An essay on the principles of mental hygiene

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Preface

This essay has been prepared with the profound conviction that mind is the most important part of man ; and that the least contribution tending to extend the world's knowledge and appreciation of the relation of mind to nature is of superlative interest to him.

There is a strong conviction in the minds of many in the medical profession, as well as among intelligent lay-people, that there exists an intimate connection — an interdependent relation — between the physical conditions and environments of man and his moral status. The purpose of this essay is to throw some light upon that interesting subject.

The medical profession has been charged with apathy toward this field of physiological inquiry ; and if the charge be just, I am confident that the neglect has arisen not so much from a want of a just appreciation of its importance, as from a disinclination to intrench upon a department of study which the custom of centuries has wrongfully confided exclusively to the profession of theology, and perhaps, also, from a x PREFACE.

modest disinclination to needlessly appear in the unpopular role of a teacher of heretical views. The time is come, it seems to me, when justice to an intelligent conviction requires such scruples to be laid aside. The cause of human progress demands the consecration of the highest professional endeavor in this regard. Truth is a legacy too precious to mankind to be sacrificed in the interest of conventional usages and set formulas. Whatever be the fate of these, truth must abide forever.

If the sense of security which this faith awakens in me has emboldened plainness of speech in reference to religious dogmas, I beg to say that it has been indulged with a deep respect for religious truth and sentiment; and I am more and more convinced with each new thought and observation that man's great want is more religion, — a more substantial growth in the religious graces : faith, hope, charity, honor, honesty, virtue. Mental hygiene comprehends the nurture of these ennobling graces.

In the following pages I have purposely confined myself to general principles, as to write out their application to individual exigencies would swell the bounds to which I had limited myself. The wisdom of this course will be questioned by many practicalminded people; but I have greatly mistaken the mental capacity of the average reader if he, by careful reading of the text and due reflection thereon, be not

PREFACE. x i

able to comprehend the bearing of these principles, and to make such application of them as individual and society's needs require. Development is the grand fact of all nature. It is exhibited in the condensation of the primordial atoms; in chemical affinity and crystallization; in the foliage which drapes the planet; in the flowers and fruits which crown the vegetable kingdom ; no less in the countless phenomena of conscious life, and the sublime unfolding of the human brain and mind. What is most needful to be known in respect to it is, that proper conditions are the antecedents indispensable to its highest realization in any department of nature y or realm of matter or of mind.

If I mistake not, when this fact is duly appreciated it will be a comparatively easy task to ascertain the conditions best suited for each particular unfolding, and to place one's self and one's children in accord therewith. Knowledge — knowledge of ourselves — is the most effectual savior from the evils which afflict mankind.

He who reads the following pages with the attention the importance of the subject demands, cannot fail to remark the number of quotations introduced from the writings of distinguished savants, past and present. To my mind, that is the best feature of my volume. And I cannot bring myself to believe that an apology for the innovation is at all necessary. Had I paraphrased freely, my paragraphs would have xii PREFACE.

looked — only looked — more original. The authors from whom I have quoted, however, write good English as well as good sense; and in bringing their ideas to my support, it seems only just to them that I should use their own superior language, instead of paraphrasing their ideas in the inferior one of my own. Moreover, a vast deal of time and mental labor is saved by pursuing the former course ; a desideratum of itself sufficiently important in this busy world to embolden me to strongly commend the practice to others under like circumstances. Our writings would sometimes appear to be less original in consequence, it is true. But appearances are often deceitful, as ail know. I do not say, however, that they are always so when the -opposite course is pursued. Pas du tout!

Deeply sensible of the shortcomings and imperfections of the volume, but conscious, at the same time, of having done the best I could with the leisure and materials at my command, I submit it to the kind consideration of the profession, and of all others interested in the moral and intellectual progress of man.

D. A. G.

311 Clinton Street,

Brooklyn, N. Y., May, 1873.

THE

PRINCIPLES OF MENTAL HYGIENE.

CHAPTER I. Mental influence of physical agents

The art of preserving the health of the mind comprehends a knowledge of the laws and conditions of sentient beings. These laws and conditions comprise man's relation to the Infinite; and if the study of them has raised hygiene to the rank of a science, the credit must be given to the progress of rational philosophy, the diffusion of which is like the reflection of light in dark places.

The bane of hygiene, like that of religion, has been superstition. Indeed, medical history is, to a great extent, the record of the struggle between rational ideas on the one hand, and blind, unreasoning credulity on the other. In the choice of means and observances for the mental and physical improvement of mankind, the most rational are by no means always the most effective. Faith is still a more ready resource in human affairs than reason ; and the day is not yet past, in the progress of either religion or medicine, when the

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IO crudest form of that element has ceased to be a sanitary as well as a religious virtue.

The change which human opinion is undergoing in this respect is, in the highest degree, interesting. In ancient Greece, among the blind, credulous worshipers at the celebrated temple of ^Esculapius, when a malady was to be cured, or the ravages of a pestilence stayed, the holy serpents kept at the temple were brought out and displayed among the credulous population of the infected districts. The charm seems to have fulfilled its purpose in a measure, for the serpent is still retained as the emblem of the healing art. The Romans invoked the magic aid of Apollo under similar circumstances, and, it is presumed, with similar success. The practice of Christendom is not altogether dissimilar. Even in our day it is customary, among the devout followers of Christ and the advocates of the mystical doctrines of Saint Paul, to appeal to the former for assistance and support in all serious emergencies, as when an epidemic of cholera, diphtheria, or a drought is threatened, or a prince, or some other important personage, is in danger from an infection of typhus ! The philosopher's method, in dealing with these exigencies, comprehends an entirely different conception of the divine order and processes. It comprehends the discovery of the causes of pestilence and other abnormal phenomena, and averts and removes their invasion by a resort to rational means. There is no lack of faith in this method ; but it is a faith of a higher order than that exhibited in priestcraft and jugglery. It is a faith founded on a knowledge that the universe is governed by no arbitrary edicts or transitory laws ; and that the phenomena of

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II nature, including those of man's physical and mental organization, proceed entirely from legitimate antecedents.* These antecedents may not always be readily apprehended nor easily removed ; but, nevertheless, no well-balanced mind, in the full possession of its faculties, could doubt for an instant their existence, nor hope for redress or exemption from their disturbing influence by frantic appeals to the Supreme Being, no more than to the holy serpents, of which the goddess Hygeia is said to have had charge at Epidaurus.

Mental diseases and derangements do not differ in their essential causes from the more obvious corporeal maladies. An unsightly physical deformity represents so much morbid force, spent in the direction of the least harm to the mental character of the individual. A goitre for example may, and I believe often does,

* "All mundane events are the results of the operation of law. Every movement in the sky, or upon the earth, proclaims to us that the universe is under government." — Draper s Intellectual Developme7it of Europe, p. 4.

" To those who have a steady conception of the regularity of events, and have firmly seized the great truth that the actions of men, being guided by their antecedents, are in reality never inconsistent, but, however capricious they may appear, only form part 'of one vast scheme of universal order, of which we, in the present state of knowledge can barely see the outline. . . . Indeed, the progress of inquiry is becoming so rapid and so earnest, that I entertain little doubt that before another century has elapsed the chain of evidence will be complete ; and it will be as rare to find an historian who denies the undeviating regularity of the moral world, as it now is to find a philosopher who denies the regularity of the material world." — Buckle's History of Civilization in England, vol. i. p. 31.

"Whether we examine the course of the planets, or the world of the animalcula, to whatever field of physical nature our researches turn, the uniform invariable result of scientific inquiry is to show that even the most apparently irregular and surprising phenomena are governed by natural antecedents, and are all parts of one connected system." — Lecky's History of European Morals, vol. i. p. 375.

hold in its cells the condensed essence of a mania ; rheumatism may divert a pneumonia; and a tubercular phthisis obviate or subvert an incurable neurosis. This important truth is well known to mental pathologists and physiologists, and yet it is continually misapprehended or disregarded by those whose business and duty it is to appreciate it. Nothing is susceptible of a more easy and complete demonstration than that the mind, no less than the body, is subject to physical laws ; and that corporeal and mental maladies may mutually supplement and counteract each other. Eminent scientists have long been of the opinion that the mental processes, — the correlation of ideas and feelings, moral perceptions, etc., — are phenomenal processes peculiar to the nervous functions.* To that, however, it is quite unnecessary to do more than to allude in this connection. All intelligent people, of every shade of philosophic or theologic belief, are firmly united in the opinion that the brain is the physical organ of the mind, — its seat, residence, and visible source ; and that their connection is quite indissoluble during life.f

* "It must be distinctly laid down," says Maudsley, "that mental action is as surely dependent on the nervous structure as the function of the liver confessedly is on the hepatic structure." — Physiology and Pathology of the Mind, p. 44.

f " If the growth of the cerebral organs be incomplete, the faculties of the mind are equally defective." — Spurzhcim ' s Phrenology, vol. ii. p. 87.

" The possibility of exercising and training the faculties of the mind also shows their dependence on the organization ; for that an immaterial being can be exercised is inconceivable." — Ibid., p. 36.

Dr. John Mason Good, whose learning and moral qualities "The Study of Medicine" sufficiently attests, acquiesces blindly and reverently in the revelations of Scripture for light upon all matters psychical and spiritual, confessing his utter ignorance of their nature and essence. " Of the nature of the mind or soul itself," he says, "we know little beyond what revelation has informed us." But we are also equally in the dark concerning the

Like matter and force, the one may be conceived as existing separable from the other, but it is only in conception after all. In fact, the twain are inseparable and indissoluble by any process short of breaking up and destroying the physical organization, by which the psychical is actuated and made known to us. Physiologically, brain and mind are to be considered one and inseparable.* nature of matter. He says : "Of the essence of matter we know nothing, and altogether as little of many of its more active qualities. . . . But if we know nothing of the essence, and but little of the qualities of matter, of that common substrate which is diffused around us in every direction, and constitutes the whole of the visible world, what can we know of that which is immaterial?" — Study of Medicine, vol. ii. pp. 161-2.

At the time our author wrote the whole scientific world was divided into materialists and immaterialists. Since the brilliant discoveries of the later physiologists, and more notably those of the spectroscope, materialistic problems have measurably ceased to disturb the moral equilibrium of any class of thinkers ; matter being sufficiently wonderful in its strange metamorphoses to enlist the earnest attention of the most enlightened and spiritually minded.

* "Consciousness gives no account of the essential material conditions which underlie every mental manifestation and determine the character of it : let the function of an individual's optic ganglia be abolished by disease or otherwise, and he would not be conscious that he was blind until experience had convinced him of it. On grounds which will not easily be shaken it is now indeed admitted, that with every display of mental activity there is a correlative change or waste of nervous element ; and on the condition of the material substratum must depend the degree and character of the manifested energy or the mental phenomenon." — Mauds ley s Physiology and Pathology of the Mind, p. 13.

" Magendie, the celebrated French physiologist of the last century, also held that the phenomena of life and mentality were the sequence of vital and nervous functions. Concerning the genesis of mind and intelligence, he says : ' L'intelligence de l'homme se compose de phenomenes tellement differens de tout ce que presente d'ailleurs la nature, qu'on les rapporte a un etre particulier qu'on regarde comme une emanation de ia Divinite.' And while the physiologist cannot doubt the existence of a Supreme Being, it is well, he thinks, to use guarded language in expressing his relations to him, since that is a subject of which he knows so little. Then he con-

"In dead matter," says Maudsley,* "the form is looked upon as the attribute of the matter ; whereas, on the other hand, in living bodies, the matter is treated as the attribute of the form. In inorganic nature the matter is the essential thing ; in the organic creation the form is all in all. But to neglect the exact consideration of the conditions and combinations of matter, as determining organic form, is not less mischievous than it is to concentrate all the attention upon the matter in inorganic nature. What are inseparably joined together in nature let us not vainly attempt to put asunder."

" This doctrine of the brain," says Lewes,f " is understood in two different ways by two contending schools. The one regards the brain as the original agent ; the other regards it as the intermediate instrument. According to the one, the brain thinks as the stomach digests ; according to the other, the brain is the instrument of thought, played upon by the mind as a piano is played upon by a musician. These two schools, however opposed, meet on neutral ground when they come to the laws of physiology. ... A piano out of tune will yield discordant music, let the performer be ever so skillful. A penny-whistle can never have the clang of a trumpet. It is obvious,

* Physiology and Pathology of the Mind, p. 75.

f Physiology of Common Life, vol. ii. p. 13.

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therefore, that on the structure and state of the instrument will depend the quality of the sounds produced." It is curious to observe that the materialistic physiologists and the metaphysical physiologists diverge just at this point. The subject is a legacy bequeathed to medicine by a dead and decaying theology.* The discussion which it has awakened in the profession of medicine resembles the wrangles of the monks of the Middle Ages over such questions as the attributes of Deity, the heat of hell, and the size of the human soul, etc. The result of the discussion has been quite as idle and profitless. It is now generally conceded that matter and force are each inexplicable, and that, in the last analysis, as much is known of one as of the other. To the physiologist it is surely enough to know, what is no longer disputed, and all that can be known, namely, the mutual dependence of matter and force, of brain and mind ; and that the principles which preside over the well-being of one are equally operative upon the destiny of the other. " That which perceives," says Dr. Thomas Brown,f " is a part of nature as truly as the objects of perception which act on it, and, as a part of nature, is itself an object of investigation purely physical." And Dr. Haven admits

* "The habit of viewing mind as an intangible entity, or incorporeal essence, which science inherited from theology, prevented men from subjecting its phenomena to the same method of investigation as other natural phenomena." — Maudsley s Gulstonian Lectures on Body and Mind, p. 12.

f Philosophy of the Human Mind. This comprehensive idea of nature is the revival of a very old doctrine. The earliest Greek conception of nature included the objective world, simply — earth, fire, water, and an active principle, or force — air. " Afterward," says Maine, " the later Greek sects, returning to a path from which the greatest intellects of Greece had meanwhile strayed, added the moral to the physical world in the conception of nature. They extended the term till it embraced not merely the visible l6 MENTAL INFLUENCE

substantially the same doctrine. " The human mind," says he, " is strictly a part, and a most important part, of nature, unless we exclude man himself from the world to which he belongs, and of which he is lord."* It may be still further observed, in passing, that from the habit of ignoring mental hygiene, by both classes of physiologists, or of giving the subject but an insignificant treatment in the study of the laws of health, and leaving to theology what it is the clear province of medicine to accomplish, has arisen the custom, by no means extinct, of observing and studying mental disorders from the purely metaphysical or subjective point of view. It has been usually assumed, by the dominant school, and tacitly admitted by the other, that mind, in the abstract, is a spiritual entity, or an " incorporeal essence," separable from the body, as force is conceived by many to be separable from matter, and independent of the recognized laws of vitality. Little attempt has been made, until modern times, to analyze its nature from a physiological stand-point, or to reduce its phenomena to a strictly scientific basis of objective observation. The physical side of mentality has been, for the most part, if not wholly, confined to a description of the brain and nervous system, and the part they play in the corporeal system ; the

creation, but the thoughts, observances, and aspirations of mankind." — Ancient Law, p. 51.

Nature comprehends all things within the ken of human reason and observation. "Not the smallest atom," says Maudsley, "that floats in the sunbeam, nor the minutest molecule that vibrates within the microcosm of an organic cell, but is bound as a part of the mysterious whole in an inextricable harmony with the laws by which planets move in their appointed orbits, or with the laws which govern the marvelous creations of godlike genius." — Maudsley' s Physiology and Pathology of the A find, p. 26.

* Mental Science, p. 16.

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influence of light, sleep, rest, exercise, and recreation on its functions : nothing more. Books of hygiene may be consulted in vain for definite information respecting the precise influence of morbific causes and agents on the mind, or of rational means of restoring and preserving the health of a mind disordered by them, especially if the phenomena presented be removed from the ordinary plane of physical observation. Surely, if mind be the most important part of man, as Sir William Hamilton and the philosophers of his type were pleased to believe, this is a grave neglect. A system of hygiene, or of moral philosophy, which does not recognize the superior excellence of man's nervous organization ; which appreciates not the grand distinction and superiority of his mentality over that of other animals ; which, in short, fails to recognize his grand spirituality, and to perceive the wide chasm which separates him from all other orders of beings in nature, must obviously be defective. The works on physiology and hygiene, of which there are many admirable in their way, apply almost equally well to man as an animal, or to an animal as man. The higher functions of the nervous system, comprehending the religious element, and the influence of physical causes upon its manifestations, are but slightly and incidentally touched upon. Studies in mental hygiene and therapeutics should remedy this obvious deficiency; and a few writers have lately been bold enough to risk the charge of heresy in opening the discussion.* Among the most

* If mind be a part of nature, and held in subjection to her laws, it is natural to conclude, what indeed is fully demonstrated by the facts of prominent works which have taken advanced views on the subject is Mr. Graham's "Science of Human Life," an able book, but little read, owing to the unpopularity of its author's well-known views of dietetics. " The Constitution of Man," by George Combe, tends in the same direction. " The Principles of Physiology," by Dr. Andrew Combe, is also an exception, in this respect, to the usual works on hygiene ; and Dr. Ray's " Mental Hygiene" is an admirable monograph, fulfilling, in many respects, the just remental physiology and pathology, viz., that there is an intimate connection between morbific causes and mental disease; between, in other words, sin and sickness, immorality and morbid anatomy. Those who read attentively the records of criminal trials cannot fail to have been impressed with the frequency with which disease and crime are associated together in the same person. So constant is this phenomenon in our law-courts, that the defense have no difficulty in getting well-informed experts to testify in support of the plea of insanity on the part of the culprit. The fact is urged by the unthinking public as an evidence of the unreliability of medical evidence in such cases. It should rather be regarded as evidence of the intimate connection subsisting between crime and disease, for which doctors and criminal counsel are, in most cases, assuredly not responsible.

These facts, in connection with the psychical influence of morbific and drug agents, point unmistakably to the ultimate establishment of a science of moral therapeutics and pathology. Mr. Lecky, the able author of the " History of European Morals," has already anticipated such a result. He says : —

" He who raises moral pathology to a science, expanding, systematizing, and applying many fragmentary observations that have already been made, will probably take a high place among the master intellects of mankind. The fastings and broodings of the mediaeval monk, the medicines for allaying or stimulating the sexual passions, the treatment of nervous diseases, the moral influences of insanity and castration, the researches of phrenology, the moral changes that accompany the successive stages of physical development, the instances of diseases which have altered, sometimes permanently, the whole complexion of the character, and have acted through the character upon all the intellectual judgments, are examples of the kind of facts with which such a science would deal." — History of European Morals, vol. i. p. 167.

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quirements of the subject. In conjunction with Maudsley's* and Winslow'sf able contributions to mental physiology, the subject of mental hygiene becomes tolerably comprehensible to those at least whose minds are free from the unhappy bias of theological tradition, and the fallacious doctrines of the earlier physiologists.

It should be borne in mind that man is a physiological unit. Divide his organization into as many parts as we may, his individuality comprehends them all ; and the loss of the most inconsequential part destroys his identity. In him the animal and the human harmoniously blend. The higher attributes of a human being, the cerebrum, may be destroyed, and yet the animal part of his organization preserve its vital integrity. This fact is illustrated in idiocy and imbecility. Moreover, M. Flourens and others have actual!^ removed the cerebra of birds and other animals without impairing the functions of the lower animal life. The animal part of man is thus observed to be, in a measure, independent of the human, and may maintain a separate existence. The characteristically human part of his organization, however, is not thus independent of the animal organs, but is united to them by an inseparable bond. The cerebrum is the flower of organic creation, — its supreme coronation. Its vital integrity is maintained by the corporeal system. The radicle may live and flourish independent of the flower; but if the flower be disconnected from the radicle, it speedily withers and dies. So is it with the

* Physiology and Pathology of the Mind, f Obscure Diseases of the Mind.

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human mind : its health and integrity are inseparable from a sound body ; and it may be seriously questioned if mind in any form or condition is ever separable in terrestrial life from the material casement of the nervous system. Mental hygiene necessarily comprehends the laws and conditions of man's whole being, physical and mental, one and inseparable. In respect to the corporeal or animal life, let us premise that its laws and conditions are well known and appreciated, and proceed to the consideration of those of the more complex and characteristically mental and human.

The brain and nervous system may, in one respect, be compared to the sensitive plate in the camera, registering faithfully all the various and conflicting impressions received from without ; but, unlike the camera, receiving and registering likewise all those from within.* The brain is the centre of the individual universe. Through the reflex action of the nerves, and vascular circulation, the various diseased states of the body are duly, it may be said unceasingly, recorded upon it, modifying its function, and interrupting, more or less seriously, the orderly flow and sequence of ideas. Thus it is impossible for a disease, however slight or inconsequential, to exist in the most

* Dr. Combe, whose able work on physiology and hygiene I have before alluded to, after admitting the existence in the brain of a distinct mental essence, — mind in the abstract, — declares : " It requires, however, to be distinctly understood that activity of mind and activity of brain are not only inseparable, but that so long as life remains the mental operations are distinctly influenced by the condition of the brain." And again : " The brain being a part of the animal system and subject to the same general laws as the other organs, the reader will not be surprised that I should, as in the case of the lungs, state a sound original constitution as the first condition of its healthy activity." — The Principles of Physiology, p. 216.

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remote extremity of the body without making itself morbidly manifest in the brain. The mental effect of a mechanical injury, as a cut or a bruise, with a knife or other instrument ; the shock coincident with a blow or a fall, the dislocation of a joint, or the fracture of a limb; or a slight loss of blood or other humors of the body, — are frequently similar to those produced on the mind by excessive fear, intense anxiety or grief, or other powerful emotions. The sight of blood causes fainting in some persons ; and I have known strong men to sink into complete coma by an unimportant cut of a finger, or from the pain of an old tooth, or the suffering attending its extraction, and even by the sympathy with the trifling pangs incident to that operation in others. Indeed, the mutual sympathy and reciprocity between mind and body are so intimate and strong, that it is impossible to conceive of the affection of one without the other being morbidly disturbed by that affection. " Experience, our only sure guide in medical inquiries," says Forbes Winslow,* " instructs the physician that a diseased condition of the body produces an alteration in the condition of the mind ; and that certain emotions of the soul, whether of a pleasurable or painful nature, are universally attended with reciprocal alterations in the bodily functions."! Every thought, no less every muscular act,