The principles of mental hygiene

Preface

For many years a small group of philanthropically minded persons have been fighting the battles of the failures in life and trying to secure for them an adequate understanding which should be the basis for creating a new, a more enlightened, and a constructive and helpful program for dealing with them. Despite the length of time this movement in its various ramifications has been in existence, and the number of people who have been engaged in it, and, too, the high type of many so engaged, there never has issued from its sponsors anything that could properly be called a comprehensive program, an adequate statement of principles scientifically founded and practically workable. The reason for this seems to me clear. These persons had no such program, they had no such principles, their moving force was faith.

Many, perhaps all, great movements, are thus shadowed forth in their origins by the faith that is in those who believe in them. It is these pioneers to whom all honour is due, who have had the courage to speak for what they believed was right, for what they had faith in, in the face of opposition and ridicule and even though when asked to state their v^ case they found themselves quite incapable of putvi PKBFACE

ting into words what they felt. They have stood firm, however, until principles could be formulated and programs projected. When that day arrived the battle was perhaps already won.

The battle for mental hygiene has already been won.' The far seeing faith of its progenitors felt and knew that a way could always be found to solve any problem that needed to be solved, if only there was the patience to keep on, the determination to succeed. Mental hygiene has come to stay, there is not the shadow of a doubt about that, but its principles remain to be formulated because its activities have been scattered over so many fields which, while not really, still are practically, disconnected. There have been the problems of the care of the insane, prison reform, pauperism, alcoholism, feeble-mindedness, juvenile delinquency, atypical children, vagrancy, prostitution, vocational education, the neuroses and psychoneuroses, drug addiction, social hygiene (venereal prophylaxis), patent medicines and faith cures, and many others, all of which have been recognized by some as being problems that would have to be attacked more or less exclusively by methods founded in the principles of a hygiene of mind.

The various directions in which these problems have arisen has tended to a somewhat mutual exclusiveness so that each group was interested only in some particular aspect of the larger problem. The whole field has, therefore, not as yet been comprehensively surveyed. To do this in an at all ade-

PEEFACE vii

quate manner would be a large undertaking, perhaps too large to be dealt with in a single volume. It will be my object in this book to sketch the outline, stressing the larger problems, and completing the statement by a briefer filling in of details. Such matters as the principles involved in the concepts of the great defective, delinquent, and dependent groups, the significance of the insane, the criminal, and the feeble-minded classes, of the principles of society's relation to them will receive the larger amount of attention, while such questions as divorce, the woman movement, etc., will come in for small mention, not because they are of less importance for perhaps they are not, but because it would seem that the great guiding principles can be seen plainer in these other problems for there we can see the springs of human conduct laid bare, less overlaid with the disguises of a conventional society. These questions will be discussed, however, not with the purpose of attempting to solve them but because they are present-day examples of bad mental hygiene, that is, they show in action those factors at work which interfere most seriously with an efficient handling of a situation — such as prejudice, hate, etc., and so come within the realm of mental hygiene indirectly, although their problems, as such, might hardly be conceived to belong there.

In accordance with this program the book will naturally fall into two parts. The first part, comprising the Introduction and Chapter I, will be theoretical, a laying down of fundamental, scientific viii PREFACE

principles, and can well be omitted by the practical worker whose interests are not primarily scientific or philosophical. The second part will take up the larger issues, such as the insane, the criminal, etc., and progress to the less well defined and less distinctly pathological problems. The summary will attempt to bring all the issues, theoretical and practical together and will thus require a knowledge of both parts of the book.

INTEODUCTION

To have accomplished the task of a practical understanding of the changes which accompany the disorders of the bodily organs may be said to have been the crowning achievement of the medicine of the nineteenth century. It is now only a question of time when such knowledge shall be put into effective relationship with social activities and much of what we have hitherto been terming disease will gradually cease to have the power of compelling fear and dread. For disease will no longer be looked upon as a single manifestation, or a group of such manifestations, to be attacked as separate entities, with a futile lack of understanding of causes and of these same relationships. The whole effect of disease upon the social body, and its origins as expressions of an interrelationship with this, will be considered an indispensable feature of its understanding and effective handling.

It is a fundamental position taken in this book, and one which will undoubtedly come to be universally held before a final conquest of disease will have been accomplished, that disease after all is maladaptation of function of the entire body in all of its relations, and that no hard and fast line separates the functions of any organ of the body into physical and mental, nor limits the disease concept to exclude mal-

X INTRODUCTION

adaptation in the social any more than in the individual functioning of the entire organism. The term physical still lingers in our mental fabric, however, and threatens by a too great conservatism of habit to obstruct the larger point of view which this valuable work seeks to point out.

Mens Sana in corpore sano, — a healthy mind in a healthy body — has been the watchword of past civilizations. It is time to modify this and to recognize that this is but one-half of a truth, which in order to be realized needs to be stated in a larger form which embraces this. Corpus sanum in mente sana, — a healthy body can only exist as its behaviour is influenced and controlled by a healthy mind. For it is becoming more and more evident that what we call mind is an organized principle in evolution with a structure just as real as any organ of the body, not a distinct static thing of material form and dimensions, but a no less distinctive working entity, a product of evolutionary growth and a grouping of functional activities, the chief distinguishing feature between mind structure and organ structure being the greater plasticity of the functional capacity of the former for the utilization of the stores of energy which surround us and force us into action.

One might say that when living matter in higher animals had more or less completely solved the problem of how to utilize the energy of the chemical substances which we roughly symbolize as sugars, for example, then this function, more or less completely learned, became structuralized into what we

INTRODUCTION xi

call, let us say, tlie liver. Liver structure becomes thus more or less finished, this metabolism of sugar has been learned, for the most part the work of energy transformation goes on automatically, only hindered when other organs, functioning imperfectly, refuse, as it were, to let it perform its own task unmolested.

Now the mind structuralizations are still open, still formulating, for social adaptations have not been so completely individualized as chemical adaptations. Many have been structuralized for the time being in wise precepts. Golden Rules, in the Talmud, Eig Veda, laws of the Twelve Tables or the whole group of gradually shifting codes contained in the Bible. Such literary crystallizations, which represent great planes in the development of thought and language, as those of Shakespeare or Goethe, constitute likewise the slowly deposited and slowly changing forms and grades of this same structuralizing process, as do also international agreements, world customs, etc., etc. But so long as time is continually progressing, new possibilities for better and better adaptations are left open, which by reason of the plasticity of the mental structures, are continually taking place.

Thus ever higher attributes of social evolution are possible and since it is so, it is incumbent upon human society to discover and attain to them. The realization of them, according to the progressing measure of social capacity, means health. Failure to attain, or disorder in the social system which inxii INTRODUCTION

terferes with such progressive functioning, expresses the various inadequacies and disabilities of society, its lack of perfect health and healthy activity. These are the various phenomena which are so ably discussed in this treatise. Whether physicians term them diseases of the spirit, or of the soul, or of the mind in its collective function, is innnaterial. The important fact to recognize is that of their origins, for only by an understanding of how such things come to pass can they be alleviated and thus human happiness made more possible.

This work will materially further such a comprehension of the various grades of certain types of failure and their underlying causes, and thus prove a constructive agency for their diminution or removal. Thus we shall arrive at a true ideal formulation of a healthy society, which means also in the individual-society relationship, upon which this discussion is based, a healthy individual and therefore a healthy body. In such an ideal society it will be seen, for instance, that such a physical disease as typhoid fever cannot exist, for it must in reality be considered a disease due to an imperfect society. The persistence of typhoid fever in a coromunity is a symbol, not alone of the ignorance of that society, but a sign of the inertness, of the cupidity and self-seeking of the majority, who consider their individual comforts and personal satisfactions ahead of those of their fellow men. They refuse, by their maintenance of corrupt, inadequate political machinery of well acknowledged incompetency, to put to work the

INTRODUCTION xiii

proper agencies to eliminate typhoid fever from the map. This is merely another way of saying that the individual in the large, in his social relationship, is still spiritually ill. His mental vision cannot yet take in the larger whole, which were he able or willing to see, would keep his body well, because his social, mental function, that is his soul, would have grown up and formed a structurally effective mental hygiene. Since moreover the practical purposes of a cultural civilization, built to express and fulfil man's greater needs, have indissolubly bound individual and the society, environment, to which he bebelongs, this limitation of a larger vision which means the individual illness makes society also ill and imperfect and deficient in its functioning. Thus while ignorance, timidity, incompetency denote the illness of the individual members of society, it is equally true that an ineffectual, incomplete, inadequate attitude towards social skeletons is symptomatic of the iUness of society.

The new century of medicine may well be characterized as that of discovery and investigation of causes and interrelationships. The keen analysis which searches out individual causations and probes to the uttermost each separate phenomenon of form or function, must be followed by a comprehensive synthesis, in which interdependence of form and mutual modification of function are sought to be understood both in their causes and in their effects for individual and society. Both analysis and synthesis, in this their pragmatic significance, are genxiv INTRODUCTION

etically considered, since cause and effect are to be understood as evidences of the energj^ which infuses life, as it is transmuted and transposed to create and to activate the lesser structuralizations of material organs and forms, or more progressively still, the higher structuralizations of mind, which are here discussed principally in their social forms, the highest expressions of psychological activity.

Thus it is that individual health and social health are interdependent. The sound body in the wellregulated mind, free and open in its conductivity of the informing energy, is both the proof of such a creative, active force, and its means of expression. Equally will a sound social body be created only out of such a free and unhindered social mind, the collective consciousness, whatever it may be called. The healthy body of the individual and the healthy activity of society depend therefore upon just such a penetrating knowledge of those elements of individual psychology and of its social forms as this book has brought to attention ; and upon such a synthesis of these factors, which reveals their necessary interrelationships, the disharmony resulting when these are interfered with or overlooked and the harmony and progress when they are logically taken into account.

Smith Ely Jelliffe.

Contents

PAGE

Preface v

Introduction by Dr. Smith Ely Jellippe . ix