From a study of about two thousand children comprising the first five grades of an entire public school system Goddard found that eighteen per cent. were definitely “backward.” Of these between two and three per cent. were actually feeble-minded, the condition in the remaining fifteen per cent. being presumably capable of correction. Other similar surveys have given practically the same results.
The Exceptionally Able Child Likely to Be Neglected.—However, while we must not forget that it is important to recognize backward children and to see that they are segregated into small groups which are not required to do the full amount of work in regular time, it is equally urgent to see that the unusually bright individual is also given opportunity to advance more rapidly than the rank and file. Only too often the holding back of a child in school leads to lack of interest and habits of mental laziness, and sometimes to truancy and incorrigibility. The general attempt in our graded schools to keep all children close to the average is to be strongly condemned.
Cost of Caring for Our Mentally Disordered.—Doctor Charles L. Dana, member of the National Committee for Mental Hygiene, estimated in 1904 that the actual cost of caring for feeble-minded and insane in the United States amounted to sixty million dollars, to which should be added the corresponding loss in industrial activity on the part of the afflicted,—at least twenty million dollars more, and he figures that the amount was increasing at the rate of four per cent. per annum. Many investigators concur in the opinion that our insane and feeble-minded alone cost us far above one hundred million dollars. Adding to this economic burden the cost of our delinquents and criminals the total expense becomes stupendous. And when we consider still further the even greater burden of suffering of the unfortunates themselves and the sorrows of those to whom they are dear, a burden not measurable in money, the feeling that something must be done to relieve the situation becomes overpowering.
Importance of Rigid Segregation of Feeble-Minded.—As regards the really feeble-minded little can be done beyond making them as happy as possible and developing the limited gifts they have been given by nature. Their teaching must be in the main concrete and simple. At the age of puberty it is imperative to see that the sexes are separated and kept under sufficient permanent supervision to prevent all possibility of procreation. There is neither economic nor common sense in even allowing the remotest chance of such occurrences as the following: “This is the case of a feeble-minded and epileptic woman who had six children by various persons while an inmate of a county poor house. One child at the age of eighteen died in the almshouse, two died in infancy, one was epileptic (the son of a man with a criminal record) and two who are now living in the almshouse are feeble-minded, one being the son of a negro.” Again, we find a superintendent of an English almshouse reporting that one hundred and two out of one hundred and five children born there in five years were feeble-minded.
As conditions are to-day every institution for the feeble-minded has a long waiting list and the same is true of most asylums for the insane. Instead of providing the prolonged care necessary for such patients, institutions are forced to discharge many prematurely in order to make room for more urgent cases.
Importance of Early Diagnosis of Insanity.—In insanities, even when of hereditary origin, there is much hope in certain cases of greatly benefiting the individual, though a permanent cure, or at least the establishment of procreative fitness may be impossible. It is extremely important that the public realize how much can be done through early examination and advice in such mental afflictions. Most of the insane who recover usually do so within a few months of their first alienation, hence the importance of losing no time in detecting the condition and securing early treatment. It is now well known that many cases of chronic insanity may be measurably improved under the care of a psychiatrist by systematic re-education, especially in industrial lines. But how little of this may be expected at the hands of the untrained custodians who “feed” the inmates of our county almshouses, to which in many states the chronic insane are entrusted, is obvious.
All Insane Should Be Passed Upon by Competent Psychiatrists.—The atrocious system of turning the chronic insane over to county poorhouses manned by supervisors whose chief qualification for the position has not infrequently been the lowness of their bid for boarding and caring for the inmates, can not be too strongly condemned. Incredible as it may seem, in some states the court can on its own judgment send patients directly to these institutions without first submitting them to the study of expert physicians in the state hospital for the insane. The viciousness of such procedure is evident when one realizes that often careful scrutiny on the part of the very best experts, extending over a considerable period of time, is required before the true condition of the patient can be determined. Recently a psychiatrist of high standing, who was gathering data on county asylums for a national organization, informed the writer that beyond the shadow of a doubt he had come across case after case in county asylums which would have been curable under proper treatment.
Here again the responsibility in last analysis must rest upon us as citizens, for it is largely through our intelligent demands as voters that conditions will be improved and competent experts be put in charge of county asylums as well as of the state hospitals for the acutely insane.
Some Insanities Not of Hereditary Origin.—Some alienists believe that self-poisoning known as auto-intoxication, due to improper elimination of poisons generated through faulty digestion or metabolism, if of long standing, may be not only a contributory but a more or less direct cause of insanity. About twenty per cent. of insanities of men living in cities and about fifteen per cent. of those living in the country seem to be directly related to the intemperate use of alcohol. The corresponding figures for women are seven per cent. and one per cent. respectively. General paresis or softening of the brain is probably invariably preceded by syphilis. About twenty-two and five-tenths per cent. of the first admissions to hospitals for the insane from city-dwelling men, and eight per cent. from men living in the country in the state of New York are cases of this kind of insanity. The corresponding figures for women are five and five-tenths per cent. and two and five-tenths per cent. respectively.
Importance of Heredity in Insanity Not Appreciated.—We have already seen that heredity plays an important part in insanities. There can be little doubt that the tendency is to under-estimate rather than over-estimate its importance. Many cases said to be “caused” by mental strain such as those occasioned by domestic infelicities, business reverses and the like should in all probability be fundamentally attributed to something far more deep-seated than the more obvious cause. In many such instances there is little doubt that an inherent weakness in mental make-up exists which predisposes the individual toward mental breakdown. This is more apparent when one recalls that there are thousands of other individuals who undergo equally great or greater calamities without loss of mental balance. There are well-recognized types of mental disposition which later contribute to corresponding forms of insanity. In many instances the final catastrophe may be averted if the “peculiar” individual can be kept in good health and guided into right habits of thought. Undoubtedly certain infectious diseases, arterio sclerosis, various poisons in the blood, child-birth, and similar influences often enter as important contributory factors. In all cases of cure, however, we must face the fact that under existing conditions these mentally restored individuals are released into society without let or hindrance as regards their marital relations.