the indiscretion, the overwork, the one-sidedness, the narrowmindedness of our ancestors did not only make the history of their own times, but is making the pathology of ours. Every action, every event which contravenes the laws of health, however remote that action or event may be, is to be regarded as a predisposing cause of insanity. It is almost constant in practice to call the disease itself the cause. This confusion of cause and effect is very common, and it is only scientific training and much natural aptitude which will enable the diagnost on all occasions to distinguish these. Thus, we often hear that intemperance was the cause of insanity, and in many cases, as we shall hereafter see, excessive use of stimulants is a cause of insanity; but in half of the cases in which it is common to say the disease is due to the vice, the vice is in reality only a symptom or manifestation of the disease. In most cases, then, really to understand the origin of insanity, one must understand the murosis or psychosis, the long history of the tendencies to disease; for it is well understood that just as poisons are poisons only in relation to the constitution they enter, so that one man may swallow with perfect impunity what would cause death in another, so certain events may cause mental unhealth in one which would only produce healthy emotion in another. In this wide sense, then, any conditions of unhealth, such as excessive strain, excessive anxiety, excessive indulgence, diminished mental or bodily activity, must be regarded as predisposing causes; and consequently all those tendencies in time and in civilization to produce disease-all those tendencies which go to produce excessive demands before the organism has been formed by many calls to meet such strains, are to be placed in this category, and to be regarded as bringing about those conditions which are favorable to disease. 39. Sex considered in relation to the Causes of Insanity. Women were at one time thought to be more predisposed to insanity than men. Esquirol and Haslam agreed that it was so. But at the present time most writers seem to imagine that men are more prone to mental disease than women. Many writers, in their utter incompetence to deal with figures, which are two-edged swords, have computed the number of patients admitted into one asylum in a certain time, and concluded that the proportion of women to men in these admissions is likely to be in the proportion of insane women to insane men throughout the world, and hence deduce a theory as to the predisposition. But it is to be remembered that the proportion between the insane of the two sexes is not found to be the same in all countries; and it can be confidently affirmed, that even in the same country, it varies at different periods. The argument as to the weakness of the female sex making her more liable to suffer from adverse circumstances, is, as has been already shown, fallacious. To say that her weakness is brought about by her servitude, and that it is her weakness makes her liable, just in consequence of never having been exposed to risks, is to reason in a circle. One must look at the whole circumstances. If her servitude has made her weak, it has been by protecting her from certain works and hardships which men have undertaken. If these works and hardships are still undertaken by men, then women, as a class, are not exposed to those circumstances which can, together with their weakness, lead to insanity. One circumstance must not be regarded as the predisposing cause of insanity in a class where other circumstances are to be set against it. Rest is produced by forces that could move. Women in their present state are said to be less liable to those forms of insanity which occur in men, and can be traced to intemperance and other excesses. But it is their weakness and consequent servitude which have kept them from those works which lead to those excesses. It is absurd, therefore, to say that sex or its weakness predisposes to insanity. We should say that the numbers of men and of women who go insane, differ little, if at all, and that it is impossible to argue that sex has any influence as a predisposing cause in the production of insanity. [29] 240. Age considered in connection with the Causes of Insanity. It follows from what has been said above, that at certain periods of life men are more prone to go insane than at others. Weakness has to be considered as a cause of disease, but it is quite erroneous to do so unless it is understood with reference to a certain strain. Although an exotic might not stand the storm so well as the oak, yet in its glass house the wind no more breaks it than it does the giant tree. So the weakness of youth and age must always be considered, in connection with questions of etiology, in relation to a full knowledge of the circumstances to which it is exposed. We should, however, expect that the type of insanity associated with different periods of life would differ, and that is actually the case. Children become insane. Wherever there is a mind at all, it may become liable to mental disorder. All the diseases which occur in adults, with the exception of general paralysis, have been observed in children. Idiocy, however, is the most common form of insanity in early life; and not unfrequently, where unusual manifestations of mental activity have occurred at birth, after the convulsions caused by dentition or gastro-intestinal irritation, imbecility has taken the place of the undue excitement of the faculties. Instances of insanity, however, previous to puberty, are rare. It is not uncommon in girls upon the appearance of the menstrual secretion, especially if it is delayed beyond the usual time for making its appearance. Insanity is most frequent at the age when man is at his best: from 25 to 50 is the stratum of time in which his activity is greatest, and in which, owing to the fact of his activity, he is most exposed to the exciting cause of the disease. "Man's first word," says Hare, "is 'Yes;' his second, 'No;' his third, 'Yes.'" And so the diseases of a life correspond to this process of thought. Idiocy is the absolute affirmation-the very acme of assent. Mania is a universal "No;" and senile dementia is the same blank assent again. Acute forms of mental disease in advanced life are rare. It requires strength to go mad. 41. Education considered in connection with the Causes of Insanity.-It has been usual to allude to education as a predisposing cause of mental disorder; and it is true that certain kinds of mental efforts are deleterious. But education is not simply learning to read. The most important lesson a man can learn in youth is to be healthy. Not always to be thinking one needs a pill, but to be thoroughly unconscious of the existence of a stomach, which, like one's friends, only obtrudes itself when it is going to annoy. That education should not make a man clever and bad, is surely true; and that it should try to make him clever and goodwhich is the exact antithesis of insanity, which is bad and stupid beyond the reach of punishment-is surely the true function of education. But education only too often is conducted upon such universal principles that individuality is altogether overlooked; and very frequently tendencies which were latent, and might in time and with careful training have been eradicated, are made actual and living, and lead to insanity, by and through a pernicious system of education. [30] Education, properly conducted, might do something to make a compromise between the future and the past. Men inherit debts from nature which many have to pay with death, many with insanity. Education ought to husband and cultivate the assets, and too often it only hastens the end, which is on its way. This is not the place, however, to deal with the large and important question as to how far education might be made to overcome the influence of hereditary taint. Much, we feel certain might, with intelligence and judicious care, be done by means of a wide and sanitary culture. to the best means of this, however, whether it is likely to be best accomplished, as several able educationists, amongst whom Mr. Herbert Spencer and Professor Huxley may be mentioned, by means of a training in scientific facts, or by means of books, as the world has by its practice affirmed, it is difficult to say; and even if the answer to this question could be given in a few lines, this is not the place to write them. As 8 42. Hereditary Tendency.-This subject has already been dealt with, but it requires a prominence in the minds of those who would understand the real science of causality in relation to mental disease, which will warrant some repetition. The fact of hereditary transmission has long been known to breeders and florists, and common people have well understood the transmission of physical beauties, physical diseases, and physical defects, from generation to generation; yet somehow there seems to have been a peculiar blindness to the fact that mental characteristics and mental diseases, as dependent upon physical conditions, must also be inherit able. Lessing, however, with that prevision of science which is often found in poets, had perceived the irrationality of such a proposition, and one of the characters in his "Nathan the Wise" says: "How! and shall Nature then have formed in me A single feature in thy brother's likeness, 2 And now its truth would not be denied by any person of even trivial culture. Sir Thomas Browne has put the whole question well and quaintly in his "Religio Medici:" "Bless not thyself only that thou wert born in Athens, but among thy multiplied acknowledgments, lift up one hand to heaven that thou wert born of honest parents, that modesty, humility, and veracity, lay in the same egg and came into the world with thee. From such foundations, thou mayst be happy in virtuous precocity, and make an early and long walk in goodness; so mayst thou more naturally feel the contrariety of vice unto nature, and resist some by the antidote of thy temper." But this is not only true of vice and temptation, but of insanity and its occasions. By such inherited health, a man may walk through events which would cause mental ruin to many, and fear no evil: he may withstand most of the causes which would shake the mental integrity of most. In one sense, all insanity might be looked at as hereditary. To a man of perfect health, the world could have no cause for insanity. Causes for tears, causes for laughter, causes for exertion, and causes for rest, but causes for none of these in such excess as to wreck the mind thereby. It is the seeds of disease which are in one which grow up under tears, or blossom under joy. But there is a narrower sense in which the phrase hereditary predisposition is understood. Some nervous disease or insanity in the father leads to the same disease, or some similar disease, in the children. So powerful is hereditary predisposition, that in almost every case one can find that the taint has a history. It seems like a river that may dip under the earth for a while, George Elliot, in her poem "The Spanish Gypsy," has the same thought unfolded into other words. 2 Hume said that his naturally happy disposition was of more value to him than a thousand pounds a year. BR. INS.-8 |