Insanity Part 2

CHAPTER III.

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 const.i.tutes 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 cla.s.ses, 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 circ.u.mstances of life, not only while pa.s.sing 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 Mitch.e.l.l,[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 pa.s.sed 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 a.s.suming 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 circ.u.mstances 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 circ.u.mstances 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 compet.i.tions 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 scholars.h.i.+p, 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 pa.s.sion 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 hards.h.i.+ps 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 circ.u.mstances 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 cla.s.s 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 pa.s.sed 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 pa.s.sed through such conditions and experiences, have suffered from disappointment and failure in respect to their plans and purposes; have endured exposures and hards.h.i.+ps 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 quant.i.ty, 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.

CHAPTER IV.

THE INSANE DIATHESIS.

The ideal human system would be one of perfection, that is, it would be one so const.i.tuted as to discharge all its functions perfectly. Yet, its capacities would be limited as they now are, though not to the same extent. Digestion of such articles of food as the system requires would be perfect, though this might not be true as to many other articles, which are appropriate as food for other animals. Sight and hearing would be perfect, but only within certain ranges and distances; memory would be perfect in reference to every thing comprehended and understood. The limitations would be dependent on the inherent nature of the organism, in its relation to the external world. What is stated above as true, in relation to certain parts of the system, would be equally true of the functions of all parts of the human system, both physical and psychical.

Now, the _actual_ human system approaches toward this _ideal_ one in a greater or less degree. It possesses all the faculties, both physical and psychical, but they are tainted with imperfections, and their health varies from the highest state attainable, down to some a.s.sumed standard, below which we say that a diseased condition exists. It will, however, be observed, and hereafter more definitely appear, that this border-line is merely one of a.s.sumption. No definite standard can be applied to all persons, and a condition which would be normal for one person may not be so for another. Besides, the _actual_ condition of many persons is one of changing stability, both in respect of the body and the mind, and this may depend upon causes which operate from either _within_ or _without_.

A few simple statements in reference to differences existing among persons, as to those physical and mental conditions which are inherited, may be in point, and prepare the way for other considerations.

I. Though we may not be able to determine the causes of these differences, yet it is quite evident that there exists, from the time of birth, the largest diversity in reference to the physical const.i.tution of persons: while some are strong and vigorous, and capable of large effort, and of enduring exposure to the heat and cold with almost indifference, others are so delicate and sensitive as to be easily affected by such influences; while the muscles of some are susceptible of making the most delicate and difficult movements in all mechanical operations, with very little training or education, those of others can never be trained sufficiently to be able to accomplish them; the skin and the lungs of some persons are so const.i.tuted as to be easily influenced by such degrees of moisture and cold as have little or no such effect on those of others; the capacity for labor, and endurance, also varies very largely.

Again, these physical conditions are more or less variable with many persons. They are conscious of feeling more active and vigorous, of experiencing a larger degree of pleasure in physical activity at one time than at another; they may be conscious of more or less painful sensations, experience a measure of indisposition to make effort; they may be more restless and uneasy, and feel discomfort from slight causes which had rarely before produced such results.