Insanity Part 11

Hence the story is almost always the same in the history of the insane; for weeks or months before the active indications of insanity appear, the patient has been more than usually anxious about some subject or other, and worried and wakeful, not sleeping more than four or five hours out of the twenty four. The trains of thought have been left too long moving on in certain channels of the brain, some experience has made too profound an impression, and the effects of what we call the will have been unable to control it; or there has been perhaps some source of eccentric irritation which has been reflected; or it may be that the blood, upon which every organ depends for nourishment and strength, has been poisoned, or its nutrient properties impaired; and the poor brain, unable to do its constant work under such influences, begins to waver, to show signs of weakness or aberration; hallucinations or delusions hover around like floating shadows in the air until, finally, disease comes and

"Plants his siege Against the mind, the which he p.r.i.c.ks and wounds With many legions of strange fantasies, Which, in their throng and press to that last hold, Confound themselves."

CHAPTER XVI.

CONCLUSION.

It has been my aim to conduct the preceding discussion in so plain and direct a manner, that its lessons of instruction and warning, if it has any, shall be readily appreciated by the reader. It will not, therefore, be necessary to add chapters filled with specific directions how to avoid insanity.

Some remarks, of a somewhat desultory character, concerning some branches of the subject will comprise this closing chapter.

There are few diseases the conditions of whose existence are so clearly and fully understood that they can in every case be avoided, and in reference to the ultimate causes of many we know little or nothing. It is true that, within a few years, we have more clearly recognized the relations of hygiene to the prevalence of some forms of disease, and by this means have done much toward limiting their progress, thus achieving some of the grandest triumphs of medical science in recent times.

In doing this, however, we have not always, or even generally, known the exact nature of the primary causes of these forms of disease, but have simply learned, from observation, their relations to hygienic conditions; but the knowledge of this relation has put society on vantage-ground in all efforts to maintain the public health, so far as it relates to certain forms of zymotic disease; and to the extent of our progress in understanding these relations to most other forms of disease, shall we be in a condition to avoid them.

The existence or the prevalence of insanity, however, does not depend on any such conditions as relate to zymotic diseases, at least in the vast majority of cases. Our study of its causes, therefore, has been in other directions; and if our views of the influences which lead to degeneration of nerve tissue are correct, these are even more easily appreciable than are the causes of some other forms of disease, and consequently may be avoided.

This must come largely, primarily, from the education of home and school life, and from the regulation of daily conduct in its relation to the brain; and, as the nervous system presides over and controls the body and its several members in the discharge of their functions, an understanding of its physiological action, at least in some degree, is of great importance to everybody. While we cannot do much to lessen the amount of brain-work or check the ambitions of adult life, as they have become so intensified by modern modes of living and the requirements of business, yet we may hope to do something by the judicious training and education of the young.

That this may be effectually done, we must study the action of the brain and nervous system when under the influence of different external conditions and agencies. We have been accustomed to draw up long lists of experiences and occurrences in the lives of those who have become insane, as _causes_, such as _shock_, _grief_, _loss of friends_, _fever_, etc., etc. but it should be borne in mind that the vast majority of persons pa.s.s through these or similar experiences, and yet do not become insane. It becomes necessary, therefore, to go back of these experiences or antecedents, and inquire as to the causation of that peculiar condition of the nervous system which renders it susceptible of the effects of such secondary causes.

This I have endeavored to do, more especially in the chapter on the Insane Diathesis. I have sought particularly to draw attention to the delicacy and great susceptibility of the brain while in childhood and youth to external influences and impressions, and to show that if much in the way of stimulation of any kind is added to its daily experiences, the effect upon its future development and character may prove to be most unfavorable. We have seen how at this early period of life it is moulded and changed in no small degree by its experiences, and that if these are of a disturbing character from any cause whatever, there can but result such an influence on the brain-cells as will be incorporated into their growth, and manifest itself in after-life in uncertainty and liability to irregularity of brain-action.

Again, I have proceeded, in discussing the subject, on the supposition that the nervous system is a unit; that, though the functions of the several parts are of diverse character, such as motion, sensation, and thought, yet the same laws of healthy activity pertain to all portions alike; and that we could safely reason, in reference to the effects of unfavorable influences, from the observed and known to the less known, from the simple to the more complex processes of nerve-function; that what is known to be injurious to the one must be so to the other. I have endeavored to show that as too great or too little activity of the various portions of the nervous system result in irregular activity or in failure of activity, so, also, too much stimulation to the brain, as well as too little exercise of function, both result in failure in some degree; that through these two channels, and also from the effects of poisons acting on the brain, comes the largest danger to its integrity of activity.

While some of the causes of insanity, however, are of such a character as has been pointed out, and consequently preventable, yet it will readily be perceived how difficult it will be to educate society so that it may be avoided. The conditions of its existence pertain in many cases to all cla.s.ses of society, and ramify in the customs and habits alike of the rich and the poor. In many other forms of disease there exists some degree of unity in etiology, and we are able to discover their immediate hygienic conditions with considerable certainty, and these conditions can in many cases be avoided without much inconvenience; but those of insanity are so multifarious, they are so interwoven with the very texture of our modern civilization, that any warning which we can give, any words of help, or of caution even, all are only too likely to fall on ears which are dull of hearing. The ruling tendencies in our modes of living and of conducting the great business enterprises of life, some of which are inherited, and others learned in the years of early life, lie directly athwart its path.

Again, in many other forms of disease, we approach toward their nature and causes by examination of the secretions and excretions of the body; we use our chemical tests; we percuss and auscultate; we reason from the pathological conditions existing after death, to those which must have existed prior to death; but in cases of insanity, these modes of procedure have so far availed us very little. While we find slight degrees of difference in the secretions of the insane at times, yet these changes do not appear to be pathognomonic. They may be found to exist equally with the sane and insane, and therefore avail little or not at all in determining any change which has taken place in the brain. Nor can we determine the nature of those vibratory movements which are supposed to take place during the processes of reasoning or the experiences of sensation.

In examinations after death of the brains of those who have died while insane, we find certain morbid changes in the cells and connective tissues in many cases, and a few years since we were indulging large expectations that we had at length arrived on solid ground, and thenceforth could proceed to more perfect knowledge and definite results. But, so far, there has very little of positive value, in determining the "_fons et origo_" of insanity, been brought to light through pathological researches. The changes in brain tissue found after death in the insane are degenerations in various stages of progress, and in no essential respect differ from those which may be found in some cases after death from injury and disease, where no insanity has existed.

Indeed, if we ever should be able to definitely determine the connections between morbid changes in the brain and the various modifications of thought and action among the insane, while we should be in a position to frame more perfect cla.s.sifications of the insaniae, yet it is not easy to perceive how we should be much the gainers in our appreciation of the ultimate causes of insanity, or in its treatment.

Notwithstanding all these and other difficulties, however, we may hope for progress in the future in our ability to appreciate at least some of the causes of insanity more fully and be able to avoid them.

A few sentences in the form of a recapitulation will serve to recall some of the more important points embraced in our discussion, and indicate through what channels we may antic.i.p.ate successful effort in the prevention of insanity.

I.--_In Improved Methods of Education._

1. A larger appreciation of the importance of _individuality_ in giving instruction. The teacher will have a fewer number of pupils, and find it necessary to study the peculiarities and tendencies, both physical and mental, of each one. Instead of having all together pa.s.s through a regular routine of education, with little or no reference to mental const.i.tution, the system will be, in some measure, adapted to the present, and what may appear to be the future, requirements of each scholar.

2. There will be less importance given to education of the brain by means of books only, for all children, and a larger importance to _industrial education_. Inasmuch as the large majority of the members of society must obtain the requirements of living by industrial operations, society will appreciate more fully the importance, not only to itself, but especially to the individual, of so educating each person, that he may be self-supporting, and consequently less liable to become a diseased and dependent member of it.

3. A larger importance will be given, in methods of education at home, to inculcating and enforcing obedience to laws and regulations. This is essential, not only to the interests of society, but especially to those of the individual in his relations to the laws of health. Man is endowed not only with intellect, but with a will in the direction and use of it, and it becomes his duty and essential to his interests to find out those courses of conduct which will lead to health. In a considerable degree he is capable of regulating his conduct so as to be in harmony with such regulations. If, however, he is not taught the necessity of obedience while young, and how to obey easily, the lesson becomes one very difficult to learn in later life, and he is in great danger of never learning it.

4. A larger degree of importance will be given to education in relation to physiology and heredity, especially so far as they relate to the inst.i.tution of the family. As the well-being of both society and the individual depends so largely on that of the family, a knowledge of the laws of heredity will be considered as essential to all persons who enter into the relation of marriage, so that tendencies toward diseases may be, at least in some measure, avoided.

II.--_In Reference to Certain Habits and Customs of Living._

1. One of the most important of these will relate to the use of alcohol, in its various forms, as a beverage. Its stimulating and deteriorating influence upon the brain will be more fully understood and avoided, thereby removing one of the largest factors in the causation of insanity.

One of the astonishing facts which confronts the student of sociology, is the unaccountable indifference, which has existed hitherto in society to the vast evils of intemperance. When, however, the young become more generally educated in reference to the physiological effects of alcohol, and more fully appreciate the fact that they do not cease with those primarily concerned, but pa.s.s over from the individual to his family and to society; that the amount of disease and suffering to both, from this evil, are so much greater than from any other--nay, I had almost written from all others together,--extending in the family to the third and fourth generations frequently in the forms of insanity and idiocy, and in society to ignorance, poverty, crime, and a larger expenditure of charity than for all other forms of evil,--why, it seems certain I shall be justified in my prophecy, that the day cannot be far distant when society will proscribe and limit the ravages of this enemy of human society.

2. The second refers to the excessive use of tobacco, especially by the young, before the system attains to the maturity of its growth.

3. The importance of less stimulating and exhausting methods of conducting business avocations in large towns and cities. A more full recognition of the fact, that every brain is limited to its unit of power in activity--so much and no more,--and that length of days and fulness of strength can be expected only by the judicious care and expenditure of brain-force.

4. A more full recognition of the importance to the brain of _change_ and longer periods of rest, both for adult persons when engaged in the usual avocations of life, and especially for children in relation to the hours of sleep.

5. The importance of improved sanitary conditions for all houses occupied by the poor, especially in cities, and of all shops and manufacturing establishments.

The kinds of avocations followed in-doors are not likely to be much changed or lessened; indeed, I think they are likely to become even more common; that larger numbers will be engaged in such occupations in the future than in the present; but it is quite possible to realize more fully the fact that the brain requires the effects of pure air, if it is to remain in a condition of health, and that it is practicable to introduce this to all places so occupied.

As will readily be perceived, the tendencies of the preceding pages have served to point toward the importance of systematic preventive measures concerning insanity. _Prevention_ is the watchword which is being signalled along the line of the medical profession, at the present time, concerning the management of disease. The importance of State Boards of Health in many of the larger States has become so generally recognized, that they are yearly appointed, and make regular reports, with more or less full accounts as to the results of observations in reference to the public health and the prevention of disease, which prove to be of the highest value.

I would suggest the importance of appointing on such Boards one or more physicians who are qualified for such a position, whose special duty it shall be to ascertain and make public reports upon the prevalence of such conditions as conduce to the production of mental disease. They should be appointed by the State, so that they may have influence with school teachers and school boards. In this way they may be able to point out the dangers which lie in methods of educating and preparing the young for the duties and responsibilities of life. Such persons should be able to wisely direct in laying the broadest and most secure foundations on which to rear the fabric of vigorous mental health.

That physicians appointed by the State, and operating in conjunction with superintendents of public inst.i.tutions and with teachers, would be able to accomplish a most valuable work, in reference to the conduct of education, and in instructing the public concerning those habits of life which are at variance with mental health, I have no doubt. I may add that there can be no question that a generous expenditure of money for such a purpose would save many minds from the suffering and ruin which result from disease, and, in the end, prove to be the wisest economy.

THE END.

FOOTNOTES:

[1] The whole number was 31,782.

[2] "The Past in the Present: What is Civilization?" by Arthur Mitch.e.l.l, M.D., LL.D., ed. 1880, p. 227.

[3] From "An Address delivered before the Graduating Cla.s.s in the Medical Department of Yale College," by the Author, 1875. Tuttle & Morehouse, New Haven, Ct.

[4] As an example of what is required of young pupils, in addition to the usual study hours in school, I herewith subjoin a list of what a lad, twelve years of age, brought home from school, by direction of the teacher, to learn during the evening:

1--_a._ From what incident is the phrase "pa.s.sed the Rubicon" derived?

_b._ Why is the Archipelago southeast of Greece sometimes called the aegean Sea?

_c._ What poet is sometimes called the Ettrick Shepherd?

_d._ What is the largest bell in the world, and how much does it weigh?