of a wood (mad) hound, or some other
venomous beast; sometimes of melancholy meats, and sometimes of
drink of strong wine. And as the causes be diverse, the tokens and
signs be diverse. For some cry and leap and hurt and wound
themselves and other men, and darken and hide themselves in privy
and secret places. The medicine of them is, that they be bound, that
they hurt not themselves and other men. And namely, such shall be
refreshed, and comforted, and withdrawn from cause and matter of
dread and busy thoughts. And they must be gladded with instruments
of music, and some deal be occupied."
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