Insanity Part 9

The cessation of menstruation must also, in most cases, be attended by such changes as are of grave import: the calling into a larger activity other organs of the body, especially the liver and the skin for the purpose of eliminating those products of secondary metamorphosis which before had pa.s.sed from the system by the uterus; the consequent disturbance of the circulation while this adjustment of functions is being made; the increased amount of carbon left in the blood, and its effects upon the brain;--every general pract.i.tioner of medicine has abundant occasion to witness how great effects all these experiences produce upon the nervous system; how excited or depressed, how irritable and nervous and changeful the brain becomes from their influence upon it.

But in addition to these generally obvious effects, the gynaecologist has occasion to observe other, and which he may regard as no less potent, results of reflex influence on the brain from uterine disturbance of other kinds, which more especially affect the unmarried cla.s.s, which every year becomes larger among all the older civilizations.

The condition of marriage is doubtless the normal one for both s.e.xes, and, as a rule, a larger degree of physical health is enjoyed by persons who live in this relation. In no other is the discharge of the natural functions of the s.e.xual organs possible. As society is at present const.i.tuted, however, more especially in the older civilizations, marriage and its consequent responsibilities become more and more difficult, and the female is the larger sufferer by a failure to consummate this relation. All those instinctive yearnings for objects of affection and love in the way of husband and children; all the outgoing of longing for all that is implied in home, the care of it, and all connected with it; with no one to cling to and depend upon in hours of sickness and trial; the turning back, keeping down, and putting forever away into darkness all those natural desires and pa.s.sions which arise and tend to press forward for recognition from time to time;--in short, the failure to develop and bring into its mutual relation to other portions of the system this, which is arranged and designed by nature to play so significant a part in the female economy of life, can but tend in no small degree to cause a somewhat abnormal condition and activity of the general nervous system.

Persons become nervous, capricious, irritable, and hysterical. A feeling of la.s.situde and weariness results from any considerable physical effort, and they are unable to endure the friction and annoyances of ordinary daily life without much complaint. They feel badly without knowing why, and are unable to long apply the mind to any particular task, or persistently to carry forward any kind of employment. An experience of a year or two, more or less, of this kind of nervous debility and suffering generally lands many of these persons in the hands of the physician, and no small number in those of the gynaecologist.

On examination there is frequently found to exist uterine derangement of one kind or another: it may be congestion or a sub-acute inflammatory condition of the neck of the uterus; in some cases there is endo-metritis, or peri-metritis, abrasive ulceration attended with discharge, or there may be displacement in the way of any of the flexions. Or again, there may be defective, or irregular menstrual discharge, dysmenorrhoea, or amenorrhoea. My impression is that some one of these various lesions of the uterus will be found to exist in a large number of females who have exhibited, for some time, such physical and mental conditions and symptoms as have been detailed above.

Now, one of the inferences of the gynaecologist is likely to be, that the uterine lesion, of whatever nature it may chance to be, is the cause of the failure in mental and general health; that it is the "_fons et origo_"

whence has arisen the long train of nervous symptoms, and, doubtless, in some cases this may be a correct inference; but in a vast majority of cases my impression is that both the existing debility of the nervous system and the uterine lesion are to be regarded as _consequences_, and that neither is a cause of the other, but rather that they both result mainly from a failure in the discharge of those functions which more especially pertain to the s.e.xual system, and a disregard of the laws of health as to physical exercise.

But what I desire to specially note in this connection is, that these symptoms or manifestations of nervous derangement are not those of insanity, that they rarely pa.s.s over or develop into those of insanity.

There is prevalent, both among lay and professional persons, an idea that a large number of females become insane, from the existence of some such uterine conditions, or that these have a large influence in producing insanity. My experience, however, points to an opposite conclusion. It is rare to find any of the uterine lesions referred to existing among insane women; and this is doubtless explicable for physiological reasons.

In almost all cases of acute insanity there exists a much larger amount of mental activity than when the brain is in a normal condition. The processes of thought go on during a larger number of hours every day, and the period of sleep, in which there is a demand for a more limited supply of blood in the brain, is correspondingly diminished. Then, again, the character of mental operations is generally of much greater intensity; impressions are more numerous, sensations are more vivid, and thoughts press their way onward through the channels of nerve-cells and fibres of the brain with greater rapidity and constancy.

Almost the whole force and energy of the nervous system appear to be centred in the brain, and to supply the wear arising from such increased activity of the brain, the system calls for a larger supply of blood in this organ. It is therefore diverted from other portions, and there results a diminished sensibility and activity especially of the s.e.xual system. In a large majority of these cases also, the monthly discharge ceases to appear, and the s.e.xual functions are in partial abeyance.

Now, in consequence of those changes which tend to occur in the vessels and cells of the brain when a person becomes insane, if there were existing any such functional uterine lesions as I have referred to, there would at once arise a tendency to recovery from them; the monthly congestions generally disappear, and such pa.s.sive congestions as may have long existed would also tend to pa.s.s away. An inflamed, or irritable, or ulcerated neck would, in the absence of the usual physiological activities of the organ, have a tendency toward recovery, except in some few rare cases; and by the removal of congestions there would exist little if any cause for displacements.

This may be said to be mere theory, but it happens to be certainly in accordance with the experience of those psychologists who have studied the tendencies and conditions of the uterus during periods of insanity. In an experience extending over many years and embracing many cases, the number of the above-named uterine diseases found by me could almost, if not quite, be counted on my fingers.

While, therefore, such diseases of different kinds and degrees may, and generally do, co-exist with general debility of the nervous system, they are rarely found to be, and probably seldom are sufficient in themselves, as causes of insanity, though they may sometimes be allied with other and more potent influences in its production.

I may add that similar conditions of the female nervous system not unfrequently arise among the married, when persons long live in the relations of marriage, and yet without its natural results in the way of a number of children, especially if, as is almost always the case, improper measures are used to prevent the increase of the family.

I might in this place refer to another of those conditions of life inherent in our civilization, which is unfavorable to the mental health of the female s.e.x, viz., the limited sphere of physical and mental occupation, as compared with that of the male s.e.x. So much, however, has been written on this subject in its relations to and effects upon the general welfare of women, and there appears to be so large a tendency on the part of society, at least in this country, to admit her to any and almost all such occupations as she may qualify herself to follow, that I shall not refer to it further than to remark that, in so far as there may exist a disposition on the part of women to avoid the care and responsibility incident to home life and family, and, instead, to indulge in physical inactivity; in so far as they avoid physical exercise in the open air, and spend their hours of leisure in reading exciting novels, or love-stories, whose heroes and heroines are generally of almost any other kind of character than real, living, healthy, ones; in so far as they avoid the conscientious discharge of those duties which devolve upon them by virtue of their high mission as wives and mothers, and seek, instead, to follow occupations or professions for which they cannot be best qualified by reason of the nature, physiological activities, and duties of their s.e.x; in so far as they divert that nervous energy and physical strength which is designed by nature to enable them to discharge the sacred function of motherhood into other channels of activity, however high and enn.o.bling they may be,--in just so far are they deviating from that great highway which leads to mental health and the highest interests of humanity.

No aspirations of woman can ever reach so high and grand a sphere in the activities of the world as that enshrined in the name of mother; and since Nature has crowned her with this supremest function, all effort to forget or change it, to belittle or push it aside for other more transitory pleasures or missions, can only lead, in the end, to unhappiness and too often to disease.

CHAPTER XIII.

POVERTY.

Physical labor is one of the greatest promoters of both physical and mental health, and its necessity should therefore be regarded as a blessing rather than a curse for the vast majority of mankind. On the other hand, idleness of mind and body, or conditions of life which give neither opportunity nor necessity for exertion, tend toward ill-health and unhappiness, and consequently are to be avoided.

The condition of poverty creates the necessity for labor, and, if its stress is not too great, is not to be regarded as an unmixed evil. It stimulates to exertion, and exertion tends to develop and strengthen all portions of the system. The natural tendency of the mind is to run riot, to avoid hardship, and to follow the enjoyment of the present moment irrespective of the future, and it is only that discipline which comes from the necessities of life in the midst of civilization, which can lead it up to a higher standard of endurance and health.

If, therefore, the effects of poverty were to end here, they might properly be regarded as blessings. But this is not the case; for the vast majority of the poor they go much beyond the requirements of health-giving labor and discipline, and manifest themselves in quite an opposite result.

The lack of brain-discipline, ignorance, too many hours of toil, too few of relaxation, illy-prepared or unsuitable food, foul air in sleeping apartments, unsanitary surroundings, and other conditions always attendant upon the poor, especially in large towns and cities, all tend toward deterioration of brain-tissue.

There have also resulted, for that cla.s.s of the poor which has, in more recent periods, and in some cases by fortuitous circ.u.mstances, come suddenly into the possession of considerable sums of money, even greater evils than those experienced from poverty. There are many persons who get along well enough while obliged to live in the simplicity and continence of a laborious life which provides for them food and raiment, who, when possessed of the requisite means, will suddenly rush into wild excesses, and in a few years their nervous systems become poisoned and wrecked. This is especially the case in many of the new cities which have been springing into existence within the last fifty years, stimulated thereto by manufacturing industries. These cities provide the temptations toward, and the means of gratifying, physical excesses, and the influence of example serves to drag down thousands who might otherwise escape.

Moreover, the acc.u.mulation of wealth in these large places exerts an influence not only upon those residing there, but also upon the ignorant poor living in the vicinage, and serves to allure them to dangerous courses of conduct who have never learned that the violation of laws which should preside over and regulate their appet.i.tes and pa.s.sions leads to death, or, what is frequently a thousand times worse than death, viz., a poisoned and wrecked life.

If the effects ceased with those primarily concerned, the mischief would be less: but, unfortunately for society, they pa.s.s on to the next, or succeeding generations, unless, as is frequently the case, through the operation of a merciful law there does not come another generation. We are told that the intemperate and the vicious will be shut out of the kingdom of heaven. We have only to observe that they are shut out of the kingdom of health while upon earth, and that the retribution of their works follows them with a surety, and often a severity, which can be fully realized only by physicians.

As ill.u.s.trative of this point, I may refer to a cla.s.s of laborers in some of the northern portions of England. When living on the simple necessities of life and obliged to practise the habits of frugality and industry, that form of disease which is termed "general paralysis of the insane" was almost unknown among them; but in consequence of physical excesses made possible and easy, by obtaining through labor combinations the means necessary, this most formidable and incurable disease has appeared among them to an extent hitherto unknown among any cla.s.s of society.

Similar influences are silently working and similar results are following in a less marked degree in all our great cities and their vicinage, so that there are to-day in all the large hospitals for the insane which are located near these places, as indicated by statistics, more than three times as many cases of this disease as existed thirty years ago.

There is another cla.s.s of the poor, or rather of those who are living in the conditions of poverty, and yet have, by virtue of hard labor and economy, succeeded in acc.u.mulating some property, which contributes a large number yearly to the admissions to hospitals for the insane. These persons go on year after year in one unvarying routine of labor and care, allowing themselves little or no change or hours of recreation. Perhaps I cannot delineate more clearly the courses of daily conduct followed by them which not unfrequently eventuate in insanity, or better ill.u.s.trate the results of such a course of life, than by reciting a case from my yearly report for 1881.

Mrs. M., aged forty-four years, the mother of eight children, was admitted to the Retreat in the month of January, 18--, affected with acute mania.

The husband, when asked if he could suggest any cause, or causes, of her illness, exclaimed with much animation that he could not conceive why his wife had become ill. "Her is a most domestic woman, is always doing something for her children; _her_ is _always_ at work for us all; _never_ goes out of the house, even to church on Sundays; her never goes gadding about at neighbors' houses, or talking from one to another; her always had the boots blacked in the morning; her has been one of the best of wives and mothers, and was _always_ at home."

This appreciative husband could hardly have furnished a more graphic delineation of the causes of his poor wife's illness if he had understood them ever so thoroughly, and I allude to the case as a type of many, and to the husband's statement as evincing how thoroughly ignorant many people, who may be shrewd and quite thrifty in worldly matters, may be as to the primary conditions of mental health.

This woman's utter disregard of the simplest laws of health, had rendered her in her husband's eyes chief among women, had raised her so high on the pedestal of housewifery, that he could not conceive how it was possible for such a model of excellence ever to become insane. If, however, she had committed a few of the sins which were so heinous in her husband's sight; if she had gossipped more; if she had broken away from the spell of husband and children, forced herself from that ceaseless round of household care and duty; if she had taken herself out of the house, into the pure air and sunshine of heaven, even at the expense of much tattle and large gossip, and, if need be, at the expense of less cleanly floors and _boots_, and an occasional tear in her husband's shirt, or her children's frocks, the probabilities are largely indicative that she would never have come to the Retreat insane.

This case, so homely in its presentation, is one representative of many, especially of persons who live in the country portions of New England, a little more p.r.o.nounced in character perhaps, and a little more exaggerated in detail, but, nevertheless, it exhibits how insensibly and slowly operate many of the influences existing among the ignorant, which ultimately land victims in inst.i.tutions for the insane.

The currents of thought and care have gone on day after day, and month after month, from early morning until late at night in one ceaseless round; wakeful and anxious often for children sick, for children who are to be clothed and fed and schooled; anxious in reference to the thousand and one household cares, which never lift from the brain of such a mother; with no intellectual or social world outside the dark walls and many times illy ventillated rooms of her own house; with no range of thought on outside matters; with no one to interpose or even understand the danger; with no books to read, or, if she had, no time to read them;--in short, with no vision for time or eternity, beyond one unending contest with cooking and scrubbing and mending,--what wonder that the poor brain succ.u.mbs! The wonder rather is that it continues in working order so long as it does without becoming utterly wrecked. More fresh, health-giving air, more change, more holidays, more reading, more gossiping, more of almost any thing to change the monotony of such a life, to break the spell which so holds these poor women, and to lead their minds in pastures more green, and by rivers whose waters are less stagnant and bitter.

But below and far beyond this cla.s.s of persons, there are the innumerable ones who are born into a world of poverty and vice. It is their inheritance from long lines of ancestry; they are crippled from the beginning and have but half a chance in securing or retaining the prizes of health and success.

In the great contest of life the weaker go to the wall. That term so commonly now in use, "the survival of the fittest" in the struggle of life, covers a large ground, and numberless are the tales of suffering, want, and consequent disease which, hidden from the light of day, are known only to the physician or the philanthropist. I hardly need refer to the sanitary surroundings of those portions of our large cities, and those of Europe, which are occupied by the poorer cla.s.ses of society: the impure air from overcrowding, the effect of which upon the delicate tissues of the nervous system is deleterious in the highest degree; the lack of all facilities for bathing; the insufficient, irregular, and often unwholesome food-supply; the habit of drunkenness from the use of alcohol in some of its worst preparations, and habits of daily tippling which keeps the brain in a state of constant excitement; together with the immoral practices which grow out of such surroundings and habits of life,--all tend strongly in one direction.

By going through some of the hospitals for the insane in the vicinity of New York, or those which are the recipients of the mental wrecks which drift out of the lower grades of society, in the great manufacturing towns and cities of this country or of England, one may gain some more vivid conceptions of the influences which expend themselves upon the nervous system among these poorer cla.s.ses of society.

We have seen, in the spring season of the year, the trees of an orchard white with unnumbered blossoms. Myriads on myriads feed every pa.s.sing breeze with delicious odors for a day, and then drop to the ground. And when the fruit is formed from a very few only of these innumerable blossoms on the trees, a limited number only of the whole attain to maturity and perfection, while the ground is strewn with the windfalls and the useless. Why the one goes on to maturity, while the other perishes so prodigally and so soon, we may not say with certainty, but doubtless it is due to some slight degree of advantage in the starting of the voyage; it may be a moment or an hour of time, or a particle of nourishment, but to whatsoever cause it may be due, it is sufficient, and there is no remedy.

So it is in the grand struggle of human life. Myriads perish at the very start, and as the process of life goes forward, as its conditions become complicated and antagonistic, one by one--always the weaker,--by reason of some poverty in organization, inherited or acquired, falls out by the way, while the vast procession of humanity presses on and upward on its mysterious mission. So it has ever been in the past, and so it will be in the future. The stronger in body and mind will rise above and triumph over the hardnesses and roughnesses of life, becoming stronger by the very effort of so doing. To him that hath shall be given, and he shall have an abundance of the possessions of life, but that abundance is drawn from him that has but little, and he falls out by the way, as the fruit untimely falls from the tree. Many of these poverty-stricken ones are the psychological windfalls of society.

Christianity has taught us to pick them up and try to nurse them to strength for further battle. She has built hospitals and asylums of refuge from the storm, into which these weaker ones drift, and here, at least for the present, lies the field for her efforts toward ameliorating their condition. It was true thousands of years ago that the poor were everywhere and always present in all conditions of society. It has been so since, and probably will always continue to be so, so long as society continues; and we have no reason to expect other results from the conditions of poverty hereafter than heretofore. Only as the number of its victims may become fewer, through the influence of an education which will enable persons to be self-supporting, will the grand total of mental disease and the misery caused by it become less.

CHAPTER XIV.

RELIGION.

Two facts relating to the history of religious belief stand out with clearness and prominence in the past. The first is, that man's belief in his relation toward and responsibility to a Supreme Being has been one of the most important and influential factors in guiding his conduct, and leading him on and up in the pathways of civilization, since his history began. Indeed, it has been the foundation on which governments and societies have been built up, and the relations and obligations of man toward man have been established.

The other, which is no less clear and important, is, that this belief has been made an instrument, in the hands of designing men, of vast suffering to thousands of the human race, and its history, under the influence of fanaticism, has been too often written in suffering. The most gigantic wars have been inst.i.tuted, and the most cruel wrongs have been perpetrated; the advancement of science and liberty has been r.e.t.a.r.ded, in too many instances, by those claiming to be the ministers of religion.

Perhaps it is not too much to allow that some of the most bigoted cruelties which have ever disgraced the human race have been done in the name and under the garb of religion.

These things, however, have not resulted directly from the character of religious influence, but rather from an absence of such influence upon the conduct of men; and in some cases from the darkness of misconceptions and only partly realized truths.

If, then, religious belief has exerted so powerful an influence for good, and indirectly for ill, on human character and conduct while in health, we are prepared to appreciate the fact that, when weakened by the influence of disease, it still manifests itself, and that, in some cases at least, the mind is tinged with morbid views concerning it. When the brain is under the influence of disease, or when the will-power is much impaired, thought runs in channels long used, or where deepest impressions have been made during some former period of life, and hence it would be expected that the disordered mind, in some cases, would dwell more or less continually on such a subject as religious experience or a lack of it; and accordingly, we find in most asylums patients whose thoughts are occupied more especially on their failures in the past in relation to religious obligation and conduct.

In my view, however, it would be a mistake to conclude in these or other cases, that the insanity has been in any wise occasioned by any form of religious belief, or by the absence of it, unless in consequence, the individual has been more ready to violate the laws of health by courses of conduct which he would have been hindered from had he been under the restraint of such belief. That these religious sentiments have become excessive is a result of the disease of brain, and has no relation to _cause_; and, if the mind did not dwell upon this subject with a morbid anxiety and intensity, it would be sure to do so on some other. The fact that it happens to be upon religion, rather than on some other subject, is a mere accident, or rather is probably due to the past experience of the individual, or lack of it in this respect.