Insanity: Its Causes and Prevention

by Henry Putnam Stearns

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 pass 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 classes 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.