SUPPLEMENT TO THE FOURTH ANNUAL REPORT. THE PREVENTION OF INSANITY. BY NATHAN ALLEN, M.D., OF LOWELL. DR. ALLEN'S PAPER. THE PREVENTION OF INSANITY. Insanity is to be ranked among the greatest misfortunes that can befall a human being. It may deprive him of his rights as a citizen, his right to manage his own property, his right to testify as a witness in court, and the right even of his own person. He becomes at once an object of distrust and notoriety. He is liable to be forced away from his home and his friends, and be confined in a lunatic hospital. He is also subjected to great expenses, which his own estate must pay or his friends; if these fail, the place of his residence, or the Commonwealth, must maintain him. These expenses in time become very large, frequently consuming all the means of the insane, and that of their friends, to such an extent that they have to be supported by the public; that is, they become paupers. In case the disease assumes a chronic form, it generally continues through life. According to established life tables it is found that a man twenty years old, becoming insane, will have an average insanity of a little over twenty-one years. The least cost of supporting an insane person in a lunatic hospital cannot be less than two hundred dollars per annum. Thus it will be seen that in twenty-one years the expenses of support will exceed four thousand dollars. But this is not all; there should be reckoned in the account the value of his services or earnings which would accrue to his family or to his friends, in case he was sane or was early restored to health. This would amount in the same time to a much larger sum. Now, if this insanity could be prevented, what an advan THE PREVENTION OF INSANITY. tage it would prove, even in a pecuniary point of view! The physical suffering, the distress of friends, the anguish of mind, the loss of reason attending a life thus spent, no language can describe. Again, let us look at the subject as exhibited at the present time in our Commonwealth. The population of the State by the census of 1880 was 1,783,085, but by January, 1882, it must have reached 1,850,000, if not more. The most correct estimate of the insane makes their number 5,500, with the probabilities that it is larger rather than smaller. This makes the proportion of the insane one to every 304 sane persons. This proportion is very large; according to some reports the largest of any State in the Union. But it may be true, as I believe, that the insane in this State are more carefully looked up and counted than in any other State. The proportion of the chronic is also very large. Of the 5,500 insane, it is estimated that more than 4,500 are chronic cases, most of whom have been subjected to treatment, but are not cured, with very small chances that they ever will be. The cost of supporting the insane in this State exceeds annually $800,000, and full three-fourths of it are expended upon the chronic cases. What a powerful argument is here presented for employing means to prevent this terrible evil! Before entering upon the discussion of its Prevention, it may be well to notice briefly the nature of the disease and some of its causes. The subject is one upon which a great variety of opinions have been entertained. In the whole history of medicine, there is no disease about which there have been such absurd and contradictory notions. These can be traced back to the earliest period, both sacred history. Reference is made in the several instances, to persons "mad," acting acter" and governed by some "evil spirit." vailed that in all such cases some demoniac or Satanic agency had taken possession of such persons, and that surely they were not in their right mind. These views respecting insanity were generally entertained by the Jews, and, with of profane and Scriptures, in a "false charA notion pre DR. ALLEN'S PAPER. some slight modifications, prevailed among the Greeks and Romans. It is a singular fact, that in all those cases where "madness was attributed to persons, it was believed they were afflicted or controlled by an "evil spirit," that it was not from a voluntary internal movement, but that they were taken possession of by some secret, mysterious agency outside, which was evil in its design, and foreboded no good. Such were the views of insanity entertained not only in those times, but which continued to have a powerful influence for centuries later. And notwithstanding their absurdity and extravagance, multitudes even at the present day are more or less affected by these strange notions. While the evidences of this "madness" were manifested through the body, singular views also prevailed with reference to the soul or mind; that it was an essence or entity acting independent of the body, and governed by no fixed laws or principles. The theories entertained in respect to the mind were so vague and indefinite that they served to mystify the subject of insanity. These theories were constantly changing, as if they had no permanent or substantial basis. Gradually more attention was given to mental studies, under the term, "Philosophy of Mind" or "Metaphysics." By this means some advances were made in obtaining a better knowledge of mental operations and the laws which govern them. These attempts to establish a system of mental science based on individual consciousness, without recognizing the laws of the physical system, proved a failure. The more thoroughly the relations of the mind to the body were investigated, the greater was found the dependence of the former on the latter. Early in the present century, special inquiries were made in respect to the functions of the brain; and, after many experiments and extended observations, it was generally conceded that the brain in some sense was the organ of the mind. If, therefore, normal, healthy operations of the mind depended upon the brain, should this organ become THE PREVENTION OF INSANITY. disturbed or in any way affected, it would at once change the character and action of the mind. This theory enables us to understand much better what is meant by insanity or mental derangement; and just in proportion as the various developments of insanity were studied in connection with the functions of the nervous system and the brain, the better they were understood, and the more rational and rect views prevailed. In this way comparisons could be instituted between insanity and other diseases. If the various diseases of the body arose from violating the laws that govern the healthy action of the system, thereby causing an unhealthy abnormal state of certain organs, then, if the healthy action of the brain was disturbed or affected, it might, on the same principle, cause mental derangement. There was a period when some writers maintained that insanity was confined exclusively to the mind, and that the brain or physical system had nothing to do with it. Taking this view, the various features of insanity, with all its changes and diversified forms, could be described and treated but with very little success. Thus, all theories of insanity that regarded the mind as acting independently of the body (whether some evil spirit had taken possession of it, or whether it assumed some other strange fantastic state), fail to give any correct ideas of the nature or causes of these phenomena. While such theories and speculations prevailed, there could not be very successful or rational treatment of insanity. Neither could there be much progress or improvement on the subject. On the hypothesis that the philosophy of mind or all mental science is based alone upon individual consciousness, it is very difficult to obtain any clear conception of insanity. With such false theories and distorted views, whatever success might attend the treatment, the idea of prevention would never receive any attention. These false views of mental philosophy have had a powerful influence, for a long time, in blinding and misleading people as to a correct knowledge of insanity. It is very important for an intelligent discussion of this subject, that correct notions of mental science should be entertained. |