The history of the movement to prevent the marriage of mental defectives is more or less familiar to all. The sentiment of the community is apparently not such at this time as to encourage the regulation of the marriage of the mentally or physically unfit by legislative restrictions. Attempts to do so have been almost a flat failure. Various states have passed laws providing for the sterilization of defective delinquents. These laws, generally speaking, have accomplished nothing because public sentiment was not behind them. All of these matters have been brought to the attention of the public by prominent speakers on numerous occasions. Frequent articles have been printed in medical journals, well-known periodicals, and even in the daily papers. Attention has been called to the mental clinics established here and there and repeated reference has been made to the fact that physicians at our state hospitals may be consulted at any time on questions pertaining to mental diseases or mental defects.
Something has been accomplished along these lines. It is unfortunate that, as a rule, people look with more or less suspicion upon institutions which are even now generally referred to as asylums. There are many who still believe that every hospital for mental diseases has its padded cells and underground dungeons. There is a rather widespread idea that the most common causes of insanity are cigarette smoking, religion and self abuse. Even in our most progressive communities it has been difficult, if not impossible, to entirely prevent the temporary detention, at least, of mental cases in jails and police stations. Very few general hospitals have psychopathic wards or any realization as to the necessity of establishing them. It is not to be denied that in many states the care of the mentally ill in our public institutions is far from being what it should be in this enlightened day. These are conditions that cannot be remedied by the medical profession without the active assistance of leaders of public sentiment. The fact that the importance of these questions is recognized by prominent educators, business men, lawyers, and other persons active in the affairs of the community, and well known to the public, will accomplish more than articles in the medical journals by physicians. This constitutes the great field of the mental hygiene organizations. They will mould public sentiment as nothing else ever has, in matters which relate to the mental health of the country. They will influence legislation where it is needed in a way that no medical society can hope to do. Above all, they can in time bring the public face to face with the fact that mental diseases should be discussed, generally understood and prevented, instead of being merely concealed and misrepresented. Possibly it would not be looking too far into the future to express the hope that an organization composed largely of laymen may be able eventually to accomplish something that the medical profession has never been able to do,—induce those who frame our laws to provide medical treatment for defective delinquents instead of merely locking them up for the protection of society. It would seem, moreover, that the time has come when the public should insist that the mental condition of persons accused of crime be made a medical rather than a legal question exclusively.
CHAPTER VIII
THE ETIOLOGY OF MENTAL DISEASES
In reviewing the history of medicine there is nothing more discouraging than the references found in literature to the views entertained from time to time relative to the cause of mental diseases. To a certain extent this may be looked upon as an index of the progress of civilization. It must be admitted that it is at the same time, nevertheless, a reflection upon the medical profession which has never shown the interest in psychiatry that the importance of the subject warrants. It has been suggested that mental diseases did not play a prominent part in ancient history, owing to the fact that the law of the survival of the fittest automatically eliminated the insane and defective. As Tuke[56] says, "They perished in the course of nature, or were stamped out of existence; many of the perverse and morally insane were stoned to death; war destroyed a large number of feeble persons; while the Romans deliberately, and in the interests of the race, threw down from the Tarpeian Rock the children who were unfit to live." The papyri of the fifteenth century before Christ show clearly that the doctrine of demoniacal possession was generally entertained at that time.
One of the earliest attempts to explain the origin of mental diseases perhaps was that of Plato. "There are two kinds of madness, one arising from human diseases, the other from an inspired deviation from established custom." Hippocrates[56] had some very clearly defined views on this subject: "As long as the brain is at rest a man enjoys his reason; but the depravement of the brain arises from phlegm and bile, either of which you may recognise in this manner: Those who are mad from phlegm are quiet, and do not cry out or make a noise, but those from bile are vociferous, malignant, and will not be quiet, but are always doing something improper. If the madness be constant, these are the causes thereof; but if terrors and fears assail, they are connected with derangement of the brain, and derangement is owing to its being heated. And it is heated by bile when it is determined to the brain along the blood-vessels running from the trunk, and fear is present until it return again to the veins and trunk, when it ceases. He is grieved and troubled when the brain is unreasonably cooled and contracted beyond its wont. It suffers this from phlegm, and from the same affection the patient becomes oblivious." An interesting theory which he evolved was that the appearance of varicose veins or hemorrhoids tended to relieve the patient's mental suffering. Celsus subscribed to the black bile doctrine. Galen's teaching was that fatuity was due to moisture, while dryness produced sagacity. In cases where the whole body contained melancholy blood he recommended venesection. Thick and black wine was to be avoided, "as from it the melancholy humour is made."[57] This he described as a condition of the blood "thickened, and more like black bile, which exhaling to the brain, causes melancholy symptoms to affect the mind." The Roman custom of appealing to the household gods, sons of the Goddess of Madness, was quite significant. Horace, in speaking of Orestes, says: "Was he not driven into frenzy by those wicked Furies, before he pierced his mother's throat with the reeking point of his sword? Nay, from the time that Orestes passed for being unsound of mind he did nothing in any way to be condemned; he never dared wound with his sword either his friend Pylades or his sister Electra; he merely abused both, calling one a Fury, the other some other name suggested by his active or bright bile." In the story of Argive, Horace says that "his relations cured him with much labour and care, by expelling the disease and the bile by doses of pure hellebore."
Little progress was made, if any, by the time of the Christian era. In fact, as Clouston[58] says, "The mental pathology of the New Testament and of the early ages of Christianity was founded on the idea that the disease was a possession of the devil, and the feeling towards this afflicted class of human beings was naturally that of repulsion and hatred, their treatment following on those lines. Neglect, the whip, chains, confinement in stone cells, starvation, unsuitable medical treatment, speedy death were the natural results."
Passing to the seventeenth century we find that Sennert, a professor in Wittenberg, believed that maniacs evacuated stones, iron, living animals, etc., things not produced in the natural body and therefore caused by demons. He also believed firmly in witchcraft. Thomas Willis (1682) is said by some to have been one of the first to suggest a relation between insanity and pathological changes in the brain. Prochaska in 1784 went so far as to say, "We think, with Haller, that no light can be thrown upon it in any other way than by a careful dissection of the brains of fatuous persons, apoplectics, and such as have other disorders of the understanding." It would appear to have been the belief of Pinel that the primary seat of disease in mental conditions was in the stomach and intestinal tract. Spreading from these centers it caused a derangement of the mind when the brain became involved. The influence of the moon, as well as the stars, was spoken of by Hippocrates and admitted by Galen. To these ideas we owe the word lunacy which appeared in the laws of England in 1320 and may be found there today.
The influence of the moon on the mind was taken quite seriously. Rush seems to have been somewhat in doubt on this subject and suggested the probability of there being a kind of sixth sense involved—a perception of the state of the air, and of light and darkness, as Pritchard expressed it, to which we are insensible in health. It was thought that the full moon, by rarefying the air, increased the amount of light, thus affecting the mind. Dr. Rush noted that during an eclipse of the sun in 1806 "there was a sudden and total silence in all the cells of the hospital." He expressed the opinion in his "Medical Inquiries and Observations" in 1812 that there are few cases in which the insane feel the influence of the moon and that the excitement resulting in such cases is to be attributed to the resulting increase of light. It is interesting to note that von Feuchtersleben, an eminent German writer, in 1845 was unwilling to go on record as stating positively that the moon was not a factor in the causation of insanity. Esquirol, in his "Maladies Mentales," in 1838, branded this belief as a superstition, but admitted that there were certain facts which could not be overlooked. "It is true that the insane are more agitated at the full moon as they are also at the dawn of day; but is it not the bright light of the moon that excites them, as that of the day every morning? Nevertheless, an opinion which has existed for ages—which has spread over all lands, and which is consecrated by popular language—demands the most careful attention of observers." Dr. Allen of the York Lunatic Asylum was very firmly of the opinion that the moon had a decided influence on the time of death in mental diseases. This question was given very serious consideration by various writers as late as 1856.