The word "insanity," as is frequently objected, means little or nothing from a biological point of view—it is a sort of catch-all to describe many different kinds of nervous disturbance. No one can properly be made the subject of restrictive measures for eugenic reasons, merely because he is said to be "insane." It would be wholly immoral so to treat, for example, a man or woman who was suffering from the form of insanity which sometimes follows typhoid fever. But there are certain forms of mental disease, generally lumped under the term "insanity," which indicate a hereditarily disordered nervous organization, and individuals suffering from one of these diseases should certainly not be given any chance to perpetuate their insanity to posterity. Two types of insanity are now recognized as especially transmissible:—dementia precox, a sort of precocious old age, in which the patient (generally young) sinks into a lethargy from which he rarely recovers; and manic-depressive insanity, an over-excitable condition, in which there are occasional very erratic motor discharges, alternating with periods of depression. Constitutional psychopathic inferiority, which means a lack of emotional adaptability, usually shows in the family history. The common type of insanity which is characterized by mild hallucinations is of less concern from a eugenic point of view.
In general, the insane are more adequately restricted than any other dysgenic class in the community; not because the community recognizes the disadvantage of letting them reproduce their kind, but because there is a general fear of them, which leads to their strict segregation; and because an insane person is not considered legally competent to enter into a marriage contract. In general, the present isolation of the sexes at institutions for the insane is satisfactory; the principal problem which insanity presents lies in the fact that an individual is frequently committed to a hospital or asylum, kept there a few years until apparently cured, and then discharged; whereupon he returns to his family to beget offspring that are fairly likely to become insane at some period in their lives. Every case of insanity should be accompanied by an investigation of the patient's ancestry, and if there is unmistakable evidence of serious neuropathic taint, such steps as are necessary should be taken to prevent that individual from becoming a parent at any time.
The hereditary nature of most types of epilepsy is generally held to be established,[81] and restrictive measures should be used to prevent the increase of the number of epileptics in the country. It has been calculated that the number of epileptics in the state of New Jersey, where the most careful investigation of the problem has been made, will double every 30 years under present conditions.
In dealing with both insanity and epilepsy, the eugenist faces the difficulty that occasionally people of the very kind whose production he most wishes to see encouraged—real geniuses—may carry the taint. The exaggerated claims of the Italian anthropologist C. Lombroso and his school, in regard to the close relation between genius and insanity, have been largely disproved; yet there remains little doubt that the two sometimes do go together; and such supposed epileptics as Mohammed, Julius Cæsar, and Napoleon will at once be called to mind. To apply sweeping restrictive measures would prevent the production of a certain amount of talent of a very high order. The situation can only be met by dealing with every case on its individual merits, and recognizing that it is to the interests of society to allow some very superior individuals to reproduce, even though part of their posterity may be mentally or physically somewhat unsound.
A field survey in two typical counties of Indiana (1916) showed that there were 1.8 recognizable epileptics per thousand population. If these figures should approximately hold good for the entire United States, the number of epileptics can hardly be put at less than 150,000. Some of them are not anti-social, but many of them are.
Feeble-mindedness and insanity were also included in the census mentioned, and the total number of the three kinds of defectives was found to be 19 per thousand in one county and 11.4 per thousand in the other. This would suggest a total for the entire United States of something like one million.
In addition to these well-recognized classes of hopelessly defective, there is a class of defectives embracing very diverse characteristics, which demands careful consideration. In it are those who are germinally physical weaklings or deformed, those born with a hereditary diathesis or predisposition toward some serious disease (e.g., Huntington's Chorea), and those with some gross defect of the organs of special sense. The germinally blind and deaf will particularly occur to mind in the latter connection. Cases falling in this category demand careful scrutiny by biological and psychological experts, before any action can be taken in the interest of eugenics; in many cases the affected individual himself will be glad to coöperate with society by remaining celibate or by the practice of birth control, to the end of leaving no offspring to bear what he has borne.
Finally, we come to the great class of delinquents who have hitherto been made the particular object of solicitude, on the part of those who have looked with favor upon sterilization legislation. The chronic inebriate, the confirmed criminal, the prostitute, the pauper, all deserve careful study by the eugenist. In many cases they will be found to be feeble-minded, and proper restriction of the feeble-minded will meet their cases. Thus there is reason to believe that from a third to two-thirds of the prostitutes in American cities are feeble-minded.[82] They should be committed to institutions for the feeble-minded and kept there. It is certain that many of the pauper class, which fills up almshouses, are similarly deficient. Indeed, the census of 1910 discovered that of the 84,198 paupers in institutions on the first of January in that year, 13,238 were feeble-minded, 3,518 insane, 2,202 epileptic, 918 deaf-mute, 3,375 blind, 13,753 crippled, maimed or deformed. A total of 63.7% of the whole had some serious physical or mental defect. Obviously, most of these would be taken care of under some other heading, in the program of restrictive eugenics. While paupers should be prohibited from reproduction as long as they are in state custody, careful discrimination is necessary in the treatment of those whose condition is due more to environment than heredity.
In a consideration of the chronic inebriate, the problem of environmental influences is again met in an acute form, aggravated by the venom of controversy engendered by bigotry and self-interest. That many chronic inebriates owe their condition almost wholly to heredity, and are likely to leave offspring of the same character, is indisputable. As to the possibility of "reforming" such an individual, there may be room for a difference of opinion; as to the possibility of reforming his germ-plasm, there can be none. Society owes them the best possible care, and part of its care should certainly be to see that they do not reproduce their kind. As to the borderland cases—and in the matter of inebriety borderland is perhaps bigger than mainland—it is doubtful whether much direct action can be taken in the present state of scientific knowledge and of public sentiment. Education of public opinion to avoid marriage with drunkards will probably be the most effective means of procedure.
Finally, there is the criminal class, over which the respective champions of heredity and environment have so often waged partisan warfare. There is probably no field in which restrictive eugenics would think of interfering, where it encounters so much danger as here—danger of wronging both the individual and society. Laws such as have been passed in several states, providing for the sterilization of criminals as such, must be deplored by the eugenist as much as they are by the pseudo-sociologist who "does not believe in heredity"; but this is not saying that there are not many cases in which eugenic action is desirable; for inheritance of a lack of emotional control makes a man in one sense a "born criminal."[83] He is not, in most respects, the creature which he was made out to be by Lombroso and his followers; but he exists, nevertheless, and no ameliorative treatment given him will be of such value to society as preventing his reproduction.