Insanity

Insanity

BY ARTHUR L. BEELEY, OF THE BRIGHAM YOUNG UNIVERSITY

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/ Conditions in Utah

It is a very difficult task to ascertain and state definitely the real cause for an insane person's condition, for two reasons. First, because the relatives of a patient, in a majority of cases, withhold valuable data, thinking that to state facts would result in social humiliation, while on the other hand, were it not for such "mock modesty," a more intelligent diagnosis and treatment of the case would often be the result. Second, because insanity is generally the result of several causes working together. For example, a man whose parents, grandparents, and great-grandparents have allbeen addicted to the prolific use of alcohol, will inherit from them a constitutional weakness, which in many cases is a mental weakness. Suppose he becomes a victim to the same vicious habit of his ancestors, this weakness will take advantage, as it were, of this new habit in him, so that the destructive effects, both mental and physical, of the drink habit, plus the inherited weakness, will shorten the period of normality and hasten the advent of abnormality or insanity. Suppose, however, the individual becomes a constant user of drugs or a deep indulger in some other intemperate habit, the influence of the inherited weakness will be just as great and pronounced along the line of such habit. Imagine such a case as the one just described, of which there are thousands, the commitment would state the cause as "alcoholism," while as a matter of fact heredity would claim an equal, if not a greater, share of the cause. Hence it is that out of a total of 2,002 male and female patients committed to the Utah State Mental Hospital, for a period of twenty-five years (from 1885-1910 inclusive), only in the case of 1,450, or 73%, has the supposed cause been stated, and in 552 cases, or 27%, the cause has been deemed so obscure as to be omitted.

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The following is a table of causes assigned to the 1,450 cases committed during this period:

SH 0J O) °0 OS *J rt -4-> ° O 03 NAME <B p 00 NAME 8 fe M «— M 03 (O t-, 03 03 oj-w m PM O 3

Alcohol 10 6.13 Mental Non-develop Apoplexy 1 .34 ment .06 Arrested Development- 6 .55 Meningitis .27 Brain Trouble 8 1.58 Neuresthenia .34 Brutal Treatment 1 .06 Nervousness .27 Chronic Mania 1 .06 Natural Weakness of Congenital 4 Mind .06 Childbirth 10 Nymphomania .08 Climatic Conditions .. 3 .27 Overwork IS 2.00 Change of Life 4 .27 Onanism .62 Congenital Defective Organic Disease of Development 2 .13 Heart .06 Disappointment in Love 6 .55 Ovarian Trouble .06 Domestic Trouble 10 1.02 Paresis .20 Degenerative Cerebral Pregnancy .08 Change 1 .05 Persecution (supposed) .06 Drugs 5 1.02 Puerperium 35 2.41 Domestic Infelicity •20 1.58 Plumbism .20 Desertion (by husband) 1 .06 Paralysis .68 Epilepsy 37 9.10 Poison .13 Earthquake 1 .27 Privation .13 Excitement 1 .08 Pre-Natal Disturbance- .08 Exposure .34 Poverty .34 Fright "~S 1.02 Reading Novels .05 Feeble-mindedness 1 .41 Religion 3.24 Fanaticism 1 .06 Remorse .24 Financial Trouble 17 "~2 1.17 Sedentary Life .03 Gravidity .13 Shock .06 Heredity 95 123 15.03 Specific .08 Hypnotism .20 Sunstroke .96 Heat (excessive) .06 Syphilis ' 2.48 Hemiplegia .05 Senility and Debility- 32 6.00 Intemperance 2.13 Solitude .05 Insomnia .62 Sepsis .06 Imprisonment .06 Studying Prize-fighting .03 Injury 3.79 Study .06 Illness 26 3.51 Stroke of Lightning... .06 Infatuation .06 Tobacco .13 Isolation .41 Trouble 3.58 Idioapathy .06 Traumatism 2.20 Jealousy .20 Self Abuse .27 Loss of Kin .75 Spiritualism .13 Lead Poisoning .62 Urinary Trouble 14 14 .95 Melancholia .06 Want of Employment- 1 1 .06 Morbidity .20 Worry 56 115 7.92 Menstrual Disorder .48 Men'opause .55 Masturbation S4 6.13 Totals. 586 1450 100.00

// Causes of Insanity

The causes enumerated above may be comprehended under five general headings Heredity, Alcohol and Other Poisons, Sex :

Immorality, Physical Diseases, and Mental Habits. I shall discuss them in the order named.

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Heredity. —Heredity may be shown either in the lineal or collateral lines. It often acts by transformation, that is, the ancestral stock may show other mental disorders, such as epilepsy, inebriety, hysteria, and neuresthenia. In such cases there is a neurotic taint, and insanity is evolved upon this soil.

The exact relation of heredity to insanity is uncertain. There is a disagreement even among the most eminent authorities. Maudsley states that from one-fourth to one-half have the hereditary taint Sankey states one-fifth. ; From a report made to the French government in 1861 it appeared that 530 out of 1,000 insane patients had a history of heredity.* As previously stated, exact figures are difficult to obtain because of the reticence or ignorance of the patients or their friends. It is very significant to note from the above table that in the case of Utah, as far as is ascertainable, only 218 out of 1,450

cases, about one-sixth, have a history of heredity.

The fact that heredity plays such a prominent part in the causation of insanity should create a keen public conscience regarding marriage. Marriages, in which the immediate families of the prospective candidates exhibit signs of transmissible insanity or feeble-mindedness, ought not to be solemnized, without first consulting a competent physician.

Alcohol and Other Poisons.— Alcohol is a direct poison to the nervous system, and is an ever active cause of mental disease. It times, beis a more prevalent cause in modern than in ancient cheapness with which distilled spirits are cause of the facility and made and placed upon the market. Alcohol causes acute and now chronic insanities: as delirium tremens, chronic systematized in-

contributes to the causation of sanity,and general paresis it also ;

and epilepsy in the offspring. It is estimated idiocy, imbecility that fully 30% of the men and 10% of the women admitted to state hospitals are suffering from conditions due directly or indi- rectly to alcohol.f Note that in Utah, however, only 6.13% of the cases were directly attributed to alcohol.

Treatment, Vol. Ill, p. 992. *James Hendrie Lloyd, M. D., Practical tState Charities Aid Association, New York, pamphlet No. 121.

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Other poisons such as opium, morphine, cocaine, chloral, which with other compounds are not infrequently found in patent medicines, often weaken the mental capacities and produce insanities.

Sex Immorality. — It is a lamentable fact that man is the only animal addicted to such vicious habits as are implied by the term "sex immorality." Paresis, syphilis, masturbation, etc., are the invariable results of such habits. The kind of insanity popularly known as "softening of the brain," scientifically called general paralysis or paresis, is the result of an earlier disease known as syphilis, and until the last few years was considered incurable by any means known to the medical profession. In a pamphlet issued by the State Charities Aid Association of New York, to which I have already referred, the number of paresis patients admitted to State Hospitals during the year 1910 was 600 men or 17% of all men admitted, and 263 women, or 8% of all women admitted. Although one may become contagioned innocently, all such diseases are the result ofimmoral habits. Every man and boy should know that by yielding to sexual temptation he is exposing himself and future generations to the possibility of catching a disease, which may, and very often does, result, years after, in incurable insanity. Over the door of every immoral resort might truthfully be written, "Incurable Insanity May Be Contracted Here."

Physical Diseases. —Many mental breakdowns are traced to the effects of other physical ailments. Typhoid fever, influenza, diphtheria, and some other diseases, often so poison the system that for some time after the disease has left, the regular functions of the body are interfered with. Consequently, a mental breakdown is sometimes a delayed result .of such diseases. Epilepsy,, tuberculosis, diseases of the arteries, heart, and kidneys are all causes of insanity. Injuries or wounds contribute to the causation of insanity, especially when associated with profound mental shock, as in the case of railroad accidents in which fright as well as physical injury is experienced. The advance of medical science, the control of infectious diseases, the protection of life, temperate habits, sanitary homes and

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workshops, portection of food, an abundance of fresh air, recreation, and exercise, are all forces which will help to prevent mental

as well as physical diseases.

— Mental Habits. Mental habits are the most important causes of some forms of insanity. Shock, for instance, when intense, results in many cases in mental derangement. Closely allied with shock are emotional disturbances of all kinds, such as grief, fear, anxiety, disappointment, shame, and religious and political excitement. The average individual little realizes the danger of brooding over slights, injuries, disappointments, and misfortunes, or of maintaining an unnatural attitude to his fellowmen, exhibited by unusual sensitiveness or suspicion. All these unwholesome and unnatural trains of thought may, if persisted in and unrelieved by healthful activities, result in insanity.

Ill —Prevention of Insanity Much has been learned in recent years of the preventable nature of many of the causes of the insanities but, unfortunately, ;

mental disease is still too often regarded with the same fatalistic attitude withwhich tuberculosis was regarded a generation ago. The more careful study of cases, however, by scientific methods which became possible when the hospital idea began to replace mere custodial care in asylums, has shown the causes of many mental disorders, under some conditions, quite within the control of the medical profession. It has also been shown that a large

number of cases of mental disorder result from the improper train- ing in early life and from faulty adjustment to environment later. In order that the work of prevention may be furthered, it will be necessary that the public be fully posted regarding the nature and causes of mental diseases, and that a new attitude towards these problems be created, so that the affliction of insanity may be disgrace. Thus, the insane will accepted as a disease and not as a be regarded as sick people, in need of sympathetic and intelligent

treatment. This humane conception, when fully sensed by the the fact that public mind, will, in turn, lead to the recognition of essential to recovery in many cases, and that early treatment is

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such treatment should not be delayed through "unfounded preju dice against hospitals for the insane through the cruel and complicated legal procedure which so commonly precedes commitment."

IV—Some Statistics

The figures stated above will convey some idea of the prevalence of insanity, but I am afraid that the average individual does not realize that on the 1st of January, 1910, there were 187,454 insane persons in institutions in the United States. This number exceeds the combined enlisted strength of the United States Army, Navy, and Marine Corps it exceeds the number of ;

students who were enrolled in all the colleges and universities in this country in 1910; it is more than half the total population of the State of Utah. The insane population of the United States is increasing at the rate of about 6,000 a year. This means that there are about 200,000 insane persons confined today in our hospitals, asylums, and places of detention. About 30,000 new cases of mental disease enter our public and private hospitals for the insane each year, and the re-admission of those who have had previous attacks of mental disorder brings the total number of commitments to 50,000 annually. The question might present itself at this juncture whether or not insanity is increasing. It is true that the number of insane in institutions has increased more than twice as fast as the popu-

lation of the United States, but there are facts which explain this without granting an increased prevalence of insanity. "The average expectation of life in 1789 was 35.5 years. In 1910 it was 45.4 years." It has been ascertained that 61% of all first admissions to hospitals are more than 35.5 years old. This means that more people live to the age periods in which mental diseases most frequently arise, and this, of course, would lead to a much greater number of insane in institutions in proportion to the population than was the case several generations ago. The cost of caring for the insane represents a sum which is amazing. The average annual cost of maintenance in institutions for the insane in the United States is about $175 per patient —

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conservative estimate ; making a total cost, during 1910, for those in institutions, $32,804,500. As it is estimated that the cost of the Panama Canal will be $325,201,000, and the time for its entire completion about ten years, it is seen that the annual cost of caring for the insane is greater than the annual cost of construction of the Panama Canal. The latter sum is so great that it was deemed wise to distribute it over several generations by the issuance of bonds ; whereas, the cost of caring for the insane in institutions is an annual expense, paid from the current revenues of the States. The amount expended in 1910 for the care of the insane, in institutions, exceeded the amount appropriated by Congress for the support of the Executive, Legislative, and Judicial departments of the federal Government. We must not forget to add to this great sum, the economic loss to the country through the withdrawal from productive labor of so many people in the prime of life. "It has been ascertained

that the average value to the community of an adult between the ages of 18 and 45 is $700 a year." Upon this basis the economic loss to thecountry through insanity is over $130,000,000 a year. Adding $32,000,000, the cost of maintenance, we see that the annual cost of insanity to the United States is more than $162,- 000,000, an amount equal to the entire value of wheat, corn, tobacco, dairy products and beef products now exported from the United States yearly. Itshould be self-evident to every intelligent person that a cause of disability which results in such an enormous number of

persons spending a considerable part of their lives in institutions, and in the necessity of appropriating so large a proportion of our has resources for their care, is deserving more attention than it yet received.

y—The National Committee for Mental Hygiene In response to this need which has assumed a widespread agency should be created to help protect belief that some national public, to work for the prevention of the mental health of the standards of nervous and mental disorders, and to help raise the the United States, care and treatment of the insane throughout Hygiene was founded in New the National Committee for Mental York, in 1909.

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Among the sixty illustrious men and women comprising the membership of this committee, we find such beacon-lights as Dr. Lewellys F. Barker, Jane Addams, James B. Angell, Arthur T. Hadley, Mrs. William James, David Starr Jordan, Harry Pratt Judson, Morris Loeb, Jacob A. Riis, and Dr. Henry P. Walcott. The chief aims of the National Committee are "to serve as a clearing-house for the nation. on the subject of mental health, the prevention of nervous and mental disorders; the care and treatment of the insane, and to serve as a co-ordinating agency for all state and local agencies interested in such problems." The Committee accomplishes these aims by giving verbal and printed advice for those who desire information regarding the avoidable causes of mental disorder and the general principles of mental hygiene ; by looking after the hitherto unprovided needs of the insane ; by enlisting the support of philanthropists by endeavor- ;

ing to regulate the present cumbersome laws of commitment ; by endeavoring to secure the best methods of treatment by creating a ;

public sentiment in our universities for the further intensive study of the preventable causes of insanity, and the wide publication of results; the relation of heredity to insanity, and the relation of crime and criminality to insanity ; and by providing for the after care of patients in the critical period following their discharge from hospitals, in order that they might be helped to re-establish themselves in society. With such a capable organization, having so magnificent a program, at the service of the American people, there is no reason why the people of Utah, together with the people of the other states, cannot be instrumental in minimizing the stupendousness of

one of the most vital sociological problems of today — insanity. PROVO, UTAH

Lines

A cloud of thoughts, as black as night, came thronging I said, "Be gone! not unto me belonging; Hist to thy cave, mine inner peace thou'rt wronging!"

A flock of thoughts, like scattered light, came straying, As calm, as free, as happy hearts a-Maying; I called them home, and they are staying, staying.

LAI, OAHU, H. T. MlNNIE IvERSON.