Signs of sanity and the principles of mental hygiene

Front matter

(QotttcU Unitjcrattg iCihtarg

ittium. New ^ntk

BOUGHT WITH THE [NCOME OF THE

Contents

CHAPTER PAGE

I. Intbodbction 1

II. Aee Sanity and Insanity Inhbei-

Chapter I. Inteoduction

A great problem that man has never faced squarely hangs like the sword of Damocles above his head. [The question is, does man to-day possess sufficient soundness of mind to exercise intelligent control over the complicated civiUzation he has created? Upon this intelligent control depends the happiness of the individual, the just settlement of the problems of labor and capital, the peace of the world, the fate of democracy, and the destiny of the race.

Only the future wiU demonstrate whether the human mind has reached a point in its evolution where it possesses the capacity to find solutions for such momentous issues. Of this fact, however, we are now sure, that man is waking up very slowly to the urgent need of finding out the conditions that are most favorable for sound thinking and sane conduct. The majority of people do not even know that the final test of the sound mind implies sane conduct, not merely intelligent thinking. Sanity measures, not only the mental, but the physical and mental quaUtiea that enable a person to face critical situations in life successfully, and not merely to sit down and think about them. Sanity is a successful, and insanity an unsuccessful, attenipt to adjust life to reality.

From still another angle sanity may be said to be the capacity to find adequate expression for man's creative energy in some one of the great fields of himian endeavor. Man is an energy-producing machine, and the energy produced should not be wasted, but be discharged through channels that lead to productive work, and accompanied by a reasonable degree of satisfaction of human desires. Sanity is an evidence that man's productive potential is able to control his destructive tendencies, that he is able to do the right thing at the right time, in the right way. Man must be sane and produce, or perish. The world is only large enough to support a sane, productive population.*

Man is a strange as well as an interesting animal; his behavior is a bundle of amazing paradoxes, a mixture of constructive and destructive tendencies. Extraordinarily boastful of possessing a more complicated and highly organized brain than any other animal, he is exceedingly reluctant to make intelligent efforts to learn how to use this superior organ, that is, to think and to act sanely. Quick to admit, when evidence is presented, that reasoning is

♦ Korzybski, Alfred, "Manhood of Humanity." E. P. Dutton & Co., New York. 1921.

a more complex process than is generally believed, he does not readily bestir himself to secure more definite information about the emotional and mental habits essential for reasoned living. Forced by the exigencies of war to realize that military efficiency and morale were seriously impaired by sending soldiers with poorly balanced brains and nervous systems to the front, he stiU ignores the unpleasant fact that unsoundness of mind in times of peace, the inability to reason correctly and to act intelligently in the presence of emergencies, is perhaps the greatest menace to an organized society. It is said that in the state of Massachusetts one person in every twenty dies in a state institution, and one in every ten, at some time or other, has been in either a hospital for the insane or an institution for the feeble minded. It is an easy matter to find plenty of statistics to show that a good many people are not adjusting their lives. The Census

Bureau, for example, reminds us that in ten years there has been an increase of 20 per cent in the number of divorces. Pearce Bailey * estimated that there were 45,000 mental defectives of school age in the state of New York, while the president of a large insurance company reports an increase of 23 per cent of suicides and 13.8 per cent in homicides. According to Stearns t the suicide rate in Massachusetts has steadily increased since 1841. But a far more subtle and dangerous menace to the progress of civilization than either insanity or feeble mindedness is "nervousness." This afPects probably one person in every five or six in civilized communities.

In spite of all the evidences of wasted and misdirected brain power few attempts are made to improve our condition. Enthusiasm in talking about the subject of universal peace, in proposing

•Bailey, Pearce, "Mental Hygiene." Vol. vl. Jan., 1922, p. 67. t Stearns, A. W., "Mental Hygiene." Oct., 1921, p. 776.

solutions for labor or international problems, is at the same time accompanied by an extraordinary indifference to the necessity of investigating human natm-e and using the information acquired to cultivate the physical and emotional characteristics of the sound mind in the sound body that are the components of a rational and peace-loving disposition. Visions and plans for leagues to establish and maintain peace will not be as effective in preventing war as the dissemination of the right kind of knowledge in regard to the development and cultivation of sane and peaceful, as distinguished from insane and belligerent, attitudes of mind. It would be interesting to know whether the mental symptoms accompanying belligerent attitudes, and the methods of preventing the development of this form of insanity were discussed at Versailles or Washington. A strange paradoxical attitude, a sentimental interest in peace combined with a lack of intelligence in promoting it, seems to be about all that can be expected of people who, while requiring satisfactory evidence (in the form of a license) that a chauffeur has had practical experience in running the relatively simple motor, calmly hand over the education of children to persons who have had little or no experience in driving the complicated human machine, and who assume no responsibility for damages that are often the after result of their poor driving. Although attempts are made to educate the body politic in the elementary knowledge essential to the economic and political safety of the individual* very little is done to ensure the mental safety of citizens. We were once asked to make the world safe for democracy, but we know now from bitter experience it is far more important to make democracy safe for the world. If civilization as well as democracy are to be saved, it can only

*Reed, Alfred Z., "Training for the Public Profession of the Law." Bulletin No. 15. Carnegie Foundation for the Advancement of Teaching. 1921.

be done by making man literally the first and most important study of man.

Probably the most amazing evidence of these paradoxical qualities is reflected in the attitude toward education. In schools as well as in colleges and universities, it is taken for granted that students somehow or other will acquire the art of reasoning as well as of living a rational existence, although relatively little attention is paid to assisting them to form a clear conception either of the general characteristics of sanity, or of such special manifestations of it as are represented by the cultured mind; while very little instruction is given in regard to the emotional and mental habits required to ensure a rational control of behavior. These are but two examples among many of the paradox of anxiety for a successivl life and indifference to the problems connected with the sane education of behavior; that is, the learning of the difficult task of using what reason we possess to direct our acts intelligently. What a ridiculous comment it is upon our educational system that students are fed on information-pie imtil they get mental indigestion, but are given practically no assistance in learning how to think consecutively and sanely! Democracy is doomed if it cannot count on the sanity of the majority of its citizens. To-day even the majority of teachers as well as the leaders of democracy are unable to distinguish clearly sanity from insanity.

As our subject the Signs of Sanity and the Principles of Mental Hygiene is a difficult one to discuss, we do not wish to make it doubly so by using terms the meaning of which is not clear ; and, therefore, a brief digression is permissible in order to explain the four words, health, disease, sanity and insanity that will be brought constantly into the discussion. We cannot form a clear idea either of what constitutes soundness of mind or the method of cultivating this highly desirable quality until we have a pretty fair idea of the significance and relation of the conditions referred to as health, disease, sanity and insanity. To begin with, they are relative terms, and are mutually explanatory. In the second place, they are employed to describe mental and bodily processes, and not fixed states. These processes are manifestations of life which is known only through action, and not by hypothetical states, and, therefore, it is incorrect to speak of states of either mind or body. Thirdly, it is important to accustom ourselves to think of the processes responsible for health and sanity as so intimately related to those occurring in disease and insanity that no sharp dividing line can be drawn between them. There is no one specific characteristic of health that distinguishes it from disease, or sanity from insanity. The changes that seem to us to be striking ones in disease and insanity are the result of differences in the organization of the processes. The organization of the bodily processes in health (the sound body) and of the body-mind processes in sanity (the sound mind) is quite different from the one present in disease or insanity. In order to live either wisely or well, we must accustom ourselves to think of life as a process of adjustment, to try to vmderstand something of the organization essential for securing the relatively successful adjustments of health and sanity, and for avoiding the unsuccessful ones of disease and insanity.

One of the greatest triumphs of biology has been to emphasize the fact that life and the activities of all living beings are processes of adjustment, and not states of body and mind. It has also directed attention to the importance of studying the nature and the organization of the processes necessary for securing successful adjustments. It has taught us to ask what is the organization essential for closing the eyes when the intense light of the sun suddenly flashes between the open lids; or, for preserving the balance when crossing some dizzy height ; or, for keeping the temper when some bore talks to us; or, for preventing ideas from becoming so fixed and insistent that it becomes impossible to adjust the mind to perceive and accept the truth.

We shall have made an excellent start in our investigation when we have grasped the idea that in order to understand the nature of the adjustments in health and how to preserve these, we must know something about those occurring in disease. For a similar reason, if we wish to be intelligent and sane we must have information about insanity, and the processes of adjustment that interfere with the exercise of our full reasoning capacity. We must be prepared to apply organized intelligence to the study of man. Disease and its special phase, insanity, are Nature's searching and ruthless analyses of the conditions we call health and its special aspect, sanity. We shall not go very far in this inquiry before we shall meet striking evidence of the fact that what the average person means by a sound mind is a variety of processes that enable us to think intelligently, and to act wisely in the daily struggle to adjust life. We have to consider, then, the processes involved in both thinking and acting; and as the latter are by far the oldest, millions of years the oldest, and supply the foundation for the former, we shall consider them first.

In the next chapter we shall have something to say about the possible effects of heredity on the processes responsible for the soundness of body that is essential for soundness of mind. In sanity as well as in insanity we have to consider first the question of inborn capacities, and then the abilities or skill actually acquired in handling the original endowment so as to secure successful adjustments in living.

Chapter II. Ake Sanity And Insanity Inherited?

"How much has heredity to do with the condition we call sanity and insanity" is a question often asked. It would be very foolish to try to discuss a topic of this scope and importance in a few pages. But, without becoming involved in a discussion of a subject concerning which relatively little is known, it is still possible to indicate very briefly a few practical advantages of knowing something about our family histories to make possible the most advantageous use of what brain-power we possess. Even a very little information of the kind we have in mind, if correctly applied, is sufficient to increase a person's chances for success and happiness as well as to prevent unfortunate or tragic results.

In considering the effects of heredity we should remember that the conditions we call sanity and insanity are expressions not only of the functions of the brain and nervous system, but of the entire body. We are accustomed to talk about intelligence, or the lack of it, as if the functions collectively described by this term were functions of the brain quite independent of, and not modified by, the functions of all the other organs of the body. When we say this person has an unusual degree of brain-power or that one exhibits defective brain-power, a great many other functions than those of the brain and nervous system have to be taken into account. We cannot, for example, consider the activity of the brain without reference to the activity of the heart, lungs, endocrine organs and other parts of the body. When we attribute certain unusual qualities or defects to inherited characteristics the brain is only one of the many organs that are involved.

IS SIGNS OF SANITY

Anomalies in character, disturbances of intellect, as well as evidences of unusual strength of character and high intellectual ability, genius, are the products, not only of the brain, but of the influence of a great many organs either interfering with or stimulating this great center of adjustment. The achievements of genius or the failures of defectives are as much the result of the full or defective activity of adrenals, thyroid, heart and kidneys as they are of the cerebral functions. For a true analysis of the hereditary causes responsible for the production of a Shakespeare it would be necessary to know something about the physical and physiological constitution of his forbears, and not merely about the size and functional capacity of their brains.

In preparing this chapter the writer has been fortunate in securing the assistance of Mr. H. H. Laughlin, Secretary of the Eugenics Record Office, Cold Spring Harbor, who has emphasized

1 1 i -fi-m-s w

Z; w o

o

S Pi w points of practical importance that can be utilized to advantage in studying the genesis of sanity or insanity — the genius as well as the defective.

Very often an intelligent observer, without any technical knowledge of biologic principles, can collect data that are extremely useful in explaining the inherited organization of a personality. Mr. Laughlin has recalled in this connection the following words of Oliver Wendell Holmes, addressed in his Valedictory Address to the Graduating Class of Bellevue Hospital, March 2nd, 1871. It emphasizes the importance of just the kind of information that was often accumulated by the general practitioner of the old school who has now, except in a very few sections of the country, almost disappeared.

"The young man knows his patient, but the old man knows also his patient's family, dead and alive, up and down for generations. He can tell beforehand what diseases their unborn children will be subject to, what they wiU die of if they live long enough, and whether they had better live at all, or remain unreaUzed possibilities, as belonging to a stock not worth being perpetuated."

The unusual interest exhibited by the modern physician in specific scientific problems very naturally calls for the exercise of the keenest powers of analysis; but unfortunately this mental attitude has vmdoubtedly tended to make a good many medical men, particularly the younger ones, less attentive to, and less appreciative of, the equally important capacity for synthesis. The modern physician, with relatively very few exceptions, has committed the unpardonable sin — of which Herbert Spencer warns scientific men — of studying only one phase of their problems. A great many doctors are satisfied as soon as they have analyzed the functions of diflferent organs, and forget entirely to study their patients as living organisms engaged in the difficult operation of adjusting their lives, not to the artificial conditions existing in clinics and laboratories, but to those in the world in which they are obhged to live. It will be very unfortunate for our civihzation if investigators engaged in studying the problems of modern scientific medicine trust entirely to analytical methods and do not show some of the capacity and interest for synthesis that was exhibited by the old-school practitioner.

By all means let us have careful analytical studies of stature, strength, endurance, eye sight and other special qualities, both physical and mental, of the individual; but let us remember that it is necessary to supplement this information by observations upon the personality. Do not let us forget to study persons as living himian beings actually engaged in meeting and overcoming, or failing to overcome, difficulties in actual life.

In discussing the question of heredity we should always be careful to avoid drawing sharp contrast between heredity and environment, since, as Hohnes * has pointed out, both heredity and environment are absolutely essential to every organism, and every organism is a function of both hereditary and environmental factors.

It is usually true that the range of abilities and hmitations that influence the lives of the offspring of a given pair of parents are most clearly suggested by the qualities exhibited by the four grandparents. On this account it is very desirable if we wish to get some idea either of special ai)titudes or defects to study the history of the grandparents.

A case in point is the Burroughs pedigree that has been so carefully studied by Mr. Laughlin, who has kindly given me permission to quote what he considers to be the essential points in the history.

"This pedigree is especially adapted to showing how the hereditary possibilities

• Holmes, Samuel J., "The Trend of Race." Harcourt. Brace & Co. 1921.

of the children of a given pair of parents are indicated more clearly by the traits possessed by the four grandparents of the possible children, than by those possessed by the parents themselves.

"In the Burroughs family the paternal grandfather, Eden Burroughs, was a serious-minded and thrifty hard-working farmer, especially noted as a lover of peace and solitude. Rachael Avery, the paternal grandmother, was of Celtic origin and was known to be warm-hearted and cheery. Of the maternal grandparents, grandfather Edmund Kelly was a great lover of the out-of-doors. He was thriftless and carried lightly the responsibilities of the family. His principal occupations were fishing and reading the Bible. He had a brother who lived in a cabin near Albany and was known as 'The Hermit.' The maternal grandmother, Lavinia Liscom, was energetic and industrious, and on her devolved the care of rearing her family of eight sons and daughters. The traits of these four grandparents, as we shall see, segregated and re-combined in various forms in their grandchildren.

"The father of John Burroughs was named Chauncey. He was a sturdy, unsophisticated farmer, emotional and tender-hearted. Burroughs says that his bark was much worse than his bite. He was narrow-minded and enjoyed religion in great ecstasy. His wife, the mother of John, was named Amy Kelly. She was a great-hearted woman, industrious, entirely unlettered and inclined to be melancholy.

"John Burroughs was a member of a family of ten children. The eldest brother, Hiram, was a dreamer, a stock fancier, a bee keeper, and was handy with tools. Of the whole fraternity, Hiram and John were the 'nearest kin,' but Hiram appears to have had no 'intellectual impetus.' Cm-tis inherited rather weak eyes. He was known to be a man of considerable wit. He was the father of six children. Next came Wilson, who died at the age of 28. John thought that Wilson had considerable promise of intellectual development. Then came Edmund, who died in infancy. Then OUy Ann, who died of tuberculosis at the age of 28. Her family remembered her as the possessor of a beautiful flower garden. Then came Mary Jane, the wife of Homer r-O rS^\

- rilf

La'i

-o r-d o

Df

P

II :i r

-nJ

-nl

I

M o

o

PI

H

P(

Lynch and the mother of five children. Then came John Burroughs, the central figure of this pedigree study — ^the only person of near kin who displayed high talent. He received from his paternal ancestry stubbornness, thrift, love of peace, and an intellectual impetus. From his mother's side of the family came the love of the out-of-doors, a hermit nature, and idealism, romantic tendencies, and emotional fluctuations. These materials which showed so clearly in the four grandparents, re-combined in various manners in the children. It was John's great fortune to receive the luckiest combination of his ancestral qualities. After John came Eden, who was a cheery man and was a lover of nature, which showed itself in fox hunting, in which art he excelled. Then came Abigail, a woman much like her own mother, Amy Kelly, in that she encouraged John in his literary ambitions. Then came a sister Eveline, who died at the age of five years.

"If in the four grandparents, there had been more uniform genetic constitution, which showed itself in talents similar in all four, we should have expected among the grandchildren a greater number of closely resembling trait-combinations, but unless the grandparental uniformity had been of high quality, talent would not have appeared in the grandchildren. John Burroughs was a fortunate combination of diverse grandparental traits."

One very interesting point illustrated by the Biuroughs family history is that a person of unusual mental ability sometimes develops from stock that has not shown any striking or unusual characteristics. If the right combination of qualities happens to occur, an individual much above the level of his ancestors' mental qualities may be the product. But unfortunately what holds for unusually good qualities also seems to be true of the combinations that make for inferior qualities or defects.

What has already been said in regard to the possible inheritance of good qualities applies to the transmission of defects and inferior qualities. There is a marked susceptibility of certain families to what is called manic-depressive insanity; a psychosis in which periods of excitability and over-activity are associated with those of mental depression and diminished motor acti^aty. By consulting the chart it can easily be seen that in this particular family a very slight exciting cause was often sufficient to bring on an attack. In the Family B., although only one of the near relatives showed any signs of the special psychosis we have been discussing, still it is apparent that other members of the family plainly display indications of a general mental instability, which it is conceivable would lead under certain environmental conditions to a manic-depressive attack.

Probably in so-called normal families these exciting causes, either small or large, would not have been sufficient alone to bring on a definite mental breakdown. In both Family A and Family B there were tendencies cropping up which suggested the existence of just those factors that usually count heavily in bringing on an attack of this special form of mental disorder.

In order to increase the chances of securing talented offspring or to prevent degeneracy we should always remember that in mate selection ancestral traits of future children are often strikingly exhibited in the persons of several ancestors. These traits tend to segregate and to recombine in the descendants. A marked uniformity of qualities for example, in the four grandparents probably means uniformity of quality in the children, whereas diversity of characteristics of forbears probably means diversity in the grandchildren. A trait cropping up in two grandparents doubles its chance of appearing in grandchildren and on this account in consanguineous marriages good or bad traits are doubly apt to re-appear.

Seashore * and other investigators have called attention both to the possibility of

* Seashore, C. E., "The Inheritance of Musical Skill." Musical Quarterly, Schirmer, New Yorlc. Octo., 1920.

O K u

P

w B

< o

W

o < analyzing a number of the factors concerned in the inheritance of musical talent, and also of tracing its genesis and forecasting the probable incidence. One of the practical advantages of these investigations is that it has shown one way of detecting the presence of unusual, but latent musical capacity, and of discovering the gifted persons to whom special instruction should then be given. But in additiori to the assistance given in picking out talented musicians these same methods are applicable, as Seashore has indicated, in bringing to light latent qualities that may, if judiciously stimulated, prevent a good many Americans from dying with all the music still in them.

Professor J. Alfred Mjoen * has reported an extraordinary example of the inheritance of unusual musical capacity. Among the thirteen members of the present generation three showed very unusual capacity while nine were decidedly

musical. In the father's family both lines exhibited great capacity, while on the mother's side there had been a combination of no musical capacity with great capacity. In this particular family there is a very striking illustration of the increased potency acquired by special traits when the right combination is struck.

Even after such a very brief summary as we have given it must be evident that heredity has a great deal to do with the capacity for forming the good adjustments in living we call sanity and the poor ones recognized as insanity. But at the same time we should never make the attempt to consider heredity quite apart from environment ; for, as Conklin * reminds us, "any hypothesis that wholly discards or disregards this factor can have no standing in science," The outer environment can easily influence not only the germ cells, but also the inner environment of the body.

* ConUlIn, Edward G., "The Direction of Human Evolution." Charles Scrlbner's Sons, New York. 1921.

No one to-day can be intelligently interested in questions of public welfare who is not prepared to consider the problems of eugenics in relation to individual success and happiness as well as to national and racial improvement.* Work such as that undertaken by the Eugenics Research Association goes to the root of problems engaging the attention of parents, teachers, physicians, clergymen, social reformers and statesmen. "Eugenics is," saj'^s Laughlin, "a long time investment and will appeal only to farsighted patriots." t

Even if the appeal to a higher patriotism to improve the racial stock at present finds relatively few responses, a selfish interest in improving our own chances for success and happiness should make us eager to know about our ancestors, — to learn why and how they succeeded as well

* Newman, Horatio H., "Evolution, Genetics and Eugenics." University of Ciiicago Press. 1921.

t Laughlin, Harry H., Eugenics. Researcii Office, Long Island, New York. Bulletin No. lOA. I. The Scope of the Committee's work.

as why and how failed as they followed their course of life — in order that we may profit by knowing what happened to them so as to keep clear, if possible, of pitfalls, to hold the straightforward road, and before it is too late to avoid a position,

"So bitter is it, death is little more."

Chapter III. The Bound Body

The sound body is a well organized body, a body well prepared to act in an emergency; a thoroughly up-to-date, efficient machine. It is a body well adapted to present conditions, not to prehistoric times ; not to the demands made upon the human machine at the time of the Greeks or Romans, but to life in this day and generation. In the sound body the functions of the organs concerned in producing, distributing, storing up or discharging energy all puU together; in other words, are well coordinated. The sound body is not necessarily one possessing great muscular strength, but it does have well adjusted machinery for utilizing to the best advantage the muscular strength available, and needed, for living in this twentieth century. Often it Is not a speedy machine nor a record-breaking hill climber, but it runs, without unnecessary friction, quietly along life's highway, often surprising us with its success in meeting difficulties when speeders and higher-powered machines either break down entirely, or are stalled.

The sound body, in addition to being a well organized, smoothly-running machine, is also a productive organism. The energy manufactured is expended in constructive effort; soundness of body is essential for productive labor. Man, we have already been reminded, must either produce or perish. The capacity of the body for constructive action is the basis for constructive thinking.

There is an extraordinarily close connection between what we do and what we think. I am walking briskly along on a cold, snappy day and suddenly become conscious of the fact that I am humming the "Marseillaise." A change in the barometer and a slowing up of the drive to action would doubtless lead me to whistle quite a different tune.

Once we understand the intimacy of the relations between soundness of body and soundness of mind, which most people do not, between well coordinated acting and thinking, we have taken a long step in the direction of answering the question whether there is any way of telling whether a person who is brought into a given situation will feel, think and act sanely. We know that the sane person does not see things out of focus, does not lose all sense of perspective, does not handicap intelligence, does not think in terms of class distinctions, nor express extreme views; but the possession of good mental quaUties depends to a much greater degree than is usually believed upon the capacity for effective action. A person who is prepared to do the right thing at the right time does not give free rein to destructive tendencies.