Popular Science Monthly/Volume 12/February 1878/Modern Life and Insanity
|←Counting by the Aid of the Fingers||Popular Science Monthly Volume 12 February 1878 (1878)
Modern Life and Insanity
By Daniel Hack Tuke
|The Growth of the Steam-Engine IV→|
By DANIEL HACK TUKE, M.D.
THE relation between modern civilized life and insanity cannot be regarded as finally determined while a marked difference of opinion exists in regard to it among those who have studied the subject; nor can this difference be wondered at by any one who has examined the data upon which a conclusion must be formed, and has found how difficult it is to decide in which direction some of the evidence points. Statistics alone may prove utterly fallacious. Mere speculation, on the other hand, is useless, and indeed is only misleading. It is a matter on which it is tempting to write dogmatically, but where the honest inquirer is quickly pulled up by the hard facts that force themselves on his attention. Nothing easier than to indulge in unqualified denunciations of modern society; nothing more difficult than a cautious attempt to connect the social evils of the present day with the statistics of lunacy. Nothing easier than to make sweeping statements without proof, nothing more difficult than to apportion the mental injury respectively caused by opposite modes of life; totally diverse social states of a nation often leading to the same termination}}insanity. These are closely bound together in the complex condition of modern civilized society. No doubt if we care for truth, and avoid rash assertions, we do it at the expense of a certain loss of force and incisiveness. Dogmatic statements usually produce more effect than carefully-balanced and strictly logical positions. Honesty, however, compels us to speak cautiously, and to confess the difficulties to which we have referred.
We shall not enter at length into the question which is at once raised by an inquiry into the relation between modern life and insanity}}whether lunacy is on the increase in England. Twenty years ago there was one lunatic or idiot officially reported to 577 of the population; the latest returns place it as high as one in 370. Were we to go further back, the contrast would be far greater. That the increase of known cases of insanity has been very great, no one, therefore, disputes. Further, that the attention paid to the disease; the provision made for the insane; the prolongation of their lives in asylums, and the consequent accumulation of cases, and other stances into which our limits forbid us to enter, account for the greater part of this alarming apparent increase, is certain. Whether, how- ever, there is not also an actual increase, unaccounted for by popula- tion, or by accumulation, remains an open question, which statistics do not absolutely determine. At the same time we think that it is quite probable that there has been some real increase.
To what social class do the great mass of our lunatics belong, and to what grade of society does the striking apparent increase of the insane point? The large majority of lunatics under legal restraint undoubtedly belong to the pauper population. On the 1st of January, 1877, of the total number of patients in asylums and elsewhere (in round numbers 66,600), about 59,000 were pauper, and only 7,600 private patients. These figures, however, fail to convey a correct statement of the relative amount of insanity existing among the class of the originally poor and uneducated masses and the class above them, because in a considerable number of instances members of the middle and still higher classes have become paupers. Again, the wealthy insane remain very frequently at home, and do not appear in the official returns. We believe this class to be very large. Probably we get a glimpse of it from the census of 1871, which contained 69,- 000 lunatics, idiots, and imbeciles (and we have good reasons for knowing that this return was very far short of the truth), yet it ex- ceeded the number given by the Lunacy Commissioners in the same year by 12,000! A large number no doubt lived with their families because these could well afford to keep them at home. None would be in receipt of relief, or they would have appeared in the Commis- sioners' Report. Another most important qualifying consideration remains the relative numbers of the classes of society from which the poor and the well-to-do lunatics are derived. Several years ago the Scotch commissioners estimated the classes from which private pa- tients are derived at only about an eighth of the entire population of Scotland; a proportion which would make them at least as relatively numerous as the pauper lunatics. No doubt in England the corre- sponding class of society is a larger one; but whatever it may be, 1 a calculation based upon the relative proportion of different social strata in this country would vastly reduce the apparent enormously different liability to insanity among the well-to-do and the poorer sec- tions of the community, although, with this correction, the pauper lunatics would still be relatively in the majority.
The disparity between the absolute number of pauper and private
1 We are informed by Dr. Fair that the proportion between the upper and middle classes on the one hand, and the lower classes on the other, is as 15 to 85. Calculated on this basis, the proportion of private and pauper lunatics to their respective popula- tions would be one in 484 for the former, and one in 353 for the latter a very different result from that obtained by the usual method of calculating the ratio of private and pauper lunatics to the whole population, viz., one in 3,231, and one in 415. patients has greatly increased in recent years. In other words, the apparent increase of insanity is mainly marked among those who be- come pauper patients. This is certainly in great measure accounted for by the disproportionate accumulation of cases in pauper asylums, for reasons into which it is not now needful to enter. It assuredly does not prove that there has been anything like a corresponding growth of insanity among the poor as compared with the rich.
In any case, however, the illiterate population does yield a very serious amount of insanity, and the fact is so patent that it shows be- yond a doubt that ignorance is no proof against the inroads.of the disease. The absence of rational employment of the mental powers may lead to debasing habits and to the indulgence in vices especially favorable to insanity, less likely to attract a mind occupied with lit- erary and scientific pursuits. No doubt mental stagnation is in itself bad, but the insanity arising out of it is more frequently an indirect than a direct result. If a Wiltshire laborer is more liable to insanity than other people, it may be not merely because his mind is in an un- cultivated condition, but rather because his habits, 1 indirectly favored by his ignorance, and the brain he inherited from parents indulging in like habits, tend to cause mental derangement. It is conceivable that he might have had no more mental cultivation, and yet have been so circumstanced that there would have been very little liability to the disease. This distinction is extremely important if we are tracing causes, however true it would remain that ignorance is a great evil. A South-Sea islander might be much more ignorant than the Wiltshire laborer, and yet not be so circumstanced that he w T ould be likely to transgress the laws of mental health. The ignorance of an African tribe and that of a village in Wilts may be associated, the one with very little, the other with very much lunacy. Mr. Bright's "residuum" of a civilized people and a tribe of North American In- dians are alike uneducated, but, notwithstanding, present totally dif- ferent conditions of life. We have no doubt that in a civilized com- munity there will always be found by far the larger number of insane persons. There are three grand reasons for this. First, because those who do become insane, or are idiotic among savages, "go to the wall " as a general rule; the other reasons are to be discovered in the mixed character and influence of European civilization; its action on the one hand in evolving forms of mental life of requisite delicacy and sensibility, easily injured or altogether crushed by the rough blasts from which they cannot escape in life; and on the other hand in pro- ducing a state confounded, as we have said, with savagery, but which differs widely from it, and is, simply in relation to mental disorders, actually worse. Recklessness, drunkenness, poverty, misery, charac-
1 Dr. Thurnam, the late superintendent of the Wilts County Asylum, found that the proportion of cases caused by drink in this county was very high in one year (1872) amounting to thirty-four per cent. terize the class; and no wonder that from such a source spring the hopelessly incurable lunatics who crowd our pauper asylums, to the horror of rate-payers, and the surprise of those who cannot understand why the natives of Madagascar, though numbering about 5,000,000, do not require a single lunatic asylum. We may add that they do not destroy the few insane and idiots which they have.
It is constantly forgotten that while there is nothing better than true civilization, there is something worse than the condition of cer- tain savages, and that almost anything is better than that stratum of civilized society which is squalid, and drunken, and sensual; cursed with whatever of evil the ingenuity of civilized man has invented, but not blessed with the counteracting advantages of civilization. The conclusion, so far from damping the efforts of progress and mod- ern developments of science, should stimulate us to improve the moral and physical condition of this class, and so lessen the dangers to mental disorder among them. The belief that savages are free from some of the insanity-producing causes prevalent in modern civil- ized England, is quite consistent with the position taken in this arti- cle, that education, ample mental occupation, knowledge, and the reg- ularly trained exercise of the faculties, exert a highly-beneficial influ- ence upon the. mind, and thus fortify it against the action of some of the causes of insanity.
The relative liability of manufacturing and agricultural districts to mental disease has excited much discussion. This has partly arisen from the assumption that the latter may be taken as the representa- tives of savages. As we have shown this to be false, the comparison between these two districts does not, from this point of view, possess any value. On other grounds, however, it would be very interesting to determine whether urban or rural lunacy is most rife. Here, how- over, the worthlessness of mere statistics is singularly evidenced, and the difficulty of actually balancing the weight of various qualifying circumstances becomes more and more apparent. An agricultural county may be found here and there with less lunacy than a manu- facturing county, but if a group of counties be taken in which the manufacturing element is greatly beyond the average, and another group in which the agricultural element greatly preponderates, we find one lunatic to 463 of the county population in the former, and one to 388 in the latter, showing an accumulation of more insane paupers in the agricultural districts. But it is very possible that, if we knew how many become insane, the result would be very different indeed. This, in fact, has been found to be the case in Scotland, where the Lunacy Commissioners have taken great pains to arrive at the real truth. In a recent report it is shown that while three High- land counties have, in proportion to the population, a decidedly heavier persistent burden of pauper lunacy than two manufacturing counties which are chosen for comparison, the number of lunatics receiving relief that is, actually coming under treatment is propor- tionally larger in the latter than in the former. In other words, the proportion of fresh cases of pauper lunacy appearing on the poor-roll is higher in urban than rural districts. The commissioners refer this result partly to the greater prevalence of the active and transitory forms of mental disorder cases which before long are discharged and partly to the greater facility of obtaining accommodation in an asylum free of charge in a city, from its being at hand; and the greater wealth of the urban districts offering no obstacle to admis- sion. They attribute the above-mentioned persistent rural lunacy chiefly to the constant migration of the strong from the rural to the urban districts; the necessary exodus of the physically and mentally healthy leaving behind an altogether disproportionate number of con- genital idiots, imbeciles, and chronic insane, in the agricultural coun- ties. Hence, returning to England, it is quite clear that the mere ratio of accumulated pauper lunacy to the county population, which is constantly relied upon, proves little or nothing as to the relative liability to insanity of the agricultural and manufacturing districts. One conclusion only can be safely drawn from such figures, until minute investigations have been made into the circumstances attend- ing rural and urban lunacy in England as has been done in Scotland namely, that while theory is apt to say that a country life, passed, as it seems to be supposed, in pastoral simplicity, will not admit of the entrance of madness into the happy valley, fact says that, what- ever may be the ultimate verdict as to the relative proportion of urban and rural lunacy, a large amount of insanity and idiocy does exist in the country districts, and that the dull swain, with clouted shoon,but too frequently finds his way into the asylum.
A glance at the annual reports of our lunatic asylums reveals the main occupations of the inmates and the apparent causes of their attacks. In a county asylum like Wilts the great majority of pa- tients are farm-laborers, with their wives and daughters; and next in order, domestic servants and weavers. The number of farmers, or members of their families, is small. The character of the occupa- tions in the population of an asylum like that for the borough of Birmingham of course differs. Here we find mechanics and artisans heading the lists, with their wives. Those engaged in domestic occu- pation form a large number. Shopkeepers and clerks come next in order. In both asylums are to be found a few governesses and teach- ers. Innkeepers, themselves the cause of so much insane misery in others, figure sparingly in these tables.
Among the causes, intemperance unmistakably takes the lead. This is one of those facts which, amid much that is open to difference of opinion, would seem to admit of no reasonable doubt. Secondly follows domestic trouble, and thirdly poverty. At the Birmingham Asylum, out of 4*70 admissions in three years, eleven cases were attributed to "over-application " a proportion much lower than that observed in private asylums.
Recently, Mr. Whitcornbe, assistant medical officer at the Bir- mingham Borough Asylum, has done good service by publishing the fact that, during the last twenty-five years, out of 3,800 pauper pa- tients admitted into that asylum, 524, or fourteen per cent., had their malady induced by drink, and that the total expenditure thus caused by intemperance amounted, in maintenance and cost of building, etc., to no less than 50,373 during that period.
Some years ago we calculated the percentage of cases caused by intemperance "in the asylums of England, and found it to be about twelve. This proportion would be immensely increased were we to add those in which domestic misery and pecuniary losses owed their origin to this vice. Although rate-payers grumble about the building of large lunatic asylums, it is amazing how meekly they bear with the great cause of their burden, and how suicidally they resent any attempt made to reduce by legislation the area of this wide-spread and costly mischief.
It is worthy of note that drink produces much less insanity in Warwickshire outside Birmingham than in Birmingham itself.
In connection with this aspect of the question, an interesting fact, recorded by Dr. Yellowlees, when superintendent of the Glamorgan County Asylum, may be mentioned: that during a "strike" of nine months the male admissions fell to half their former number, the female admissions being almost unaffected. "The decrease is doubt- lessly mainly due to the fact that there is no money to spend in drink and debauchery." High wages, however, would be infinitely better than strikes, if the money were spent in good food, house-rent, and clothing.
The diet of the children of factory-operatives in Lancashire points to one source of mental degeneration among that class. Dr. Fergus- son, of Bolton, gave important evidence not long ago which indicated the main cause of their debility and stunted development, whether or not they are worse now than they were. He does not consider that factory-labor in itself operates prejudicially, and reports the mills to be more healthy to work in now than they were in years past. The prime cause producing the bad physical condition of the factory-pop- ulation is, in his opinion, the intemperate habits of the factory -work- ers. By free indulgence in stimulants and in smoking, the parents debilitate their own constitutions, and transmit feeble ones to their children. Instead of rearing them on milk after they are weaned, they give them tea or coffee in a morning, and in too many instances they feed them upon tea three times a day. In short, they get very little milk.
Mr. Redgrave, the Senior Inspector of Factories, does not consider that this miserable state of things has increased we hope not but he admits that more women are employed in the mills than formerly, and that this is most disastrous to the training of children. Some curious figures have been published, showing the weight of children at various years of age in the factory and agricultural districts the comparison being greatly in favor of the latter.
Another cause of deterioration mentioned is that at least one-half of the boys in the mills from twelve to twenty years of age either smoke or chew tobacco, or do both a habit most prejudicial to the healthy development of the nervous system. It was recently ob- served by Mr. Mundella that the lad who began at eight years of age in a mine without education, and who was associated with men whose whole ambition was a gallon of beer and a bull-dog, was not likely to grow up to be a Christian and a gentleman. We may add he would be very likely to end his days either in a prison or in a pauper asylum. It is observed in a recent report of the Royal Edinburgh Asylum that "such coal and iron mining counties as Durham and Glamorgan pro- duce, in twice the proportion we do, the most marked and fatal of all the brain-diseases caused by excesses." It may be stated that the relation between crime and insanity, especially weak-mindedness, is one of the most intimate character, both in regard to the people who commit criminal acts and their descendants. Our examination of the mental condition of convicts, and of their physiognomy and cerebral development, has long convinced us that a large number of this class are mentally deficient: sometimes from birth; at other times their mental development being arrested by their wretched bringing up. From the reports of the English convict-prisons generally, it appears that one in every twenty-five of the males is of weak mind, insane, or epileptic, without including those sufficiently insane to be removed to an asylum. The resident surgeon to the general prison of Scotland at Perth (Mr. Thompson) gives a proportion of twelve per cent., founded upon a prison population of 6,000 prisoners.
Having referred to the bearing of the habits of one large portion of the population upon the manufacture of insanity, we pass on to the consideration of the relation between higher grades of modern society and mental disorder. It has been observed in institutions into which private and pauper patients are admitted, that the moral or psychical causes of lunacy are more frequently the occasion of the attack with the former than the latter class. This is not always accounted for as might have been expected by there having been less drink-pro- duced insanity among the well-to-do patients; for in the Royal Ed- inburgh Asylum, where this disparity strongly comes out, there is even a higher percentage of insanity from this cause among the pri- vate than the pauper lunatics. The history of the daily mode of life of many members of the Stock Exchange would reveal, in the matter of diet, an amount of alcoholic imbibition in the form of morning "nips," wine at luncheon, and at dinner, difficult to realize by many of less porous constitutions, and easily explaining the disastrous re- sults which in many instances follow, sooner or later, as respects dis- turbances of the nervous system, in one form or other. In fact, by the time dinner is due, the stomach is in despair, and its owner finds it necessary to goad a lost appetite by strong pickles and spirits, end- ing with black coffee and some liqueur. When either dyspepsia or over-business work is set down as the cause of the insanity of such individuals, it should be considered what influence the amount of alcohol imbibed has exerted upon the final catastrophe as well as the assigned cause. But whatever may be the relative amount of insanity produced among the affluent and the poor, of this there can be no doubt, that certain mental causes of lunacy, as over-study and business worry, produce more insanity among the upper than the lower classes. We have examined the statistics of six asylums in England for private patients only, and have found this to be the case. At one such institution, Ticehurst, Sussex, we find, from statistics kindly furnished us by Dr. Newington, that out of 266 admissions 29 were referred to over-study, and 18 to over-business work. Only 2S were referred to intemperance. Allowing a liberal margin for the tendency of friends to refer the disease to the former rather than the latter class, the figures remain striking, as pointing to the influence of so-called overwork. We say "so-called " because there is an ap- parent and fictitious as well as a real overwork. Both, however, may terminate in nervous disorder. Overwork is often confounded with the opposite condition want of occupation. Civilization and mental strain are regarded by many as identical, and in consequence much confusion is caused in the discussion of the present question. It is forgotten that an idle life, leading to hysteria and to actual in- sanity, is much more likely to be the product of civilization than of savagery or barbarism. This is quite consistent with the other truth, that without civilization we do not see evolved a certain high pressure, also injurious to mental health. A London physician, Dr. Wilks, when speaking of a common class of cases, young women without either useful occupation or amusements, in whom the moral nature becomes perverted, in addition to the derangement of the bodily health, observes that the mother's sympathies too often only foster her daughter's morbid proclivities, by insisting on her delicacy and the necessity of various artificial methods for her restoration. It is obvi- ous that such a case as this is the very child of a highly-organized society, that is, of a high state of civilization, and yet that such a young lady is not the victim of high pressure or mental strain in her own person, although it is certainly possible that she may inherit a susceptible brain from an overworked parent. However, the remedy is work, not rest; occupation, not idleness. We certainly do not want to make her more refined or artificial, but more natural, and to occupy herself with some really useful work. A luxurious, idle life is her curse. That insanity itself, as well as mere hysteria, is developed by such a mode of existence, we- fully believe. The mind, although not uneducated, deteriorates for want of either healthy intellectual excitement, the occupation of business, or the necessary duties of a family. Life must have an aim, although to achieve it there ought not to be prolonged worry.
In the same way there is the lady instanced who eats no breakfast, takes a glass of sherry at eleven o'clock, and drinks tea all the after- noon, and who, "when night arrives, has been ready to engage in any performance to which she may have been invited." Clearly she is the product of a highly-artificial mode of life, found in the midst of modern civilization. She is certainly not suffering from mental strain; at the same time she is the outcome of the progress from barbarism and the hardy forms of early national life to our present complex social con- dition. We have particularly inquired into cases coming under our own observation in regard to the alleged influence of overwork, and have found it a most difficult thing to distinguish between it and other maleficent agents which, on close observation, were often found to be associated with it. We do not now refer to the circumstances which almost always attach themselves to mental fatigue, as sleep- lessness, but to those which have no necessary relation to them, as vice. Here we have felt bound to attribute the attack to both causes, certainly as much to the latter as the former. In some cases, on the other hand, we could not doubt that long-continued severe mental labor was the efficient cause of derangement. In a large proportion of other cases we satisfied ourselves that overwork meant not only mental strain, but the anxiety and harass which arose out of the work in which a student or literary man was engaged. The overwork connected with business, also largely associated with anxiety, proved a very tangible factor of insanity. Indeed it is always sure to be a more tangible factor of mental disease than overwork from study, because of the much greater liability to its invasion during the busi- ness period of brain-life than the study period. At Bedlam Hospi- tal, Dr. Savage finds that there are many cases in which overwork causes a breakdown, "especially if associated with worry and money troubles." Among the women, the cases are few in number. In one, where there was probably hereditary tendency, an examination, fol- lowed in two days by an attack of insanity, may be regarded as the exciting cause. Monotonous work long continued would seem to exert an unfavorable influence on the mind. Letter-sorting, short- hand writing, and continuous railway-traveling, are instanced. If diversified, hard work is much less likely to prove injurious. During a year and a half twenty men and eight women were admitted whose attacks were attributed to overwork. The employments of architect, surveyor, accountant, schoolmaster, policeman, and boot-maker, were here represented. Seven were clerks, two of whom were law-writers; two were students, one being "an Oxford man who bad exhausted himself in getting a double first, and the other a medical student pre- paring for his second college." Of the women, five were teachers, one a school-girl, and two dressmakers. Three of the teachers were in elementary schools, one a governess and the other a teacher of music and languages. If overwork alone did not, strictly speaking, cause the mental breakdown, still the concomitants must be blamed for these melancholy results.
A late medical officer to Rugby School (Dr. Farquharson), in de- fending that institution from a charge of injury in the direction of which we now speak, considers that instances of mental strain are more common at the universities, "for not only are the young men at a more sensitive period of life, but they natm-ally feel that to many of them this is the great opportunity the great crisis of their exist- ence and that their success or failure will now effectually make or mar their career. Here the element of anxiety comes into play, sleep is disturbed, exercise neglected, digestion suffers, and the inevitable result follows of total collapse, from which recovery is slow and per- haps never complete." (Lancet, January 1, 1876.) He thinks he has seen an increase of headaches and nervous complaints among poor children since compulsory attendance at board schools was adopted, and records a warning against too suddenly forcing the minds of wretchedly-feeble, ill-fed and ill-housed children, and against attempts to make bricks too rapidly out of the straw which is placed in our hands.
The psychological mischief done by excessive cramming both in some schools and at home is sufficiently serious to show that the reck- less course pursued in many instances ought to be loudly protested against. As we write, four cases come to our knowledge of girls se- riously injured by this folly and unintentional wickedness. In one, the brain is utterly unable to bear the burden put upon it, and the pupil is removed from school in a highly-excitable state; in another, epileptic fits have followed the host of subjects pressed upon the scholar; in the third, the symptoms of brain-fog have become so ob- vious that the amount of schooling has been greatly reduced; and, in a fourth, fits have been induced and complete prostration of brain has followed. These cases are merely illustrations of a class, coming to hand in one day, familiar to most physicians. The enormous number of subjects which are forced into the curriculum of some schools and are required by some professional examinations, confuse and distract the mind, and by lowering its healthy tone often unfit it for the world. While insanity may not directly result from this stuffing, and very likely will not, exciting causes of mental disorder occurring in later life may upset a brain which, had it been subjected to more moderate pressure, would have escaped unscathed. Training in its highest sense is forgotten in the multiplicity of subjects, originality is stunted and individual thirst for knowledge overlaid by a crowd of novel the- ories based upon yet unproved statements. Mr. Brudenell Carter, in his "Influence of Education and training in preventing Diseases of the Nervous System," speaks of a large public school in London, from which boys of ten to twelve years of age carry home tasks which would occupy them till near midnight, and of which the rules and laws of study are so arranged as to preclude the possibility of suffi- cient recreation. The teacher in a high-school says that the host of subjects on which parents insist upon instruction being given to their children is simply preposterous, and disastrous alike to health and to real steady progress in necessary branches of knowledge. The other day we met an examiner in the street with a roll of papers con- sisting of answers to questions. He deplored the fashion of the day; the number of subjects crammed within a few years of growing life; the character of the questions which were frequently asked; and the requiring a student to master, at the peril of being rejected, scientific theories, and crude speculations, which they would have to unlearn in a year or two. He sincerely pitied the unfortunate students. During the last year or two the public have been startled by the suicides which have occurred on the part of young men preparing for exam- ination at the University of London; and the press has spoken out strongly on the subject. Notwithstanding this, the authorities appear to be disposed to increase instead of diminish the stringency of some of the examinations. The Lancet has recently protested against this course in regard to the preliminary scientific M. B. of the London University, and points out that the average of candidates who fail at this examination is already about forty per cent., and that these in- clude many of the best students. This further raising of the standard will, it is maintained, make a serious addition to the labors of the in- dustrious student who desires the M. D. degree. Whether this par- ticular instance is or is not a fair example, we must say, judging from others, that it seems to be thought that the cubic capacity of the Brit- ish skull undergoes an extraordinary increase every few years, and that therefore for our young students more subjects must be added to fill up the additional space.
The master of a private school informs us that he has proof of the ill effects of overwork in the fact of boys being withdrawn from the keen competition of a public-school career, which was proving inju- rious to their health, and sent to him, that they might in the less am- bitious atmosphere of a private school pick up health and strength again. He refers to instances of boys who had been crammed and much pressed in order that they might enter a certain form or gain a desired exhibition, having reached the goal successfully, and then stagnated. He says that the too extensive curriculum now de- manded ends in the impossibility of doing the work thoroughly and well. You must either force unduly or not advance as you would wish to do; the former does injury, and the latter causes dis- satisfaction.
Of mental stagnation among the poor we have already spoken; an analogous condition among the well-to-do classes, not to be con- founded with that of the young lady already described as seen in the London physician's consulting-room, deserves a passing observation. Excessive activity and excessive dullness may lead to the same dire result. Hence both conditions must be recognized as factors in the causation of mental disease. We have said that the indirect action of the latter it more powerful than its direct action, but there are no doubt cases of insanity which arise from the directly injurious influ- ence of intellectual inactivity. The intelligence is inert; the range of ideas extremely limited; the mind broods upon some trivial cir- cumstance until it becomes exaggerated into a delusion; the mind feeds upon itself, and is hyper-sensitive and suspicious, or it may be- come absorbed in some morbid religious notions which at last exert a paramount influence and induce religious depression or exaltation. From the immediate surroundings of the individual, whether in con- nection with parental training or from ecclesiastical or theological influences, or perhaps a solitary condition of life, there may be a dan- gerously restricted area of psychical activity. Prejudices of various kinds hamper the free play of thought; the buoyancy of the man's nature is destroyed; its elasticity broken; its strength weakened; and it is in fine reduced to a state in which it is a prey to almost any assertion however monstrous, if placed before it with the solemn sanc- tions which, from education, habit, or predilection, it is accustomed to reverence. Fantastic scruples and religious delusions frequently spring up in this soil. Such persons have been saved from the evils of drunkenness and vice; they have also been sheltered from worry and excitement, yet, to the astonishment of many, they become the inmates of a lunatic asylum. They have in truth escaped the Scylla of dissipation or drink, only to be shipwrecked on the Charybdis of a dreary monotony of existence. On this barren rock not a very few doubtless perish, and if parents they transmit, to a posterity deserving our sincerest pity, mediocre brains or irritably susceptible and unsta- ble nerve-tissue.
On the dangers arising from waves of religious excitement, it would be easy to dilate, but we shall content ourselves with remark- ing that, if they have been exaggerated by some, they have been im- properly ignored or denied by others. They are real; and frightful is the responsibility of those who, by excited utterances and hideous caricatures of religion, upset the mental equilibrium of their auditors, whether men, women, or children.
One remarkable feature of modern life spiritualism has been said to produce an alarming amount of insanity, especially in America. It has been recently stated by an English writer that nearly 10,000 persons have gone insane on the subject, and are confined in asylums in the United States; but careful inquiry, made in consequence, has happily disproved the statement, and we learn that the amount of insanity produced from this cause is almost insignificant much less than that caused by religious excitement.
Looking broadly at the facts which force themselves upon our at- tention, we may say that a study of the relation between modern life and insanity shows that it is of a many-sided and complex character; that the rich and the poor, from different causes, though certainly in one respect the same cause, labor under a large amount of preventable lunacy; that beer and gin, mal-nutrition, a dreary monotony of toil, muscidar exhaustion, domestic distress, misery and anxiety, account largely, not only for the number of the poor who become insane in adult life, but who, from hereditary predisposition, are born weak- minded or actually idiotic; that among the middle classes, stress of business, excessive competition, failures, and, also in many cases, reck- less and intemperate living, occasion the attack; while in the upper classes intemperance still works woe and under this head must be comprised lady and gentlemen dipsomaniacs who are not confined in asylums; that while multiplicity of subjects of study in youth and excessive brain-work in after-life exert a certain amount of injurious influence, under-work, luxurious habits, undisciplined wills, desultory life, produce a crop of nervous disorders, terminating not unfrequently in insanity. In a state of civilization like ours, it must also happen that many children of extremely feeble mental as well as bodily con- stitutions will be reared who otherwise would have died. These either prove to be imbeciles, or they grow up only to fall a prey to the upsetting influence of the cares and anxieties of the world. A considerable number of insane persons have never been really whole- minded people; there has, it will be found on careful inquiry, been always something a little peculiar about them, and when their past life is interpreted by the attack which has rendered restraint neces- sary, it is seen that there had been a smouldering fire in the constitu- tion for a lifetime, though now, for the first time, bursting forth into actual conflagration.
Lastly, modern society comprises a numerous class of persons, well-meaning, excitable, and morbidly sensitive. Some of these are always on the border-land between sanity and insanity, and their friends are sometimes tempted to wish that they would actually cross the line, and save them from constant harass. When they do, it is easier to make allowance for them and their vagaries.
Whatever uncertainty there may attach to some aspects of this inquiry, unquestionable conclusions have been drawn; and, if these only accord with results arrived at from other considerations, they are valuable as confirming them. Had there appeared to be among the poor and ignorant a striking immunity from attacks of insanity, a strong argument would have been afforded, and would probably have been employed, against the extension of education at the present day to the working-classes. Nothing, however, in our facts or figures supports such an anti-progressive view; and, if the educated classes did not sin against their mental health in so many ways, they would doubtless compare more favorably than they do, in fact as well as in mere figures, with tht uneducated poor. So again with regard to in- temperance, and all that it involves, in spite of the difficulty of dis- criminating between the many factors which often go to make up the sum total of causes of an attack, we have no doubt of the large influ- ence for mental evil exerted by drink always admitting that where the constitution has no latent tendency to insanity, you may do almost what you like with it, in this or any other way, without causing this particular disease. A man will break down at his weak point, be it what it may.
Again, the lessons are taugnt of the importance, not of mere edu- cation, but a real training of the feelings; the evil of mental stagna- tion, not simply per se, but from the train of sensual degradation in one direction, and of gloomy fanaticism in the other, engendered, and the danger of dwelling too long and intently on agitating religious questions, especially when presented in narrow and exclusive forms, which drive people either to despair or to a perilous exaltation of the feelings. To true religious reformers, the physician best ac- quainted with the causation of mental disease will award his hearti- est approval. Only as the high claims of duty, demanded from man by considerations of the dependence of his work in the world upon mental health, of what he owes to his fellow-men, and of what he owes to God, are fulfilled as well as acknowledged, will civilized man benefit by his civilization, as regards the prevention of insanity. TTn- preventable lunacy will still exist, but a great saving will be effected for British rate-payers when that which is preventable shall have been reduced to a minimum by the widest extension of a thorough but not oppressive and too early commenced education, by the practical ap- plication of the ascertained truths of physiological and medical sci- ence, and by the influence of a Christianity, deep in proportion to its breadth, which shall really lay hold of life and conduct, and mould them in accordance with itself. Macmillan's Magazine.