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£0 k 50 1 60 7 69

lH E P RIN C IP L E S
OF

M E NTAL HY GIE N E

BY
sp r /
h
"
W ILL IAM A W HITE M , . D .

W IT H AN I NTRODUCTION BY
S M ITH E LY J E LL IFF E , M D . Pu D
. .

gar b
New
T HE M A C M IL L A N C O M P A N Y
1 91 7
 P RE F ACE
For many years a s m allgr oup of p hilan t hr Op i c

al ly minde d p er s on s have been fi ghting the b attles

of the failures in li f e and trying to s ecure for them
an adequate understanding which should b e the
b asis f or creating a new a more enlightened and a
, ,

constructive and hel p ful p rogram for dealing with

them D es p ite the length o f time thi s movement in
.

its various ramifications has been in existence and ,

the numb er of people who have b een engaged

in it and too the high typ e of many s o engaged
, , , ,

there never has issued from its s p ons ors anything

that could p roperly be called a comprehensive p ro
gram an adequate statement of princi p les s ci en
,

t ifica ll
y f ounded and practically workab le The .

reas on for this seems to me clear These p ersons .

ha d no such p rogram they had no such princi

,

p les their moving f orce wa s faith

, .

M any p erhap s all great movements are thus

, , ,

shadowed forth in their origins b y the faith that is in

those who believe in them I t i s thes e p ioneers t o
.

whom all honour is due who have had the courage

,

to s p eak f or what they believed was right for what ,

they had faith in in the face of o pp osition and

,

ridicule an d even though when asked to state their

ca se they foun d themselves quite inca p able of put
vi P RE F A C E

t ing into words what they felt They have stood

m
.

fir , however until p rinci p les could b e formulate d

,

and p rograms proj ected When that day arrived .

the b attle was perha p s al ready won .

The battle for mental hygi ene has a l ready been

won The far seeing faith of its progenitors felt
.

and kn ew that a way could always be found to solve

any p ro blem that needed to b e s olved if only there ,

wa s the patience to keep on the determination to ,

succeed M ental hygiene has come to stay there is

.
,

not the shadow of a dou b t a b out that but its p rin ,

c ip l es remain to be formul ated b ecause its activities

have been scattered over s o many fi elds which wh il e ,

not really still are p ractically disconnected There

, , .

have been the pro b lems of the care of the insane ,

p rison reform pau p erism a l coho l

, ism feeble mind
, ,
-

edn e s s,
juvenil e delinquency atypica l children , ,

vagrancy p rostitution vocational education the

, , ,

neuroses and psychoneuroses drug addiction s ocial , ,

hygiene ( venereal p ro p hyl axis ) patent medicin es ,

and faith cures and many others a ll of which have

, ,

been recogniz ed by some a s being p roblems that

woul d have to be attacked more or l es s exclusively
by methods founded in the p rinci pl es of a hygiene
o f mind .

The various di rections in which thes e p ro blems

have arisen ha s tended to a somewhat mutual ex
cl u s iv en es s s o that each group w a s interested only

in s ome p articu l ar a spect of the l arger p roblem .

The whol e fiel d has therefore not as yet been com

, ,

p r e h e n s iv ely su r veyed To do t hi.s in an at a l

l ade
 P RE F A CE vii
quate manner would b e a large underta in g p er k ,

ha p s too large to b e dealt with in a s ingle volume .

It will be my o b ject in this book to sketch the out

line stressing the larger prob l ems and comp leting
, ,

the statement by a brie f er fil ling in of details Such .

matters a s the p rinci p les involved in the conce p ts

of the great defective delinquent and de p endent
, ,

grou p s the signifi cance of the insane the criminal

, , ,

and the fee b le minded clas ses of the princi p les of

-

s ociety s relation to them will receive the l arger

’

amount of attention while such questions a s divorce

, ,

the woman movement etc , will come in for small

m
,
.

mention not because they are of les s i p ortance for

,

p erha p s they are not but b ecause it wou l d seem that

,

the great guiding p rinci p les can b e seen p lainer in

these other pro b lems f or there we can s ee the s p rings
o f human conduct laid bare l es s overlaid with the ,

disguises of a conventiona l society These questions .

'

will be discuss ed however not with the p ur p os e of

, ,

attemp tin g to solve them but b ecause they are p res

ent day examples of bad mental hygiene that is
-

, ,

they show in action those factors at work which i n

t er f er e most s eriously with an e ffi cient handling of a
situation— such as prejudice hate etc and s o come , , .
,

within the realm of mental hygiene indirectly a l ,

though their p rob lems as such might hardly b e con

, ,

ceiv e d to belong there .

In accordance with this program the book wil l

naturally fall into two p arts Th e fi rst p art com .
,

p rising the I ntroduction and Cha p ter I will b e ,

theoretical a laying down of fundamental scientific

, ,
v iii PRE F A C E

princi pl es an d can well be omitted by the p r ac

,

tical worker whose interests are not p rimarily s cien

t ifi c or p h il os o p hica l
. The second part wi ll take up
the l arger issues such as the insane the criminal
, , ,

etc and progres s t o the l es s well defined and less

.
,

distinctly pathological prob l ems The summary

.

will attem p t to brin g all the i ssues theoretical and

,

p ractical together and wil l thus require a knowledge

of b oth parts of the book .
 I NT R ODUCTI ON

To have accomp lishe d the task of a practical un

de r s t a n din g of the changes which accomp any the d is
orders of the b odily organs may b e said to have
b een the crowning achievement of the medicine of
the nineteenth century It is now only a question
.

of time when such kn owl edge shall b e put into efi ec

tive relationship with soci a l activities and much of

m
what we have hitherto been ter i ng di sease wil l
gradually cease to have the power of compellin g
fear and dread For disease will no l onger b e
.

looked u p on as a single manifestation or a grou p

,

of such manifestations ,
to b e attacked as separate
entities with a futile lack of understanding of causes
,

and of thes e same relationshi p s The whole efi ect

.

of disease u p on the s ocial b ody and its origins as

,

ex p ressions of an interrelationship with this will ,

be considered an indis p ensab le feature of its under

standing and efi ectiv e handlin g .

I t is a fundamenta l p osition t aken in this book ,

an d one which will undoub tedly come to be univer

sally held b efore a fin al conquest of di sease will have
m
b een accomp lished that diseas e after all is ala da p
,

t a t i on of function of the entire b ody in al l of its r e

la t i on s and that no hard and fast li ne separates the
,

f unctions of any organ of the body into physica l and

mental nor limits the diseas e concept to exclude mal
,
ix
 I N T R O DUC T IO N
ada p tation in the s ocial any more than in the indi
vidua l functioning of the entire organism Th e .

term physical still l ingers in our mental fa b ric how ,

ever an d threatens by a too great conservatism of

,

ha b it to obstruct the l arger p oint of view which this

valuab l e work s eeks to point out .

M ens s a n a i n c or p or a s a n o a healthy mind in a

,
-

—
heal thy b ody has been the watchword of past civi
liz a ti on s. It is t ime to modify this a nd to recogniz e
that thi s is but one half of a truth which in order to
-

b e rea li z ed needs to be stated i n a l arger form which

emb ra ces this C or p us s a n umi n m
. e n t e s a na —a ,

healthy bod y can only exist as i ts behaviour is in flu

en c ed and contro l led b y a hea l thy m
ind For it is .

becomin g more and more evident that what we ca ll

mind is an organiz ed p rinciple in evolution with a
structure just a s rea l as any organ of the body not ,

a di stinct static thing of materia l form and dim on

sions but a no l ess distinctive working entity a
, ,

p roduct of evolutionary growth and a grou p ing of

functiona l activities the chi ef distinguis hing feature
,

between mind structure and organ structure b eing

the greater plasticity of the functiona l capacity of
the former for the util iz ation of the stores of energy
which surround us and force us into action .

One might say that when l iving matter in higher

anima l s ha d more or les s comp letel y s olved the
pro b lem of how to uti l iz e the energy of the chemical
substa nce s whi ch we roughly symboliz e a s sugars ,

for examp l e then thi s function more or l es s com

, ,

p le t e l
y l earn ed be, c ame structura l
iz ed into what we
 I N T R O DUC T IO N xi

call let us say the liver L iver structure become s

, , .

thus more or less fi nished this metab olism of sugar ,

has b een learned f or the most p art the work of

,

energy trans f ormation goes on automatica l ly only ,

hin d ered when other organs functioning imper ,

f ec tly refuse as it were to l et it perform its own

, , ,

task unmolested .

N ow the mind structura l izations are still o p en ,

stil l formulating for social ada p tations have not

,

been s o comp letely in di vidualized as chemical

a d a p tations M any have b een structuralized for
.

the time being in wis e p rece p ts G olden R ules , ,

in the Talmud R ig Veda laws of the Twelve

, ,

Ta b les or the whole grou p of gradually shi f t

ing codes contained in the Bi b le Such literary .

crystallizations which represent great p lanes in the

,

develo p ment of thought and language as thos e of ,

Shakespeare or G oethe constitute likewis e the ,

slowly de p osited an d slowly changi ng forms and

grades of this same structuralizing p rocess as do ,

also international agreements world customs etc , ,

.
,

etc But s o long as time is continually p rogressing

.
,

new possi b ilities f or b etter and b etter ada p tations

are left o p en which b y reason of the p lasticity of the
,

mental structures are continually ta k ing p lace

,
.

T hus ever higher attri b utes of social evolution are

p ossib le and since it is so it is incumb ent u p on ,

human s ociety to discover an d attain to them Th e .

realization of them a ccor d ing to the p rogressing

,

measure of social ca p acity means health Failure ,

.

to attain or di sorder in the s ocia l system which in

,
x ii I N T R O DUC TIO N
t e r f er with such progres sive functioning ex
es ,

p res ses th e various inadequacies and disa b ilities of

s ociety its l ack of perfect health and healthy a c t iv
,

ity These are the various phenomena which are s o

.

ably discus sed in thi s treatise Whether p hysicians .

term them di s eas es of the spirit or of the s oul or of , ,

the mind in its collective function i s immaterial ,

.

Th e import ant fact to recogni ze is that of their ori

gins for only b y an understanding of how such
,

things come to pass ca n they be alleviated and thus

human ha pp in es s made more p ossib le .

Thi s work will materially further such a compre

h en s i on of the various grades of certain types of
failure and their underlying caus es and thus p rove a ,

c onstructive a gency for their dimi nution or remova l .

Thus we sha ll arrive at a true ideal formulation of a

healthy society which means also in the individual
,

s ociety relations hi p u p on which thi s discussion is

,

bas ed a h ealthy in dividual and therefore a healthy

,

body In such an ideal society it will b e seen for

.
,

instance that such a physical disease as typ hoid

,

fever cann ot exist for it must in reality b e c on s id

,

ered a diseas e due t o an im p erfect society The p er .

sistence of ty p hoid fever in a community is a sym b ol ,

not a l one of the ignoran ce of that s ociety but a sign ,

of the inertnes s of the cupidity and sel f seeking of

,
-

the maj ority who consider their indivi dual comforts

,

and personal satisfactions ahead of those of their

fe llow men They refuse b y their maintenance of
.
,

corru p t inadequate p olitical machin ery of well

,

acknowl edged incom p etency to p ut to work the ,

 I N T R O DUC TIO N xi ii
m
proper agenci es to eli inate t yp hoid fever from the
ma p T his is merely anot her way of sayin g that the
.

individual in the l arge in hi s social relationship is

, ,

sti ll s p i r i tually il
l His menta l vi sion cann ot yet
.

t ake in the larger whole whi ch were he able or will

,

ing to s ee woul d keep hi s body we ll because his

, ,

s ocial menta l function that is hi s s oul would have

, , ,

grown up and formed a structu r a ll y e ff ective mental

hygiene Since moreover the practica l purposes of
.

a cul tura l civi l iz ation bui l t to expres s and fulfil

,

man s greater needs have indis sol ub ly bound indi

’
,

vidua l and the society environment to which he b e

m
, ,

be l ongs this li itation of a l arger vision which

,

means the in dividua l il lnes s makes s ociety also ill

m
and i perfect and deficient in its functioning Thus .

whil e ignoran ce timidity incompetency denote the

, ,

illness of the individual memb ers of s ociety it is ,

equal ly true that an in efi ectual incomplete i n a de

m
, ,

quate attitude towards social skeletons is s y p t o

matic of the i llnes s of society .

The new century of medicine may wel l b e char

a ct er i z ed as that of discovery and investigation of

c auses and interre l ations hi ps The keen analysis

.

which searches out in dividual causations and p rob es

t o the uttermost each separate phenomenon of form
o r function, must be fol l owed by a comprehensive

synthesis in whi ch in terdependence of form and

,

mutua l modification of function are sought to be un

d er s t ood both in their causes and in their e ff ects for
individua l and s ociety B oth analysis and syn
.

thesis in thi s their pragmatic signifi ca nce are gen

, ,
xi v I N T R O DUC T IO N

e t i ca l
lconsidered since cause and e ff ect are to be
y ,

understood a s evi d ences of the energy whi ch infuses

life a s it is transmuted and trans p os ed to create and
,

to activate the lesser structuralizations of material

organs an d forms or more progressively stil
,
l the ,

higher structuralizations of mind which are here ,

discussed principally in their s ocia l forms the high ,

est expressions of psychologica l activ ity .

Thus it is that individua l health and social heal th

are interde p endent The sound body in the well
.

regulated mind free and open in its conductivity of

,

the informing energy i s b oth the proof of such a

,

creative active force and its means of ex p ression

, , .

E qually wil l a s ound s ocia l body be created only out

of such a free and unh indered social mind the col ,

l ectivo consciousnes s whatever it may b e called

, .

The hea l thy b ody of the individua l and the healthy

activity of society depend therefore u p on just such
a penetratin g kn owl edge of those e l ements of indi
vidua l psychology and of its s ocial forms as this
book has brought to attention ; and upon such a s yn
thesis of these factors whi ch reveal s their neces sary
,

interre l ationships the disha rmony resulting when

,

these are interfered with or overlooked and the

ha r mony and p rogres s when they are l ogically taken
into account .

S M I T H E L Y J EL LIF FE .
 CON T E N T S

I N TRODU C TION BY DR . S M I TH E L Y J ELLIF FE

C H A P TE R

I I N TRODU CT ION

II UNDE RLY I N G C ONC EPT S

ME N T AL ME C H A N IS M S
Th u co scious 3 4 ; Th i sti ct for t h f mi l i r
e n n , e n n e a a

—th s f ty motiv 3 8 ; Th p th of o pposite s

e a e e, e a

l ov e d h t
an 4 4 ; Proj ctio —t h
a e, ti p thic m e n e an a e o

tio s 4 6 ; A ta go ism—i d t i fi t i 5 1 ; Co versio

n , n n en ca on , n n,

5 3 ; O th r d f c m ch
e isms 5 6
e en e e an , .

TH E I N SA NE
Th wor d i se 6 0 ; H istoric a l 6 6 ; Th e i dea l of
n an e, ,

k ow l dg 76 ; The co fl ict 84 ; Th hosp it l 8 9; Th e

n e e, n e a

ci s 92 ; The m an s 94 ; Th e m ethod s 1 01 ; sum

, ,

ag en e ,
e , ,

m a ry 1 1 6 , .

TH E C RIM I N AL
Th co c p t cri mi a l 1 1 8 ; Th
e n e a tur of crimi l
n , e n e na

co d uct 1 2 0; Th r su l ts 1 2 9; Th cri min l a sca p

n , e e , e a s e

go t 1 3 1 ; Th r m d y 1 3 6 ; S umm ry 1 56
a , e e e ,
a , .

TH E F EEB LE M I NDED -

The con c e p t f eebl e mi n d edn ess 1 6 6 ; Th e eugen i c

-

so l utio 1 70; Th m n a ce of f ebl e mi n dedn ess 1 8 0

n ,
e e e -

Wh a t is to be don e a bout it ? 1 85 .
 C ON TE N T S

V II MIS CEIL AN EOUS G RO UPS

The pa u p er 1 92 ; Th p ros titu te 1 95 ; The i n b ria te
e e

2 01 ; Th e ep i l p tic 2 06 ; The homosexua l 2 08 ; The

, , ,

vagr t 2 1 1 ; Th hom l es s un em p l oyed 2 1 2

, ,

an , e e , .

MI SCELLANEOUS PRO BLEMS

a en
“
P t t m edi ci es cur es 2 1 5 ; Fa ti gue 2 2 5 ;
n -
, ,

Divorce 23 1 ; Th woma n movem en t 2 3 7; Fr

e ee

speech 239; Ill egi tim ac y 2 43 ; S oci a l hygi en 24 5 ;

, ,

, ,
e,

D ge rous occu pa tio s 24 7; Voc tio l p sycho l ogy

an n ,
a na ,

2 4 9; F a d s 25 0; Wea l th 2 3 ; I dlen es s 255 ; O ld age

5

—
, , ,

d th 2 58
ea , .

I" TH E NEURO SE S—P SY CH OAN ALYSIS

Ch a r a ct r an oma l i s 2 6 7 ; Ch a r a ct e r tra its 2 70;
e e , ,

S oci l i za tio of i sti cts 2 73 ; A imi sm 2 8 3 ; Th

a n n n n e

org ic bas is of m la d jus tm

, ,

an en t 28 4 ; Psych oa na l ys is
a , .

2 88 .

" S UMMA R Y
 T H E PRIN C IP LE S OF M E NTA L
H Y G IE N E

CHA P TE R I

IN TR ODUCTI ON

Hygeia the goddess of health was very ap p ropri

, ,

ately the daughter of £Es cula p iu s the god of medi ,

cine I t i s fi tting b oth that she shoul d have come

.
,

a f ter and that she should have been related to the

,

god of medicine Hygiene b y carrying forward the

.
,

p rin ci p les learned in comb atting disease comes t o ,

emb ody the i d eal of medical p ractice and its latest

development preventive medicine If preventive
, .

me di c ine had a goddes s it would pro b ab ly b e r e

corded that she was the daughter of Hygeia and
m
that she wa s born a b out the i ddle of the nineteenth
century .

The earl iest manifestations of what grew to b e

,

come p reventive medicine were along the sim p ler

,

develo p ments of sanitation They came into b eing

.

in the cities p roba b ly largely as a result of the con

gestion of the p o p ulation in thes e centres due to the
growt h of the factory a s an i ndustrial institution .

The crowding of large numb ers of p oor la b ourers

together in the b ig cities under unsanitary condi
2 ME N T AL H YG I ENE

tions employment of hous ing and of liv ing gen

of , ,

er a ll y came to be a pp reciated a s a menace to the

health of the city Out of such si t uations grew the .

general p rinciples of sanitation directed to the r e

moval of o b vious fil th p rinci pl es of sewage disposal , ,

water su p ply etc This deve l opment dea l t only

, .

with the most obvious defects its vision was very ,

narrow com p rising only the immediate interests

,

without any vi sion for the future or the wider p os si

b ilit i e s and requiring little more than police author
,

ity and n ot expert knowledge and experience , t o

,

carry out 1
.

From thes e s imp l e beginnings deve l opment p r o

ceed e d ra p idly along lines not on l y calculated to ,

remove the most s erious i mmediate dangers to l ife

and health but going along hand in hand with social
, ,

reform movements tended to a genera l im p rove ,

ment of the envi ronment such as well paved streets ,

-

th e creation of the great p u blic utilities and in gen ,

era l fosterin g those deve l o p ments that made life de

ci dedl y more worth l i v ing .

The most de finite advances along the combined

lin es of social reform and p u b lic sanitation grew up
in conn ection with the great industria l renais san ce
incident to the supplementing and replacing of the
methods of the old han di crafts b y the use of ma
chinery and the congregation of labour in l arge co m
m un iti es by the deve l o p ment of the factory system .

1 For short histo rica l su mma ry of t he growth of sa n ita tion

a e tc

Th Ta sk of S oci a l H ygi e
, .
,

s ee H v l ock E ll is
a e
“ :
”
eH oughto n ne . M ii
fl in Co .
, 1 91 5 .
4 ME NT A L HY G I EN E

v ided means fo r recreation schoo l s library de

, , ,

vised specia l p urchasing methods to the advantage

of the workman undertook the elimination of drunk
,

e nn e s s and reduced the hours of l a b our from thir

teen and fourteen or even s ixteen in some instances

, ,

to ten .

From these earl y beginn ings the movement has

continu ed which ha s a s its obj ect to surround the
worker with better con di tions both in his work and
i n hi s l iving which is based fi rst u p on a fee l
,
ing of
duty and thus has come to b e understood a s desir
,

able and which ha s fin ally b een demanded by the

m
worker hi self a s a right .

L egislation and p ractice have developed from the

crude b eginnings based on a desire to b e rid of
o b viously unsanitary and disorderly conditions b e ,

caus e of their manif est dangers to the provision of

,

who l esome workin g and living conditions incl ud

m
,

ing reas ona b le hours of work and adequate c o p en

sation to still further and more extensive provi sion
,

for the we lfare of the worker by givin g o p portuni

ties to acquire an industria l education which wil l fit
hi m for th e better skilled pos itions The future is .

still fu rther provided for b y vocational training in

the public schools by workmen s lia b il ity and i n
,
’

surance acts and old age pensions In another

, .

d irection simi l ar ends are sought by providing ade

quate re l ief from work w ith full pay of women just
, ,

b efore and after confi nement and legis l ation con

troll ing their hours of duty and li miting p rohi b it ,

in g or prescribing the conditions of chi l d labour

, .
 I N T R O DUC TIO N 5

Al ong w ith all of these developments have grown

up a b o d y of laws whi ch have invaded more and
m ore the region that used to b e thought of as b e
longing a b s olutely to the individual and whi ch have
,

s ought to regulate his conduct in di vers ways su p

o s edl calculated for hi s own welfare and for the

p y
we lfare of the grou p F or example : He must see
.

that hi s children go t o school for a certain minimum

period : he must p ay taxes for the support of pub
li c schools even though he send his ow n children
,

to private ones : he i s prohi b ited from using a l

c oh ol i c l iquors except under cert ain prescri b ed con
di ti on s or he may in fact be p rohibited from using
,

them a l together : if he wishes to buil d a house or a

factory there are the buil ding regul ations to b e co m
p lied with : if it is a factory that he has buil t and
m
is o p eratin g then he may not per i t dense black
smoke to issue from its stacks b eyond certain li i tsm
of time and frequency : if he is an em p loyer he must

make certain prescri b ed sanitary and hygieni c pro

m
visions f or hi s e p loy é s whil e under certain condi
,

tions he is held responsible if they acquire disease

or are injured while workin g for hi m In these and
.
,

in many other ways the State reaches into the

,

p rivate a fl a i r s of its citiz ens and s eeks to regulate

them f or the common good .

The more de fini tely p u blic heal th deve l opments

have been of like character D isease ha s been
.

sought out with ever increasing accuracy and suc

ces s a large number are re p orta b le under p ena l ty
, ,

quarantine regulations have been p erfected and

6 ME N TA L HY G I ENE

made enforceab l e by police authori ty, whil e such

preventive mea sures a s vaccin ation are made com
p u ls o r y and many others are pro v ided o f ten for the ,

asking The welfare of the individual and the com

.

muni ty have both received consideration whil e in ,

such mea sures a s the s anita ry rehabil i tation of a

m
communi ty following an e p ide ic such a s typ hoid , ,

we s ee some of the best of pu b lic health e ff orts cal

c ul a t ed to a fi o r d p rotection not only now b ut to
,

ca rry the protection forward indefin itely .

Such are some of the activities directed first to

a ff ording protection from an o b vious a present and ,

an acute da n ger and deve l o p ing finally into meas

ures the e ff ects of wh ich will only accru e in succeed
,

ing generations but whi ch are calcul ated to make

,

for better health greater e fficiency and greater

, ,

safety from diseas e and injury In other words .

,

they are methods which are directed almost ex ,

cl us iv el y to improving l iving conditions that is the

, , ,

envi ronment
m
.

That improvements in l iving that greater co ,

forts more hap p ines s could be attained s olely by an

,

a p proach to the pro blems from w i thou t has always

seemed the natura l way of l ooking at the situation .

That the p rob l em should be a pp roached from

w i thin ha s never s eemed to cha ll enge the attention ,

of cours e wi th certa in notab l e most l y individua l ex

,

ce p t i on s .

The reason for thi s fai l ure to l ook Within is rather

difii cult to as si gn It seems quite evi dent that if
.

sa tisfactory li ving i s an ex p ression of the relation

 I N T R O DUC T IO N 7

individua l environment then not only the envir on

-

ment but the individual must b e looked to for r e

s ul ts. True the individual has been looked to but
,

only a s constituting part of the environment A .

p ers on sick with a contagious diseas e i s so much

dangerous environment so far as the rest of the .

community is concerned Only in this way as en

m
.
,

v i r on en t h a s the individua l been at a ll adequate l y

,

dealt with .

To approach the probl em from wi thin means

something very different from thi s Thi s is es sen .

t ia lly a matter of mind of p sychology and means

, ,

that the indi vidua l must regard himself in the r e

lation in di v dua lenvironment and seek to deter
-

mine what are the elements of that relation which

are under his control what he is giving to the situa
,

tion how he can change hi mse lf s o a s to change the

,

relation to his advantage .

That this movement to deve l op a menta l hygiene

has arisen onl y after all other kinds of hygiene have
been advanced t o a pretty high grade of e ffi ciency is
due to many causes In the fi rst place it is perha p s
.

to no small extent the usua l result of the tendency

to overl ook the obvious The one particul ar thing
.

that we are l east a p t to regard as at faul t when we

get into trouble is ourse lves that is our mora l per , , ,

s onal se lves n ot s o much our bodily selves this for

, ,

reasons which wi ll come up for more careful exam

in at i on l ater We may rest here with the a s s u p
. m
tion that it is an instance of fail ure t o s ee the obv i
ous to overlook the t hi ng nea r est at hand
, .
8 ME N T A L H YG I ENE

Perhap s the most im p ort a nt reason however is , ,

de p endent u p on the really enormous comple xity of

the problems The tremendous complexity of the
.

h uman organism which has baffl ed man s reason

,
’

for s o many generations is only beginning to b e ,

suffi ciently fathomed s o that a comprehensive gras p

o f th e entire prob l em i s coming to be within the

bounds of p os sib i lity and it i s onl y when such a

,

com p rehensive grasp i s possib l e that the phenomena

of mi n d fall into pl ace for consideration at a l l for ,

they deal with the organism a s a whole and there

fore it i s onl y after its s e p arate p arts in their in
t er r el
a t i on s and interdependencies have b een un

der s t ood that the prob l em of the who l e c an be a p

pr o a ch ed .

A s soon we come t o an appreciation of this way

as

o f lookin g at man we come als o to s ee that there is a

psychologica l as p ect t o many a situation that we

had before l ooked at excl usively from s ome other
angle Thi s who l e matter will be more fu lly dis
.

cussed l ater but in order to illustrate this thesis I

,

wil l undertake to defend it briefly in a s imple case .

Why for exampl e does a p erson who is su ffering

, ,

the pain and inconvenience of a s ore finger consult a

physician ? It wi l l be said that it is because his
finger is s ore I say no that i s not the reas on It
.
, .

i s b eca use he i s mentally ill at ease The reason .

is a menta l on e and not a physica l on e But it will .

,

be said the man has pain in his finger and that i s a

,

p hysica l fact and the reason he cons ults his phy

si ai an A gain I s ay no that is not s o The pain
.
, .
 I N T R O DUC T IO N 9

does n ot reside in the fin ger : p ain is not a physical

but a mental fact While the p ain is directly due
.

to the p hysical condition of the finger the p ain itself ,

is p urely a mental experience If the man had no

.

mind he could have no p ain And s o again I con

.

tend that the reason the man consults hi s physician

is that he is mentally ill at ease What does the .

physician do for him ? The usua l answer will b e

that he cures the physica l ailment That is true . .

But in doing s o he is only em p loying that means

to the end of p utt ing the patient s mind at rest ’

m
.

After the p atient s i nd is satis fi ed then he is well

’

he no l onger s ufi e r s pain : he no l onger s ufi er s from

the kn owledge that there is a disagreea b le looking
place on his b ody and he is at p eac e— b ecaus e it
, ,

is tru e the p hysical cause of his s ufi er in g has been

,

removed I t wil l be said that this result i s aecom

.

pl i s h ed by dea l ing with the fi nger I admit that by

.
-

doing certain things to the fin ger thes e results were

p roduced but I insist that the ultimate results p ro
,

duced s o far a s the comfort and we l l being of the

,
-

p atient are concerned are menta l resul ts and that

,

the changes that were wrought in the fin ger are

only to the end of bringing about such a mental con
dition.

Thi s illustration serves to indi cate how much

more pervasive are the phenomena of mind in our
daily livi ng than we are wont to su p pose and als o ,

how com p letely the obvious may be overlooked A .

convulsion of nature a vol canic eru p tion or an

,

earthquake a di splay of the northern lights , an

,
1 0 ME NT A L H YG I E N E

ecli pse or the return of a comet are unusua l and s o

, ,

attract attention and are o b served with s ome ca r s

m
.

The operation of our ow n inds with which not only ,

th es e unusua l events but a ll the events of every day

are perceived just b ecause it is s o to speak an in
m
, , ,

gr ed ien t of every relation i s the l east unco mon

element of all and becaus e of that fact escapes ob
servation and e xamina tion the l ongest and th e most
successfull y .

Thi s book then w il

, ,lproceed t o an exami nation of
the obvi ous in the sense expl ained p sychological
, ,

elements as they may be found in as s oc iation with

and related t o the various p robl ems whi ch as I see
,

them b e l ong in the real

, m of menta l hygiene .
1 2 ME N T AL HY G I EN E

changes incident to digestion and metabo lism and as

they are intimately boun d up with certain p hysica l
reactions such as osmotic tension hydrodynamics ,

( circu lation ) we may speak o f th i s group of rc s c

m
,

tions a s p hy s i c o che ic a l
-
.

" uite ear l y in the hi story o f evo l ution pathways

were l aid do w n which ena b led a reaction to take place
at on e p art of th e body a s a result of a st imulus at
another p art These are the nervous pathways and
m
.

were made necessary by the growing s iz e and c o

pl ex i ty of animal life and the neces sity for a more

accurate interre l ation between its severa l parts B e .

cause thes e reactions are the expres sion of an as so

c i a t i on between a stimulus ( sensation ) and a motor

res p onse ( motion ) reactions of this charact er are

known as s en s or i— motor The s imp lest and ear liest
.

fo rm of reaction in this category had as obj ect th e

more accurate re l ating of the vita l organs more par ,

t icul ar l
y thos e engaged in digestion and circul ation ,

and this earl y nervous sys tem probab ly corresponded

roughl y to what we know a s the vegetative nervous
system in man It i s only re latively l ate in ani mal
.

evo lution that we fin d what we know a s a centra l

ne r vou s system ( b rain and spina l cord ) in fact not
,

until we get to the verte b rates and on l y at this l eve l

,

o f develo p ment that we get that exqui site deve l o p

ment of the s ense organs whi ch serves wonderfu ll y

to re l ate man to his environment .

Onl y after a ll of this p re p aration do we fin d that

there ha s developed anything to which we may give
the na me of p syche and to the reactions which issue
 UND E R L YI NG C O N C EP TS 1 3

the name p s ychol ogic a l while fi nally b y the associa

, ,

tion of individual s at the p sychologi cal level of de

v el m
op en t there issues a stil l more complex type o f

reaction the s oci a l

,
.

With this evo lutiona l scheme in mind we may con

sider for descri p tive purposes only the various
, ,

typ es of reaction a s we s ee them exhibited in man .

The physical reactions are such as are invol ved in

the maintenance of the erect p osture the relation ,

of the various curves in the S p inal co l umn the ,

ada p tation of the joint surfaces to on e an other and

numerous other reactions of a similar nature : the
chemical and p hysico chemica l reactions still deal
-

largely wi th questions of growth nutrition and , ,

metab olism The sensori motor reactions mediated

.
-

by the central nervous system occu p y a sti ll higher

,

plane and serve for bringin g about larger c o ordina -

tions between the various parts of the body ; while

the p sychological and social types of reaction are
hardly even ap p roached by any of the lower animals .

If we will take the broadest conce p t of the rela

tion of the individua l t o hi s environment and of the
functions of thes e various levels if I may s o call
,

them we wi ll s ee at once that the indi vidua l is a l

,

ways endeavouring t o brin g about an adjustment

b etween hi mself and hi s surroundi ngs and that in ,

order to do this he i s a lways in a p osition where it

is advantageous to be able to concentrate all e fforts
in a given direction and make everyt hing s ub s er v i
ent to that particular end The fi rst function is that
of a djus tm
.

en t .The second function i s that of i s

1 4 ME N T A L HY G I ENE

tcg r a ti on ,
and at each leve l we find the f unctions of
the orga nism serving b oth of these ends A s we .

p roce ed from the physical through th e various nerv

ous l eve ls to the psychologica l l eve l we find that each
seri es of functions a s they increase in c omple xity
, ,

a l so serve more thoroughly and more e fficiently to

integrate th e individual and therefore make it possi
b le for hi to b ring a l m lof hi s energies together and
concentrate them upon a specifi c goal A t the same .

time thi s function of integration i s the very n ec es

sa ry pre condition to e fficiency of adjustment to the
-

environment .

If I were to ill ustrate the type of instrument which

man uses at the vari ous l evels to bring a b out these
two ends namely adjustment and integration I
, , ,

should name fi rst at the physica l l evel the lev er

, , .

Thi s is exem p l ifi ed b y the type of action between

muscles and bones which s e r ves the purp ose of in
t egr a t in g man s framework s o that he may di rect
’

his exerti ons toward any particul ar end he wi shes

and thereby e ff ect to that extent an adj ustment with
his surroundi ngs A t the next l evel , the physico
m
.

chemica l the hor on e i s the typ e of instrument

,
1

which i s used t o e ff ect these two pu r p oses The .

chemica l regu lation of metabo l ism is a means

whereby the body i s rel ated to itse lf in its diff erent
The a ctiv
l pr in ci pl of c rta i g lan d s the ao—
e e ca ll ed d uct l ss
e n e

gl ds suc h as t he thyroi d t h d r l th p ituita ry et c Th

,

an , , e a en a , e , . e

wor d m s m essen ger d is so us d beca use it s rv s to b r in g out

ean a an e e e

rea ctio s a t d ist c I t so works l ik a rvous system but is

n a an e e ne

sim pl r a n d mor p rimitive w ay se rvin g t t im be fore t he la y

.
,

a e e a a e

in g d own of d fi ite a d pe rm n n t e rvous p a thw ys

,

e n n a e n a .
 UN D ER L Y I N G C O NCE PT S 1 5

parts s o that it grows and develops as a whole each ,

portion receiving and util i z ing only its p ro p er

amount and character of nutriment to serve the
s p ecifi c purp os e of the development of that part in
so far a s it may be useful to the whol e organism .

Integration i s thus served the orga nism as a whol e ,

is raised by this integration to a hi gher level of

e fii ci en cy and thereby adjustment with the environ

ment to a greater ni cety is rendered pos sib l e This .

hormone regulation whi ch is efi ect ed through the

medium of the endocrine ( ductless ) glands i s a l
ready in higher animals very l argely under the
, ,

control of the vegetative nervous system S o even .

at this l evel we are dealing with nervous control .

A t the next level the level of the centra l nervous ,

system the r eflex is the typ e of instrument whi ch is

,

used The refle x i s brought into action by contact

.

b etween the individua l and the environment I t .

may b e simp le it may be compound it may be condi

, ,

t i on ed or uncon di tioned , but it i s by buil ding up

2

2 te rm con d ition ed r eflex w as used to d escri be c e rta in p h en om

Th e
n
e a r esu l ti g from his xp rim ts by th e Russi an physio l ogi st
n e e en

Pa w l ow In his ex perimen ts o t h sa l iva ry secr etion in d ogs h

, ,

. n e e

fou d th t it w a s n orm a ll y b rought a bout b y th e si ght an d sm ell of

n a

foo d I f ow for exa m p l h a l w ays r an g a b ell in con jun ction with

. n , e, e

showin g t h e foo d h fou d th t a ft r a whi l e a fte r t h e a ssoci a tio

e n a e ,
n

f od be ll h d tim to becom fi rm l y form d if h e m r el y r a n g t he

o a e e e e

b ll even though h e d i d n ot show t h e food a t all t h e sa l iva w a s

-

n v rth l ss s e cr et e d
e e e e Th e s a l iv a ry r efl ex w as thus con d ition e d b y
E x pe rim n t show ed th a t th er e w a
.

th soun d stimu l us of th e be ll
e . e s

a pp a r t l y n o l imit to th e p ossi b i l ity of co d itio i g refl ex es in this

en n n n

w ay I t wi ll be se n how im p orta n t is this con c ep t for t he un der

e

s t an d g of how com pl e x systems of r efl ex e s ca n be b ui l t u p

.

n .
1 6 ME N T AL HY G I ENE

s eries of intricately interre lated reflexes t hat the

organism c omes t o respond accurately to certa in
aspects of it s environment It is needl ess to i l . l us
trate further how this p roce ss of compounding
o f reflexes serves both the purposes of integration

an d of adjust m
ent Still higher and further a d
.

v an ced in th e cours e o f evo l ution the typ e of in s t r u

ment which is brought into p lay t o e ff ect these two

purposes is th e idea 3
The idea not only integrates
.

by keeping before the indi vidual the goal whi ch he

i s endeavour ing to reach an d thereby serving t o
bring a l lhi s force s to bear to that s p ecific end b ut ,

it also reflects th e environment much more accu

r a t el
y than can the st imul us which b rings a b out the
reflex and thereby l eads to a much finer adjustment .

And last of a l lwe have arrived at that region which

S p encer ca ll ed the region of supra organic evol a -

tion the region of s ocial psychology in whi ch con

,

duct gets its values from the a p proval or di s a p

proval of the commun ity—the herd—of which the
individual forms a part The typ e of in strument .

w hich i s us ed at this l eve l to e ff ect the dou ble pur

pose of integration and adjustment is the s ocia lc us
t om Cu stoms serve t o in tegrate society rather
.

than th e individual perha p s by bindi ng al lits units

together to a common end but in so doing they ,

serve also t o efi ect a more efli ci en t adjustment of

the individua l to the requirements of the community .

For a d iscussio n of t he i dea as sym

8 bo l a n d as such a s a tran s ~

form er of ene
“
rgy see t he a uthor s M ech a isms of Ch ra ct r Form a
’
n a e

tion A I trod uction to Psychoa n alysis The Ma cmi ll an Co m pan y

, n n
”
.
,

N ew Y ork 1 91 6 , .
 UN D E RL Y I NG C O NCE P TS 1 7

It wil lthus b e seen that in the p r ocess of ev ol u

tion there is an orderly p rogressi on from the low

est to the hi ghest t yp es of reaction until they
culmi nate in the reactions a s I have put it at the
, ,

psycholo gical level and then reactions at thi s leve l

finally take on social values .

Thi s b rief summary which I have given of the

evo lution of the various ty pes of reaction shows a ,

constant inter p lay b etween the individual and hi s

environment whi ch p recludes the p ossib ility of con
s i de r i n g the in d ividual as a p art from the environ

ment T his im p ossib ility is es p ecially to b e b orne

.

in mind when the in d ivi d ual i s considered as a s o

ci a lunit and his reactions are considered from the

standp oint of the social level .

From thi s p oint of vi ew therefore we s e e c on

, ,

duc t as an end result of the whole system of mechan

isms and the com p romi s es which have b een struck in
the p rogressive evolution of integration and a d just
ment The p sycholo gica l level is only reache d at
.

that stage in evolution when integration has reached

a p oint of develo p ment so that action which results i s
action of the indivi d ual as a whole In f act p s y
.
,

ch ol ogy i s just that discipl in e whi ch deals with rea o

tions whi ch involve the individual as a whole The .

investigation of the di gestive p ro p erties of the p an

creatic juice is a p hysiological study at the p hysico
chemical level the investigation of the patella ten
,

don reflex ( knee j erk ) is a study of function ( p hysi

o l ogy ) at the sensori motor level an investigation of
-

the reasons a man took a train and went to B oston is

1 8 A
ME N T L HY G I ENE

a psychological study C onduct therefore is made .

, ,

p ossi ble by these final integrations which comb ine ,

unify and centra liz e a ll lower integrations and p s y

,

ch ol ogy is th e science which dea l s with reactions at

thi s level .

Throughout the discussion thus far I have used

the terms indi vidua l and env iron ent as if they m
were mutually exclusive Thi s is not so The con . .

ce p t individual a s imp l ying a clear cut distinction

,

from the environment has had a di stin ct history ,

an evolution and a consideration of the facts wi ll

show that this imp lied distinction is l argely a r t ifi
c ia l
‘
.

A study of the deve l opment the ch il d p sych e of

will show that the child must go through a long and

tedious proces s in learning the distinction between
himself and things about him in b uilding up the con ,

c ep t s of the
“ ” “
I and the not I ”
We s ee the con -
.

fusion in the child s mind we ll il l ustrated if we will

’

watch the details of the p lay wi th dolls and note

the uniformity with which the various o b j ects about
it are pers onifi ed This same stage is we ll s een
.
,

and ha s b een extensively studied in p rimitive man ,

—the stage of ani mism— while the ela b orately built

u p di stinction is b roken down in menta l disease
with its de l usions and halluc inations the l atter es p e
m
,

c ia l
ly co ing often from inanimate obj ects or l ower
animals and thus reviving the ani istic leve l of m
culture .

uthor s I ’ “ n d ivi d u l ity In tr ov ersi o Ps ycho

G S ee t he a a an d n, Th e
y t i c Revi w J an ua ry
a na l e , , 1 91 7.
20 ME N T A L HY G I ENE

stan t fl ux s o the same state of a ff airs pertains to

,

the relation indi vi dual s ociety M any writers see

-
.

in s ocial p sychology onl y the sum of the individual

p sychologi es of the constituent units I think this .
,

however a grave mistake The relation whi ch the

, .

in di vidua l bears t o other individua l s and to the

group as a whole i s the new element which is intro
duced an d forms a part of m a n s make up when con
’
-

s id e r e d a s a social animal A s well s ay that any

.

anima l or plant can b e fully understood by under

standin g the individual cells of which it is com p osed .

Such a viewp oint would fail completely to take into

consideration the speciali z ation of structure and
function and the integration of their s evera l organs
an d functions which are functions of this relation

rather than of the cells themselves The relation as .

such is as much a reality as the cell and it is just as

true as b etween individual man and society as it is
between the individua l cell and the body This is an .

important vi ewp oint b ecause it sees society as an

integration stil , l higher than the p sychological
l eve l in whi ch the individuals are grouped acc ord
,

in g t o race re ligion profession trade degree o f

, , , ,

education and in a thousand and on e other ways ,

much as the cells of the b ody are grouped into or

gans and in whi ch al l these groups are integrated
,

to the common end of the l arger social group— the

herd— as are the ce ll s t o the common larger end of ,

the b ody.

One other aspect of this matter of integration

which is of importance E ach ce ll each organ each
.
, ,
 UND ERL Y I N G C O NCE PT S 1

individua l has the function fi rst of p reservin g itself ,

of continuing to live broa dl y the p roblem of nu

, ,

t r i ti on . But in addi tion to its se lf p reservative a o

-

t i v iti e s it must give somethi ng to the grou p T his .

is the b asis of that relationship that makes integra

tion p ossibl e The c arapace of the beetle must
.

maintain its ow n integrity but it protects the deli

cate vita l parts of the a ni ma l whi ch it encl oses ; the
li ver has to maintain itself a s liver but it stores up,

glycogen— muscle food—t o be call ed upon in an

emergency and s o sup plies its quota to the prepared
nes s of the b ody a s a whole against danger ; the in
dividua l man must obtain food and shelter for hi m
self b ut in addition he must pay hi s taxes and s o
,

contri b ute to the needs of the herd .

All this is pre liminary but necessary t o the un

der s t a n di n g of the place that the p sychological typ e
of reaction occu p ies in the genera l scheme of the
individua l s develo p ment and it is als o neces sary
’
,

to the understanding of how b y a proces s of evo

,

lut i on, the type of reaction which the individual

manifests gets it s values reflected from the herd .

C onduct i s the basis u p on which the communi t y

judges the individual The individual may think as
.

he pl eases and the community has no interest in his

thoughts but he must act along fairly wel l de fin e d
,

lines if he expects to be left undisturbed C onduct .

,

therefore has a socia l value and its s ocia l val ue i s

,

b ased upon its worth to the communi ty E very i n .

divi dual owes certain duties t o the community in

which he lives in return for the i mense b enefits m
22 ME N T A L HY G I E N E

th at that communi ty bestows upon hi m

Practic all y
.

al lof the thi ngs for which we consider life worth

living a r e made p os sibl e by the s ocial organiz ation ,

an d in return for a ll thes e gifts from s ociety the

individu al ha s a duty towards that s oc iety It i s .

upon the basis of the e ffi ciency with which he dis

charges this duty that society passes judgment u p on
his conduct and deals with those de p artures from
certain s t andards which it sees fit to ma intain .

From this standp oint we see the individual ev alu

ated on the basis of his us efulness to the community
a s e xpressed in hi s conduct .C onduct a s we have
,

seen i s psych ologica l and s o it i s proper to in

,

quire whether al l forms of socia l in efii ci en cy may

not be viewed and properly s o from the standpoint
, ,

of mental de fi ciency The s o ca ll ed insane and the

.
-

various grades of the feeb l e mi nded are al ready

-

viewed in thi s way whil e there i s pretty genera l

,

a greement that a pp roximately fifty per cent of crim

in als and an equa l percentage of prostitutes easil y
fa ll wi t hin such a grouping T o my mind it will
.

be useful t o l ook at a ll the s ociall y ine ffi cient cl as ses

in thi s way If we can do t his without bein g ham
.

pered b y such old time and mis l eading concepts

-

“ ” “ ”
a s insanity and crimina lity ( as if insanity
and crimin a lity were tangibl e entities that took up
their residence within certain individual s ) if we can ,

l ook upon s ocially in efi cien t ty p es of reaction in the

broad way in which I have indicated rather than ,

from the narrow viewp oint of cer t ifi a b il ity and con

 UN D ER L YI NG C O NCE PT S 23

v i cti on ,we shall commence to understand and to

deal e ff ectively with the s ocially ina d equate .

If we take thi s viewp oint for the moment and l ook

at this fif ty p er cent of asocia l individuals and real
m
.

ize that they cannot l ive in the co munity as use

ful citizens but have to be shut up in s ome form of
institution and then place this fact by the side of
,

our scheme of evolution of reactions we see in ,

s ta n t l
y that these in di vidua l s fai l at the socia l level .

It is not neces sary to find in such persons pl ain evi

d en ces of menta l defect whi ch show themse l ves at
what I have called the pure l y p sychologica l l evel .

M any such individuals are wellbehaved well con ,

ducted and relatively at l east efii cien t persons

, , ,

within the milieu of an institution Subj ected to .

the increased complexities with the resulting

stresses of s ocial l ife however they show imme
, ,

di at el y their inabil ity to make adequate adjustment .

T hey fail at the socia l l eve l of adjustment and to ,

say that thi s fai lure is not p sychological is to lack

in appreciation of what p sychol ogica l means .

To il lustrate l et me cite extreme examples L et .

us take the ca ses of a pauper and a criminal E ach .

fa il s to make a satisfactory s ocial adjustment .

The main di ff erence between the two typ es of fail

ure is difi er en c e in the particular way in whi ch the
.

failure has come about In on e instance ( the crim

.

inal ) there has been a positive o ff ence against the

standards of the herd and in the other ( the pauper )
,

there has not The inte ll ectua l l evel or the de p th

.
,
24 ME N T AL HY G I ENE

of defec t from which the indi vidua l su ff ers may b e ,

the sam e in both instances L et us however take

.
, ,

a s an examp l e the individual who ha s gone to the

p oorhouse because he can no l onger earn his living ;
p erhaps he ha s l ost an a rm or a l eg or his vision , ,

or some other organ or function u p on whi ch he

ha s been accu stomed very l argel y to de p end On e .

woul d naturally s a y that such a cas e certa inly

showed no psychological evidences of defici en cy
that th e d ifficul ty wa s entirely physical I do not .

think that is a fair way to judge the situation .

I have in mind M is s He l en Keller who in her ea r li ,

est inf ancy was stricken absolutely b lin d and to

ta lly deaf This young woman to day is not only a
.
-

highl y respected and much l oved member of the

community but she i s highly e ffi cient She writes
,
.

beautifull y she takes the lecture platform efi ec

,

t iv ely and she ha s trained her other senses to take

, ,

the p l ace of those which were l ost in a manner ,

which is nothin g short of marve l ous She gets from .

life a l l o f the wonder that a high l y cul tured and

hi gh l y educated indivi dual can with his senses in
tact and vastly more than the average norma l i n
,

dividual N ow when we s e e a person ( p erhaps he is

m
.

a blacks ith it matters not ) go to the p oorhouse

,

becaus e he has l ost an arm the onl y reas onabl e ex

,

p lanation that we can give for such conduct is that

his ine fficiency is p sychological W e may expres s.

“
it in such c ommon p hrases a s he ha s l ost hi s
nerve ” “
or he i s unequa l to maki ng a readjust
,
” “ ”
ment ,
he is too o l d to b egin over again or in a ,
 UN D ERL YI N G C O N CE PT S 25

thousand other ways b ut reduced to their greatest

,

common divisor to resort to a mathematical fi gure

, ,

the common element in a l l of these formu la is the

element of mental ine fficiency .

I t is only when we b egin to s ee the true meanings

of the failures in life as they surround us that we
are a b le to a pp roach the p rob lem of mental defi
ci s ney in a p ractical way through the natural ave
nues The main emp hasis of the argument should
.

b e u p on the fact that socially e ffi cient conduct is an

end result de p ending not alone u p on p sychological
-

, ,

integrity but b ack of that u p on integrity at a llthe

,

vari ous reaction levels a s I have descri b ed them .

E ach level is de p endent u p on the o e b eneath its

n —
historical antecedent C onduct is the end result of
.
-

the whole comp lex of mechanisms and the resultin g

com p romises and its e ffi ciency is a function of their
integrity .

I n the p reface to our recent work on the D iseases

of the N ervous System
5
D r J el
lifi e and I have said
, .

“M an is not onl y a meta b olic a pp aratus a ccurately

,

adjusted to a marvelous efii ci en cy through the in

t r i ca c i e s of the vegetative neurological mechanisms ,

nor do hi s sensori motor functions make him solely

-

a fee lin g moving animal s eekin g p leasure and

, ,

avoidin g p ain conquering t ime and space b y the

,

enhancement of hi s sensory p ossi b ilities and the

ma gni fication of hi s motor p owers ; nor yet i s he
5 J el
lifi e
'

an d White :
“Di s ea s e s
of t h N rvous S yst m e A T xt
e e . e

Book of N eurol ogy an d Psychi try Pu bl ish ed by Lea

”
a F b ig r
e e

Phi l d l phi a an d N ew Y ork 2 n d Ed 1 91 7

.
.
,

a e ,
.
, .
26 ME N T L HY G I EN EA
excl usively a psychical machine which by means of ,

a masterly symbo lic hand lin g of the vast horde of

rea li ti es about him has given him almost unl imited
powers He is all three and a neurolo gy of to day
.
,
-

that fail s to inter p ret nervous distur b ances in terms

of a ll three of these l evels takes too narrow a view
,

o f the fun ction of that master spirit of evolution ,

the nervous system .

An d n ow finally and thi s i s very important

, .

C onduct at the p sychological leve l does not b y any

mean s neces saril y imply conduct that is motivated
and ca rried out with clear conscious knowl edge .

The evolution of the d iff erent l evels of integration

has been a long one extending b ack through t he
,

ages an d has finally reached its cu lmination via the

,

route which pas ses through the lower anima l s .

M ankind therefore sha res many of its tendencies

, ,

with them The s ocial tendency itse lf— gregari ous

.

ness— is shared with a large number of animals the ,

bufi al , o deer and hors e with birds and even w ith

,

in s ects ants b ees an d wasps C onduct based upon

, , , .

such a tendency therefore ha s become s o we ll in

, ,

grained in the individual that it is a s we say

m
, ,

auto atic and whi le the in dividua l may know what

,

he is doin g the underlying motive is buried dee p b e

yond hi s p owers of insight in his history Such , .

conduct whi l e it i s psycho l ogical in the sense in

which I have used it that is invo l ves the final in
, ,

t egr a t ion s and s o the individual a s a who l e is mo , ,

t iv a t ed by causes which l ie far outside the rea lm of

hi s knowl edge o f himse l f Thi s is the conduct to
.
28 ME N TA L HY G I ENE

gr eat significance for mental hygiene Trotter de .

7

votes some s p ace to a descri p tion of conduct of this

instinctive irrational sort When an o p inion is eu
, .

t e r t a in ed with a fee l ing that it would b e a b surd ,

o b viously unnecessary unprofi ta b le undesira b le , , ,

bad f orm or wicked to inquire into it then we know

, ,

that th e opinion in question is held instinctively and

not a s the result of individual ex p erience It i s .

held b ecause of its obvi ousnes s which is another ,

way of saying because it is dictated b y the herd that ,

is b y the grou p of which the individual holding it

m
,

for s a p art O p inions which are held as the r e

.

sul t of experience do not o ff er such resistances to

b eing inquired into There is no such resistance to
.

inquiry into the p henomena of p hysics and chem

i s t r y, th e p roblems of mathematics the proving of a ,

geometrical theorem but a b out matters of reli gion, ,

morals and po litics it is largely in evidence In .

fact most of our O p inions have been built u p b y the

herd and we reflect them after this instinctive fash
ion Allo f which goes to show that much too much
.

credit i s given to reason for the running of this ma

chine of ours while a s a matter of fact what we do
is the exp res sion of our whole vast past coneen ,

t r a t ed u p on the pro b lem of the present .

The relative unimportance for our everyday con ,

duct of cl ear consciousnes s and reas on should not

,

surp rise us if we bear in mind just the b arest out

l ines o f man s history on earth From the earl iest
’
.

7 W T rotte r
. :
“ n sti
I n cts o f t he H e rd in Peac e an d Wa r . L o n d on ,

1 91 6 .
 UN D ER L Y I N G C O N CE PT S 29

appearance of man upon the earth as calcul ated

from a study of his remains that is f rom the a p ,

ea r a n c e o f Pithecanthro p us o r the T rinil race it

p ,

is estimated that a p eriod of five hundr ed thou

sand years has elapsed a p eriod a lmost one hun ,

dred times greater than the tota l extent of hi storic

m
ti es 8
From a consideration of thi s fact a study
.
,

of the anatomical remains and a consideration of ,

the f acts of p sychology as revealed in history and

the study of contemp orary p eop les the conclusion i s
ap p arent that the s i mil arities between any two per
sons no matter how far removed they may b e from
,

one another a ccording to the existing socia l stand

ards are not sim p ly more numerous than their dis
,

similarities but that there is literally no comp aris on

m
.

The si ilarities are vastly greater than the difi er

en ce s which latter can on l y maintain in regard to
,

the very last relatively s p eaking almost micro ,

s c op i c a lly thin l ayer w hi ch has been added in recent

times If we consider on l y the anatomical and the
.

p hysiological simil arities we wil lb e prepared to a o

knowledge this a t once The difi er en c e s at these .

levels are not only inconsidera b le but for the most

p art unim p ortant A study of the psychological .

level wi ll S how the same thi ng The great maj ority .

and the overwhe lmingly more p owerful motives for

conduct come from the great region of the un con
scious where this vast region of man s past is ’

stored .

8 O sbor n, H F :
“M en of t heO ld S ton e Age Th eir En vi ron m n t e

Pu blish ed by Ch r l e s S cri bn er s S on s N ew Y ork

. .
, ,

Lif e an d Ar t .
”
a
’
, ,

1 91 6 .
30 ME N T A L H YG I ENE

B ecause of the preponderance of s imil arities b e

tween ours elves and others we must be prepared to
see ourselves in thos e others to l ook in the phenom
,

ena we are studying for re fl ections of ourselves .

In orienting himse lf towards persona l and s ocia l

pro blems man has ever been too prone to forget
that he wa s one e l ement in the re l ation He ha s .

too often failed to s ee that w ha t he perceived

was dependent u p on h ow he p erceived it This we .

sha ll fin d to b e of the utmost p ractica l importance if

we are to clarify our vision for useful ends .

M ental hygiene i s therefore the last word in pre

v en t i v e medicine The a syl um the prison , the
.
,

p oorhous e are where we fin d the resul ts of fail ure .

Such typ es of fail ure a s are represented in thes e in

s t itut i on s will of cours e a l ways be with us but the
, , ,

work of mental hygiene is not primar il y with them

exce p t in s o far a s they are sa lvable M ental .

hygiene i s p rimaril y addressed t o preventing such

failures whenever p os sible .

For a great many men tal disorders especia ll y the

,
“ ”
various typ es of ne rvousnes s and the s o ca ll ed -

“functiona l ” conditions — the benign as op p osed to

the more seriou s types founded upon marked de
—
feet for such conditions especia ll y among adul ts ,

the p ub lic hospita l for mental di seases the p sycho ,

p athic clini c and the public dispensary are the

, ,

natura l avenues through which to extend hel p It .

will take s ome little time however and some eff or t

, ,

b e f ore the mas s of p eo p le know that such agencies

exist or are avail able and als o some littl e time and
 UN DERLY IN G C O NCE PT S 31

efi or t b efore there are enough o f such agencies or

those that do exist are p re p ared to meet such de
mands .

For the more s erious conditions , particularly for

the frankly defective states the schools are the ,

p laces in whi ch t o work Here the individual is

.

f ound at an early age when remedial agencies will be

e ff ective if ever and if not then ste p s can b e taken
,

to s p are society an enormous amount of waste en

e r gy in tryi ng to make a u seful citiz en out of ma

t er ia lthat can never arrive .

In thi s connection there must be considered the

whole p rob lem of education The study of the a typ
.

ical and sub normal child has b rought into relie f

certain vita l pro b lems in our educational scheme .

M any modifications are already working throughout

this scheme and it is ever coming nearer and nearer
,

the ideal of fi tting the educational treatment to the

individua l rather than ex p ecting all individuals to
fi t the same educational mould We would not think
.

of p rescrib ing mountain clim b ing to a p erson with a

b roken cardiac compensation ; we should be as care
ful in our educational p rescriptions Here comes .

also the p ro blem of vocational training a still more ,

s p eci fic attempt to make educational means serve

livi ng en d s .

G oing deeper sti ll al l p rob l ems of factory sani

m
,

t a t i on of the employ ent of women and children

, ,

of emp loyers liab ility acts working men s in s u r

’ ’

m
,

ance organizations dangerous occ u p ations c o p ul

, ,

sory education and innumerab le others , all take on a

32 ME N T AL H YG I ENE

ne w asp ect when viewed in the light of the ul timate

goal the end p roduct of individual develo p ment
, ,

s ocially efli c i en t conduct Viewed in t his light they

.

are a ll pro b lems of menta l efii c ien cy and s o from ,

this angle belong to the fi eld of menta l hygiene

,
.

Thi s is true too of eugenics which is a worse than

, ,

useles s effort un l es s it rests upon the broadest of

foundations .

And s o the menta l hygiene movement is a move

ment ca l cul ated to push the whole p roblem of the
consideration of the sick individual to a l ittle higher
plane It has been the custom to treat the child
.

with Pott s disease s o as to bring a b out an arrest of

’

the tubercul ar proces s and subsequent cure of the

disease The problem now becomes one of helping
.

the individual to get the ma ximum of good from l ife

in in di vidua l ex p ansion and by s ocial usefulness .

This aspect is b eing met now by the nurse who goes

to the house of the p atient and helps regulate his
way of l iving after he l eaves the hos p ital We wi ll .

probably s e e further deve l opments along this line .

From this higher plane of observation the crim

ina l l aw that puni shes is unintelligent D isorders .

of co nduct need constructive handling To destroy

.

the individual either by ca p ita l punishment or b y the

s l ower proces s of constant re p res sion i s a l ow level
means of meeting the si t uation .

The menta l hygiene movement has a s on e of its

functions the encouragement of a l l those lines of
inqui r y and research that lead to a b etter knowledge
o f the hu m
an anima l , pa rticularly his conduct r eac
 UN DERL Y I NG C O NCE PT S 33

tions It i s the task of mental hygiene to find l ess

.

wasteful more efi ci en t means for dealing

, the
pro blems that arise at thi s l evel and when found
, , ,

to urge such measures unceasingly u p on those who

make and administer our l aws and dir ect the trends
of pub l ic thought
.
 CHAPTER III

In order t hat we may approach the various pro b

l ems that present themselves for the app lication of
the principle s of menta l hygiene—in order that we

—
may di scus s these p ro b lems without the n ecessity of
repeating thes e general princip l es each time in or
der therefore that we may discus s to the best a d
, ,

vantage practica l is sues whi ch invol ve prob l ems at

the psychologicallevel I sha ll discus s in thi s chapter
,

thos e features of p sycho l ogical integration and a d

justment which are p ertinent t o these various issues .

In other words I s hall discus s in thi s chapter thos e

,

fundamental menta l mechanisms an understa nding

,

of whi ch i s n ecessary in order to intelligently a p

proach the various practica l app lications of the
princip l es of menta l hygiene .

T HE U NCO N SC I O U S
F irst of all the great fact it seems to me which
, , ,

ha s always t o be b orne in mind i s the fact that our

,

psyche bears the record of its hundreds of thousands

of years deve l opment within itse lf a s truly a s does
’

our body This i s perhap s on e of the hardest one

.
,

o f the most difi cul t facts for those who have not
,

been thinki ng a l ong these lines , to appreciate, b e

36 A
ME N T L HY G I EN E

while a part of the psyche is stil l not in conscious

ness .

We have first to realize that all progres s i s

e fi e c t e d by overcoming resistance The ne xt t hing
.

to realiz e is that this resistance when it becomes

,

p sychological is located in this vast historical past

,

of the psyche which we call the unconscious L et

,
.

me il lustrate what I mean by thi s : M an i s a gre

ga r i ou s an imal . He does not and cannot live alone ,

and as in the proces s o f development the group with

which he allied himself has grown from a s im p le
band of wanderers hunting and fi shing for their
,

food and confined to relatively warm climates b e

k
,

cause they did not now enough to make clothes to

protect them from the cold as this b and has grad
,

ua l ly evolved and e n l arged until it has become what

we callto day a nation the individua l memb ers have
-

had gradually to readjust to ever increasin gly com

plex condi tions This readjustment has meant that
.

they have had to progressively abandon immediate

p ersona l aims for more remote ones to give up in ,

sistent s e lfi sh desires because they were opposed t o

the we lfare of the gr oup A s s ociety b ecomes more
'

comp lex it becomes increasingly impossible for any

in dividua l t o fo ll ow his ow n sel fi sh instincts to the
exclusion of others His path cros ses the interests
.

of others more and more frequently so that constant

readjustment ha s produced an ever increas ing n eces
s i ty for p utting aside immediate personal s a t i s fac

tions becaus e they confl icted with the interests of

others
'
. These readjustments have been necessa r y
 M E N T AL ME C H A N IS M S 37

in order that s ociety should continue to expand and

in order that man might rea p in return for his sac ,

r ifi c e s the b ene fits that come from such ex p ansion

,
.

I need not define what thes e benefi ts are further than

to say that they result in a constant specializ ation
on the p art of the di fi er en t memb ers of the social
grou p which bring to the individuals of the grou p
results far superior to thos e whi ch coul d be other
wis e attained .

N ow as man goes forward and is successful con ,

s ta n tl y readjusting to greater demands the adjust ,

ments whi ch he leaves behind which he a b andons in ,

hi s p rogress go to build up this great region of his

,

unconscious and as wil l be s een thi s regi on con

,

s t it ut e s b y far the greater part of the p syche .

E very readjustment that is made therefore has to , ,

reckon with this past has so to s p eak to overcome

, ,

it and herein l ies the conflict ab out which s o much

,

has recently b een written It is the con flict b etween

.

man s as p irations hi s ho p es which he consciously

’
, ,

entertains and which involve sacrifice in their attain

ment and his historic past which drags him b ack
m
,

and makes hi desire the p ath of least resistance ,

which is selfi sh Dr Hall has illustrated this situa

. .

tion most ha pp il y by using the simile of the ice b erg .

The iceberg is nine tenths sub merged and although

-

it may appear that its motion is controlled b y the

forces whi ch act upon its visi ble p ortions yet we ,

very frequently see that this i s not s o that the great ,

submerged nine tenths often move it in direct opp o

-

s it i on to win ds and su p erfi cia l currents And s o it .

38 ME N T AL HY G I E N E

is with the un conscious — its motive power has al

,

ways to b e reckoned with and oftentimes it moves us

to action in a direction quite contrary to that whi ch
we would conscious l y choose The unconscious .

wishes are therefore a l ways selfis h They may b e

, , .

“
ex p res sed in terms of the wi ll t o power They .

des ire th e greatest possible deve l opment of the in

, m
dividual th e maxi ation of hi s ego whereas prog ,

ress can only take p l ace by sacrifi cing something of

thi s desire giving it u p in order to attain to some
,

thing higher and s omething b etter .

T HE IN S TIN C
T HE F A M IL IAR— T H E SAF E TY M O T IV E
T F OR

T o b e more s p ecifi c l et me trace the way in which

this co n flict aris es in the individual The baby, in .

its mother s uterus may be said to b e omnipotent ,

’
,

that i s it has no un gr a tifi ed desires it does not have

, ,

to eat to breathe o r do in fact anythin g All the

, , , ,
.

functions are performed for it , and it rests quietly

and undi sturb ed in a warm fluid in whi ch it floats
without eff or t When the ch il d is born there i s born
.

at the same time : desire All of these comforts s o

.
,

to s p eak are given u p and the child is thrust into a

,

world in whi ch it wi ll never know again the p ea c e

that has been l eft b e hi nd About the fi rst thin g a
.

chil d does i s to cry, i t s futil e protest again st the

deman ds of reality and the way in whi ch this cry
,

is still ed by the nurs e i s to wra p it up in warm

blankets and put it in a dark room thus re p roducing ,

as nearl y a s pos si b le the in tra uterine condition -

.

From now on there is a co n s tant con fli ct, between the

 ME N T A L ME C HA N IS M S 39

desire of the baby to seek comf ort and rest on the

one hand and the insistent demands of the world of
,

reality which never for a moment ceas e their e ff orts

,

to obtain recognition All sorts of lights and .

shadows play about the b a b y a ll kinds of sounds ,

assail his ear new sensations come from his skin at

,

every p oint and he must needs pay s ome attention

,

to all these multip l e stimul i—make some ki nd of

adjustment to them Here is the b eginning of the .

conflict the struggl e for ascendancy between what

,

has b een called the p leasure p ain and the reality -

p rinci p les or as I p refer to say between the p l eas

, ,

ure motive and the reality motive for conduct The .

b aby would fain continue in the luxury of soft warm

k
,

blan ets in the darkness and away from all sources

,

of stimulation b ut reality is not to be s o easily side

,

tracked i t breaks through all hi s defences by skin

, ,

eye and ear stimuli by hunger and thirst and in

, , ,

innumerab l e other ways demands and obtains recog

n i t i on .

Here we find in i t s s impl est terms the struggle

, ,

between what may b e called instinct on the one

, ,

hand and reality on the other The baby exhib its in .

his reactions the paradigm for all hi s future di fli cul

ties in l ife he p refers to remain attached to that
,
‘

which he has become familiar with resists and r e ,

s ents those forces that compel him to leave the

m
fa iliar for the unfamiliar to abandon the kn own
k
,

for a venture into the re gion of the un n own I wi ll .

ca ll this typ e of reaction the reaction of the i n s tin c t

f or t h e fa i l
ia r — m
the s af e ty mo ti ve .
40 M E N T AL H Y G IENE

Without fo ll owing further the detai l s of this won

m
der f ulperiod o f life we may ju p to a little l ater
,

time when we fin d the b a b y old enough to be sitting

,

u p and p l aying with things which have been given

him . Su p pose he plays with his rattle for a while
and then drops it Some one is standing by to pick
.

up th e dropped rattl e and to p ut it again into the

b aby s hands The househo l d is at the b aby s com
’
.
’

mand there is always s ome on e stan di ng a b out to

,

wait upon him to do the thi ng that he wants done

, .

He ha s given up s ome of the comforts but he stil,

l
retains a tremendous command over his surround
ings H e gives up hi s omni p otence only under the
.

dures s of the unavoidable demands of reality : he

m
resents his slowly fail ing co mand over his environ
ment : his reactions show his desire to hang on to his
waning p owers : they are the reactions of the in s tin ct
f or t h e f a iml
i a r — the s a f e ty mo ti v e
.

From now on for a considerable time the infant

is in what corresponds to the cultural l evel of a n i
mis ma s it is designa ted when a pp lied to primitive
man Thi s is typ ically seen in the play of the child
. .

The dolls are not only p ersoni fied b ut are given

de finite personalities whi ch are developed often ,

with great ela b oration a s time goes on N ot onl y

, .

the do ll s but the whole environment tends to b e

given p ersonal attributes The animals are con
.

versed with and become intimate friends whi le even ,

inani mate nature i s dea l t wi th in simi l ar ways .

Trees chairs and tables are addres s ed the stars

, ,

l ook down a s pers ons upon the chi l d and are com
 ME N T AL ME C H A N IS M S 41

miun c a t ed with whi le the moon often b ecomes an

,

intimate confi dant .

Th e typ e of reaction whi ch b elongs to this ani

mistic stage of develo p ment is only relinquishe d
with great difii culty and indicates the ext ent of his
,

failure to se p arate himself com p letely from hi s en

v i r on men t It testifi es to the reali t y of the i ndi vid
.

ual environment relation a s set fort h in the last

-

cha p ter for wh ile during al l this period of develo p

,

ment he is engaged in a pro f ound research whi ch

has the very p ur p oses of se p arating himself from
his environment of finding out just what b elongs to
,

him and what does not still hi s reactions in later l ife

,

show wherein he has fa iled .

To give an exam p le that wi ll be easily recogniz ed .

An in di vidual has a task to p er f orm p erha p s the ,

writing of a letter I nstead of sitting down and

.

doing it he b ecomes surly and irrita b le and finally

when he does start to do it he writes out the fi rst
p ortion it does not s ui t him and he tears it up in
k
, ,

anger throws it dow n and m a es use of certain ex

,

p ressions whi ch in di cate clearly that he i s p ers on i

f yi n g the l etter that i s the pa p er the task
, ,
The .

ex p lanation of such conduct is that it is i n fantil e in

several respects He is p ersoni fying hi s environ
.

ment just as children and savages do T h e savage .

s ees mali gn spirits at work in the tree against which

he b arks his shins just as the child talks in anger
to the chair against which he has bumped himse l f .

T his is the animistic stage of develo p ment in whi ch

the indi vidual has not yet adequately s eparated him
42 ME N T A L HY G I E NE

s e lf from hi s environment In thi s stage of de

m
.

v el en t it is relatively easy to proj ect one s ow n

’
op

diffi cul ties upon the environment and react in this

way and thus avoid a recognition of person a l short
m
co ings— in short avoid the demands of reality .

W itnes s the b illiard p layer who b lames his poor

p l ayin g upon the ball s the ta b le the cue in short
, , ,

everything but hi s own l ack of ski ll Such a person .

i s reacting a s w a s hi s wont when a chi ld t o react

again st thos e persons in his environment who inter
f er ed with hi s p l easure seeking If we wil lstop and
.

thi nk we wi ll rea l iz e that a great p art of the child s ’

education in the home is taken u p with being told

what n ot to do He i s being constantly interfered
.

with in his activities and these activities are con

s t a n tly being repressed a s bad a s naughty as not , ,

nice etc etc We are accustomed to seeing the chil d

,
.
, .

grow irritable and restive under such constant r e

p res sions The typ e of reaction I have described is
.

just such a return to infantile ways of reacting a ,

return under the s tres s of rea l ity to a more famil iar

region a region w hich gives the sens e of a t home
,
-

ness Just as he us ed t o react against hi s mother

.

who interfered with his enj oyment of forb idden

p l easures s o now the billi ard player reacts against
the ba ll s and the cue A s the mother used to sym
.

bol iz e his inabi l ity to get pleasure s o now they

symboliz e hi s own in adequacy to p l ay the game a s
wel l as he w ishes to We would prefer to remain in
k m
.

the region of the nown , the fa i li ar where we fee l ,

44 A
ME NT L HY G I E N E

fee lin g spe lls dependence infantil ism Th e excess

,
.

ive a ff ection which holds many famil ies together is

often purely of t his se lfish kind seekin g o nly per
s ona l s afety and not the in dependence and se lf
suffi cien cy of the l oved one 1
A gain we find the in
.

dividual resisting the demands of rea lity that woul d

m
proj ect hi in to the great region of the unknown
m
,

a gain we fin d hi reacting to the in s tin ct for the

fa m ia r — th e s a fe ty
il oti v e m .

T HE P A T H O F O PP O S ITE S—L OVE AN D HAT E

That idea that lies closest in as s ociati on with any
other idea is its opposite The idea cl osest in our
.

mind t o the idea of hot i s cold to long i s short to , ,

fat is l ean to weak is strong etc Thi s tendency to

, , .

group ideas in our minds in accordance with this

princip l e of opposites i s a fundamental cha r a ct er i s
tic of our thought pro c esses pro b ab ly a law of ,

thinking whi ch has grown out of certain necessities

in our re la tions with our surroun din gs For ex .

am p le if it was always b right sunlight the idea of

,

brightn es s woul d never have to be formulated a s

nothi ng ever happened with which it came i nto con
trast and therefore such an idea would have no use .

But the night fo llows the day and s o for each of

these portions of the day an idea arises which is in
contrast to the other .

This contra st is wellshown in the deve l opment of

1 For fu ll d iscu s sion of
a t he fa mi l y roman ce see
“M ech an isms of
Cha ra cte r Forma ti on .
”
 MEN T AL ME C H AN IS M S 45

l anguage The early E gyptians had only one word

.

for strong and weak It is as if the word so to

.
,

speak re f erred to the whole question of the amount

,

of strength I n their hieroglyp hics they indicated

.

its more specifi c reference by the addition of a p ic

ture of an erect, vigorous man or a s eated ex ,

ha u s t ed man Proba b ly in speech these di stin ctions

.

were made by gestures .

This p rinci p le of the path of opposites i s appar

ently a very fundamental on e M uch might b e writ .

ten in further il lustration and ex p lanation of it I .

have merely set it forth b riefly we wi ll meet it often ,

in our ex p eriences with p eo p le .

Two very im p ortant o pp osites , in fact , perhaps

the most im p ortant and the most fundamental are ,

the o pp osites love and hate Thes e antithetic emo

m
.

tions have always b een recogniz ed a s b eing y s t er i

ous l y closely allied although on the face of it they
,

have nothing in common That they are opposites .

is the key to their cl os e re l ationshi p and the ease

with whi ch , at times on e may repla ce the other
, .

This ambivalent love hate type of reaction i s very

m
-

common very important in its pathologica l an if es

,

t a t i on s
. L ove is always the ex p ression for what
is constru ctive in the individual hate for what is ,

destructive and s o their outward manifestations are

,

of great importance in determining which way s o ,

to s p eak the individual is going whether he i s on

, ,

the forward path that leads to l ife or the backward

path that leads to death .

L ove and hate are expressions for what is most

46 ME N T A L HY G I EN E

fundamenta l in our emotional l ife and becaus e l ove ,

is c onstructive and hate destructive it is equall y

fundamenta l that any movement cal culated for the
betterment of mankind must b e fo unded u p on the
on e and eschew the other W e wil l s ee the great
.

val ue of thi s di stinction which may perhaps s eem

,

rather s imple and axi omatic when we come t o the ,

sp ecia l problems and fin d that in S pite of it s a p ,

parent se lf evident qual ity it has been entirel y over

,

l ooked in meet ing many practical is sues W e shall .

be able t o trace certain typ es of fai l ure in dealing

with th e s ocia l ly inadequate t o just t hi s fail ure to
apprec iate thi s principle .

I w il lfo ll ow out some of the common typ es of this

l ove hate reaction in the mechan ism known a s pro
-

j ec ti on .

P RO C I ON—
JEH E AN TIPAT H IC E M O T I ONS
T T

I have al ready given examp l es of proj ection in the

l ast section— the p erson with the ta sk ( to write a
l etter ) and the bil liard player Thes e typ es of r e
.

action are exceedingly common and even impres s

the average observer when extreme a s childish
, ,
.

In the cas e of the billiard p l ayer for instance a ,

moderate amount of fus sing about the cue the ball s , ,

etc i s al
.
, l right Of course on e cue i s b etter than
.

another and some ba ll s are better than others .

When however such a pl ayer kee p s u p a constant

, ,

stream of ta lk all through the game of bitter s a r

casm and cri ticism aga inst the management of the
Cl ub f or in stan c e , the care of the tab l es the negl ect
, ,
 ME N TAL ME C H AN IS M S 47

of every one to do their duty when he b roadens the

,

whole criticism out to include p eople in general and

hi s talk degenerates into a series of cyni cisms u p on
life the government the country when the slightest
, , ,

remark or even the failure t o S p eak when a good ,

shot or a bad one equally ca ll for a torrent of cr iti

cism of every b ody and everythi ng the reaction is at
,

l east b ordering on the pathol ogical and can at least

be appreciated by the average observer as certainly
very di sagreea ble and s omething to be avoided .

T hi s is the common form of proj ecting one s ow n ’

diffi culties u p on the p ersons and things about them

and blami ng them It is the old method of the child
.

and of primitive man and not s o primitive after a ll

,
.

D uring the Inquisition not only were animals tried

and condemn ed but inanimate obj ects as wel l and ,

still further back we have the picture of " erxes hav

ing the ocean l ashed with chains for wr ecking his
shi p s.

The term p roj ection however is technically used

, ,

for a s omewhat more su b tle mechanism It may be .

simp ly ex p ressed in that homely o b serv ation on e

hears s o frequently from the friends of the mentally
— “
ill that the i nsane always turn u p on their b est
friends . Here of course we meet again the l ove
, ,

hate opposites but why ? Su pp os e a b usiness man

,

is attracted to a young clerk in hi s emp loy and

singles him out for s p ecia l favours gives him ex cep ,

t i on a lo pp ortunities in short puts everyt hi ng in his

,

way with whi ch he can b uild su cces s N ow su pp ose .

that thi s clerk i s a fail ure and when promoted to a

48 ME N T A L H YG I ENE

high p osition of tru st demonstrates his abs o l ute in

competency for th e position H ow does the busi
.

nes s man feel towards him ? He feels “di s a p

pointed in hi ”
m
and somehow this fee ling of dis
m
,

a pp ointment s eems in s ome way t o come f r o the

young man N ow sup p os e the cl erk had not only
.

fail ed but had fal s ified the accounts and robbed hi s

emp l oyer The feeling of a ff ection which the em
.

ployer had previously had f or hi s cl erk might now ,

ea s ily be tu rned into its ambiva l ent opposite hate ,

whi ch would always be excited when he came into

hi s presence or wa s ca ll ed u p on to consider him in
any way A gain the emotion s eems to depend u p on
m
.

a some thi ng coming f r o the hated on e .

Of cours e this kind of reaction does n ot a lways

take place but when it does it is because the l ove was
se lfi sh in the sense a l ready described The em pl oy .

er s love w a s not directed towards makin g the youn g

’

m
man independent of hi but dependent upon him
becaus e he took p l easure in thi s dependence .

Therefore the di sappointment as even the hate is

for himse l f a s symbo l iz ed in the cl erk That it
m
.

s eems to come from hi i s a di stortion t o escape the

un p leasant rea l iz ation of the fact .

All thes e mechanisms are s imp l e and easy to

understand N ow su p pose that on e pers on has an
.

a ff ection for another without quite knowing it in ,

other words without it s bein g clear ly conscious A

,
.

woman for examp l e may be very fond of a young

, ,

man without even ha v in g ackn owl edged it to herself

because he ha s never e xp res sed love for her Her .
 ME N T AL ME C H A N IS M S 49

pride therefore wo uld not p ermi t her to a c n ow l

, ,
k
edge a love that was not returned U nder such cir
m
.

cu s tan c e s the absolutely po l ite and considerate

conduct of the man towards her s o l ong as it con ,

tains not the least suggestion of love i s o nly ex a s ,

perating to th e l ast degree The woman comes to.

“
actually hate the man s he coul d tear hi s eyes out ”

m
, ,
“ ”
she can t bear to have hi around and shows by
’

such expressions a s these that her l ove ha s switched

over tem p orarily at l east to its ambivalent opposite
, ,

hate An d too in thi s instance the hate seems to b e

due to something coming fr omthe man His man
.
, ,

ner his way of dres sing hi s method of addres s are

, ,

all hateful .

This example gives us the key t o the projection

mechanism When our l ove would go out in a cer
.

tain di rection but fi nds its path blocked fi nds itself ,

up against a stone wall s o to speak then we fee l

fr omthe l oved obj ect onl y pain This pain comes
, ,

fr omthe loved obj ect and s o prevents a rea liz ation

.

th at the trouble is within and not without This is .

the mechanism which is at the back of the del usions

of p ers ecution s o common in the p sychoses But .

why all these ela b orate mechani sms ? Wh y is it

necessary to p revent a realization that the troub l e i s
w ith ourse l f and not in the other person ?
Whenever it has been p ossible to adequately a n
al yz e one of these hates such for exam p le a s are
, , ,

seen in the delusions of persecution of p aranoiacs

where instead of a feeling of hate there is a feeling
on the part of the patient of some ma lign in fluence
50 ME N T A L H YG I E N E

m
e anating from the persecutor a fee lin g of dange r ,

from t his s ource whenever it ha s b een pos si ble to

,

analyze such a situation it has been fo und that the

l ove whi ch i s felt a s hate coming f r omthe l oved on e
,

, ,

ha s a qua l ity which appeals to the patient s sense of

’

s ec urity In other words the p erson l oved i s loved

.
,

n ot in the norma l adult way that makes for e fficiency

but b ecaus e they a fford a sense of safety becaus e ,

they have money or p ower and can protect because , ,

perhaps they resemble the parent and therefore r e

,

animate the old feelin g of infantile dependence .

Thus it w ill be seen such hates tend to drive u s

, ,

away from s ources of danger from attachments ,

that woul d prove o ur undoing It is again our old

friend t he i n s tin ct for t he fa m ia r — the s af e ty m
.

il o

ti v e .

Proj ected hate or the feeling of persecutio n can

thus be seen to have a positive function to p erform .

When under such circ umstances a s are fo und in

,

the examp l es given we are tempted s o to speak to

, , ,

l apse from an e fficient dealing With reality we find

an arti ficia l barrier erected by ourselves the barrier ,

of ha te which more or les s e ffectually closes the

pathway to indolence ine ffi ciency and destruction

,
.

T o rema in in the region of the familiar not to ven ,

ture forth where no trails are blazed i s all too easy ,

and a l lour p sychologi cal res erves must b e b rought

to th e front if the day is to b e saved There are no .

stronger emotions than hate and fear s o these are ,

pressed into active service W e hate and we fear

.
52 ME N TAL H YG I E NE

lif e efi or t s on the part of those in authority mee t

wi th l ike reactions the chil d prefers to rema in in
,

the region of the known—again the i n s tinc t for t he

fa m i l
i a r — the s a f e ty o ti v e m .

C onversely we fin d certain peop l e , not a n ta gon i s

tic not hostil e towards the love o b j ect but and thi s
, ,

is a widespread typ e of reaction , tendi ng to ident ify

m
the s elves with it Of course here are the fa iliar
. m
instances o f the boy who wants to grow up to be like
father the gir l to be l ike mother, and quite as clearl y
,

thos e who form s ome attachment outside the fami ly ,

a teacher employer a noted person who i s taken as

, ,

a model The desira b ility of the resul t depends a

.

go od dea l, naturally, upon the mode l chos en whether ,

it be a respectab le citiz en or a hi ghwayman It is .

also very important just how the ident ification is

worked out whether the mode l is an idea l and leads
,

to the best aspirationa l e ff ort s or whether the iden

t ifica t i on is o nl y used to reinforce the safety motive
for c onduct .

The identifi cation with the l ove obj ec t when that

l ove obj ect i s desired not a s an ideal b ut as a means
,

o f safety and protection , i s on e of the ways in wh ich

the love o b j ect is a p propriated in thought one of the ,

ways in which s ecurity is s ought by thi nkin g ( phan

t a s yin g ) rather than by action M any neurotic and .

p sychotic p atients for examp l e , reproduce quite ac

,

c u r a t ely the peculiarities even t o the i ll nes,

ses of a ,

parent 2
. N ot infrequently the identifi cation i s w ith
2 This usua lly bee
ha s n ex pl d
a in e as due to h er edi ty which of
c ourse it m p sycho logica l rea ction
,

a y be b ut it n ,
ot i frequ en tl y is
n a
 M E N TAL ME CH AN I S M S 53

the p atient s own inf antile se lf as in those cases that

’

persist in ce rta i n habits of eating as for i nstance , ,

o nly eatin g those foods to whi ch they had b een a o

customed a s chil dren in the home A gain the i n
m m
.

s tin c t for t he fa i a r — the s a f ety

il oti v e .

CON RS ON
VE I

In genera l the di fficulties at the p sychological leve l

ari s e because of ina b ility to deal efi ec tiv ely with
rea lity and in b eing forced back from an efi ectiv e
,

adjustment to reality the individual is p ushed back

wards to earlier instinctive levels of activity which
are more familiar to regions i n which he feels a
,

greater sens e of security Inasmuch as the psycho

.

l ogical integrations are made possible only because

of the physiological integrations whi ch have p re ,

ceded them in the course of evolution and develo p

ment it must happen that if the p ush back from
, ,

re a l it y is very great and long continued that thos e

l ower bodi l y typ es of integration must often suff er
, .

The mental con fli ct i s outwardly ex p ressed by dis

tur b a n c e s of bodily function Psycho l ogica l con.

fli ct is converted into b odi l y disorder Thi s i s what .

is im plied b y the term c on ver s i on and is the charac

t er i s t i c mechani sm of hysteria .

W e are all fami liar with those cases of hysterical

( symbo l iz tio ) p ur
a n e an d sim p l e T o a l wa ys xp l a in on t he h r d i
e e e

t ry hyp th sis wou ld b a p oor w a y to pp ro ch t h p robl m t h r a

.

a o e e a a e e e

p e ut ica l
ly a n d i n an y c a s e it must oft be im p ossi bl e to p r d ic t
en e a e

h er ed ity un ti l a t l ea st
an e ff ort is m a de to d a lwi th t h e situa tio
e n

a t t h e p sycho l ogica l mod i fi a bl

, e l ev l
e .
54 ME N TA L H YG I E N E

p aralysis in whi ch an arm or a l eg may be quite use

less for months and which not in frequentl y is “ ir m
”
aculous ly made to disappear over night , often to
the chagrin o f the attending physician , by s ome
e xtra professiona l cure
-
“ ”
The meaning of such .

cases can be s een in such an instance as that cited

b y P fis te r 3
A youn g man of s eventeen notices a
.

queer fee li ng in his l eft arm contemporaneous with

a desire upon the part of hi s father to transfer him
to a school to whi ch he does not wish to go An aly .

sis revealed the fact that when a child he struggled

s o violently against being vaccinated that it had to
be given up Translated into terms of hi s present
.

difficul ty it means that s ince as a chi ld he had suc

ce e d e d in avoiding s omething di sagreeab l e b y his

stub b orn resistance he wishes again t o avoid s ome ,

thi ng di sagreeable in the same way He tends when .

,

presented with a rea lity situation to which he can

m
not bring hi se lf t o make an adequate adjustment ,
to revert unconsciously of course to a fami liar typ e
, ,

of reaction which had succeeded b efore in saving

him from a disagreeable adjustmen t —the in s tin c t
f o r t h e fa i l
ia r — the s a f ety m m
ot i v e .

These hysterica l conversions are used in a ll sort s

of ways and serve many p urposes Ames report s .

a case of hysterica l blindnes s in a man which was

4

the resul t of a l ong period of incom p atibil ity with

8 “
The Psychoana ly ti c M ethod .
”
M ofl a t Yar d
’

Co .
, N ew York ,

1 91 7
ms
.

4
T H A e :
“Bl in dn ess as a Wis h ”
The Ps ychoa na ly tic Review,
ov embe r
. .
,

Vo l I.
, No . I , N , 1 91 3 .
 MEN T AL ME C H A N IS M S 55

hi s wife and ex p res sed the desire on hi s part n ot to

see her any more M any hysterics develop bodily
.

symp toms of il lnes s in order to get that so licitous

attention and consideration which often because of ,

their lack of lovable qualities they could not other

,

wise o b tain They seek safety in chi ldish reactions

. .

Acting like ch ildren they are cared for and treated

as children .

The conversion mechani sm a l s o serves more com

plex ends A woman sues a railroad corp oration
.

for injuries received in an accident and collects a

l arge verdict C ontrary to the su p posed rule she
.

does not get immediately wel l after the cas e is set

tl ed . She goes from on e physician to another com
-

plaining o f pain until she finally succeeds in induc

ing a surgeon to o p erate upon her The O p eration .

revea l ed a p erfectly normal state of a fi a ir s but after

it the p atient got p rom p tly well Allthe whi le she
k
.

n ew in the back of her head that she had not been

i njured and was not entitled t o the money The .

operation is a penance for her guilt She wants the .

devil cast out ( in t his instance cut out ) of her The .

p enance motive is ve r y dee p s eated in man we ,

meet it over and over again in hi s various religions

and in this case we s e e the hysterical conversion
s erving thi s motive The patient feels the n e ces
.

s i ty unconsciously of course of su ff ering injury in

, ,

order to justify herself for taking the money She .

seeks for a return of her old self with its sense of

‘

security before s he v entured on the dangerous path

56 ME N TAL H YG I ENE

of de ceit It is t he i n s tin c t for t he fa i l ia r —t he m

s a f e ty m
.

o ti v e .

The num b er and duration of physica l and a p

p a r en tl y physical dis orders which may originate at
the p sycho l ogica l l eve l i s endles s 5
It includes many .

forms of asthma sore t hroat diffi cul t nasal breath , ,

ing stammering headache neurasthenia backache

, , , , ,

ten d er s p ine “weak heart ”

faint attacks ex op h
m
, , ,

t ha l ic goitre ( G rave s o r Basedow s disease ) ’ ’

,

apho n ia spasmodi c snee z in g hi ccough rapid res

, , ,

p i r a t i on hay fever gastro intestinal di sturb a nces

, ,
-

( constipati on diarrh oea indi gestion co litis ul cer , , , ,

of stomach ) ptosis of ki dney diabetes di sturbances, , ,

o f ur ination ( p olyu ria incontinence preci p itancy )

‘

, , ,

menstrua l disorders autointo xication ( from long ,

cont inued digestive disturbance ) nutritional dis ,

orders of ski n teeth and hair e tc e t c This list , , ,

.
, .

wi ll give s ome idea of how frequent these distur b

an oes are how they a ff ect all organs of the body and
, ,

s o invade all departments of medicine .

O T H ER DE F E NC E ME C H N IS S
A M

All the various mechani sms I have described

of

belong to what may be ca ll ed defen ce mec ha n i s ms .

They have a s their purpose among other things , ,

defending the individua l from a knowl edge of his

For r ecen t l ite r a tur e s ee G H u d so Mak
5 uen Presi d en ti a l Ad . n -
,

d ress Am erica La r yn go l ogic a l A ssoci atio N Y M ed J oa n N ov

n n,

1 91 6 ; G uthri
.
, . . .
,

“
Ra ki n The H i gh l y S trun g N e rvous S yst m
”
4 e n : e

M an —An Ada p tive M ech an

, ,

Br M d Jo u e O ct 2 1 1 91 6 ; Cri l
r
“ e:

i sm N Y 1 91 6 Th e M a cmi l l n Co
. . .
, .
,

”
, . .
, , a .
 MEN TAL ME C H A N IS M S 57

ow n shortcomings his own defi ciencies They are

,
.

al lefi or t s ine ff ectual efi or t s and therefore forms of

c om m m
,

p r o i s e and c o p en s a ti on to esca p e the

, ade
quate straightforward and necessary way of deal
,

in g with reality if it is to b e e ff ectually handl ed .

A murderer kil led a man by stab b ing I ques

m
.

ti on ed hi in order to s ee how he felt about hi s act

m
and his s entence to life i prisonment In the fi rst .

place he was very emp hatic in hi s blame of the de

ce ased for picking a quarrel with him He was very .

much larger than the prisoner and s o the only way

in which he ( the p risoner ) could adequately defend
himself was with some wea p on T h e deceased knew .

this and w a s virtually taking his life in hi s hands

when he started the trouble T hen again the doc
.

tor did not treat the wound as he should have The .

man there f ore really came to his death through his

, ,

own foolhardi nes s and the lack of skill of the p hy

s ic i an . This was all told with a smiling countenance
and without the remotest suggestion that the p ris
oner blamed hi mself in the least This is the r e .

action of jus tifica ti on by the p roces s of r a ti on a l is a

ti on .

The a l cohol ic justifi es his indulgence by just such

rationaliz ations He drinks b ecaus e it is hot or b e
.

cause it i s cold b ecause he cannot refuse a frien d

, ,

or one drink won t hurt him or he did not really

’
,

mean to drink that evening at al l or a thousand ,

“ ”
other so p hi sms of the indolent to protect him
from a realization that he is not equa l to the efi or t
of refusa l or resistance .
58 MEN T A L HY G I EN E

The man who is failing in menta l efli cien cy be

li ev e s that o ther mem b ers of the o ffice force are
putting up j obs on hi m
annoying him interfering
m
, ,

wi th hi in a ll sorts of ways s o he cannot do his

work He proj ec t s hi s fai ling e fli c i en cy upon others
.

and saves himself f rom rea l i z ing it .

A disagreeable ta sk ha s t o b e perform ed at a
certain tim e— i t is forgotten o r a headache is de
v el op ed a s an excuse for i t s avoidance .

A man is guil ty of cheating his closest friends out

of s ome considera ble money He cannot l ook hi s
.

friends in the face T o escape a realization that he

.

is ashamed of hi s conduct becaus e he is gu il ty he ,

develops a defect of vision and has t o go about with

smoked glas ses and shad ed eyes .

An automobil ist runs over some on e and speeds

up his machi ne and runs away without looking b ack ,

trying to make himse lf think he did not s ee the acci

dent therefore knows nothing about it therefore it
, ,

did not hap p en .

A profoundly depres sed woman dreams of being

at home happy with her children and s o is com
,

pensated to s ome extent for her depres sion

, , .

Persons of rather defective type of p ersona l ity

a p e the manne r isms and pecu liarities of dres s of
p rominent peo ple and thus bol ster up their self e s
teem
m
.

The list is endl ess defence compromi se c o p en

, , ,

sation adjustment the mechanisms are few but the

, ,

l imits of the ir us e are as many as the indivi dua l s

 CHA TE RP IV
THE IN SANE

TH E W OR mD SAN E

In the fi rst pla ce b efore we can inte lligent ly ap

,

proach the problem in dicated by the head ing of this

cha p ter it wi ll b e necessary t o correct an almost
uni versal mi sap p rehension a s to the meaning of the
word insane The wrong us e of this word is r e s p on
.

si ble for really grievous errors and must be cor

r ec t e d if it i s to b e pos sib l e t o dea l with the ques

tions included in thi s concept with inte lligence .

The word ins ane has been appli ed l oosely for a

l ong time t o those patients who were to be found in
m
the large asylu s and hos p itals for the insane and to
p ers ons in the community who acted s o strangely a s
to s et them apart from other peo p le The word has .

never had in its popul ar use a more de finite mean

, ,

ing than this The only im p ortant e ff ort to cl early

.

de fine what was meant b y insane has b een made b y

the law Here even we do not fi n d any very under
.

s ta n da b le attempt if we read the statutes but we do

fin d a perfectly we ll de fined method of procedure to

determine whether a given individua l conforms to
the defini tion l aid down or not This method i s the
.

method of trial before a jury and the verdict of the

jury dec ides the issue On the face of it this seems
.

so
 THE I N SA NE 6 1

an absolutely ab surd pro p osition especially when ,

“
we find that the statute defines an insane p erson ”

“ ”
as a person of unsound mind thus merely s ub s t i
tuting one term for another Any one at all famil iar
k
.

with menta l diseas e nows that there are many

forms of menta l il lnes s and to group them al l un d er
,

on e term — i nsani ty— gives us hardl y any more i n

formation than to s a y they are al l sick and cer ,

t a in ly no more information than we would have of a

sick p erson if we inquired what the matter was with
him and were tol d that he had a cough In the lat
m
.

ter case the patient i ght have a cold bronchitis , ,

laryngitis pneumoni a pulmonary tuberculosis heart

, , ,

di sease asthma and I am sure I do not kn ow how

, ,

many more things— in the former cas e the informa

tion would be quite a s inde finite .

I t is p erfectly clear therefore that the jury can

, ,

have n o intelligent understanding of what they are

doing in the l ight of present day scientific standards
-
.

What i s the meaning of their action then ? If the

jury i s conceived as s ociety in miniature then their
verdict is the verdi ct of society, whi ch means that
s ociety ha s decided to l abe l such and such an indi
“
vidual a s insane in the same arbitrary way that
it does other t hi n gs attaches other l a b el s a s for
, ,

examp l e the label of maj ority ( age twenty one ) the -

age of consent the l abe l of grand larceny as distin

,

gui s hed from p etit l arceny ( based on value stolen ) ,

the l abe l of l egis l ator, judge etc etc From the

, .
, .

p revious discussion it is easy to see that the jury i s

acting not with cl ear conscious intent but instin o
,
6 2 ME N T AL HY G I ENE

ti v el
y, refl ect i ng the attitude of the herd, whi ch in
thi s instance is to regard the individua l a s sick, as
irresponsib l e and s o to treat hi mk
in dly and take
m
,

such ca re of hi a s may result in hi s getting wel l

m
.

Of course I a referring o n l y to the more advanced

comm unities I am painfull y aware that t his i s very
,

much more than can be read into th e verdi ct in all

too many p l ace s .

“
To kn ow that a person ha s been l abell ed in sane ”

“ ”
by due proc ess of l aw there f ore tells us p r a ct i
, ,

cally nothi n g about that individual except that the

herd a s re p resented b y the jury having noted hi s
, ,

b eing so di fi er en t from the average individual ,

“ ”
has concluded to l abe l him insane and send him to
a p u b lic institution for the ca re of the in sane “ ”
.

Insanity therefore means nothing more nor l es s than

co m
m i ta ble or better c er t ifi a bl
, , e .

Ca n we get an y better idea of the characteristics

of thi s grou p l abe ll ed
“ insane ? ”

If one will think of a p rimitive community out in

the M iddl e W est during the times when the M iddl e
W est was yet the frontier one wi ll rea l ize that a
,

member of that re l atively primitive community

cou l d i f one wil l think of M ark Twa in s de s cr ip
,
’

tions r ide down the ce ntre of the street and ye ll and

,

ho ll er and shoot and it was thought to b e a com

,

p a r a t iv el y norma l kind of conduct and no b ody

thought it was strange and no b ody interfered with
it N ow when communities get to b e older and more
.

civil iz ed when they get to be more congested one

, ,

c annot d o anyt hi ng that he may ha pp en to choose ,

 THE I N SA NE 63

without perhaps crossing the path of someone else

, ,
.

Then certain conventions of conduct have to b e fol

l owed and there have to be greatly restricted lines
of conduct so that if a man acted as I have de
,

scrib ed he knows just where he would land It

,
.

might be and p ro b a bly would be in the jail I n ,

.

other words he is exh i b iting a ce r tain typ e of con

,

duct whi ch the communi ty— t o s p eak in slang p hrase

— won t stand for and they simply remove hi
’
,
m
from it .

“
In the group of peop l e that are ca ll ed insane
are peo p le who exhib it certain typ es of conduct
whi ch cannot b e tolerated in the communi ty in which
they ha pp en to live I rememb er some time ago in
.
,

walking down to my quarters at the hos p ital a ,

woman threw up the window thrust her head out ,

“
and shouted M urder " ”
N ob ody paid any atten
,

tion whatever to her W e were used to that sort of

.

t hi ng She shut the window down and went back

.
,

to b ed She was in a community where she was n u

.

d e r s t o od But she could not do that sort of thi ng

.

anyw here outside of an institution without being

“
shut u p for insanity ”
And so it is that an indi
.

vidua l must conform to the established usages of the

s ociety in which he lives .

N ow what is the characteri stic of thes e typ es of

conduct ? I t is s o cial inadequacy The in d ividual .

who manifests a ki nd of conduct that is calculated to

tear down the existing conventions to deviate ,

greatly from the normal conduct of the commun i ty

—that person i s an individua l who has to b e
64 MEN TAL HY G I ENE

relegated to s ome p l ace other than a position of free

citiz enshi p Thus certain types of social ly in efli
.

“
cient conduct may b e said t o be i nsane conduct”
,
“ ”
and so the word insanity comes t o be as I s ee it , ,

not a medical term at a l l but a socia l term which

,

de fines certain kinds o f social ly ine fficient conduct .

L et me el aborate a little further what I mean by

conduct Y ou or I or any on e e l se can think a ll we
.

want to about threate n ing some on e s life ; we can

’

formul ate a l lsorts o f plans about meetin g hi and m

shooting him a s l ong as we do not s a y anythi ng about
,

it or do not do anything about it B ut l et us for a

.

moment start to put such a plan into execution and ,

that moment s omething will happen to us In other .

words we may have any sort of desire our thin kin g

, ,

ap p aratus may function in any on e of a great num

ber of ways but s o l ong a s it does not manifest itself
,

in our outward conduct in any way society has ,

no interest in it So then I would say that in “

.
,
”
sanity includes certain types of socially ine ffi cient
conduct ce rtain kin ds of sociall y ine ffi cient conduct
m
,

that ca use troub l e in the co munity .

T o gather up the thread s — “ ”

insanity i s not a
medi ca l term at a l lbut a socia l and lega l term : it
does not refer p rimaril y to menta l disease b ut to
conduct : the t ypes of conduct to which it refers are
social l y in adequate conduct but on l y of such kinds
and degrees as are incompatibl e with l ife in the com
mun ity of which the indivi dua l is a member : and fur
ther they are such types of conduct which the herd
 THE I N SA NE 6 5

l ooks upon as evidence of disease and as implying

irresponsib ility and therefore leniency .

“ ”
Whil e insane conduct is therefore , the result
,
“ ”
of mental disease , insanity and mental disease
are not interchangeable terms While all the in .

sane are theoretically mentally ill ( a person a d

judi ca t e d as insane is nevertheles s insane even
though it be found out afterwards that a mistake
had b een made ) not al l the mentally i ll by any
means are insane in the sense of having been a d
judica t ed or even in the sense of c er t ifiable that is , ,

could b e adjudicated M enta l i llness is a b road

.

conce p t that may well include many hi ghly e fficient

and valua b le memb ers of the com unity It is m .
,

there f ore only certain kinds and degrees of mental

,

illnes s which may b e classifi ed socially and legally

“
as insanity .
”

And finally that feature of the conduct which

,

makes the herd look leniently u p on it is of great

im p ortance as we shall s e e when we come to con
sider those varieties of conduct upon whi ch the herd
looks very diff erently , namely the criminal
, .

T h e insane therefore to us e the word as I have

, ,

de fined it will be s een to b e constituted of a hetero

,

gen eou s mi xture of typ es , the only common charac

t er i s t i c of which is that they have been l a b el l ed and
that they p resent a series of conduct disorders due ,

to a multitude of various menta l diseases that ren ,

der their orderly living in a community and consti

tuting usefu l memb ers thereof im p ossible They .
6 6 MEN T AL H YG I ENE

are segregated and put a p art from the rest o f the

herd b ecause they are p oints o f lost motion which
inter f ere with the e ffi cient running o f the soci al
machine The disorder is a disorder of the i n
.

dividua l society relation From now on I sha ll

-
.

avoid the use of the word insane exce p t as be in g ,

syn onymous with ce r t ifia ble and use instead such ,

term s a s mental disease and psychosis .

H I ST ORI C AL
This b ook is not b y any means intended to take
, ,

u p all of the multitudinous is sues that present f o r

consideration in relation to the dependent defective ,

and delinquent cl asses It has no such obj ect Its

. .

o b j ect is quite di ff erent ; it i s to efi ect a new orien

t a t ion towards thes e problems more especia ll y from
the viewp oint of p reventive medicine rather than
from such viewp oints a s the econo ic or the admin m
i s tr a t iv e for exam p le
,
Historical matters will
.
,

therefore only be touched u p on to the extent that

,

they may throw light u p on thi s p articul ar p athway .

A s is we ll kn own in the earl y days in the M id

, ,

dle A ges and among peoples at l ower cultura l levels

,

than o urse l ves the s o called insane have been r e

-

garded usually from on e of two opposite stand

points either a s be ing inspired or a s b eing
, ,

p ossessed of the devi l Unfortunatel y the latter

.

vie w p oint ha s been taken much the more frequently ,

and the resu l t has b een disastrous for the p oor sick ,

indi v idual .

E ven in later t imes the l atter p art of the 1 8 th cen

,
6 8 MEN TAL H YG I EN E

recent times since the menta l mechanisms some of

, ,

which I have descri b ed in the last cha p ter have b een ,

worked out that we have been a b le to turn an un

,

der s t an di n g ear t o what they had to say .

In the midst of all the horror and the degrada

tion with which the care of the insane has b een
surrounded a s a result of ignorance and fear there
have always stood forth c ommanding p ersonalities
who have preached the gospe l of love and have en
dea v our ed b y the force o f their no b le exam p le to
introduce a spirit of kindliness and human itarianism
into the work Such men for exam p le were C e l sus
.
, , ,

who nearly t w o thousand years ago advocated quiet

walks in beautifu l gardens music hydrothera p y , , ,

reading meditation in the treatment of mental dis

, ,

ease ; Pine l ( 1 74 5—1 826 ) who in the latter part of the

1 8t h century struck the cha ins from the un f or t u
,

nate inmates of the Paris hospitals ; R ei l ( 1 759

1

1 8 1 3 ) whos e work on the treatment of menta l dis

eases mi ght b e read with p ro fi t to day and l ater in -

, ,

our own times and withi n comp aratively recent

years Dorthea L D ix ( 1 802
,
whose name is .

in timately connected with s o many hospita l s f or the

ca re of this cl as s of patients in the United States ,

and l ater stil l B eers through whose activities the

2
, ,

N ationa l C ommittee for M ental Hygiene came into

exi stence .

1 8 ee t he a uthor s ’ “Re i l ’ s Rh
a p so dieen ,
”
JomN '
. er o . and M ea t .

Die J n ua ry 1 91 6
a

Cliff or d W Bee rs A Mi n d th at m I ts l f
.
, , .

“
2 F ol d An Autob iog
N ew Y or k
. : e ,
”
r a p hy . 1 91 3 , .
 TH E I N S AN E 6 9

As a resul t of humanitarian endeavour the care

of th e insane emerged from the dark ages control led ,

by su p erstition into the phil anthropic p eriod The

,
.

history of this movement in thi s country b egan ,

about a hundred years a go The idea of kindnes s

.

was b rought from E ngland l argel y by the "uakers ,

who first gave concrete ex p res sion to their view in

the in stitutions in Pennsylvania and this idea ,

s p read and b rought to its s tandard many men and

women of no b le sel f s a cr ifi cin g character and
,
-

there grew out of it the doctrine of non restraint -

whi ch has b een so splendi dly put i nto o p eration b y

such men as Page i n M assachusetts and there fur
, ,

ther grew out of it the idea of treatment by indus

trial occu p ation which is used to such good a dv an
tage in so many institutions at the present t ime .

Al l these develo p ments were use ful and served

valuab le ends but they were not satis fyin g It was
,
.

st ill felt even a f ter the develop ment had proceeded

,

along all these li nes and reached a fair degree of

p er f ection that after all the great hospitals for the
,

care of the mentally di seased were largely b oarding

houses where group s of peo p le who were inefficient
and could not get along in the social mi lieu were
brought and housed treated kindly to be sure and
, , ,

given o pp ortunity for occu p ation t o whil e away

otherwise idl e hours but that aside from removin g
,

them p articularly in acute condi tions from the cir

m
, ,

cu s t a n ces in which and a b out w hi ch their di sorder

develo p ed aside from thi s one thin g w ith of course

, ,

good feeding and housing a side from this there

, ,
70 MEN T AL H YG I EN E

was very little practica ll y nothi ng done in the way

,

of actual treatment .

The most signi ficant attemp t to de fini tely intro

duce the therapeutic idea into these h OS p it a ls wa s
made through an e ff ort to conduct them after the
same m ann er a s the general hospital s Patients .

were received and placed in b ed trained nurses ,

were provided for their care and most careful ex

m
,

a in a t i on s and o b servations were made tem p era ,

ture puls e respiration were recorded the physical

, , ,

examinations of the internal organs were carefully

gone into and every attem p t wa s made to di s cover
,

any p hysical illnes s which might b e present and to

care for the physica l health on the theo r y that in
s ome way the mental state wa s dependent u p on it
m
.

Thi s general hos p ital idea had much to com end

it much indeed whi ch w a s not conceived of by those
,

who originated it The tr ai ning schools for nurses

.

are the outgrowth of this idea and in its o p eration ,

it b rought to the care of the mentally diseased p a

tient a hi gher grade of care taker and one who the
-

hospital made considera b le e ffort to specially equi p

for the work The trained nurse as a graduate
.

of the hos p i tal training school was therefore m o r e

e ffi cient and more inte lligent and the patient b ene
,

fi tted accord ingly

m
.

Stil l with all thi s and with a l l the i provements

,

whi ch resul t ed there was sti ll di ssatisfaction f o r ,

after a l ,l the actua l prob l em the treatment of the

,

menta l disease itself not a s an outgrowt h an a d

, ,

jun ct or a dependency of some physica l troubl e ,

,
 TH E I N SA NE 71

but as a thin g in itself as it usually is the actual

, ,

treatment of the mental disease per s e was not really

touched Kindliness was the order of the day was
.
,

the idealtowards whi ch every on e who entered into

the work was made to look ; greater intelli gence
p ermeated the entire situation and yet and here is
, ,

the sign ificant thing not greater intelligence a b out

,

the actua l mental disease itself Very little in all

.

this time had actually been learned a b out what

menta l disease really meant It was still a b out as
.

much of a mystery as it had been when it was su p er

s t it i ou s l
y regarded as the result o f divine ins p ira
tion or diabolical p ossession Such su p erstition
.
,

to b e true had left the stage and left f orever b ut

, ,

nothing had e ffectively ta k en its p lace With the .

exce p tion of a few con di tions de p endent u p on gros s

injury or diseas e of the brain we were in as much
,

darkness regarding the un derlying factors of dis

eas e as had b een our p redecessors of generations b e
f ore .
“ ”
C raziness was for the most p art still just
“craziness ” and while ignorance and fear had been
,

rob b ed of the p ro p s of su p erstition they were st il

,
l
very much in evidence on their own account .

Perha p s throughout this stage of develo p ment

that I have b een tracing this stage of transition
, ,

from the p eriod of superstition to that of p hi lan

thr op y in whi ch the idea l —
, kindn es s —was the goal
, ,

toward which every e ffort was di rected the most ,

constant matter for controversy was the doctrine of

non restraint There seemed to be a constant tend
-
.

ency of the whole question of the care and treatment

72 MEN T AL H YG I EN E

of the mentally diseased t o revol ve about thi s prob

l em and yet t he amount of cha n ge which was gradu
,

ally wr ought in th e matter of physical restra int wa s

p erhaps on the whole very small as com p ared with
the amount of agitation which the sub j ect received .

Institutions during the past generation at least

, ,

went on and continued to go on much as they had

b efore while here and there came forth a man like
,

Page a lready mentioned who stood out for a b solute

, ,

non restr aint and who succeeded in e ff ecting his

-

ends b y giving an enormous amo unt of p ersonal a t

tention an d never ending vigilance to that particular
p ro blem Other institutions went their way with
.

out very much change unles s they were brought to

,

book by serious criticism and still others and this

, ,

app lies perha p s to the l arger number substituted ,

chemical restra int for p hysical restraint a s ub s t itu ,

tion of very doubtful advantage Patients from b e

m
.
,

ing manacled tied p l aced in ca i so l es or under

, , ,

strong sheets were made continuously stu p id b y

,

the admi nistration of powerful drugs This largely .

was yielding to the l etter of the new ideal but not ,

to its spirit The humanitarian movement the c i

.
,

forts towards kindli ness and consideration in the

treatment o f these unfo r tunate peop l e seemed still
to be e ff ectually stopped b y the same factors that
wrought such havoc hundreds of years b efore ,

i gnorance and fear Progres s beyond a certain

.

p oint seemed p ractica lly im p ossi ble except a s here

,

and there it was the reflection of s ome great person

a lity To ill ustrate the state of a ff airs I wi ll quote
.
 TH E I N SA NE 73

from the preface of an anonymous p ublication of

1 823
“ ”
It is called Sketches in B e dlam and con
.
,

tains a short account of that hi storic institution to ,

gether with the case hi stories of a considerable num

b er of its inmates “Among the great charitable
.

estab lishments of the B ritish empire t hi s holds a

-
k
p re eminent ran and by the exce ll ence of its regu
,

la t i on s and medical treatment it may be justly con

m
,

s id er ed a mode l of i i tation for all E urope F or .

this rare imp rovement B ethl ehem Hos p ita l is in

debted to a series of measures p lanned and executed
,

with consummate wisdom and indefatigable p er

severance E xperience was the grand b asis of these
.

measures D uring a l ong min ute and patient in

.
, ,

v e s t iga t i on carried on through successive sessions

m
, ,

by a Par liamentary C om i ttee the practice adopted ,

in a ll other establ ishments of a similar nature ,

whether publi c or private throughout the United

,

Kingdom was di ligently examined ; the skill and

,

op inions of a ll the medi cal men most conversant

with the su b j ect were attentively consulted and
,

compared The detection and reform of errors and

.

abuses arisin g from ignorance apathy ca p rice

, , , ,

or crue l ty , which had been too l ong p revalent con ,

sti t uted the happy result of that l ab orious but ,

humane inqui ry ; and b enevolence was never per ,

ha p s consecrated b y a nob ler triumph than when

, ,

it was satis f actorily demonstrated that force and ,

terror instead of alleviating tended but to a ggr a

m
, ,

vate the i series and horrors of insanity and de

l m
i r iu . The phil anthropic views of the B ritish
74 M EN T A L H YG I ENE

l egislature and the B ritish nation were at l ength

realized H arsh usage and irritating coercion gave
m
.

way to ildness f orb earan ce , and indul gence , and

’

the wretched inmates of thi s asylum of menta l de

rangement were li b erated from unneces sary vio
”
lence intimidation and solitary co n finement
, ,
.

Surely thi s might have been written yesterday .

The o b j ects the aims are our own o b j ects and aims
, , ,

the intentions are a s good as they coul d b e Wh en .

we turn from this p reface to the a c count of the

cases we fin d that the fi rst ca s e Patrick Walsh , i s ,

descri b ed in considera ble det a il L et me quote you

.

from the description of his ca se A fter having

k
.

illed a fellow patient the foll owing is a descri p tion

of the means that were taken to restrain hi by the m
kee p er .
“ He had put on him at first a pair of hand
cuff s of extraordi nary strength made p urposel y for
,

hi mse l f whi ch he broke in a very short time The

, .

kee p er then put on him , by order, two pairs of the

common handcuff s ; but these with in two hours ,

afterwards he sma shed into a hundred piece s It

, .

wa s then fo und neces sary to contrive other means

for his restriction , consisting of an iron cincture
that surrounds hi s waist with strong handcu ff s a t
,

t a ched to it sufficient to check his powers of manual

,

mi schi ef but with liberty for a l

, lhis requisite occa
sions of food drink taking s n ufi etc etc Such
, ,
’
, .
, .

are the means for his restraint day b y day : not

p ainfulto him but merely for the safety of others
, .

A t night it is found neces sary to fasten him by one

hand and leg t o hi s bedstead , with strong l ocks and
76 M E N TAL HY G I ENE

oth er than the ex pl anation which occurs to her of

innate cuss edness and yet the girls and b oys that
,

were b rought in from the surrounding districts to

take care of thes e patients di d measure u p in a way ,

that is nothing short of remarka b le to the demands ,

that the institutions made upon them I do not .

know of any greater tri b ute that could be paid to

m
the innate decency of hu an nature than the tri b ute
that is paid every day b y the young men and the
young women on the wards of institutions caring
f or this clas s of patients who have nothing within
them to draw u p on b ut just their s p irit of in dl i k
, ,
m
ness gentlenes s and sy p athy without in the ma ,

jo r i ty o f ca ses one b eam of a real intelligent a p p r e

c ia t i on of what it a l lmeans It b ecame apparent
k
.

that s ometh ing more than indness was needed and

that s omethi ng more was knowl edge .

T HE IDEAL OF " N O W L E DG E
It ha s b een shown in the pre v ious cha p ter how
peo p le are continually trying to escape from the
demands of reality Thi s is the key to the under
.

st an ding of the p sychosis In the p sychosis there is

.

a very successful flight from reality s o succes sful

‘
,

in fact as to quite inca p acitate the patient for li fe ex

cept in a well protected situation usually an in s titu ,

tion The p sychotic however does something more

.
, ,

than run away from reality I n p lace of the world

.

he ca n n o t live in he b uilds a new world in which he

ca n l ive
. I t is ou r b usines s to try and fin d out a b out
thi s worl d of hi s a s a necessary p recondition to an y
 TH E I N SANE 77

inte lli gent e ffort to hel p him back into the world
shared in common b y hi s fellows To do this we .

must learn to understand hi s language b e ab le to

know what his delusions m
,

ea n . This is the ideal of

kn owledge the inter p retative p has e in our study
,

of the psychoses which must re p lace the sim p le de

scriptive p hase which was satis fi ed with recording
a symptom and thought no more about it W e must .

learn to read meani ng into the symp toms of mental

di seas e just as p hysicians in other dep artments of
me d icine have learned to read meaning into the
sym p toms of the di seases they treat T o inquire .

into the meaning of a delusion is on a ll fours with

enquiring into the meaning of an eruption and a r i se
in temperature .

N ot only is this true from the scient ific point of

view but it is equa l ly true from the p atient s p oint ’

of view . Any one who has b een ill n ows how i k m

p ortant it is for hi s peace of mind to feel that the
physician understands hi s symptoms it is the b asis
m
,

of co nfi dence . I t is equally true of mental s y p

toms and without doubt a great amount of the fric
,

tion b etween patient and institution is b ased solely

u p on this ignorance An individual society dis
m
-
.

har ony has only t oo frequently in the p ast b een

, ,

re p laced b y a p atient institution on e when the men

-

tally il lperson was committed .

An attit ude on the p art of the institution that sees

in a rest l es s irrita b ility sim pl y somethin g to be r e
p ressed is not only unintelligent b ut invites a con
t in ua ti on of th e very condition it i s tryi ng t o do
78 M EN T AL H YG I ENE

away with and hel p s by the very repressive meas

ures used to e ff ect t hi s end and to create and con
tinne th at patient institution di sharmony upon whi ch
-

it is very frequently b ased .

T o give an examp le : A patient kicks out a l ot of

window lights in a paroxy sm of un c ontrolled irri
-

ta t i on perha p s cuts himse l

,
f in s o doing gets into a ,

general squabble with his care takers who en deav

m
-

our to restrain hi mayb e wi th the result that the

,

p hysician in charge of that de p artment is tele

phoned for N ow if knowledge is not the idea l of
.

the institution how sha ll such a situation b e dealt

with ? The patient ha s been irritated has b een di s ,

t ur b ed ha s yielded to his irritation has gotten into

, ,

a mix up a general disturbance on the ward ha s

-

resu l ted a lot o f window lights have been kicked

,
-

out one or t w o p eople have b een struck and tem

, ,

p or a r i l
y the whole ward ha s been thrown into con
.

situation ? Si m
fusion What can be the obj ect in dealing with thi s
m
y that the p atient must b e s o cared
for that he cannot go on b reaking out window lights -

that he cannot go on getting into squa bbles with

other people that he cannot go on str iking kicking
, , ,

tearing How is such a thing to be accomp l ished ?

.

There are not very many ways The natural way in .

recent years would be to give him a hyp odermic or

some powerful drug which would p ut him t o sleep .

A l ittl e l onger ago he wou l d have been put in a cami

so l e and in any ca se he i s shut up in a room by him
,

self perha p s fastened to a bed the ward is r e

, ,

adjusted the lights are p ut b ack in the patient con

, ,
 TH E I N SA NE 79

tinnes in more or less restraint for an inde finite

p eriod of time from which he may gradually emerge
,

to repeat the same kind of p rocedure with the sam e

kind of results N o matter how much kindlines s
.

may ani mate everybody concerned it wi ll b e agreed ,

that nothing es p ecial has b een accomp lished exce p t ,

that the p atient has been succes sfully re p ressed ,

usually very much to hi s discomfort s ometimes to ,

hi s actual terror N ow if the ideal of knowledge I s

.

the ideal which animates this institution what will ,

happen ? Th e doctor will come to the ward he wil l ,

dres s the wounds of the p atient if there are wounds ,

to dress and then what will he do ? Th e natural

m
,

thing for hi to do if such an occurrence as this is

,

perchance the fi rst in the history of thi s patient is ,

to try to fin d out what it means why did the p atient ,

smash out thes e window lights was he disturbed ir

-

, ,

r i t a t ed b y s ome b ody else a b out him and if so could ,

a l ittle different distribution of p atients be made t o

their mutual advantage or did the cause lie withi n
,

himsel f ? Was smashing out the window lights a -

certain ex p ression of s omething that was going on

within ? C ertainly there must b e s ome reason why
the p atient b roke out the wi ndow lights and did not
break furniture why he did it at that particular
,

time and why as he p ro b ab ly did he got relief from

, , ,

s o doing . The whole attitude of the physician to

wards the p ro b lem wou l d b e to endeavour as far as ,

p ossi ble to try and fin d out the answers to all thes e

,

questions and he will try and fin d out not only from

,

the p atients b ut t h e nurses ; he wi l l question every

,
80 MEN TAL H YG I ENE

b ody for l ight on the situation so that it may b e dealt

with more intelligently s o that p erha p s the knowl
,

edge gained may b e u sed to the advantage of the p a

tient and hel p in a little way p erchance towards his

recovery C an not you see how such an attitude to
.

wards such a situation s inks a llquestions o f p er

sonal irritation ? There no l onger i s any problem
of whether the patient is to be roughl y handl ed ,

strapped up in some restrain ing a p paratus terri ,

fi ed hu r t
,
N othing p ers onal can enter into thi s ex
.

cept the love which the doctor has for hi s work and
whi ch is reflected in t hi s individua l S ituation D oc .

tors nurses p atients every on e see an abso l utely

, , , ,

new attitude toward t hi s kind of occurrence an a t ,

ti tude of trying to understand tryi ng to fin d the ,

meaning in the peculiar aberrant distorted ways in

, ,

which only the p atient i s a b le t o ex p ress himself ,

for remember the patient speaks a l anguage that

we must learn We can not ex p ect hi to s p eak our
. m
l anguage we must learn his and this attitude of try
, ,

in g to understand i s on e o f hel p fu lnes s c on s t r uc ,

tive he lpfulness never on e of kin dl iness alone which

, ,

may easily degenerate into sentimenta lity 3

It is .

constructive and he lp ful it does away with the n e

,

ces s ity for meeting other p rob l ems for the minute

m
,

such an idea l do inates thes e prob l ems cease to ,

exist .

In an institution dominated by the idea l of seien

8 O f course I d o n ot m ea to be u d erstoo d a s im p l yi n g th at ki n d
I t is b ut t he i dea l of k
n n

n e ss is n o l o ge r an i d ea " i n dn e ss is th e
k i n dn es s th a t is groun ded i k
n .
,

n ow l edg
n e .
 TH E I N SA NE 81

t ifi c knowl edge thi s ideal wil l so permeate the a t

m
,

o s p h e r e and its e ff ects wil

l b e s o p ro f oun d u p on
the s ta fi u p on the employé s u p on a l
,
lin fact that
, ,

there wil l gradually grow out of such a new stand

p oint a hospita l fi nally and everlastingly free from
the shackles of ignorance and fear a hospital in ,

which the patient will be received with the same un

der s tan din g attitude that the patient wi th p hysical
diseas e is now received in a general hospital and ,

when the patients are s o received and when they ,

are s o dealt with the number of instances of vio l ent

k
,

outbrea s serious injury of resorting to terroriz ing

, ,

and re p res sing measures will s ink to an in con s ider

,

a b le minim um .

If there i s going to b e antagonism between the

institution and the p atient it will begin the moment
the patient is received If the idea l of scientifi c
.

knowledge dominates the hospita l the patient will

be received into an atmosphere that he fee l s at once
to b e filled with interest desire to understand con
, ,

stru ctive hel p fulnes s and from the very fi rst there
,

will be no occasion for that revul sion in his fee l ings

m
which s o sensitize hi to i rritation and s o lay the ,

foundation for future out b reaks of irritabi lity r e

m
,

s en t en t resistance to the institution environment

,

and in fluences .

The introduction of the ideal of scient ific knowl

edge p laces the whole institution u p on a higher
p lane not only in the community but in the minds
, ,

of the very people who make u p its p ersonne l The .

p hysician is di gn ifi ed by being no l onger a boarding

82 MEN TAL H YG I ENE

house keeper but a professional an practicing his

,
m ,

p rofession with a full eq ui p ment of the necessary

tools He wil
. l be placed in a di gn ified p osition
which w ill command the respect of his profes siona l
brethren The hospital wi l
. l a ssume i ts proper p lace
in the community a s the s ource of a ll the best in
f ormation about menta l diseases and menta l medi
cine ; the p hysicians wil k
lta e their natural p l aces a s
p os sess ors and exploiters of that knowledge ; the
nurse willfeel that s h e is trul y practicing a de finite
nursing specialty based upon scientifi c experi ence
,

and not upon a lot of sentimenta l p l atitudes ; and

the communi ty wil lfee l that they have in their midst
a truly representative in stitu tion whi ch stands in a
p osition to e xtend aid to them when they need i t ,

aid of th e most approved recent and valuable kind

, , .

The French fail ed to build the Panama C anal not ,

b ecause of any inherent defec ts in the French as a

p eop l e but becaus e the ta sk at that time was not
,

humanly pos sib l e The hospital s for example

.
, ,

which they buil t upon the Ist hmus were provided ,

among o t her thi ngs with l arge quantities of tropical

,

plants whi ch of course had to be kept pro p erl y w a

,

t er ed in order that they might grow These p lants .

,

with their little puddles of water standing a b out

them were the very best breedi ng p l aces in the
,

world for the mosqui to It was not kn own then

.

that the mosquito ca rried mal aria and so in their ,

efforts to take care of the sick they did the one thing
above all others that defeated anything else that
they might do they provided the very means for the
,
84 MEN TAL H YG I EN E

to a still higher stage — the period of knowledge

, .

Know l edge and knowledge alone will p rovide the

,

data make possible the s olution of the many p rob

,

lems involved and fin all y and most important of all ,

it will be the means of deve l oping principles which

wi ll e ffective l y bring this branch of medic ine within
the fi eld of endeavour of preventive medicine The .

great hospital s for the in sane must become the

la b oratories where thes e immense l y ixfip or ta n t s o
c ia l problems are worked out The knowledge
.

which is pr imaril y needed is the knowledge of the

nature of the psychi c disharmonies which are at the
basis of mental diseas e and to which in specific ,

in stances we give the name of conflict .

T HE CO N FL I C T
Th e antithesis of instinct which seeks the f a
,

mil iar, and the reality motive whi ch urges the in

dividua l fo r ward and into the region of the un
known ha s a l ready been indicated in the previous
cha p ter E very psychosis —menta l diseas e—c an b e
,

understood a s such a conflict This however is not

.
, ,

sayin g enough E very p sycho l ogica l integration

.
,

and for that matter integration at all other levels

resul ts from just such conflicts The confl ict states
.

the probl em , the signi ficant t hing i s the way in

which it is answered It may be pict ured as two op
.

p osin g forces meeting on a certain pl ane The r e .

sult may be the yi elding of one and the ascendancy

o f the other ; a re p eated vacillation fi rst one and ,

then the other gainin g the ascendancy ; disaster by ,

 TH E I N SA N E 85

the smashin g of on e b y the other ; or finally a higher

in tegration in a new setting For example : The
.

conflict is between the fl ex or muscl es and the exten

s or muscles of the l eg . One may overcome the other
—the leg is either flexed or extended ; neither on e
is a b le to dominate— the l eg alternates between par
tial fl exi on and partia l extension ; one force breaks
—
through the resistance of the other the bone is
broken ( fracture of the knee cap—a not unusua l r e
sult of sudden extension when time i s not given in a ,

sudden e ffort at extension for the fl ex or s to relax )

,

or a well adjusted movement for the accom p lish

ment of a given end b y the orderly and integrated
action of both s ets in harmony i e whil e one set
,
. .
,

of muscles is being flexed the oppos ing group is

corres p ondingly extending .

This illustration may be taken over to the p s y

ch ol ogi c a l leve l
. A wish is carried into execution
—there is a s imp le overcoming of o pp osition ( the
in dividual overcomes his inertia in face of a task )
neither tendency is a b le to overcome the other—a
state of dou b t results in which fi rst one and then
the other course of conduct is decided upon ; on e
smashes the other instinct su cceeds in shuttin g
-

out reality— a p sychosis results ; or a higher integra

tion is reached by comb ining both motives in a s ubl i
mate d socialized form of conduct
, .

A p sychosis results when reality is overcome .

The p atient becomes asocial and then can onl y carry

out his wishes b y a form of conduct w hich 1 s recog
n iz ed a s evi dence of sickness A boy for examp le
.
, ,
86 MEN TAL HY G I EN E

the ca s e already cited ( Cha p ter III ) wishes to over ,

come hi s father and develops a peculiar feelin g in

,

his a rm thus re p roducing a p sychologica l situation

,

in which he had previously succeeded in doing s o .

A p atient who once because of a neural gia of the

,

arm muscles coul d n ot work later deve l ops pain in,

the arm muscles of p sycho l ogica l origin ( psycho

,

ge n ic ) in fear of a new situation when confronted

b y a ta sk she does not wish to p erform The en .

e r gy in these ca ses is not available for adequate a d

justment the conduct is inadequate to the situa

,

ti on.

In sublimated or s ocializ ed integration the two

,

forces are gathered u p in a higher synthesis The .

desire for wealth is s ocialized along thos e acce p ted

lin es of activity which are recogn iz ed a s being l egit
m
i a t e ways of obta inin g it .

N ow from thi s p oint of view it wi ll be seen ,

tha t a c o n flict can only meet a socialized solution

either by repression— the overcoming of instinct by
the reality motive—o r better yet by a higher form
-

of integrati on in which b oth motives are made t o

su b serve a hi gher end A s im pl e story wi l
. l i ll us
trate this apro p os at this p oint of the illustration
, ,

o f the exam p le of the unruly patient who became ex

cited and broke out some window panes Once u p on .

a time s o the story goes there were a number of

, ,

students col lected in a laboratory ; they were dis

cus sing various pro blems among themse lves ; they
had just entered a room together and a s they en ,
88 MEN TAL HY G I EN E

s olved Knowl edge had di ssipated the necessity of

.

a solution because in the light of that kn owl edge

,

there wa s no pro blem

m
.

Thi s story tells in a s i fl e way the story of the

resolution of the conflict It shows how the intro .

duction of a new element knowl edge could gather , ,

u p a ll the confli cting p oints in the evidence and

bring them to a satisfying syn thesis and how as
'

soon a s this wa s done there was nothing further to

,

discus s—the confl ict wa s at an end It is an illus .

t r a t i on of the idea l of knowledge .

N ow the patient in a hospital who i s unruly as

, ,

thi s on e was and who acts instinctively if met by

, ,

just repres sion on the part of the hos p ita l a uth or i

ties i s not hel ped in any way The various acts of
, .

repression restraint ( physica l or chemi ca l ) are

,

themselves inst inctive acts and at the same l evel as

those of the patient The patient may be overcome
.

but nothi n g ha s been accom pl ished that is con s t r u c

tive T o s ucce ed ther e us t be to use a lega l m
m
e e ti n g of m
.
,
“ ”
phra se a ,
in ds a n d n ot jus t a cl
as h

i n g of i n s tin c ts . Such a disturb ance as descri b ed ,

due to a clashin g of instincts i s an artificial creation,

of an environment incapable of adequately dealing

with the situation In an in stitution dominated by

.

an e ff ort to understand and hel p ( love ) such a situa

tion woul d not arise or at l east not as frequently
, ,

and when it did would be met in a constructive way .

By this I mean it would tend to b e met in that way

in which every d iffi cult situation in life shoul d be
met—by tryin g to learn that from it which woul d
 TH E I N SA NE 89

be hel p ful in avoidi ng such things in the future .

I f patients are dea l t with in thi s way then such an

outbreak may be of the greatest value in b ringing
them to such an understanding of themselves a s will
be hel p ful in b ringing about that readjustment
which spells recovery .

T HE H OSP ITAL
In the p ast few years a great change has come
over many hospitals for the insane Th e im p rove
.

ment in conditions is evident to the most casual oh

s erver There does not b egin to be such a large
.

clas s of noisy, filthy and destructive patients an d ,

throughout the institution there are all sorts of evi

den c es of im p rovement not only in the p hysical
m
,

surroun dings b ut in the state of i nd of the p a

t i en t s
. They are more at home , more comp osed ,

calmer and happier—in short they are b etter a d

justed to a better environment If the s up er in
.

tendent of such a hospita l were asked to what the

imp rovement was due he would p roba b ly have a
good deal of di fficu l ty in findin g an answer , in put
ting his finger upon any S p ecifi c explanation Thi s .

would particul arly be s o i f he had only b een in the

work a short time , if he had not lived through the
transition period and s een the changes slowly
brought about The truth of the matter is , there i s
.

no s p ecifi c reason for this great change It has .

b een brought about by a multitude of causes among ,

which im p ortant ones are the taking over b y the

State of the care of the insane ( State care ) whi ch
90 MEN T AL H YG I EN E

has meant the abo lition of the C ounty syste , the m

county havin g been proven to be too sma ll a politica l
unit to gra p ple with such a l arge pro b lem : the r e
moval of the hos p ita l from poli tics and s o sav ing
it from the evil s of a p olitica l spoils system : p l ac
ing the contro l of the hospita l abso lutely in the
hands of a physician and so reco gniz ing the over
whe lmingly medica l character of the p rob l ems : the
ma intenance of tra inin g schools for nurses in the
hos p ital and s o raising the standard of care and of
the care takers : placing p hysicians under C ivi l
Service regulations and basin g p romotion on merit ,

t hus attracting a better clas s of medica l men to the

work ; th e introduction of courses in menta l medicine
in th e various medica l colleges and s o better equip,

p ing physicians for s p ecializing in this fi eld : rec

‘

ogn i t i on of the evil s of over crowding and a cor

-

res p ondi ng attem p t to correct them : the incorpora

tion of industries and the cons equent em p loy ent m
o f a larger number o f patients Allof these have .

b een factors in the net res ul t and in fact many , ,

more ch anges have contributed to that end but

thes e are p erha p s the most important Su ming . m
them all u p they are moves in the direction of a
greater knowledge of the prob l em of the dee p er n u ,

der s ta n di n g of the insane and of the nature and

meanin g of menta l disease .

W hat ha s b een accom plished by the hos p ita l s

4 S tr an ge as it my
se m it is o n l y withi com p a ra tiv ly rec t
a e n e en

y rs th a t an y a ttem p t ha b en mad e to system tica lly tea ch

ea s e a

p sychi a try in t he m ed ica l schoo l s .

92 ME N T AL H YG I EN E

forging ahead on the p ath of scientific progress

th e ideal o f nowl edge k .

TH E AGE NC I S
E

Th e St at e s — The
Hosp i tal agencies which are
avail a b le for atta cking the p rob l em of mental dis
m
eas e in the com unity are first of a ll the large State
Hos p itals which are the natural centers in their sev
m
era l co munities from which all good infl uences
should have their origin Somethi ng of the history .

o f the development of these institutions and their

pres ent tendencies I have a l ready indicated A side .

from takin g ca re of and treatin g the cases sent to

them they should be the natura l p l aces to turn to
for a ll information of any sort on the su b j ect of
menta l dis ease and for as sis tance in a ll of the prob
,

l ems of the community into which this p ro b lem en

ters They shoul d be a s much the centers of in
.

formation and a s sistance along these l ines as the

ol d G othic C athedrals of E uro p e were the centers
of the re l igious busines s and s ocia l li fe of the dis
,

t r i c t s in which they were l ocated .

Th e Ps ychop athi c Hos p i t al_Th e psychopathic h o s .

p ita l is the receiving hospita l f or menta l cases in

the l arger cities Here all menta l cases are r e
.

c e iv e d and recl a ssi fied some going to the State Hos

,

pital some going home s ome remaining a short time

, ,

for treatment etc It is the clearing house for men

, .

tal di sease in the community

Di ap ens ar y Servi ce —Out patient service i s begin
.

-
.
 TH E I N SA NE 93

ning to b e estab lished in connection with dis p en

s a r i e s as mental disease i s comi ng to b e d ealt with

b y the medical p rofession outside of th e asylum

walls— extra mural p sychiatry The out p atient .
-

service t yp ically originates in the State Hos p ital

and the Psycho p athi c Hos p ital and l ater b ranches
out f rom neurologica l clin ics in genera l di s p ensaries .

S oci al S ervi ce — In connection with State Hos p i

tals Psycho p athi c hos p itals and dispensaries field
, ,

workers p ut the medical o ffi cer in touch with outside

living conditions and co o p erate in hel p ing the hos
-

pital to discharge p atients more intelligently and ,

als o in hel p ing to readjust l iving con d itions e s

p ec i a l ly along the lines that had responsi b ility for
the mental b reak .

Afterc ar e — A further kind of s ocia l service cal

c ul a t e d to assist the di scharged p atient to r eh a b il
i
tate himself in the community .

Oth er Soci al Agen ci es — Various socia l and char

.

i ta bl e organizations both p u b lic and p rivate are

constantly running acros s the p ro b lem of mental

di sease . Al l sorts of distress poverty and crime
,

are comp licated or more or les s de p endent u p on this

cause I t is for exampl e the underlyin g factor in
.
, ,

many of those mal adjustments that fin d their way

-

to the juvenile courts the truancy o ffi cers etc The

, , .

p o lice are meeting it at every turn It is essential .

that all thes e agencies—the social worker the after ,

care worker the juvenile court the p sycho p athic

, ,

hos p ital the dis p ensary the State hos p ital the p o
, , ,
94 ME N T A L H YG I ENE

li ce—should all c o operate and s o by preventing

-

doubling on each other s tracks get the greatest ’

e fficiency with the l east l ost motion

The Nati on al Com m
.

i tt ee —The N ationa l C ommit s

tee for M ental Hygiene with central o ffi ces in N ew

Y ork C ity , supported by private funds is conducting ,

a country wide movement with branches in many

-

States ( eighteen at the present writing ) for the bet

ter ca re of the insane Its chief pur p oses are .

“To work for the conservation of menta l health to

;
promote the study of mental dis orders and mental
defects in a ll the i r forms and relations ; to obta in
and disseminate re lia b le data concerning them ; to
help rais e the standards of care and treatment ; t o
hel p c o ordinate existing agencies Federa l State
-

, ,

and local and to organize in every State an a ffiliated

,

Society for M enta l Hygiene ” 3

.

T H E M EANS
The means which must b e empl oyed working
through all these various agencies must have three
l arge ends in vi ew— The getting at the individual
patient and hi s p roblems ; the getting at those p ro b
l ems in a broad enough way ( his socia l environ
ment ) s o a s to be able to help hi ; and l ast b ut not m
l east the actua l discove r y of the p atient in the first
,

Those w h ar i n te reste d shou l d by a ll m ea n s r ea d

0 o e Mi d “A n

Th at Foun d I tsel f by C l iff or d W Bee rs an d wi th more es p ci l

, ,
”
, .
, e a

re fe r ce to t he N a tio n a l Committee P a rt V o f t he revise d fourth

en ,

edi tio of th a t work gi vi g a a ccoun t of t he ori gi n a d growt h of

n n n n

the M t l H ygi e e mov m en t w hich has r e cen t l y been p u bl i sh ed

en a n e

as a s p a r a te
,

e .
96 MEN TAL H YG I ENE

with it but a s to the pro b lems of the mind sho uld

,

deal with them en ma s se and purely from an ex

p e d i e n c y standpoint Patients who
. were fil thy were
p ut together patients who were noisy were put to
,

gether patients w ho could have p arole were p ut

,

together etc etc and th e matter rested there

,
.
, .
,
.

Thi s was the s tate of a ff airs that confronted the new

scient ific era in the care of the insane while the ,

advances in p sychology which had meanwhil e b een

made made it cl ear that the thera p eutic a pp roach to
the psychoses must b e exquisitely individual The .

princi p le is plain ; the p sychotic p atient is as much

entitled to have his delusiona l system treated with
detailed care and intelligence a s is the general hos
p ita l patient entitled to have his broken leg treated
i n that way . This statement sounds axiomatic b ut
if a patient has the idea that electricity is b eing
“turned on ” him or that he is b eing “doped ” or
he is suicidal the question i s What are you going
, ,

to do a b out it ? The old answer was to treat any

bodi ly illthat mi ght be present and so get them in
a s good physical health a s p ossi bl e and watch them
t o s ee that they did no harm .

The reason for the failure in the past to dea l even

inte l ligently with the psychoses is quite evident a s
already indicated ; in the p sychosis the p atient not
only withdraws from reality but tends to b uild u p an
artificial a p hantasy world in which he can live
, .

This phanta sy world i s not th e world you and I live

in and so the l anguage and the acts of the p atient
appear strange to us we cann ot understand them
, .
 TH E I N SA NE 97

It has been just as essential to learn the l anguage of

the p sychoses as it is to learn the language of b odily
“
disease the meaning of being do p ed must b e ”
,

fathomed in order to do anyt hi ng about it just as ,

the meaning of an alb uminuria must b e worked out

if we are going to intelligently advise our patient .

The language of the psychosis is symb olic just as i s

—
the language of internal medicin a broken cardiac
e

comp ensation is homologous to a delusional system .

N ow in the nature of things every one cannot read

or even learn to read this strange l anguage just as ,

every one cannot become a great surgeon The .

p ro b lem however narrows down how to get the in

, , ,

dividua l siz ed u p dealt with treated in accordance

m
, ,

with what is the rea l trouble with hi .

T his problem is bein g met in several ways ; by

larger s tafi s by better equipped s ta fi s as the med
ical colleges are b egi nning to teach psychiatry ; by
enlargin g the me dical sta ffs by the ap p ointment of
m
men who have little or no ad in istrative work to do
m
b ut occupy their whole ti e in scientifi c work ( p ath
ologist histopatho l ogist serol ogist p sychologist
, , , ,

clini cal director scientifi c director c lin i ca l p s ychia

, ,

trist p sychothera p ist ) The hos p ita l p o p ul ation i s

,
.

thus gradually being broken u p into smaller units s o

as to bring the indi vidual p roblem of the patient
ever closer to the surface .

Another healthy change is takin g p l ace namely a , ,

change in the attitude of p sychology towards the

pro blems Academic p sychology had l ittle interest
.

in the individual and les s interest in what might be

98 M EN TAL H Y G I ENE

trou bling hi m
. The fact that a man got into a quar
rel wi th his wife over what a p peared to b e a trifling
matter was none of its a ffair M odern psychol ogy
.
,

however is beginn ing to see that such pro b lems have

,

importance and to di gnify them with i t s attention

becaus e a f ter all it is the multitude of little things
that are happening all day every day that make up
th e l ife of the average p erson and not the unusual
and occasiona l if p erha p s more strik ing events If
, ,
.

p sychology i s ever to make a last ing contribution to

the art of right living it must occu p y itse lf with just
su ch p ro blems And when we come to take up a
.

di scussion of their lives with our patients we wi ll

fi n d that outwardl y whi le they may have ap p eared
common p lace that within th ey were the host of a
,

conflict that was tearing them asunder .

The original method of dealing with the insane ,

a s I have already s et forth was born of ignorance

, ,

fear and su p erstition The main e ff ort of thi s p e

.

r i od was to remove the insane person from the com

munity to segregate him in an asylum Then fol

, .

l owed the p eriod of philanthropy in which kindness

re p laced cru elty and the insane person was regarded
as bein g a sick p erson Then began the scientifi c
.

era in whi ch the asyl ums were changed in name at ,

l east to hos p itals and the e ff ort was made to dea l

, ,

with the mentally sick just as patients sick of b odily

di seas e were dealt w ith in genera l hO S p itals I n this .

period the p atien t wa s treated in bed hi s tem p era

,

tu re p ulse and res p iration were carefully taken and

,

studi ed ; s p ecia l dietaries were prescribed and e ff ort ,

1 00 MEN TAL H Y G I EN E

and o f ten can materially assist in readjustments p r e

paratory to discharge from th e hos p ital .

Thi s s ort of s ocia l work has been of great use in

exami ni ng into the s oci alconditions of patients r e
cen t ly admitted ; in helping to make readjus t ments
for thos e just or a b out to b e discharged ; and in
, ,

doing research work and follo w ing out s p ecial lines

o f in q ui ry .

3 Fi n di n g th e Pati en t — This even has to be done

.

in the hospital itself for with the immense number of

patients the individua l patient tends to get lost in
the shuffl e unless s omething unusual attracts atten
tion to him S o many p atients are of the shut in
.
“ ”

ty p e and natura lly eliminate themselves b y making

no requests accepting everything b e ing content
, ,

with being over l ooked that in the hurry of press ing

,

activities they succeed in getting side tracked Of -

.

cours e in a way thi s i s what they want but it is not ,

real l y what they want either and it becomes n eces ,

sary to create some meth od of reaching such p a

t ien t s .

I be lieve that the hospita l should have on e or more

psychoth erapists against the day when every p s y
c hi a t r i s t shall be trained in psychothera p y E ven .

with thi s equipment many patients wi ll not be

reached I am tryin g now by means of an intra
.
,

mural publication a s ort of newspa p er to create a

, ,

more help ful spirit of c o o p eration between medica l

-

o fii c e r and patient w ith thi s end in view among ,

“ ”
others of getting the shut in p atient on the b ack
,

wards to come forward and ask for he lp .

 TH E I N S AN E 1 01

A side from this p ro b lem there is , of course the ,

very l arge p rob lem of getting the mentally i l lcared

for as such no matter where they may be This
,
.

necessitates their recognition and als o the creation

of agencies f or their recognition and the a b ility of

such agencies to carry their p oin t At p resent in

.
,

the ceaseless gr ind of our courts hundreds of thou

,

sands of human b eings are consigned to one or

another sort of p enal institution every year for no
other reason than because they are mentally ill .

This only serves to make the sick sicker and from ,

every p oint of view is a waste f ul senseless unin

, ,

t el ligen t method of procedure that b rings good to

no one an d harm to many I will have more to say
.

of thi s as p ect of the question in l ater cha p ters p ar ,

t i cular l
y the next. Fully fi fty per cent and p ro b
.
,

a b ly more of the s o called criminals are mentally

,
-

ill about fi fty per cent of the prostitutes who come

, .

within the p urvi ew of the criminal courts and prob ,

ably a s large or a larger per cent of juvenile ofi en d

.

ers U ntil it is l earned to treat these persons for

.

what they are and not for somethi ng else very little
p rogress can b e ex p ected in so lving the prob l ems to
which they give rise .

T HE M E T H ODS
It will thus be s een that the p roblem of mental
disease is a l arge on e and far reachi ng It is a
-
.

p roblem whi ch has never b een adequately attacked

from the standpoin t of p reventive medicine and yet
m
,

it is one whi ch economically is of the greatest i

1 02 ME N TAL H Y G I EN E

p ortance b ecause no cl as s of p eople in the com

,

munity p ro b a bly cost more in dollars an d cents to

ca re for than the s o ca ll ed ins a ne A s it is at pres
-
.

ent however mental disea se goes largely un r ecog

, ,

n iz ed not only s o far a s our pub l ic hos p itals are

,

concerned b ut s o far a s a l arge num b er of the p r a c

,

t i t i on er s of medicin e are concerned and no e fi or t is ,

made to hel p inci p ient ca ses p revious to a frank out

cro p of sym p toms which makes their inca rceration
,

neces sary In fact these p eo p le have no p lace to go

.
, ,

exce p t in rare instances where they may get in t elli

,

gent ad v ice and s o the p ro b lem is not recognized

,

until it becomes self evident and b y that same token

-

until the period has passed when treatment might

a va fl .

It should be cl ear to those who are accustomed to

dea ling with medica l facts that the existence of
mental di seas e should be recogniz ed in a p ractical
m
manner b y ad i tting peop l e for advice and treat
ment to the vari ous institutions conducted by
medical charity on the same basis a s p atients are
admitted for treatment for other and in many ,

instances much les s importa nt maladies And

, .

when I say they shoul d be admitted on the same basis

a s other patients I mean that the various legal r e
,

strictions and disa b ilities from whi ch they are now

made t o su ff er before they can get anything like
m
adequate treat ent shoul d b e removed A s it .

s ta nds toda y the patient who fal

, l s down on the
street and b reaks his l eg not only may receive
k
prompt and s il ful treatment in a genera l hospita l
1 04 M E N T AL H YG I ENE

other purposes—medica l surgica l obstetri cal or

, , ,

what not with their res p ective specially trained men

,

in the p ro b lems invo lved This mean s that some

.

where in a city of any considera b le size there should

be wards specially designed and maintained for the
recei p t of patients suff ering from mental disease .

Such wards are usually ca lled p sycho p athic wards ,

p sychopathic clin ics or psycho p athic hos p itals

,
.

They may be organically connected w ith the general

hos p ital ; they may occu p y an isolated position at
s ome distance from the rest of the institution ; they
may be separate insti t utions a l together ; or they may
b e constructed se p arately but in as s ociation with
,

the other b uildings of a l arge general hos p ital .

Whi ch of the several plans suggested above is the

most desira ble is almost always a matter which has
to b e considered on the merits of the loca l situation .

Our American cities with their ra p id p atchwork

,

growth often p resent problems that make any solu

,

tion necessarily a compromise The ideal arrange .

ment it wou l d seem to me is for the city to have a

, ,

m unici p al hos p ital located not too near the heart of

the city and not too far away to be accessible but on ,

gro und sufficientl y extensive not only for the p res ,

ent purp oses of the hos p ital but for all reasona b le
,

future growt h The p lans of such an institution

.

should incl ude a psycho p athic ward .

The advantages of such an arrangement are mani

fold In the first place the p atient goes p rimar ily
.
,

to the b ig municip al hos p ital ; he goes to the medical

ward if he has pne umonia he goes to the surgica l,
 TH E I N SA NE 1 05

ward if he has a pp endicitis and he goes to the ,

psychopathic ward if he has mental disease He ‘

feels in this envi ronment the influence of the hos

p ital atmos p here he is where he b elongs he is in an
, ,

institution conducted for the care of sick p eo p le and ,

this feeling would b e doub ly strong if the municipal

ity in its wisdom could be induced to withdraw the
d isa b ling legal preliminaries Then again his rel .
, ,

atives feel more at peace ab out him when he is here

in t hi s b ig hos p ital than they would if he were
legally committed to an in sane asylum The u . m
n i cip a l
i ty is on the face of it endeavouring to treat
m
, ,

a sick man and not si p ly to S hut u p a cra zy on e

,
.

I t is the logical the humane a pp roach and not the

, ,

legal disa bling method of turning the back to a

,

disagreeab le p ro b lem and locking the door .

In addition to the advantages of an arrangement ,

as describ ed a b ove for the p atient and the patient s

,
’

relatives there are other advantages In the fi rst

, .

p lace the mental cases throughout the b ig general

,

hos p itals can b e taken where they belong just a s , ,

f or examp le if a woman is b rought i nto the medica l

,

ward vomiting and examination shows that s he is

,

p regnant and that the vomi ting is the result of her

p regnancy she may be transferred to the o b stetrical
,

ward where she will receive the best care and treat
,

ment f or the p articular condition from which she is

su ffering ; s o the mental cases in a general hos p ital
will go to the p sychop athi c pavili on where they will ,

receive the b est care and treatment In addition to .

that the psychopathic ward with its corps of trained

, ,
1 06 M EN T AL H YG I E N E

men wi ll be at the call of the other de p artment s of

,

the hos p ital E very p atient in the institution in

.
,

addition t o the trained advi c e of p hysicians and

surgeons in all the di ff erent de p artments of medi
cine wi ll have added to the list of men on whom he
m
, ,

can draw to hel p hi in ca se he needs it a p s ychia ,

trist .

This introduction of the p sychiatrist into the gen

eral hos p i tal is to my mi nd filled with the greatest
pos si b ilities for medicine We have always met on
.

the medical and surgical wards the neurasthenic and

the hysteric b ut how rar e it has been through the
,

years that most of us have l ived to see such cases

treated intelligently not to s a y sym p athetica l ly or
,

understan di ngly But the hysteric and the n eur a s

.

thenic and such other patent conditions are b y no

means the o nly ones in whi ch the psychi atrist can
b e of inestima b le s ervice to th e internist and the
internist can b e of inest imab l e service to the p s y
c hi a t r i s t
. There is literally a host of conditions that
lie on the borderland between internal medicine and
psychiatry T o mention one only there is that im
.
,

mense grou p of fever deliria of which every hospital

,

ha s i n numerable ca ses at all times The fever de .

li ria w ill no doubt some day throw a great deal of

, , ,

light on the functions of the high er ne r vous centres ‘

,

to say nothin g of the p ossibilities on t he or ga n ic

side In addition to this immense group of the
.

fever de li ria there are hosts of other cases where

,

interna l medicine and p sychiat r y must needs meet ,

and the sooner the better There are to mention .

,
1 08 MEN TAL HY G I E N E

meet its solution in the p sychi atrist s hands It is ’

.

true that the p hysical conditions are o f ten most

prominent and p erhaps require the most intensive
treatment A neuritis of the phrenic nerve for ex
.
,

ample is of course not pr imarily a matter for the

,

p sychiatrist but taking the pro b lem as a whole it

, , ,

b elongs in his doma in Patients that are admitted

m
.

are ad i tted almost invaria b ly b ecause of s ome di s

t ur b an ce s o f conduct They are either delirious
.
,

ha llucin ated or deluded in an active way which leads

,

to their arrest or to a pp rehensiveness or com p laint

,

on the p art of s ome on e as sociated with them In .

addition to this many o f them have actually com

m
,

i tted s ome overt act perhap s homicide and it i s

, ,

important that when under these circumstances a

, ,

patient is brought to the hospital he should at the ,

earl iest pos sib le moment be p laced under the ob s e r

,

vation of those who are trained to dea l with mental

questions in their l ega l bearings in conn ection with
the admini stration of the crimina l l aw .

In addition to all the a b ove and flo w ing naturally

,

and inevita b ly from the conclusions reached I b e ,

lieve t hat the genera l hospita l should maintain an

out patient de p artment for the advice and treatment
-

of p ersons with mental disease W ith such a ma .

chinery attached to the munici p a l hos p ital there is ,

no rea son why all who are a fll i c ted cannot a s readily

s eek aid as those with bodily disease The details .

of transfer from the p sycho p athic ward to the larger

state institutions should b e made as s im p le as pos
sible Transfer shoul d be made e ff ective on a cer
.
 TH E I N SA NE 1 09

tifi ca t e of two properly qualifi ed p hysicians and ,

the matter should not have to come into court at al l

unles s it is b rought there b y the p atient hi s rela ,

tiy es or some friends on hi s b ehal f I would not

,
.

close the courts to the s o called insane b y any means

-

b ut I would not insist on a l egal proces s whether ,

the patient wanted it or not ; I would not insist so

m
,

to s p eak on cram ing an al l eged constitutional

,

right down the p atient s throat at the ex p ens e of his

’

li f e We see today this proces s of commitment go

.

ing on where nobody wants it The patient does .

not want it the p atient s friends and relatives do

,
’

not want it and anybody who stands and watches it

,

p roceed recognizes on the face of it that it is a farce .

I would therefore proceed to the matter of com

m i tm
, ,

en t in the simplest way L eave the courts .

accessib le to the p atient if he wants to a pp eal f or

relief and it will be surprising how rare such a p
,

peals will b e .

In the construction of the psychopathi c ward

arrangements shoul d b e made and equip ment p ro
v i ded for all the scientifi c work which modern science

demands in connection with the p roper diagnosis and

treatment of the cases that the p sycho p athic ward
is called on to deal with and s o far as possib le it
,

wou l d b e b est that addi tional o pp ortuni ty should be

p rovided in the way of lab oratories equi p ment and , ,

f ellows hi p s for carryi ng on original research work .

Whether this latter is or is not p rovided it is highly ,

desirab l e that the war d s should b e constructed with

a view to teaching p urp oses The materia l shoul d .
1 10 M EN T AL HY G I EN E

be made acce ssible to the medica l schools and it ,

would b e the p art of wisdom to provide a ca p acious

m
au di toriu in which lectures might be de livered and
where patients coul d b e exh ib ited Such material .

coming in from a b ig city of all cl as ses and de s cr i p

,

tions large num b ers of acute ca ses with access to

, ,

all s orts of b orderland conditions makes an in v alu

,

a ble supply for the p urposes of instruction and if , ,

in addition to the instruction of the medica l student ,

the law student should have to come there and listen

to the l ectures on mental medicine we might p er ,

ha p s work through such an in stitution the greatest

of miracles— a rational set of statutes with rational ,

methods of legal procedure where ca ses of menta l

,

disease are under consideration Such an in s titu

.

tion s o equi p ped and manned woul d als o be the

, ,

rationa l p lace for the courts to s end p risoners await

ing trial under s entence or what not in regard to
, , ,

whom the sus p icion of menta l disease had arisen .

It is my b elief that such institutions shoul d take the

place of the p resent method of procedure in criminal
ca ses in which the cl aim of insanity is raised Per .

haps they should n ot altogether take their place ,

b ut they should p ractically take their place In a .

s p ecifi c instance in whi ch the question of insanity is

under consideration the p risoner could b e sent to
,

the psycho p athic ward he l d there for o b servation

,

for a su ffi cient l ength of time and a careful detailed

, , ,

an d scienti fi c report made to the court u p on his case ,

without any al terations in our p resent methods of

1 12 M E N T AL H Y G I ENE

the natural centre from which would radiate al l

e ff orts at p o p ular instruction in matters conn ected
with mental di sease
m
.

Al l these suggesti ons are si p ly in the way of

ins isti ng that mental sickness should be given the
same kind of consideration as other kinds of sick
ness Of cours e thi s resul t cannot b e brought about
.

in a mi nute It means perhaps more than any

.
, ,

t h ing els e the education of the physician in mental

medicine T od ay a patient admitted to the hos p ital
.

for typhoid fever a b roken leg or other s o called or

,
-

ganie physical dis order is given alls orts of atten

tion on the physica l side B oth cases are treated
.
,

not onl y for what they have when they are received ,

b ut for what may deve l o p while in the hos p ital For .

exam p le the man with a broken leg may develop a

,

pneumonia and i s treated accordi ngly With all .

their complicated armamentarium however the , ,

hos p itals are not equi p ped to deal with de p artures

from th e norma l in the mental sphere or even for ,

the most part to recognize them It is only when

,
.

they are forced u p on the attention of the attending

physician b y some very evident disorder of conduct
such as the unconsciousnes s o r del irium following a
head injury the violence of a pneumo n ia delirium
, ,

a p ost partum attemp t at suicide that anything is

done and then only that which is forced in order to
take care of the p ractical situation There is no .

adequate a pp reciation of either the p art p layed b y

the min d in the causation of diseas e or of the i m
 TH E I N SA NE 1 1 3

p ortance of menta l factors in maintaining effi ciency

and in making ha p pines s pos sib le .

Al l of these questions involving mental health are

begi nning to be asked , and there is a decided move
ment in the direction of an adequate consideration
of the menta l factors of di sease W e are at p resent
.
,

however, a l ong way from thi s goal We already .

kn ow that many conditions which are usually treated

medically or surgically may have a very i portant m
mental caus e , p erhaps may be , at fi rst at l east alto ,

gether menta l in origin F or examp le the mental

.
,

factors of such diseases as exophthalmic goitre and

dia b etes mellitus have never b een adequately a n
al y ed nor have the menta l factors in the various
z

v i c er op t os e s ( p rolapse of the various abdominal o r

gans ) although in all of these conditions they un

doub te dly p l ay a large perha p s the l argest p art in
,

some cases We know too that certain diseases are

.

voluntarily acquired a s p artly or comp letely un con

scious attem p ts at suicide or as equally unconscious
ways of doing penance for previous conduct con
ce iv ed of a s sinful
. We have a fairly good realiza
tion of motives of self interest often unconscious
-

, ,

in illnes s the result of injury f or which suit is p end

ing and in illnes s for which recovery is p ossib le un
der insurance or liability acts All of these are .

matters of great im p ortance as bearing u p on the

menta l factors involved and also as b earing u p on
t h e larger individual society relation
-
.

B efore any of the myriad p rob lems of such types

1 1 4 M EN TAL H YG I ENE

will rece ive adequate attention it must be b rought

about that the average p hysician will take as much
interest in p ay as much attention to hi s p atient s
, ,
’

psyche as he does to a great many other often far ,

les s important matters Of course I do not mean

, .

b y thi s that every p hysician should b e a p sychiatrist

b ut he should have had as much instruction a b out
psychological types of reaction as he had a b out the
other typ es of reaction He should have had some
.

instruction in the fundamental princi p les of human

behavi our E very physician for exam p le is not
m
.
, ,

equi pp ed n or i s he capa ble of making an exa i na

tion of the hea r t according to p resent day standards ,

but he should know enough a b out heart disorders to

know when to send his patient t o a heart s p ecialist .

Simi larly every physician shoul d know enough of

,

conduct disorders to know when to ca ll the p s ych ia

trist When there begins t o be a genera l a p p r ecia
.

tion of the im p ortance of the menta l in medic ine

then we may begin to l ook forward t o the day when
there wi ll be a genera l understanding of a menta l
m
a s of a s omatic sign or sy p tom The heart s p ecial .

ist ca n read the various curved lines on a stri p of

pa p er that record the action of the difi er en t p ortions
o f the heart Thes e symbols to thos e who have
.
,

studied them are fu ll of meaning Why should not

m
, .

“
the delusion expres sed by the sy bo l s I am b eing
,
”
doped yi e l d just as much meaning to the special l y
trained p sychi atrist .

In the meantime it is im p ortant that the h O S p it a ls

for the care and treatment of the menta ll y il lshoul d
1 1 6 MEN TAL H YG I ENE

sis ) and s econdl y if p os si bl e he shoul d b e given

, ,

such work a s he may us e when disch arged to help

m
su pp ort hi s elf to r e esta bli sh hi s s ocial relations
- -
.

Such specifi c individua l treatment is not now often

,

pos si ble but it shoul d b e the aim .

The aim of the hos p ital should b e of course to get , ,

the patient welland to turn him back into the com

munity a useful citizen I n this however the hos.
,

pital must often fail The capacity of many a.

patient is not equal to an inde p endent social e xist

ence For such patients the hospital must create
.

an env ironment in which they c a n live and t oo at

thei r maximum e fficiency L iving at their ma xi
mm
.

u efli c i en cy is not only best f or them but it is best

for s ociety too b ecaus e they are under such circum

, ,

stances of their maximum value to the herd

, .

These then are the two fundamental functions of

the hos p ita l T o get the p atient well or fai ling in
.
,

that to create an environment for him that wi ll per

m
mit hi to live at hi s maxi mum e ffici en cy .

S U M MARY
The in sane are a group of s ocia ll y inadequate per
sons who su ff er from a great variety of mental dis
orders .

In order that the prob l em of the insan e may be

intelligently met it must be ap p roached from the
stand p oint of menta l p athology .

The stand p oint of mental pathol ogy demands that

the psycho l ogica l reactions be given a s much con
 TH E I N SA NE 1 1 7

sideration as other reactions This involves i

. m
p roved medical education .

G iving full value to mental di sorders would mean

that they would b e recognized wherever they were
and b e treated as such .

The hos p itals for mental disease nee d to recog

nize that thes e diseases require a p sychothera p eutic
a pp roach and intensively individual treatment .

Various social agencies will fin d the mentally ill

before they are so sick as to be at once recognized
and sent to a hos p ital ; other agencies will hel p the
discharged p atient r e establish and r e adjust where
- -

necessary hi s social relations .

The dis p ensary and p racticing p hysicians will

recogniz e and treat inci p ient disorders of adjust
ment at the p sychological and s ocial level an d p re
vent many serious break d owns that would otherwise
require hos p ital treatment .
 CHA TE R P V
THE CR IMIN AL

T HE CO N C EP T CR I M I N AL
B efore we can deal intelligently with the socia l
“
group to which the te rm criminal has been a p ”

pli ed we must fi rst as in the last cha p ter on the

,
”
insane ,
examine the concept and s ee what it in
eludes .

Just as we have seen in the last chapter in con

s id e r in g the word
“ ”
insane s o we see here that
“crimina l ” can only mean one w h o ha s been pro
n oun c e d by
“ ”
due proces s of l aw guil ty of an
o ff ence which the l a w declares to b e a crime And .

a crime is a given form of conduct which as de fined , ,

i s s p ec ifically p rohi bited by statute In other words

.
,

the law proceeds to say that the doing of such and

such acts sha ll constitute a crime and then if in ,

th e o p inion of a jury a given pers on has done on e

,

of these p roscri b ed acts he thereby becomes a crim

inal
.

“
W e thus see that the concept criminal l ike the ”

“ ”
conce p t insane i s a purely l egal and sociological
conce p t T o cl assif y persons a s criminal s te ll s us
.

a b solute ly nothing about them it rather onl y tells

,

u s of society s attitude towards them Take , for

’

m m
.

e xa pl e the more li i ted concept of t hief “ ”

One
, .

1 18
1 20 ME N T A L H YG I ENE

an ele p han t a mous e an eagle a bat a whal e a l a e

, , , , , k
trout and a lam p rey eel are averaged T he resul t
,
.

is a ma thematical fact b ut does not correspond to ,

any living t hing bird b east or fowl on the earth

, , , ,

in the heavens a b ove the earth or in the waters b e ,

neath What use is it ? Perhaps by studyin g crim

.

in a ls indi vidually we may come to s ort out groups ,

but never b y studyi ng them that way the way of the ,

artifi cial grou p ings de fined an d created b y the law .

The criminal after a l l is only a p ers on who has b een

, ,

found guilty whose conduct has been passed upon

,

b y a jury and who has thus come to be lega lly

,

la b elled A fundamentally dynamic vi ewpoint of

.

human beings should ena b le on e to s ee them as b io

logical uni ts in the last analysis but not any too ,

clearly di ff erentiated from their environment .

They should be vi ewed as integra l parts of the

social organi sm and we need to study the inter p lay
of action and reaction b etween what at their focal ,

points we term the individual and the environment

,
‘
.

T HE N A T UR E O F CRI M I N AL CON DU C T
I have said in the last chapter that the insane were
a group of socially inadequate p ersons who were
se p arat ed off from the com unity but upon whom m
the communi ty l ooked with leni ency and sym p athy ,

and thought of them a s su ff ering from menta l di s

ease and therefore as irres p onsible N ow the crim .

inal on the other hand although he too manifests , ,

1 S ee t h e author s ’ “I n d ivi du a l ity an d I troversio n

n , The Ps yc ho
an a l
yt ic Revi ew J an ua ry
, , 1 91 7 .
 T HE CR IM I N A L 1 21

a s ocia ll y inadequate typ e of conduct conduct which ,

cannot b e assimilated b y the herd and although he ,

too is se p arated off from the community he is

, ,

looked u p on b y that communi ty quite di fferently .

He is not considered leniently and w ith sym p athy

b ut hars hly in fact with hate and he is held a s
, ,

res p onsib le for hi s acts and accordingly p unished

f or them that is is made to su ffer p ain
, , W ith b oth .

“ “
classes therefore the in sane and the criminal
, ,

we see we are dealing with socially inadequate con

duct and whether a given individua l is called i n “
,
” “ ”
sane or criminal is the result not s o much of ,

any p articular qua lity or characteristic which he

may p ossess but is rather the result of the way in
,

which the comm un ity comes to regard him either

m
,

with sy p athy ( love ) or hate In other words in .

,

sanity and criminality are not inherent in the i ndi

v idua l s as such b ut are rather proj ected u p on them
,

b y the commun ity they are forms of herd critique

, .

They are lab els which society a pp lies to individuals

whos e conduct comes withi n certain categories whi ch
society b y means of its law maki ng function a t
,
-

temp ts to define .

Perha p s we can gain an inkl ing of how this state

of a fi a ir s has come a b out if we exam ine somewhat
the nature of symp athy and hate Sym p athy of .
,

course is a variant of l ove It is that form of love

, .

f or anoth er which is possi b le b ecause we can thi nk

'

a n d f e ellike that other b ecause we can to use the

, ,

po p ular p hrase p ut ourself in his pl ace We are

, .

ab l e to s ee thin gs as they see th em becaus e w e can ,

1 22 M E N T AL H YG I ENE

s o to speak l ook through their eyes W e feel with

,
.

the o ther person we respond to hi s situation wi th

,

feel ings of the s ame kind because we ident ify our

m
self with hi and therefore in feeli ng for hi we
, ,
m
fee l for ourself That which i s em p has iz ed in sym
.

p athy therefore is the suff ering or di stres s of the

, ,

other person which we treat a s if it were our own .

The fee lin g of hate uses a s omewhat di fferent

mechanism Hate and allsuch ( antipat hic ) feel ings
.

are reactions of the individua l against th ings which

threaten him ( Chap III ) Hate against ce r tain
. .

kin ds of acts is therefore not so l ely because they

, ,

may be considered antis oci a l f or example but b e , ,

cause a s antis ocial they are a l so apprehended as acts

which we ourselves might do and therefore we have , ,

s o to speak to array our most p owerfu l emotiona l

,

wea p ons against them in s e lf defence In the mech

m
.

an i s which is us ed b y hate therefore the iden t i , ,

fi ca t i on with the other person whil e p resent is by , ,

n o means as obvious The hate is directed more .

towards hi s ac t t han towards hi mse lf This i s .

clearly seen in t he s e acts of mob violence in whi ch

'

an individual is lu ll ed by a crowd of persons who

have no kn owl edge or acquaintance with hi for the m ,

most part but are wreaki ng vengean ce upon him

,

because of hi s act .

Why do we divide those who are asocia l or anti

s oc ial in the ir b ehaviour into grou p s on the b asis o f
.

sym p athy and hate ? A com p lete answer to this

question woul d have to be an individua l ans w er in
each instance The actor and the act wo uld not onl y
.
1 24 MEN TAL H YG I ENE

than the insane pers on He s eems to have acted

.

with thos e facul ties with whi ch we are fami l iar in

ourse lves and furthermore he has often done t h e s e
,

things we might be tempted to do He has acquired .

what he desired by the easy way he has not worked , ,

la b oured plodded for years but has just taken it

, ,

when it came withi n his grasp Our dis in clin a .

tion to exertion our desire to stay in the region of

,

the kn own the familiar our disli ke for the hard

, ,

facts and sharp corners of reality in short an in ,

s t in c t iv e l a z ines s m a kes us all feel that we would

,

l ike t o grasp succes s a s easily E ven though we

.

might know that rea l succes s could never come that

way stil
,
l if we had the opp ortunity few of us could
,

r esist it except for the fact that just these anti p athic
emotions come to our aid and we hate and des p ise
the man who acts in that way and corres p ond ingly
exalt good deeds and good men How close a l l such.

activities li e to our pos sibilities of action is s een on

the on e hand in the l ove of the chi l d for tales of
pirates and highwaymen and in the ease with which
in war times a l lth e socia l standards are swe p t aside
and man yie l ds to hi s predatory instin cts ( N ote .

the tales of inh umanity rape pill age ars on which

, , ,

come from fie l ds of war ) .

Th e concl usion i s further supported b y the fact

that the tendency is constantl y growing to get away
from treatin g the insane l ike the criminal by court
proce dure and s o forth while if we examine into the
,

meth od of crimin a l procedure we wi ll note that s o ,

far as p ossible the indi vidual as such is eliminated

,
 T HE CR I MI N AL 1 25

and o nly the act given consideration Thus the .

statute defines certain crimes by stating the act

whi ch constitutes them and in the indictment the ,

defendant is charged with doing certain things I t

i s th e c r i me a n d n ot t he c r i m
.

in a lt ha t i s g i v en fir s t
c on s i de r a ti on .

We see this emp hasized in severa l di rections when

we come to consider some of the results A jury .

wil l bring in a verdict accor di ng to their feelings of

sym p athy or hate It is a well known device of the
.

de f ence to give the jury an excuse for declaring the

“ ”
prisoner not guil ty if it i s felt that they would
.
“
wish to An occasiona l excus e is that of insanity .

I have known trials in which there was never any

question but that the defendant had done the act
charged in whi ch a defence of insanity was entered
,

and a lmost no evidence introduced to support it and

m
that of the fl i s i e s t kind N evertheles s the jury.

found the defendant insane because in my belief , ,

they felt unconsciously they would have wanted to

do just what he did under l ike circumstances
m
,
.

Juries too sometimes bring in a compro i se ver

, ,

di ct whi ch has no possib le l ogica l s ens e For in .

stance a p erson is charged with murder in the first

,

degree He is clearly either guilty and should be

.

hung under the l aw or he is insane and s o innocent .

The jury find a verdi ct of murder in the second de

gree Such a verdict can onl y b e exp lained as a
.

compromise of sympathy and hate in the jury and

in no other way Such ca ses and there are many of
.
,

them still further i llustrate my conclusion

, .
1 26 M E N TAL HY G I EN E

If we examine further the methods of criminal

procedure we will fin d further eviden ce of the s ame
kind A s I have indicated the w hole p r oc edur e
.
,

t en ds t o c on s i de r t he a c t r a the r tha n t he a c t o r The .

medical expert for examp l e is asked a hyp othetical

, ,

question in which a ce rtain group of facts o r a ll eged

facts t a ken from the evidence are attached to a
hy p othetical in dividuality and his opinion is asked
a s to the s anity or res p onsib ility of this hyp othetica l
pers on The theory is that only the jury can dea l
.

with the question of the sanity or responsibility of

the defendant that i s a question of fact and the
,

ul timate on e for them to decide but in rea ch ing a ,

decision the de f endant as such is kept in the back

gr ound as much as pos sib le and the act constituting ,

the cr ime is given the principa l consideration

, .

Thi s of course tends to give the hate motivat ed a c

, ,

t iv it i e s free play because they are not di rected to

any person The expert for example passes u p on
m
.
, ,

the sani ty of a hypotheti cal individual in a p r es u

a bly wholly j udicial frame of mi nd and free from
any consideration of h umanity or sympathy whi ch
mi ght make him hesitate if he were actua ll y asked
to do an act which would send a man to hi s death
.
.

The method of proc edure is the method of in di r ec

tion .

To sum up the whole mat ter the jury li stens to the ,

evi dence and then gives a verdict which is very a p t

to be much more controll ed by their unconsciou s
than by their cl ear consciousness and the degree to ,

whi ch the un c onscious contro l s i s based upon the

1 28 M EN T AL H YG I EN E

the a b stract pro p osition never quite describes the

concrete ca se .

Human b e ings individually and collective l y are

, ,

always trying to get things settled to express them

m
,

selves in a fi n a l formulation about things to co ,

p a ss a p roblem com p lete l y in a definition or a law ,

b ut reality a lways just escapes they never can quite

,

do it They are doomed to fin d as a result of each

.

e ff ort on l y on e more way in which it just cannot be

d one T o b e ab l e to fix real ity in s ome fina l f or u
. m
l ation woul d be to secure f or all time certainty where
now there is unce rtainty the known where now there
,

is the unkn own It is the everl asting s earch for the

.

fi xed an d the stab l e in a world which in its very

es sence is dyn amic It is our ol d friend again the
m m
.
,

i a r — the s a f e ty
i n s tin c t for t he fa i l oti v e .

Tria l and failure however are the very essen ce

, ,

out of whi ch pro gres s is mad e A given formul a

.

tion s o lves on e prob l em and opens up an hundred

more but then thes e hundred represent the new
,

light that ha s been shed b y the solution and the

who l e ma tter is attacked from a higher p l ane a ,

new l eve l of inte gration has been atta ined And s o .

each formul ation st imulates to new inquiries which , ,

when p retty well worked over give birth to another

formulation to take the p l ace of the la st on e and s o ,

on .

The l aw can only embody those p ri nci pl es of con

duct which are acceptable to the community and
therefore cannot be materially at a higher point in
the integration sca l e than that comm unity N at .
 TH E CR I M I N AL 1 29

ur al
ly, there f ore it must necessarily a pp ear p rimi
,

tive and unjust to s p ecial students Th e jury as .

,

we have s een re p resenting society in miniature

, ,

b rings in its verdict in a ccordance with its un con

scious vi b rating in harmony with the unconscious
of the herd out of which grew the l aw The integra .

tion has to be pushed upward from t hi s level there ,

fore and no e ffort which seeks to i mpos e law u p on

,

a community otherwis e can ex p ect to succeed Sta .

bil ity of government is grounded in the last a n a l

, y
srs,
1 1 1 the consent o f the governed only b oth the

forms and institutes of the government and the con

sent of the governed are much more p roducts of
the unconscious than i s generally a p preciated .

T HE R E S U L T S
T he results of treating men in accordance with
the p rinci p les a s I have ex p lained them have b een
known by prison re f ormers f or a long time They .

can of course not be otherwis e than destructive as

, ,

are all lines of conduct which derive their strength

from hate The p rison system is a means of p un
m
.

i s h en t both negative and p ositive It p unishes .

in a negative way by taking out of life everyt hin g

d esira b le and positively by enforcing all sorts of r e
pressive measures R epression is the order of the
.

d ay The p risoner cannot talk he cannot turn his

.
,

head at mealtime he cannot go to his cell exce p t at

,

certain times nor leave it exce p t at ce rtain times ,

he cannot walk exce p t in a certain way and so forth ,

and so on a series of negations of p rohib itions

, ,
.
1 30 MEN T AL H Y G I ENE

N ow whil e such a scheme of living would take all

,

the j oy ou t of life for most any one it woul d al so be

im p ossible to endure by very any It takes a m .

fairly good character make up to be able to s tand a -

l ong period of such systematic re p ression wi th

hardly an avenue open for wholesome self expres -

sion in any di rection And when we remember that .

many who fin d their way t o prison must n ece s s a

rily because they exhi b it a s ocially inadeq uate adap
,

t a t i on be of defective typ e of personality , we can

,

still further understand how the prison r é gime

“ ”
serves to break the prisoner The multitude of .

prison ru l es not being formul ated to hel p the pris

,

oner but to keep a dangerous popul ation safe l y sub

dued operate t o destroy both mind and b ody s o
,

that s ociety through its prison system has been

, ,

wreaking an awful revenge u p on thos e who do not

con form by ruining them mentally and physically ,

destroying them body and soul S ociety tries to .

O

rid itse lf of its antis ocial paras itic growths s ome

what a s the surgeon tries t o remove a cancerous
growth from the b ody E xce pt in the cas e of ca p .

ita l puni shment however the me thod is l ess heroic

, ,

and remin ds us more of the ol d days of treating

cance r w ith arse n ic paste 2

k
.

Thi s brea ing of men by severity of punishment

is a very costly O peration In the fi rst place the .

2 The a ppl i
tion of a corrosive p a ste con ta in ing a rs n ic which
ca e

s l ow l y bu rn d t he ca n ce r a way a d i ci den ta ll y n y of t he sur

e n n a .

roun di ng fl sh w ith whi ch it ca m i n co ta ct Cl umsy i exa c t

e e n .
, n ,

pa i n fu l im poss i bl of co tro l oft in ff ctua l an d i j urious to sur

, e n , en e e n

roun d i g hea l thy tiss ues

n .
1 32 MEN T AL H Y G I ENE

The obvious principle emb odied in the concept of

the scapegoat was the p rinciple that evil could b e
gotten rid of b y transferring it t o some obj ect ,

animal or even man and then by getting rid of them

,

the evil of course went a l ong ,

It i s the p rinci ple
, .

otherwise kn own a s the principle of vicarious suf

f e r in g A s Fra z er very well p uts it namely t hat
.
, ,

because he can shi ft a burden of wood or stones

from his back to that of another the savage imagines
that he can a s easil y shift his burden of pain and
sorrow to another who wil lbear it in hi s stead A .

few exam p les make the principl e clear 4

In some .

o f th e E ast I ndi an is l ands epi l epsy is believed to be

cu red by striking the patient on the face with the

leaves of certain trees and then throwing the leaves
away The di sease transferred to the leaves b y
.
,

this p roces s disappears with them In certain of

,
.

the tribes of C entralAustralia the men when su ff er ,

in g from headache would wear women s head rings ,

’

in the belief that the pain would pas s into the rings
and coul d then be gotten rid of b y throwing them
into the bush Thes e are perfectly typ ical exam.

ples of this kind of conduct T o S how in what a .

concrete way pain i s conceived of the exam p le of

the Austra li an blacks way of deal ing with tooth ’

ache i s il luminatin g A heated spear thrower i s .

-

held to the cheek and then ca st away The tooth .

ache goes with it in the sha p e of a black stone called

The S ca p e goa t , which 8 Pt VI of
1 .
“Th e Go ld Bou gh A S tu dy
en ,

in M gic a an d Re l igi o by J G F r aze r

n, . . . Pu bl i sh ed b y M a cmi ll an
Co Lo d o n n

m pl es l
.
, .

6 Al
lex a ar e from Fr a e z r , . c .
 TH E CR I M I N AL 1 33

k ii
ar r Stones of thi s kind are found in old
tch .

mounds and sand hills and are carefully collected

and used to throw in the direction of ene i es in or m
der to give them the toothache .

I n a precisely simil ar way evil i s trans f erred

to animals Among the M alays if a wi l d bir d flies
.

into the house it is caught smeared with oil then , ,

released a formula b eing recited in which it is b id

,

d en to fly away with all the ill luck and misfortunes -

of the occu p ant In A rabia when the p lague is rag

.
,

ing a came l is led through al l the qua r ters of the

,

town in order that it may take the p estil ence on it

self The camel is then killed Af ter an illnes s a
. .

B echuana king s eated himself u p on an ox The .

native doctor p oured water over the h n g which ran

down over his b ody The ox was then killed b y
.

holding his head in a vessel of water until it ex

p ir e d The p eo p le b elieved that the ox died of the
.

king s disease which had b een thus transferred to it

’
.

The transfer may b e e ffected to human sca p egoats

in similar manner For exam p le the sins of the
.
,

R ajah of M ani p ur and his wife could b e transferred

to some on e else usually a criminal who earned
, ,

his p ardon b y his vicarious s uff erings This was .

done b y the royal cou p le bathing on a scaff ol d b e

neath which the criminal crouched The water .

washed their sins away and falling u p on the human

sca p egoat transferred their sins to him In U ganda .

when the king had been warned by the gods that

evil attached to hi s army it was customary t o pick
out a woman s l ave from among the captives a cow , ,
1 34 MEN T A L HY G I ENE

a goat a fowl and a dog B unches of gras s were

, ,
.

ru bb ed over the peop l e and cattle to collect the evil

and transfer it to the victims who were then taken
a considerab l e di s tance and their li b s b roken so m ,

they coul d not crawl back to Uganda and left to ,

die .

From usin g a s ca p egoat u p on occasions and for

such p ur p oses a s I have indica ted it comes to b e
reso rted to p eriodically usua ll y annuall y Such
,
.

p eriodi c us e of a scapegoat also im p lies that the

s ca p egoat is a pub lic one that is at certain sea
, ,

s ons of the year the peo p le rid themselves of their

s ins b y a p u b lic sca p egoat On the D ay of Atone
.

ment the Jewish high priest l ai d hi s hands on the

-

head of a goat confessed all the iniquities of the

,

C hildren o f Israel and having thus transferred

,

their s in s to the animal drove it into the wilder

,

nes s A t Onitsha on the N iger two human b eings

.
, ,

are annually p urchased by pub l ic sub scri p tion and

sacrificed to take away the sins of the land All .

those who durin g the year had b een gr ossly sin

ful were expected to contribute and the money so ,

col l ected was us ed t o purchase two sickl y persons

who were o ff ered as sacrifices on e for the land and ,

one for the river

m
.

This last exa ple i s interesting as showing the

tendency to select p eo p le who had to die anyway
( in this ca se of disease ) for sacrifi cial victims It .

therefore i s not strange to fin d a tendency prob ,

a b ly goin g along with a develo p ing lack of sym

p athy with human sacri fices to sacr ifice those a l ,
1 36 MEN T AL H Y G I ENE

f rom l
ike indulgences an d to kee p himse lf upon the
strai ght and narrow p ath .

Thi s is the material out of which is made our un

conscious attitude toward crim e and criminals and
is an e xp lanati on of why s oc iety has b een s o l oathe
m
to ad it reforms in dea ling with the criminal and ,

also why it has b een wi lling to permit the grievous

abuses to which he has been su b j ected .

T HE RE M EDY
T o treat the crimin al b y the scheme of punishment
that has been in vogue s o long which in fact i s in
, , ,

p rinci pl e the princip l e o f the M osaic l aw an eye

“
”
f or an eye and a tooth for a tooth
, can no l onger
b e justifi ed Whil e at one t ime in the history of
.

mankind such methods were not only justifi abl e b ut

embodi ed the only pos sible solution of the diffic ul
ties that can no l onger be held in this scientifi c day
,

and a ge It is time that the S p irit of revenge should

.

be p ut aside for a more constru ctive program

t han ha s thus far been made pos sible by the more
and more impersonal attitude of the cr iminal fos
t er ed by th e meth ods of crimina l procedure a l ready ,
in p art a ll uded to N ot onl y does the law consider
, .

the crime rather than the cri minal but in the carry
,

in g out of retributive acts the in di vidua l has handed

over the conduct of his persona l quarrels to a s p e
c in lgroup o f men s elected for that p articu l ar pur

pose He ha s de l egated s o to speak the wreaking

.
, ,

of hi s p ers ona l revenges to the o fficers of the l aw .

R eali zi ng the meaning of these various mechan

 TH E CR I M I N AL 1 37

isms we can understand somewhat why the cri in al m

law is s o slow to change M ankind gives u p with
.

great reluctance the small measure of revenge which

t hi s scheme leaves to them and p erhap s it may b e
,

just as well if we can fin d some other way to a t

tack the probl em in an at all satisfactory way T his .

has already been done b y taking u p the p ro b lem

from an angle b ound to a pp eal to the sym p athy of
every on e namely in connection with the work of
, ,

the juvenil e courts T h e next avenue of a pp roach

.

is of cours e the criminal h imself a f ter c onviction .

A fter care s ocieties that attemp ted to get the dis

-

charged criminal a p lace and s o hel p him to r e e s -

t a bl i s h himself have existed f o r a long time Th e .

destructive work of the pri son however was so , ,

well done that they have o b tained b ut indi ff erent

success The work must begin earlier
. .

T o be of rea l va l ue then the work must b e b e

, ,

gun in prison Society will have used the p ris oner

.

a s its scapegoat condemned him to p unishment

, ,

and havin g shut him u p in prison is pretty willing

to forget a disagreeable matter and s o leave him to
thos e who are charged with his care I t i s with .

these caretakers therefore that the immediate ho p e

, ,

for the work of prison reform r ests S o long as .

they conduct their work in a way not to stir u p a n

t a gon i s mthey will p robab ly be p ermitted to go on
with it The princi p les of the work are relatively
.

simp l e
m
.

The defect in the cri ina l is that for some reason ,

or other he has b een unab le to adjust his conduct

,
1 38 MEN TAL H YG I ENE

to s oci a lly acce p ta b le standards Thi s inca p acity

.

may b e dee p ly organi c ( severe grades of ment a l

de f ect ) and therefore incapa b le of remedy or it ,

may b e and often is due to faults of environment

, ,

and education One coul d hardly ex p ect a chi l d

.

brought u p in the criminal quarter of a large city

and surrounded on a ll sides by crime p erhaps ,

taught crimi nal p ractice s in hi s early chil dhood to ,

grow into anyt hing but a crimin a l Such a chil d .

is reacting in precisely the same way as his more

—
fortunately situated brothers he is s imulating his
elders M any such crimi na l s are f undamenta ll y
.

we ll endowed but owing to the accident of their

b ir th so to speak have never rea ll y had a chance
, , .

They have remained at a rel atively low cultura l

level of development because their immediate en
v i r on me n t never demanded anyt hing more of them .

They were adjusted t o the environment in whi ch

they found themse lves Such an individual when .
,

im p ri soned o ff ers the best materia l to work with

,

and a fai r pros p ect of good results .

For such a type the unintelligent and revengeful

attitude of the usua l pris on environment can do
nothing but further deba se n ot only mentally but
p hysicall y Ins tinctive tendencies funda menta l bio
.
,

logical trends when not pe r mitted a norma l and

natura l out l et must fin d s ome other p ath and s o
necessaril y give origin t o conduct that is patho
logical Such c onduct still further repressed b y
.
,

the p rison authorities aggravates the patholo gica l

,

te ndencies and as a consequen ce th e not at a ll

, ,
1 40 M E N TA L HY G I EN E

no longer a ff ord to crush its creatures in t hi s way .

Instead of t hrusting the o ff ender into a patho

logica l environment worse than the on e he was ,

taken f rom the environment shou ld be cal cu lated

,

to develop a ll that is best in th e prisoner The .

obj ect of the prison is nomina lly and should b e s o ,

in fact to reha b il
,
i ta te the pri soner and fit him for
a usefulsocia l life If it is going t o be able to make
.

over an antisocia l indi vidua l into a useful citiz en

it must undertake t o do s o by attemp t ing to de
v el op those qua l ities in him which m a ke for good

citiz enshi p It goes without saying that a p ro

.

g ram of repression that i s o nly repres sion will

not only not do thi s but is wholly incapable of de
v el op in g anythi ng that is constructive it only drives ,

the p risoner to pathologica l ways of expression .

The direction in which to proce ed is t o endeavour

to produce conditions within the prison as nearly
a s pos si b le like those outside more especia lly as to
the matter of p ers ona l res p onsibility In other .

words the p rison must try to develop in the prisoner

,

those qualities of persona l and social responsibility

whi ch are neces sary for him to have if he is to be
a b le to live a useful life in the community .

T his e ff ort to develo p the ca p acity for adequate

socia l adjustments in t he p rison is the basic prin ,

c ip le u p on whi ch the M utua l W e l fare L eague w a s

fo unded by M r Os b orne at S ing Sing prison Hi s

0
. .

ex p eriment co rrected the fault of previous e ff orts of

0 T . M O sborn
. e :
“
S oci ety an d Priso s
n .
”
Ya le U n iv rsity
e Pr es s ,

N ew Y ork 1 91 6, .
 THE CR I M I N AL 1 41

k
l ike in d in whi ch the same sort of exp eriment had
been carried out in form but not in sub stance I n .

order to accomp lish its p urp ose he th in ks the

, ,

prisoners must actually b e p ermi tted to estab lish

their own scheme of government and to carry it out
with practically no interference from the warden S ’

ofli ce
. Only under these circumstances where a u ,

th or ity and res p onsibility are commensurate can ,

there be borne home to the soul of the p risoner those

distinctions b etween right and wrong u p on which
the orderly conduct of s ociety is founded .

I t was Socrates who said that kn owledge was

k
virtue , and I thin M r Os b orne would agree with
m
.

hi in such a statement except that it is p lain

k
,

that it m a es a great dea l of di fi er en c e what is

meant by knowledge The lecturing of a convicte d
.

criminal b y the judge who exhibits anger and r e

m
s en t en t and hate in his denunciation of the p oor

wretch whom he is a b out to sentence to p rison may

convince the prisoner intellectually or may only
reiterate what he already knows The beatings the
.
,

deprivations of food the dark cell may do the same

,

thi ng in prison but knowledge acquired in such

,

ways if indeed it can b e called k n owl edge at all is

, ,

of no value . Knowledge is virtue but it is only

virtue when we have l earned to know in the same
way that we love To know as on e l oves is not
.

only to a pp reciate intellectua lly but t o feel the fun

m
,

da en t alt r uth in a way that makes it essential to

act u p on it
.

The l ecturing of a prisoner by the presiding judge

1 42 MEN T AL H YG I ENE

is a part o f just on e it e m in the a lmost universal

unintelli gence which the great man hunt ing machi n
-

ery of the crimi nal law exhibits It is as if a per

.

s on had b ecome il l from a l ong course of wrong

l iving extending over years and the doctor shoul d
, ,

dismi ss him with a prescription for a p il l and say

not a word about the regulation of his life The .

crimin al act which fi nally leads to a prison s entence

is b ut the outcome of a li f e of distorted viewpoints ,

o f standards of conduct turned and twisted out of

all resemb lance t o those with which the normal per

s on i s familiar in his daily living and to expect that
,

the natura l p roduct of such conditions can be

metamorp hos ed by a three minute sermon dis p lays
a p ro f oun d ignorance of human beings A pris oner .

s o lectured will pro b ab ly leave the court room to

start u p on the serving of his sentence not in a hum ,

b le frame of mind res olved to make out of his mis

f ortune an opportunity for deve l opment , he does not
know anythin g a b out such things he has never ,

thought such thoughts never been ab l e to never

, ,

developed enough to entertain them He is how .

,

ever accustomed to hate and act from the Sp irit

,

o f revenge and s o he wi ll probably react to such a

l ecture in about the only way he knows how to r e

‘

act—with hate and enmity H e will l eave the court

.

in hate and start his sentence in hate and it wi ll r e ,

main for the p ris on t o undo thi s damage and teach

m
h i that knowl edge is virtue not by prece p t or even
m
,

b y example but by giving hi an opportunity to

,
1 44 MEN T AL H YG I ENE

" uite a few p risoners on admi ssion are physica lly

il.l A cute venereal infections and tu b ercu l osis are
considera bly in evidence The p rison should sort
.

out all these various classes immediately upon a d

mission and treat them accor di ngly and not as has ,

been the custom in the p ast try to fi t them a l linto

the same form treat them a ll just a li e Those k
,

.
,

who are physically sick need treatment On the .

medica l side the princi pl e is the same as with the

i nsane an d the feeble minded namely to train the
,

individual to live at hi s b est at the l eve l of adjust

ment which he is capab l e of mainta in in g Such .

a constructive program deve l ops the best that is

in the indi vidua l and i s equally advantageous for
s oc iety becaus e it raises the e fficiency of a socia l

The detail s o f such a plan as I have out l ined I

will not enter into here a s I am only dea l ing in thi s ,

book with the pr i nciples of menta l hygiene I can

, .

not refrain however from touch ing u p on one mat

m
, ,

ter that strikes m e a s i p ortant and as indicating

a pathway which might be followed to great a d
vantage One of the principa l difficul ties which has
.

always confronted the problem of prison l a b our and

prison made materials ha s been the opposition of
-

the l a b our unions I do not know just how this

.

antagonism i s going to work out but I am convinced

that it will ultima tely b e adjusted to th e s a t i s fa c
tion of labo ur when l a b our sees that co operati on
-

and not antagoni sm is to its advantage I am con .

vinced tha t with modern machinery and shop meth

,
 TH E CR I M I N AL 1 45

ods of management the prisons could b e made

,

largely self supporting with material reduction in

-

the tax rates as a consequence B esides I am sure.

that the a b le b odied prisoners could manuf acture

and rais e on farms a very large part of the material
needed b y the sick and i n fi rm in other pu b lic insti
t ut i on s and in many other p u b lic proj ects could fin d
ample room for activity when the pub lic i nd gets m
adjusted F or examp le the prisoners might make
.
,

materia l for the army and navy a suggestion which

m
,

ight not be well received as yet for I recently saw ,

that p rison made goods had b een rej ected b y an

army o fficer becaus e the soldiers might have some
s entiment against wearing it If the s oldiers a p
.

p r e c i a t e d that the making of what they wore ha d

help ed save a fellow being from destruction I am
sure they would not o b j ect .

N ot only this but the scheme of teaching p risoners

to work effi ciently at some trade and then utilizing
the products of their work is a scheme which could ,

to advantage b e applied to a large part of the rela

,

t iv el y unproductive and destructive elements in the

community It is applied here and there but the
m
.

ad i n istrative divisions of State government are

usually not suffi ciently well c o ordinated to dev olop
-

such a scheme to its maximum of efii ci en cy ‘

.

W ith our modern methods it would b e a relativel y

sim p le thing to devise and to construct a plant a ,

s eries of p lants which could turn out a p air of shoes

,

for every individual in the United States but the

s ocial organization has never b een develo p ed s uffi
1 46 MEN TAL H YG I EN E

ci en t l
y so that it would b e possi ble to fin d a way
to get thos e shoes on the feet that needed them As .

a result thousands of people need shoes whil e the

wealth of th e community a s a who l e is amp l e to p r o
vide them If the un p r oduct ive defective , very
.
,

often physica ll y sick individua l s could be organ iz ed

into productive units it wou l d be of inestimable
bene fi t b oth to them and to th e com unity for they m ,

woul d cea se to be just burdens but would develop

more or l es s pro ficiency in each instan ce , s o that
f rom representing a z ero va l ue a s an as set their
value woul d ris e in many instances to an hundred
per cent a s based on ca p acity for s e lf support a s
.
-

re p resent ed in earni ng capacity or s ome fracti on

,

of that
m m
.

W ith the es tab l ish ent of a sy pathetic attitude

on the pa rt o f the pub lic to pris on reform al ong
the l ines I have indicated hel p ed along by the work
,

of the juvenile court s and the p sychologica l investi

gati e n of juvenil es and the p sychologica l l aborato

ries for studying cr iminal s such a s that recently
m
,

estab l ished in N ew Y ork C ity it a y be possi ble

,

to go further and do somethin g about the method of

crimi na l procedure and als o somethin g to modify
the mach inery of the courts di strict attorneys
,
’

o ffi ce pol ice de p artments etc

m
, , .

A ong the changes which are needed are ade

quate courses in the l aw sch oo l s to properl y equip
the graduate to attack the va rious s ocia l problems
centred a b out crime in a mann er com ensurate with m
p resent day knowl edge In many schools little o r
-
.
1 48 MEN TAL H YG I EN E

Thi s woul d give th e l awyer some fir s t hand informa -

tion scientifi cally presented of what menta l dis

, ,

ease rea lly is and help him to understand the doc

tor s viewpoint A s it is today the attorney and
’
.

the medi ca l expert talk di ff erent languages and

many diffi cul ties which surround the whole question
of expert evidence are due to thi s l ack of the two
p rofessions to com p rehend each other Anything .

that wi ll hel p to bring a b out a mutual understand

ing will be hel pful for a s I have already intimated
, ,

reforms in l aw can only come about after reforms in

practice Thi s princi p le I shall di scus s more full y
.

in a later cha p ter but it seems quite clear that thi s

,

is the cours e that events must take I have already .

ill ustrated how and why juries often b ring in ver

dicts which disregard the law a l together Such ver .

d icts are as a rule I think advances over the literal

, , ,

interpretation of the law and are forced by pu blic

o p ini on when it has advan c ed b eyond the p eri od in
whi ch the law wa s enacted The l aw might be said .

t o always follow never to l ead the practice

, , .

In addition to courses in the psychol ogy of evi

dence human be havi our and p sychi atry there should
, ,

als o be a course in sociology with special empha sis

on criminol ogy Thi s l ast might perhaps be a p ost
.

graduate cours e for thos e w h o were going to specia l

iz e in crimina l l aw .

All of these advances wi ll probab l y onl y come

a b out contem p oraneous l y wi th an im p rovement in
the status of the D istrict A ttorney and such other
public o ffi ce rs a s mi ght be needed in dealing with
 TH E CR I M I N AL 1 49

the prob l em of crime The D istrict Attorney

.
7

shoul d receive hi s a p pointment solely u p on a fi tnes s

b asis based up on his s p ecia l knowl edge of the p rob
l em he is to undertake I should say the p osition
.

should have a C ivi l Service status to insure p erma

nency of tenure during good b ehaviour and e fficient
,

conduct of the office a s far as possible Such a

,
.

change a s thi s is sorely needed for the position ,

nowadays is not only a politica l on e but because of

that fact is used by the occu p ant as an o pp ortunity
to exp l oit hi mself in such a manner as will b e to his
greatest persona l interest when he comes t o enter
private practice In this way the offi ce b ecomes
.

p rimarily a means of persona l gain rather than of

pu blic service .

I think also and this I recognize is a l ong ways

,

OS,
that the D istrict Attorney should s p end on e
year to eighteen months as an in t er n s in one or more
pena l institutions before takin g o ffi ce and I woul d ,

consider it highly desirable to extend this require

ment to the judge sitting in criminal court I do .

not see how it is possible b y any other method for , ,

these officials to have any adequate idea of the na

ture of the human materia l which they are called
upon to dea l with Thi s p rinci p le has always b een
.

a p preciated by the p hysician and I do not s ee why

it should not be extended to the lawyers A s it is .

today the jud ge who is to sit in the cri minal court

is chosen not because of any s p ecial qual i fications
,

for that p articular service but usually because he is ,

7 For x m pl
e a p ubl ic d f d r
e a e en e .
1 50 M EN TAL H YG I ENE

th e j uni or mem b er of the b ench The work is con .

s ide r e d least agreea b le and therefore i s relegated to

th e n e w ap p ointee .

Perha p s after a l l these thi ngs are done it wil l

b e possi ble to secure some changes i n proc edure .

I wi ll mention o nly tw o T o the ordinary man con

.
,

f ronted with the rules o f evidence in a crimi nal

p rocedure it seems a s if the rules were especially
,

constructed to rule out every singl e matter which

th e average man left to hi s ow n devices wou l d con
, ,

sider o f im p ortance and would utilize F or ex .

am p le : A man has stolen a l oaf of bread E vi .

dence that he was sta rving that his fami l y were , .

starving that he had tried and been unable to ob ta in

,

work etc a ll such evidence is on p rinciple ruled

,
.
,

out ,and yet it must b e perfectly evident that no

understandin g of the situation whatever can be
gained without it I know that I am treadi ng upon
.

de b ata b le ground and that a l awyer could pres ent

a good ca se to the contrary but I b e li eve that thi s
,

lawyer s good ca se must soon go the way of a ll go o d

’

things that have s erved their purp os e—it must be

su p erseded b y something b etter It is a ll ve r y we l
. l
f or society to close its eyes in s eeming com p lacency
t o the s ocial p ro b lem such a ca se presents and r e
fus e to s ee it b y rulin g out the evidence but some ,

day it wil l be just a s pertinent to ask—why i s it

that thi s man is starving amongst you ?— a s it i s
t o day to a sk the questi ons which are ad issib le m .

A s we have seen the fundamental defect of the

,
1 52 MEN T AL HY G IE N E

and is therefore to be in di cted for petit or grand

larce ny respective ly but What manner of man
, ,

is he ?
In order to answer thi s question it i s necessary
to make an anal ysis of the indi vidual and the ,

causes leadi n g u p to his o ff ence Only after this .

is done ca n a reasonable concl usion be reached as

to whether the o ff ender is best treated as a menace
to society and p ut in pri son whether he is a proper
,

su b j ect for reformato r y e ff orts or whether he might

,

better b e p aroled with a sus p ended senten c e .

We as physicians do not a lways p rescribe the

m
, ,

s a e drug in the same dose for a given disease no ,

matter in whom it may occur vigorous youth or ,

decre p it o l d man W e treat the patient not the

.
,

disease and s o in criminology we wi ll never make

,

any further p rogres s under the system of dealing

with the crim e in the abstract we must l earn to ,

treat the crimi na l .

In order to divorce c r imina l procedure from the

practice of dealing with the crime instead of the
crimina l the assistance of expert s in menta l di s
,

orders and in crimino l ogy must b e s ought and I ,

b elieve it is the duty of the State to furnish this

a ssistance so that it may di scharge it s r es p on s ib ili
,

ties both to s ociety and the crimina l inte lligently .

This a ssistance can hardl y be exp ec ted from the

jury or from the overworked court ; it must come
from a s p ecia l body of men whose business it is to
furnish it .
 T HE CR I M I N AL 1 53

m
These p re li inary considerations lead logically
and I thi nk inevita b ly to the conclusion that the
, ,

function of the jury should end with estab lishi ng the

fact that an ofi en c e has b een com itted by the a o m
cu s ed . Thi s fact being esta b lished should give the
State authority over the p erson of the ofi en der and ,

he should be taken into custody dealt with accord

,

ing to the sort of person he is and not turned b ack

m
,

into the com unity until he may b e with sa f ety ,

and such action should be a s little a s p os sible de

pendent u p on the degree of crim e as now de fined .

G iven then an individual the jury determines that

,

he has in f act committed an antisocial act H e is .

then remanded to a court or committee or whatever

else it may be advisab le to call it who make a full
,

report to the tria l judge upon the character of the

ofi e n der with recommendations f or treatment such ,

recommendations so that the amenities may b e p re

,

s erved to be advisory and not controlling On t h e

, .

basis of this report the judge pronounces sentence .

R educed to its sim p lest terms the whole situa

tion i s just thi s : An indi vidual commits an anti
-

social act By s o doing the State assumes control

.

of his person and l iberty It does this p rimarily

.

becaus e it has a right to p rotect its elf from his de p

r ed at i on s Having done s o and protected itsel f
.
,

however it has a further duty both to the individual

,

and to the community It must endeavour to r e

.

store the ofi en der to useful citizenshi p if that is

p ossib l e In other words it must p rescrib e a form
.
,
1 54 M EN T AL H YG I EN E

of m
treat ent suitable to hi s ail ment In or der t o .

do thi s his ca se must be diagnosticated All thi s .

i s clearl y the duty of the State .

Society has too l ong deal t with crime either from ,

— “
the stand p oint of revenge the princip l e of an eye
”
for an eye a t ooth for a tooth, is the princi p le
,

u p on which our cri min a l code i s buil t and whi ch

controls much of i ts a p p li cation even today—o r
from the stand p oin t of a disagreeab l e a ff air with
which the easiest way is the best and s o it loo s up ,
k
th e cul p rit turns i t s back u p on him and tries to
, ,

forget a ll about it .

The time has p assed f or either one of these atti

tudes R evenge may be sweet but it is usually a
.
,

pretty exp ensive indul gence C rime is a s ocia l

.

p henomenon and demands attention if for no other

than e c onomic reas ons It is distin ctly an unwise
.

p olicy that continues a system which actually makes

criminals What e l se can b e ex p ected when a young
.

boy f or his first ofi en c e i s rut hl es s l y shut up in

p ris on to as s ociate excl usive l y f or months with a
collection of the worst and most incorrigi ble o ff end
ers ? It is a distinct duty p ointed to by actua l do l
,

lars and cents e conomy to kee p men out of prison

, ,

or if they get in to restore them to independence

at the earliest possi ble date These results will

.

never take p lace until we l ea rn to dea l with the

crimi nal and not the crime .

Thi s woul d seem to b e the rational method for

the State to pursue How can it best be a ecom
.

pl
i s hed ?
1 56 MEN T AL H YG I ENE

Thi s grou p ing of the noncriminal with the crim

inal insan e may b e obj ected to by some It is how .
,

ever a n entirely reasonable procedure when it is

,

considered that we are dealing with the individua l

in each instance and not the isolated res ult of some
one of hi s acts Whether a given person comes
.

within the purview of the crimina l l aw or not i s

often p urely a matter of accident The point to be .

considered s olely is the character of the p erson he

is and if he has manifest crimina l and vicious tend
,

e n c i es he should b e se p arated from the general

p o p ulation of the hos p ital and cared f or with hi s

These are lin es along whi ch in my opin i on we

, ,

may look for b etterment of p resent conditions .

T here are already p lenty of well recogniz ed prin

c ip l m
e s of cri i nology whi ch have yet to be adopted

in many communi ties A parole system and the in

.

determin ate sentence are among the most impor

tant The principles underlying these however are
.
, ,

pretty generally acce p ted and for the most part

they are b eing adopted a s fast a s circumstances
admit that is as rapidly a s the genera l enlighten
, ,

ment in the severa l communities ca ll for such meas

ures They do not therefore requi re to be argued
.
, ,

in thi s connection .

SU R
M MA Y

The di stinction between conduct which is regarded

as insan e and conduct which is regarded as criminal
is based u p on th e herd critique and “ ”
insane and
 TH E CR I M I N AL 1 57

”
crimina l are in fact p roj ected o p in ions of the
her d.

The herd critique results in an attitude of

“ ”
leniency toward conduct whi ch is insane because
it is regarded as un p sycholo gical that is s o strange
, ,

or grotesque that it is not considered a p ossi b le

means of ex p ression and therefore must b e the r e
m
sult of illnes s C ri inal conduct on the other hand
.

does not create the impress ion of b eing un p sy ch o

logical strange or grotesque b ut on the contrary
, , , ,

is considered a p os si b le means of ex p ression and

therefore as this realization has to b e re p ressed
, ,

f ought ofi hate is b rought to the task and criminal

,

conduct is not considered leniently but a s a form

o f behaviour which calls for p unis hment .

The l aw b y considering the crime rather than the

m
,

cri i nal tends to the perpetuation of thi s method

,

of ex p ression .

Change in the l aw and the methods of crimin a l

p rocedure are difficult in p ro p ortion to the difii culty
of giving u p t hi s method of ex p ression b y the herd .

Society tends to hang on to this way by means of

which it can continue to give exp ression to its hate .

The criminal therefore b ecomes the scapegoat for

, ,

the herd .

R eform had thus best start in some other part of

the system Prison reform is suggested b ecaus e
.

society wil l have had its fling at the criminal and

forgotten him and then something may b e done for

N ot to rehabilitate the criminal when p ossibl e i s , ,

1 58 ME N TAL H Y G I ENE

economically an d otherwi se a disastrous po licy not

only for the individual but for the herd when the
resul ts are considered in terms of efi ci en cy .

The princip l e upon whi ch the reha b ilitation of th e

pris oner must pr oceed i s that he should be pre
pared whil e in confi nement to exercise those func
, ,

tions that he will have to exercise when he is dis

charged if he is to make a good citiz en He can .

only b e s o prepared b y b eing given an Op p or t u

'

n ity to us e those faculties .

A fter a plan has been worked out for the r e

habilitation of the prisoner and that plan has
,

p roven succes sful in practice then p erhaps it wil

, l
b e p ossi ble to approach the problem of criminal
procedure with s ome as surance of being ab l e to do
s omething .

The change in crimi na l procedure shoul d be a

change from a consideration of the act to a con
sideration of the p ri soner as a human individua l and
a s an integra l part of society He should thus b e
.

dealt with in a way that w i ll best serve both with of , ,

cou rs e a dh erence to the p rincipl e that when their

,

two interests cros s the interests of the in di vidua l

must give way to the interests of s ociety .
1 60 MEN T AL H YG I ENE

be heredi tary in th e true sense ; or it may be due to

injury to the brain the result of disease b efore b irt h ,

and s o b e congenital b ut not hereditary ; or it may b e

due to injury operat ing upon the brain during the
early years of develo p ment All sorts of injuries.

may p roduce such results Physical injuries at b irth

.

and i n fections either pre nata l or during infancy

-

are p rominent causes while entirely extraneous

,

factors such a s an inh erited deaf mutism may resul t -

in fee b le mindedness if this serious deprivation is

m
-

not corrected by s p ecial educationa l e ff orts Si i .

lar l y high degrees of myo p ia ( short sightedness ) ,

adenoids ( which interfere with breathing ) and a ,

multitude of other caus es may operate However, .

this is not the place for a discussion of the pathology

o f fee b le mindedn es s
-
.I on l y wished t o give s ome
sl ight idea of the extreme multip l icity of the factors
which enter into its p roduction .

From this brief indication of the variety of causes

which may o p erate to produce fee b le mindedness it -

will b e a pp arent that we are not dealing with a un i

ta ry conce p t in any sense When we survey the
.

social p roblems into which feeble mindedness p ro -

j ec t s itsel f as an important factor this is further em

p h a s iz e d These p roblems include not only thos e
m
.
,

of the idiot i, b ecile and fee b le mi nded as ordina

,
-

rily understood and a s found in institutions b ut the ,

problems of the juvenile de l inquent the crimina l ,

and the p rostitute Of these two latter classes r e

.

cent surveys would seem t o indicate that conserva

ti v e ly fif ty per ce nt could be included in the feeb l e
.
 T HE F E E BLE M I N DE D
-
1 6 1

minded grou p b y ordinary methods of examination

which woul d b e generally acce p tab le I n a dd ition .

to these grou p s there are the b ackward an d atyp ical

chi l d ren— for the most p art at p resent p ro b lems of
our school system— and a p ercentage no one knows ,

how large of the vagab ond unem p loyed and pau

, ,

p er classes A dd to these a consi d era b le numb er of

.

those otherw is e c lassed as e p ile p tics and some idea

of the comp lexity of the pro b lem and its wide rami
fi ca t i on s can b e gained .

Age — In order to expres s fee b le mindedness in a -

concrete way a way that would in d icate the degree

,

of fee b le mindednes s p resent in any p articular case

-

a standard was sought in the relative age of the

individual A ge as ordinarily understood means
.
, ,

the length of time a p erson has lived since hi s b irth .

T hus a child of ten years of age has completed ten

years since birth b ut not eleven That t ime is a .

very inaccurate measure of age has long b een rec

ogn iz ed and in medicine is well ex p ressed b y the
“
saying that a man is a s old as his arteries ”
A ge .
,

th ef ef or e means rather the amount of development

,

which has b een attained or as in the matter of the

,

arteries the degree of wear and tear manifest

, .

That p eo p le develo p unequally is a common p lace

s o we can speak of their age in term s of their

develo p ment rather than in terms of years lived

since b irth whi ch to di fi er en t i at e it from these other
,

ways of designating age , may b e called the Chr on o

log i ca la g e From the p oint of view of the develo p
.

ment age may be considered as showing in strue

1 62 MEN TA L HY G I EN E

ture or in function a s compared with what is con

ce iv ed of as normal I n thi s way the individual
may be cl assed as having a certain a n a t o m
.

i ca la g e
if hi s development a s shown structura ll y corre
s p on ds roughl y to the normal develo p ment at a like
p eriod and in the same way from the standpoint of
, , ,

function he may b e clas sed a s having a certain p hys i

ol ogi c al a g e The particul ar functions however
.
, ,

whi ch are of special importance in the c onsideration

of feeble mi ndednes s are the psychological or men
-

ta l functions s o it becomes desira b le t o designate

m
, ,

if possi ble the en ta lor p s y cholog ic a lag e of the

,

individual for purposes of clas s ifying hi s degree of

feeble mindedness
-
.

The most ambitious attempt t o determine the p ey

ch ol ogi ca lage has b een by the use o f the s o called -

B inet Simon measur ing scale of intelligence which

m
-

is ad i ttedly useful only for the fi rst twelve years .

This test has b een modi fi ed more p articularly by ,

G oddard an d other tests have been de v ised b y many

,

workers There are f or example the D e Sanctis

.
, ,

tests and more recently the Y erkes point scale wh ile ,

tests for s p ecial p ur p oses have been devised by

Hea l y, Whi pp le Fernald and a host of others In
, .

short the literature of mental testing has grown

,

t o enorm ous p ro p ortions .

The questions naturally aris e—Wh at i s the net

value of a ll these tests ? D o they s erve t o clas sify
the in dividual in an at all accurate way a s to the
de gree of menta l deve l opment ? These questions
may b e answered b riefly In th e first place the vari
.
1 6 4 MEN T AL H YG I ENE

value o f mental tests I merely wanted again to .

em p hasize the extreme heterogeneity of the grou p

fee ble minded to show how i pos si b le it is of defi
-

,
m
n i ti on to i ndicate it as a dynamic concept l ike those
,

other l arge groups I have al rea dy considered .

“
I t w a s D avid Starr Jordan who said A good
citizen i s one who can take care of hi mse l f and ha s
”
somethi n g l eft over for the common we lfare .

Perha p s if we keep t his s tatement in mind and thi nk

o f the feeb l e minded as be ing inherently una b le to
-

ca re for thems elves except under the most favour

,

a ble circumsta nces and as therefore having noth

, , ,

ing left over for the common we lfare we will come ,

a s near a s possi bl e to a correct attitude towards the

grou p although o f course we shoul d find that even
, ,

as loose a designation a s this woul d often have t o

b e stretched to fi t a particul ar ca s e and not in fr e
quently would n ot fit even then .

Feeble mi ndedn ess even from the standpoint of

-

an intelligence measuring sca l e is a rel ative a ff air ,

when e xp res sed in the behaviour of an individual ,

and conduct which woul d be considered norma l un

der ce r ta in conditions might well be open to in
quiry a s possibly defective under others
, ,
.

With respect to this defect the main feature is

that it is organica ll y conditioned for every inad s ,

quate a djustment may be thought of as due t o a

de fect an d every on e a s havi ng a capacity for a d
justment at some l eve l The feeb l e mi nded how .
-

ever have an orga n ica ll y conditioned defect whi ch

,

renders forever M p os s ible an adequate adjustment

 THE F E E B LE M I ND E D-
1 65

to the social requirements Still we must thin of . k

these requi rements always not as a fixed quantity , ,

b ut as representing a relationshi p variab le with in

m
wide li i ts S o again it is the relation individual
.
,

society whi ch is the im p ortant thing and feeble

,

mindedness is a conce p t which incl udes certain or

ga n ica l ly defective indi v iduals who can not develo p
this relationshi p to the p oint of being a b le to care
for themselves
k
.

On the other hand we must not thin of the feeb l e

minde d as b eing necessarily sim p ly children Some .

o f them quite truly are but for the most p art they
,

p resent features whi ch do not square with any one

p eriod of develo p ment as a l ready i nti ated in dis m
cussing age I n the fi rst place the defect is not
.

usually a horizontal on e s o to S peak in vo lving th e

, ,

whole individual at a certain l eve l The defect quite .

usually is more p ronounced in certain respects than

in others For examp le the emotional defect is
.
,

much more p ronounced than the intellectua l in many

high grade defectives Then again the develo p ment
.

of the sexual organs to the pos sibility of adult func

t i on in g with the corres p onding growth of the sex

craving in individua l s still infantil e in many res p ects
p resents a grotesque disharmony quite un li e any k
normal p eriod of development Further than thi s .
,

and very fundamental is the fact that chi ldren

, ,

though they may be when viewed from the stand

p oint of their develo p ment they are rarely per
m
,

i tt ed to l ead the life of a child b ut on the contrary

are forced as a rule through economi c necessity to
, ,
1 6 6 M E N T AL H YG I ENE

take u p the ad ult p roblems of self aintenan ce m .

T hi s b rings us b ack again to the f undamental is sue

o f the s ociety individual relation in which we fin d
-

the indi v idual wi t h infantil e characters attempting

the p ro bl ems of adulthood The res ul ting picture .

i s a s mi ght b e ex p ected neither that of a normal

, ,

chi l d nor o f a normal ad ul t .

T HE CONC EP T F EEBL E M I N DE DN ESS -

Thus far we have come to certain conclusions b y ,

considering what is meant b y age as to what sort of ,

individuals might be in cluded under the broad des

ign a ti on of feeble minded name l y those who b e
-

, , ,

cause of an inherent defect , inherited or acquired ,

have never deve l oped and are unab l e to develo p to

a degree of s ocially e fficient conduct suffi cient for
se lf su pp ort E ven from t hi s viewp oint crudely
-
.
,

out l ined a s it i s , we have had the e xt reme hetero

g en e i ty o f the group forced upon our attention .

When however , we come to consider th e question

,

from the point of view of therapeutics we see still

f urther evidences of comp l e xity .

As s oon as we b egin t o l ook at the various prob

lems from this angle we w ill s ee that the pro b lem of
feeb l e mindednes s and many other s ocia l pro b lems
-

in t r a digi ta t e a s it were , and the resul ting p ro b lems

,

are not necessari ly prob l ems of feeb l e min dednes s -

at all For examp l e not a few defectives are such

.
,

b eca us e of the e ff ects of congenital syphi li s u p on

t he central nervous system The s oci alproblem of
m
.

such a syphil i tic imbecil e i s not pri aril y the pro b

1 68 MEN TAL HY G I EN E

the adenoids the prob lem is surgical : and in the

ca se of th e defective s ense organs it is in the fi rst
i nstance a p ro b lem for the specialist ( op ht ha l ol o m
gist o r aurist ) and fi nally a problem for the edu
,

ca tor .

M any o ther exampl es could of course be given ,

particularly exam p les of sordid and unh ygienic en

v i r on m
en t w ith p erha p s alcoholic ha b its at a tender

age de p rivation toxemia and vicious influences a ll

, , , ,

of which only add em p hasis to the heterogeneity and

the com p lexity of the conce p t and the problem of
feeble mindednes s
-
.

Heredi ty — The questions invo l ved in the conce pt

of heredity have in recent years been given a large

measure of attention based very l argely upon the

rebirth of the M endelian l aw and its ap p lication to
solving the p roblems of heredity in the whole b i olog
ical fi eld including the human s p ecies Fee b le mi nd.
-

edn es s h a s come in for its share of attention f rom

this fi eld of science and here di ty has come to fi gure

as its cause p ar excellence .

B riefly stated the theory of heredity is as fo ll ows

There are se p arated OS from the b ody as a whole
,

( the soma ) the sex cells made up of what is known

, ,

a s the ge r m plasm When two such cells from op

.

p o s it e sexes u n ite ( fertilization ) the mixed germ

p lasm resulting conta inin g as it does germ plasm
,

stock from both p hylums ( the stock of b oth p art

ners ) contains the p otentia lities for the develo p
ment of a new indivi d ua l .

The germ p lasm is supposed to contain minute

 THE F E E B LE M I N DE D
-
1 69

material particles whi ch are the here d itary carriers

of the several qualities of the new in d ivi d ual the ,

s o called determiners and these determi ners during

-

the stages of cell division b y which the mate r ial f o r

the new individual is s orted out are di vide d u p
,

accordi ng to mathematical ratios which give in each ,

instance a certain mathematically exp ressib le de

,

gree of p roba b ility that the new indi vidual wil l or

willnot have a certa i n quality posses sed b y on e or
other of the parents .

T h e various hereditary ratios have been worked

out with consi d erable accuracy in ex p erimental work
d one with many p lants and animals and the attem p t
has b een made to carry over the conclusions reached
to ex p lain the p henomena of heredity in man .

T hese theories of heredity have largely controlled

thought with regard to the p ractical a pp roach to the
s olution of the f ee b le minded p ro blem des p ite the
-

f act which I have already p ointed out that in a con

e num
, ,

s i de r a bl b er of cases the f eeb le min dedness is

-

only inci d ental and b ut a mi nor p art of an entirely

di ff erent p ro b lem Th e u p shot of the whole matter
.

is that fee b le min dedness has been held f or the most

-

p art at least to in di ct the germ p lasm and therefore

,

the conclusion has b een reached that the only p r a c

tical attack u p on the question must b e an attack u p on
b ad strains of germ p lasm wherever found Th e .

essential f allacy of thi s p osition I shall di scuss later

when I come in the next section to a consideration
of the euge n ic s olution for the problem .
1 70 ME N TAL HY G I E N E

T HE E U GE N I C O S L U TI O N
The solution the p ro blem
f or the feeble minded
of -

o ff ered by the euge n icist is as suggested an attack

, ,

u p on the germ p lasm His suggestion is to b ring

.

the p articul ar strain of germ plasm which has b een

condemned to an end either by s egregating its host
during th e peri od of s exual potency o r by some form
o f surgical procedure which wil l cut o ff the germ
plasm from the pos si b ility of finding its com p lement
for re p roduction ( ca stration or vasectomy and s a l
in m
p g to y )
ec .

T hi s solution would be ideal if it coul d be deter

m ined that a certa in strain of germ p l asm was s o
b ad that no good could come out of it B ut such a .

determina tion i s to my mind clearl y im p ossible

, , .

By the very terms of the theory the determiners

whi ch ca rry the qualities of the o ff s p ring to b e are
segregated accordi ng to mathematical ratios there ,

fore just because a person may b e n o good in on e

p articul ar that b y n o means im p li es that that specifi c
form of n o goodnes s wil l necessarily be transmitted
-

to any or all descendants Al l we can be sure o f

.
,

acce p tin g the theory i s that a s a result of diseased

,

germ p lasm a certain pro p ortion of the p rogeny will

b e diseased b ut just which ones they wi ll be c a n n ot
be p r edic t e d
. These laws of heredity are useful to
explain w ha t ha s ha p p en ed but of a lmost no va l ue in
predi cting w ha t w i llha p p en as the result of a p ar
t icul a r human fertiliz ation Of course it can be un
.

de r s t ood how thes e laws are usefulto fruit raisers

m
,

for exa ple who can te ll just what p roportion of a

,
1 72 ME N T AL HY G I ENE

m indednes s a s a unita r y conce p t A s a result of .

this they formul ated a law some time since that the
union of two feeble mi nded persons could p roduce -

only feeble min ded p rogeny Soon afterwards how

-
.
,

ever there were found exceptions to this l aw and

,

the explanation was that if one p arent poss es sed

ce rtain qua lities a b c but lacked d which l ack , . . . .

p rod uced the fee bl e mindedness in t hi s particular -

instance and the other p arent p ossessed certain

,

qualities a b d b ut lacked c which p roduced the

, . . . .

fee ble mindednes s in this instance then o b viously

-

th e child might p os ses s all f our qualities a b c d . . . .

derivi ng the quality 0 from the fi rst parents and the .

quality ( 1 f rom the second . .

I t is unneces sary to further contend against the

idea that insanity criminality or fee ble mindedness , ,
-

are unitary conce p ts This whole b ook is an argu .

ment against the p ossibility of maintaining any such

p osition To tal about insanity crime and fee b le
. k , ,

mindedness as if they were unit characters which

could b e transmitted in toto is to fail utterly to gras p
the meanin g o f these p henomena in the social organ
ism and is assuming a p osition which is a b solutely
,

in defensible and untena bl e E verything I have said .

a b out these three groups contradicts it .

That the error of such practice is a real error

and not merely a theoretica l one is easily demon
s t r a t ed T o note but a few instances taken from
.

Walter : 1

1
H . E . Wa l te r :
“
G
e ne tics A I n trod uction to
, n t he S tu dy of He r ed
ity .
”
N ew Y ork , Th e M a cmi ll n C o 1 91 3 a .
, .
 T HE F E E BL E M I N DE D -
1 73

The list of weakling b a b ies f or instance who , ,

were ap p arently p hysically un fi t an d hardly worth

raising u p on fi rst judgment b ut who a f terwards b e ,

came powerful f actors in the world s p rogress is a ’

,

notab le one and includes the names of C alvin N ew ,

ton Heine Voltaire Herb ert Spencer and R obert

, , ,

L ouis Stevenson .

“Or take another example E liz ab eth Tuttle the .

,

grandmother of Jonathan E dwards is describ e d as

‘
a woman of great b eauty of tall and commandin g
k
,

a pp earance stri ing carriage of strong will ex

, , ,

treme intellectual vigour b ut with an extraordinary ,

defi ciency in mora l sense She was divorced from .

her hus b and on the ground of adultery and other

‘

immoralities The evil trait was in the b lood

.
,

for one of her sisters murdered her own son and a ,

b rother murdered his ow n sister That Jonathan .

’

E dwards owed hi s remarka b le qualities largely to

hi s grandmother is shown b y the fact that R ichard
E dwards the grandfather married again after hi s
, ,

divorce b ut none of their numerous p rogeny rose

,
‘

a b ove mediocrity and their descendants gained no,

abidi ng reputation A s shown b y su b sequent .

’

events it would have b een a great eugenic mistake

,

to have de p rived the world of E liza b eth Tuttle s ’

germ p lasm although it would have been easy to

,
” 2
fin d judges t o condemn her .

2 Th e desc en dan ts of Jon a th an E dwa r d s a r e d escri b ed by W i n shi p

a s fo ll ows
“1 3 94 of his d e sc en d a n ts w er e i d en ti fi e d i n 1 900 of
whom 2 95 w er e coll ege gr a du ates ; 1 3 p r esi den ts of our gr ea test co l
,

l eges be si des m an y p ri n ci pa l s of oth er im p orta n t ed uc a tion a l i sti

, n

t ut i on s ; 6 0 p hysici a n s m a y of whom w er e emi n en t ; 1 00 an d mor e

, n
1 74 M E N T A L HY G I EN E

In the old Puritan days there would probably have

been a pretty complete unanimity of opini on that a
girl who smoked cigarettes or danced or a boy who ,

chopped wo od on Sundays or a man who had doubts ,

a s to the literal truth of the B ib l e were all sure of

eterna l punishment in He ll and that they pretty we ll
deserved it Today however while we might per
.
, ,

s on a l
ly agree or disagree approve o r disapprove of ,

these s everal persons we would hardly fee l war

ranted in cutting off their germ plasm from the world
although in the old days if such a cours e of p ro ,

ce dur e had been suggested I fee l sure it wou l d have ,

found many hearty s p ons ors .

The reader should b e pre p ared by thi s time if he ,

has followed the thought which runs through the

book up to thi s point to rea l ize that what i s ri ght or ,

wrong what is good or bad is very much what we

k
,

thi n t o be right and wrong good and bad s o that , ,

c l rgym
e en missio ri e s or th eo l ogica l p rof ssors ; 75 w e re offic rs
na e e

in t h a rmy a d na vy ; 6 0 w er e p romin en t a uthors a d write rs b y

, ,

e n n

whom 1 35 books of m erit w re writte n d p ubl ish ed a n d 1 8 im

,

e n a

porta t p eriod ica l s d it d ; 33 Am rican S ta tes a d severa l foreign

n e e e n

coun tri s a n d 92 Am rica n citi es an d man y for eign citi e s h a ve

e e

p ro fited by t h ben efi ie t i n fl uen ce of th eir em in en t a ctivity ; 1 00

e c n

a d mor e w e r e l a wy e rs
n of whom on e w a s our mos t emi n en t p ro
a w ; 3 0 w r e ju d g s ; 80 h eld p u bl ic offi c e
,

f so r of l
es e of whom on e
e

vice p r esi den t of t he Un ite d S ta te s ; 3 w ere Un ited S ta te s

,

w as

s tors ; sev r a l w r e gov rn ors M em be rs of Con gr ess fra m rs of

en a e e e , , e

sta te co stitutio s m a yors of citi s a n d mi n iste rs to for ign courts ;

n n e e

o e w a s p r si d en t of t h e P a ci fi c Ma i l S tea mshi p Com p a n y ; 1 5 r i l

, ,

n e a

roa d s m a y ban ks in sura n ce com p an i es a n d l arg i n d ustri a l e te r

n e n

p rises h v bee i d bted to th ir ma g m en t Almost if n ot v ry

, , ,

a e n n e e na e e e

d p rtm n t of soci a l p rogr es s d of p ubl ic w ea l ha s f l t t h im p u l se

.

e a e an e e

of this h l thy l on g l ived f mi l y I t is n ot kn own th a t an y on e

ea a

of th em was eve r con victe d of crim e

-
.
,

.
1 76 ME N TAL HY G I ENE

th at tendency already referred to of attempting to

, ,

crowd l i f e into dead forms of try ing to think of ,

s omething moving dynamic in terms of something

m
, ,

dead static Individual environment are not u

, .
,

t ua lly exclusive M an is only

. a bit of the l ife of the
world and unles s he is s een a s such and his reactions
,

viewed from that s tand p oint no adequate p rogram

of dea l ing wi th hi s reactions can b e worked out W e .

will s ee this more c l early in the next section .

iza ti on Legisl
S teril ati on — The advocates of l aws
whi ch sha ll p rovide for the steri lization of certain
classes of defectives are l a b ouring under a peculiar
delusion of the nature and function of l aw already
hinted at in the cha p ter on the crimina l in the section
dealing with crimina l procedure The whole ques .

tion of the place of law in dealing with the larger

question of mental defect needs to be better under
sto od and b ecaus e of the em p hasis which has been
,

recently laid upon the need for steri lization l aws per
ha p s this is as good a p lace as any to consider it .

I have already intimated that law a s such was not , ,

a means t hrough which to e ff ect reforms by stating

the general pro p osition that practi ce had to precede
f ormal enactment into statute In fact it woul d .

seem that the fi rst ste p in the administration of j us

tice has always b een the a p pointment of a judge and
this b efore the existence of forma l written law 8
, .

Sta tutory l aw is by no manner of means a body of

8 Ja m es C C a rte r
. :
“Th e
I d l d t he Actu a l i t he La w a n ua l
ea an n n

a dd r e ss a t th thi rte n th a nn ua l m ee tin g of th e Am er i ca n Bar

e e

Associ a tion 1 890

, .
 TH E F E E BLE M I NDE D -
1 77

commands imposed u p on s ociety fr o w it hout but m

the crystalli z ed expression in written form of what
was already nascent in the social consciousnes s what
had already grown fr omw i thin and was waiting to
,

b e b orn to b e emb odi ed in concrete form Unless

,
.
,

therefore the written law ex p resses the desires of

,

the p eople it can be nothing else than a dead letter

on the statute b ooks Th e Honoura b le Henry E
. .

D avis has e xp res sed the general p rinci p le that gov

4

er n m en t is based u p on the consent of the governed

s o far as the law is concerned b y de fining law a s

“That b o d y of rules for the regulation of human
conduct which is enforced b y the State emb odying ,

so much of the attri b ute of justice as each p articular

s ociety of men is a b le to comp rehend and will ing to
”
ap p ly in human a ffairs .

This meanin g of the law namely that it must be

m
, ,

read out of society not into it has b een most a d i r

, ,

ably expressed by the Honourab le James 0 C arter 5

.

and I can do no b etter than to quote from hi s address

already referred to .

“In early R ome and in every other instance of

,

whi ch we have authentic in f ormation we fin d that

m
,

the fi rst ste p in the ad ini stration of justice has b een

to elect a judge The creation of judges everywhere
.

antedates the existence of formal law But though .

formal law does not at fi rst exist the law itself ex ,

i s t s or there would b e no occasion to a pp oint a judge

,

to admini ster it Th e social standard of justice

.

4 O f t h D istrict of Co l um b i a Bar
e .

5 Loc cit
. .
1 78 M E N T A L HY G I E N E

exi s ts in the habits customs and thoughts of the

m
,

people and a l ,
lthat is needed in order to a pp ly it to
the sim e a ff airs of such a period is the s election of
a person for a j udge who best comprehends those
ha b its customs and thoughts
,
“M oreover the only means open t o us of certainly
k
,

nowing the law n amely a resort to the judge is

, , ,

ava il able onl y in the ca se of an all eged violation ;

and what s ort of a command is that which must be
violated or all eged to have been vio l ated before it
, ,

can be known ? But if law be not a command but

, ,

th e mere jural form of the habits usages and

m
,

thoughts of a people the ma xi that a ll are pre

k m
,

sumed t o now it does not expres s a fals e as s u p

tion but a manifest tru th
, .

“The o ffice of the judge is not t o make it but to

,

find it and when it is found to a ffix to it hi s o ffi ci a l

, , ,

mark by whi ch it becomes more certainly known and

authenticated The ofiic e of the l egis lator
. is
s omewhat but not fundamenta lly di ff erent
, , .

“These are that l aw i s not a body of commands

imposed upon s ociety from without either by an ,

indi v idual s overei gn or superi or or by a s overeign ,

body cons tituted by repres entatives of society itself .

It exi sts at a ll times a s on e of the elements of s ociety

sprin ging directl y from habit and custom .

The statute l aw i s the fruit of the conscious ex er

cise o f the power of s ocie ty while the unwritten and,

customa ry law i s the product of its unconscious ef

fort The former i s indeed to a certain extent a
.

creative work ; but a s we have a l ready seen the

, ,
1 80 M EN TAL HY G I ENE

A custom begins to grow , and b ecomes more and

more general to make to them some remuneration
,
.

I t is not u n iversal The judge cann ot consistently

.
,

wi th hi s p rior declarations recogni z e it ; b ut the un

,

conscious forces of society are struggling for it and ,

the final legislative sanction is M p a ti en tly awaited .

“In legislation therefore the r ule should be never

, ,

to act unless there i s an end to be gained for whi ch

legi slative action alone is com p etent ; and when such
action is initiated it should seek to recogniz e and
,

ex p ress the customs whi ch s ociety is aiming to make

uniform .

From all this the futility of l egis l ation which p r o

vides for the steril iz ation of defectives is manifest 6
.

L aw a s I have said i s only ca p able of giving eff ec

, ,

tive ex p ression to what is already nascent in the

herd L aw is not an avenue through which to e ffect
.

reforms b ut a means of fi xing crystal liz ing the r e,

s ul t s of reforms already e ffected in the s ocial con

s c i ous n e s s and merely awaiting the sanction of l eg

is l a t iv e recognition and enactment .

M E N A C E or F EEB LE M I N DED N E SS
TH E -

It is the habit in certain quarters to paint a l armist

p ictures of the menace of the fee b le minded, more -

es p ecia ll y by emphasizing their greater p roductivity

than the norma l and the further fact that they are
being cared for b y society and kept alive and so the
means of their elimination are prevented from p ro
0 st ri l i za tio l ws which h a v bee p ut u p o
Th e e n a e n n t he sta tute s in
som e of t he sta te s a r e p ra ctica ll y i op r tiv
n e a e .
 THE F E E BL E -
MI N D E D 1 81

ducin g their natural consequences Whereas I do .

not want to minimize any real d anger still I am sure ,

that the menace has b een greatly overdrawn .

In the fir st p lace even under the most favourab le

,

conditions the viab ility of the fee b le mi nded as a

,
-

class is b elow that of the normal so that this f act has

to b e set over against any increased p roductivenes s
that they may show T heir ca p acity for li f e is b e
.

low p ar not only as a direct consequence of their

defective p hysical make up of which their feeble
-

mindedness is one ex p ression and which makes them

relatively non resistant to d isease but also b ecaus e
-

of their defective intelligence which makes them in

ca p a b le of adequately dealing with sickness when

they or their f rien d s or relatives are a ffected A .

neglected p a in in the ab domen may b e due to an

acute a pp endicitis whi ch causes death b ut which was
not brought to the attention of the surgeon early
enough b ecause of the defective intelligence of the
p atient who did not know how to comp lain or of hi s
k
,

f amily who di d not now what to do if he did com

plain.

It is the same with the care of the children Th e

m
.

fee b le i nde d mother takes care of her baby much

-

as a child ( to use D r Salmon s a p t illustration )

.
’

looks after its doll She is quite as a p t to forget

m
.

about it and leave it outdoors somewhere in in cle

ent weather with disastrous results .

These are the natural ways in which feeb l e mind

m
-

e dn e s s tends to eli i nate itself an d which many

eugeni sts t h ink are b eing negatived b y present

1 82 M EN TAL H YG I EN E

methods of pub lic care Of course they are not b e

.

ing negatived to any great extent as yet because only

com p aratively few of the fee b le minded are being
-

p u blicly ca red for but the principle remains the

,

same and it is l argely because of thes e reasons that

these eugenists are s o insistent upon steri l i z ation .

The more rapid mul tipli cation of the relatively in

f e r i or seems to b e a l aw of na t ure The l ower down
.

in the s cale of life we go the greater the ca p acity for

reproduction because the ada p tabi lity is l ess and the
morta l ity correspondingly greater T his being s o it
.

woul d look as if there were some ground for the

eugenists fears that natura l means of elimination
’

are b eing s et at naught by pub lic care There is a .

certain truth in this but if the eugeni sts are right

,

there will soon be no one but feeble minded to p op u -

late the earth and in fact it wo ul d seem that th e

,

mathematica l neces sities based upon their fertil ity

would have e li mi nated a ll others l ong before this .

The fallacy here seems to be fundamental namely , ,

a failure to s ee fee ble mindednes s as a rel ative mat

-

ter and the act of caring for the weaker as a part

of socia l activity as a who l e which here as e l sewhere
,

a ll a l ong the l ine of deve l opment has a ssured the

,

surviva l and the dominance of those best equipped .

The attitude of the eugen ists is too simp li stic It .

fail s t o appreciate the enormous comple xity of

s ociety and considers that a singl e factor in that
com pl exity namely the fertil ity of the feeble
, ,

m inded can be considered alone and that its resul ts

,

may be considered a s coming about natura ll y in a

1 84 ME N TAL H YG I ENE

why many fee ble minded p ersons cannot get along

-

in the community is b ecause they are not let alone .

A s a cl as s they are childlike tracta b le give their , ,

confi dence and a ff ection easil y and if pro p erly and

kindly handl ed many woul d get along allright The .

feeble minded boy however is not l et a l one He is

-

, ,
.

teased into a state of constant irritability and fina ll y

in an excess of rage: when he i s no longer able to
m
control hi self he turns about and strikes the caus e
,

o f hi s su ff erings dead Then the community says

.

there is a pro b lem Thi s of course i s b ut on e of

.
, ,

those artificial problems which I have a l ready men

t i on e d and which should not a ll at l east b e laid at , ,

the door of the fee bl e minded N ot infrequently the

-
.

productivity of the feeb l e minded is as much an ar -

t ifi cia lpro bl em in the same way The f e eble minded .

-

gir l is n ot in frequently but the pas sive victim either

o f the unscru pul ous seducer or the ado l escent youth

who knows no better Here again the fault shoul d

.

n ot a ll be l aid again st the feeb l e minded -

.

I feel very much toward the question of s t er il i za

tion as I do toward the prop osition to chl oroform a l l
the insane and crimina l s The dependents are the .

b urdens which the effi cient have to bear and b ecome

e ffi cient in hea r in g The pain and the su ffering they
.

“ ”
caus e have forward ends which make for a b etter
and more humane society Ch loroform might b e a
k
.

s o lution but I for one woul d not li e to l ive in a

, ,

society which ado p ted it .

There wi ll always b e a l ong way between the man

at the top of the ladder and the man at the foot , and
 TH E F EE B LE -
M IND E D 1 85

the man at the foot wil

lrelatively s p eakin g be feeb le
minded We need not ex p ect to eliminate the p rob
.

lem but we must b e satis fi ed if b y great efi or t we can

shorten that distance just a little .

W HAT IS TO BE D O E AB O U T
N II ?
In makin g for a remedy for the p rob lem of feeble
mindedness we must of cours e kee p always in mind
the complexity of the concept and never make the
k
mista e of dealing with it as if it were unitary A s .

we have seen that the factors which produce fee b le

min d edness are many s o must the remedies b e Th e .

remedy for adenoids is surgical ; f or sensory defect

f ollowing the eru p t ive fevers is sanitation ; for de
f ect iv e eyesight a p propriate gl asses ; for vicious sur
roundings with no o pp ortunities im p roved environ
ment and education etc etc There remains a l arge
, .
,
.

numb er who are de f ective b ecause of serious defect

of structure either developmental ( hereditary ) or
,

acquired ( disease injury ) H ow shall this l arge

, .

grou p of which there are p ro b ab ly s ome three or

,

four hundred thousand in the Uni ted States not in ,

institutions b e dealt with ?

,

In the fi rst p lace I have al ready unequivoca ll y

o pp osed sterilization as a s olution of the p ro b lem
b ecause I bel ieve it to be unscientific unwarranted ,

b y our present kn owl edge and inhuman this latter

, ,

having p erhaps a more serious efi ect u p on the

society which sanctions it than u p on the defective
who has to su b mit although as yet we do not know
,

the extent of damage which such operations may

1 86 ME N TAL H YG I ENE

p roduce I be lieve i t greater than generally s up

.

pos ed C ertainl y we do not yet fully know the pos

.

s i bil i ti es f or harm at th e psycho l ogica l leve l of rea o

ti on of destroyin g f or an individual al lpos sibil ity of
their ever f ulfill ing their bio l ogica l goal .

Institu ti on care of course suggests itse lf and has

been an d is being pushed forward largely as a solu
tion Undoubtedl y many ca ses shoul d be segregated
.

in proper institutions Just how many or what pro

.

po r tion we do not know, but certain ly a ll those who

are in a broad sense , active l y dangerous to the s o
,

c ialwe l fare Such cases f or examp l e a s show dan

.
, ,

g e r ou s crimi n al tendencies , particul arl y thos e with

tendencies to commit crimes against the person ( sex
o ff enders ) t hos e which are di stributors of venereal
,

inf ection ( prostitutes ) , and those which , be cause s o

defective they cann ot mainta in a s emb l ance of socia l
e fii ci en cy , l ive in such squal or fil th and depravity as
,

not only tends to degrade the neighbourhood but

makes of them dangerous foci of infection whi ch
threaten the heal th and the l ives of the communi ty .

These shoul d be the first t o b e prepared f or by insti

t ut i on care .

A great man y of the feeb l e mi nded bes ide s those

-

described wil lbe ab l e t o l ive outside of an in s titu

tion In fact , not a littl e of the s imp l e s ort of work
.
,

the drudgery of life i s done by in dividual s who , b y

,

any acce p ted s tandard of measurement woul d n u

doubtedl y fa ll within the feeb l e minded group
m
-
.

With the estab li sh ent o f institutions however , ,

many of di s t in ct ily higher grade than those de

1 88 ME N TA L H YG I ENE

ing new in the way o f principles invo lved The oh .

j cet is to take individuals who can not live in the

s ocial environment and create an environment for
them in which they can l ive and not only l ive b ut at
,

the highest e ffi ciency of whi ch they are capab l e The .

environment ha s of course to be made sim p le

, ,

enough to meet their l evel of deve l opment and as far

a s pos si ble adjusted to individua l needs .

E duca tion will naturally p lay a l arge p art in deal

in g with this clas s o f defectives In order that they
.

may live at their b est dormant and neglected f a cul

ties must be develo p ed to ca p acity The process of
.

education going hand in hand with useful occupation

will ena b le all to get the most out of li f e by giving
the most under circumstances in which maximum
activity can be developed with l east danger to s o
c i e ty Under these circumstances an institution
m
m
.

shoul d not be considered an ex p ens e to the c o u

n it y but a distinct economi c advantage making the

most out of its defective members It will enable .

a given defective who perhaps l ived at zero e ffi ciency

in the community or perhap s worse being positively ,

destructive to live at ten or fifteen per cent effi

, .

c i en cy and thus serve to give much that would other

wise be lost to the s ocia l group a s a whole In the .

proces s of doing this the immediate burden is taken

from the shoul ders of the few and re distributed ,

through the process of taxation to the shoulders of

,

the many This is one of the ways in which society

.

equaliz es its b urdens

m
.

In a ddition to the fee b le inded who willnatur

-
 THE F EE B L E -
M IN D E D 1 89

ally gravitate to institution care there wi ll of n ec e s

s it y remain a large num b er variously distri b ute d in

the community Of those who come to form part of

.

other defective dependent and delinquent classes

,

more wi ll b e said in the next cha p ter There still .

remain a great many who are inadequately dealt

with and who are not a b le to adequately p rotect
themselves The B ritish C om i ssion which was
. m
a p pointed t o study thi s whole subj ect recommended ,

among other t hi ngs that the fee b le minded in the

m
-

com unity b e adjudi cated as such and thus given

the legal status of chi ldren By s o doing the com
.

munity would not be endangered b y their attem p ted

adult activities and the feeble minded themselves -

would have the legal p rotection whi ch their status as

children would naturally entitle them to For ex .

amp le : The law provides that maj ority i s attained

at twenty one years of age From this time forth
-
.

the indi vidual is entitled to exercis e the ful l rights ,

duties and p rivileges of citizenshi p votin g for i n ,

stance and ceases to be entitled to p rotection as

,

a minor From what has already been said a b out

.

age the mani f est ab surdity of t hi s legal p rovision

when interpreted s olely a s chronological age i s at
once a pp arent That a p erson who b ecause he has
.
,

lived twenty one years should b e entitled to all the

-

p rivil eges of citiz enshi p even though he may only

,

have the mental develo p ment corres p onding to a

two or three year old infant or even a nine or ten
year old child i s a state of a ffairs which to p ut it
, ,

mil dly cannot but seriously impair the e fficiency of

,
1 90 ME N TAL H YG I EN E

th e s ocial machin e if there are many such , seems a

se lf e v ident pro p osition Such a l eve l of in efiicien cy
m
-
.

tends c ons tantly to drag the whole l eve l of acco

p li s h m
en t downward Then aga .i n the rights and
p rivi l ege s of citiz enship give the citiz en a right to
buy liquor in a sa l oon and drink it Those who are .

fami l iar with the reactions of the feeble mi nded -

kn ow what that means They are natura lly not .

nearly s o we ll abl e to take care of al c oho l a s the

a pp roximately norma l individua l and are therefore , ,

much more prone to commit outrages of various

sorts under i t s infl uence If the fee b le min ded had
.
-

the l egal status of chi l dren in the community every

one wo uld be put on notice of that fact and t o se ll ,

liquor to a feeble min ded man even though he were

-

forty years of age ( chronologically ) would constitute

identica l ly the same ofi en ce a s to se ll liquor to a
chi ld Such a way of handl ing the prob l em would
.

not only put every on e on notice but woul d foster

t hat sort of understandin g of the feeble minded -

problem in the l arge a s wo uld mak e f or a more i nte l

ligen t han dling a ll al o ng the lin e .

With these methods of taki ng care of the feeb l e

min ded situation the defective individual instead of ,

b eing s ought out and steriliz ed would tend only b y ,

hi s ow n behaviour t o remove himsel f from the com

,

muni ty C ontinuing antisocia l tendencies would

.

ca ll forth measures graduated in their e ff ectiv eness

,

to exclude from the herd to meet it First an a d , .

judi cation then institutiona l s e gregation s o that the

m
,

feebl e inded person a s a resul t of hi s ow n b e

-

,
 C H APT E R VII

MISCELLANEOUS GROUPS

In the three p revious cha p ters I have discussed the

three great groups o f the de p endent defective and, ,

delinquent class es namely the insane the criminal

, , , ,

and the fee b le minded I n the present chapter I shall

-

take u p for consideration certain other groups ,

namely the pau p ers prostitu tes a l coho l and drug

, , ,

addicts the unem p loyed the epi l eptic and show

m
, , ,

a ong other things that those who go to make u p

these several grou p s might a l l b e classed with the
three grou p s a l ready discussed and treated as such ,

or in certain instances notab l y the epi l eptics be

, ,

considered a s su b groups
-
.

T HE PA UP ER
We are incl ined to look u p on the pauper a s one
who has been unfortunate unlucky in l ife whose fail
, ,

ure in other words ha s b e en due to circumstan c es

, ,

largely outside of himse lf The more we examine

.

into this pro p osition , especially in individual in

stances the more we a r e forced to conclude that it is
,

fun damentally wrong and that the counter p ro p osi

“
tion Succes s in this world depends upon brains is”

very much nearer the truth .

Le t us take an extreme example to il lustrate the

1 92
 M I S C E LLA N E OUS G ROUP S 1 93

t r uth of the a b ove p osition Su pp ose that a man

.

loses his arm and su pp ose in a dd ition that hi s p osi

, ,

tion in the herd ha pp ens to b e that of a b lacksmith s o

that his arm is of su p reme im p ortance to him and its
los s p revents him f rom p lying his trade Su pp ose .
,

as a result of that loss that he goes to the p oorhouse

,
.

One naturally thinks of his p au p erism as de p endent

u p on due to his p hysica l injury But after all is
, .

this a fair conclusion ? Think how many p eo p le

there are who have lost an arm or a leg or b oth legs , ,

or p erha p s their eyesight and yet were a ble to get

along and lead e fficient lives in the community " I
m
have in i nd a man who comp letely lost his eyesight
in his twenties as the result of an acci d ent yet who ,

lived an e fficient li f e to the time of his d eath at ab out

sixty having managed to raise and su pp ort a family
,

and give his children co ll ege educations And then .

of course all of us think of such well known exam p les

as that of M iss Helen Keller a young woman now

, ,

I think in the neighb orhood of forty who lost a b s o

,

lut e ly b oth her eyesight and her hearing when s h e

was ab out three years old and yet she is not only
,

an effi cient member of the community b ut is a ca p a b le

writer and speaker and very much be l oved by every
body .

With such fact s as these in mind it b ecomes n ec e s

sary to reconsider the pro p osition that the p au
p er i sm of the blacksmith is due to the physical los s of
his arm It would seem that there must b e some
.

thing more than the p hysical injury to account for

such a com p lete failure To p ut the matter broadly
.
1 94 ME N TAL H YG I ENE

he has fa il ed to b e a b le to make the readjustment

necessitated b y his injury which prevents him effec
t ua ll y from followin g his trade of blacksmith . What
does that mean if not a menta l fail ure " It may be
express ed b y saying that he has lost his nerve or
.

in any o ther way but th e essentia l fact is that b e

,

neither has the menta l res il iency or resourcefulnes s ,

o r the mora l courage to tackle the p ro b lem of life

on this new basis The fact that he may be too old
.

does not alter the ex p lanation The failure is a

.

psychological one If he had had the mental capa c

.

ity he would not have had to go to the poorhouse .

A side from the fact that the p oorhouses have been

caring for many years for the manifestly insane and
feeble mi nded it must be e v ident from the a b ove dis
-

c us s i on that the other inmates are also though per

,

ha p s not so p atently mentally in e ffi c ien t— socially i n

,

adequate Those w ho are f amiliar with p oorhous e

.

ty p es wil l be a b le to recall the numerous manifestly

fee ble minded and otherwise defective typ es which
-

eve ry p oorhous e has di strib uted in its p opul ation

a n d wi ll perha p s a l s o recall th e numerous instances

o f individua l s who are a b le to live in the community ,

a fter a fashion during the warm months of summer

,

b ut seek the protection of the p oorhouse when th e

extreme demands of col d weather are ushered in with
the winter .

In addition to the typ es thus far referred to there

w il l be found in every p oorhous e a considerabl e num
ber of aged p ersons more or les s blin d and deaf and
in a number o f ins tances p aralyzed f rom the e ff ects
1 96 ME N TAL HY G I ENE

feeble mi nded Some surveys have given a much

-
.

higher per cent than this although it is to b e remem

.

bered that p robably o n ly the most defective get “

caught Fifty per cent I am convinced is a con
.

s e r v a t iv e estimate Y et even if the proportion is no

m
.

higher feeble inde dness easily constitutes the one

,
-

most important caus e of prostitution and the one

m
most i p ortant and at once most hopeful aspect to
attack with remedia l measures .

Probably no social prob l em ha s been attacked with

more vigo r and more frequently and also with fewer
desirable resul ts than the problem of prostitu tion
k
.

The histo r y of prostitution is generously sprin l ed

with attempt after attempt each on e use l ess or worse
,

than use l es s to suppress or regulate it The funda

, .

menta l defects in a ll thes e attempts have been two .

I n the fi rst pl ace prostitution in just the same way ,

as I have shown with reference to other s ocia l prob

lems was treated as a unita ry concept that is a s a
, ,

s ingle phenomenon in its elf and not a s it rea ll y is a , ,

complex of al l manner of thi ngs In the second .

place the e ff ort was made t o deal with it so l ely b y

,

re p res sive measures The repression of instincts

.
,

a s I have re p eatedl y shown can only l ead to some ,

other form of e xpression R epression alone is never

.

the true so lution of any menta l p rob l em If a cer .

tain avenue of expres sion i s cut off the energy ha s to

fin d an outlet in some other way therefore unles s , ,

some socially useful way is provided o r ready to

hand then the energy wi ll break through in some un
 MI S C E LLA NE OUS G ROUP S 1 97

desirable form expression will b e o b tained in a

,

socially undesira b le and d est r uctive form .

Perhaps no other social phenomenon has illus

t r a t ed b etter th an prostitution the utter uselessnes s
o f tryi ng to solve it b y means o f methods which found

their ultimate motivating forces in the hate of the

herd Wh at this means I have alrea d y indicate d in
m
.

the cha p ter on the c ri i nal ( Chap V ) B riefly of . .

,

course it means that this particular way of dealing

,

with the sex li f e ap p eals s o strongly to the instinctive

cravings of the herd tends s o strongly to unloose all
,

its tendencies which make for letting go b acksliding, ,

taking the easiest way turning aside from the higher

,

aims of culture that the strongest of a ll emotions for

fighting p ur p os es hate , has t o be pressed in the
,

s ervice against it .

A s I have indicated however real lasting gains can

, ,

not b e obtained b y means of actions founding in

hate Hate is always destructive it never b uil d s
.
,

p ermanent and enduring structures The prostitute .

f o r cen t uries has been shunned as sinful her sin irre ,

t r i ev a bl
e and has been hunted from place to p l
, a ce

b y the o ffi cers of the law unremittingly or else p reyed

upon b y the whole h ideous pack of underworld
grafters She has b een hunted and p reyed u p on b ut
.

almost never considered as a social p ro b lem worthy

of scienti fic study with a view to solution until today .

Only now is it p ossib le to see through the thick veil

of hate which for so long ha s o b scured the vision of
,

the herd and realiz e that the p roblem of p rostitution

, ,
1 98 ME N TAL HY G I ENE

like the other social pro bl ems dealt wi th in this book ,

must b e judicially dea l t with with a view not of vent ,

ing our ow n individual pers onal spleen but seeing

, , ,

what ca n be done about it A nd too that when we .

,

come to attempt th e so l ution of this pro bl em like all ,

the others we must understand that no so l ution can

,

is sue whi ch i s not at once to some extent at least a

, ,

s o l ution for both factors invo l ved— the individual

m
and the com uni ty— in order to help one we must b e
ab l e t o hel p the other D estroying the individual
.

does not hel p the herd To destroy an individual is

.

too much l ike destroying s o much energy We must .

t r y and see if it is not possi b le to turn the energy into

more u sefu l chann els to direct it to better ends to
, ,

use it to better advantage .

Without doubt the most important singl e factor in

t he prostitution p roblem is the factor o f feeble mind -

e dn e s s
. Feeb l e mindednes s is l argely responsi ble
-

for the ease with which the prostitutes can b e traf

k
fic ed in it m ust be l argely at the basis of the white
,

s l ave trade a l though of cours e not wholly The very .

fact of fee bl e mi ndednes s however makes these

-

, ,

women pe cu liarl y the prey o f the unsc r upu l ous puts ,

them a l most who ll y at their mercy Feeb l e minded .

-

ness and the cons equent de p endence i s too the l arge

element in many o f the crimes which are associated
with prostitu tion the p rostitute bein g ex p loited and
,

u sed by the more inte ll igent forcefu l and e x p e r i ,

en c e d ma le criminal Fee b le mindedness is also

.
-

probab ly an impo rtant fact or in increas ing the dan

,
200 ME NT AL H YG I ENE

in a ll cas es i s as ridicul ous a s to expec t quinine to b e

the remedy for a ll fevers Such a view p oint ca n .

only b e due to a fail ure to study the individual pro b

l em .

A s soon as the individua l is studied we wil l fin d

that th e prostitute class li ke eve ry large social class
, ,

is made up of a great va riety of types We will .

fin d a l lsorts o f mild inci p ient and residual menta l

, ,

di sease a ll s orts of physica l i ll ness a l l sorts of

, ,

stres ses at the socia l l evel economic particul arly and

, ,

fina ll y and most important a l arge pro p ortion of

, ,

fee b le mindedness N ow when a prostitu t e is ar

-
.

r a ign e d for s ome o ff ence if she coul d b e treated for

what is rea l l y the matter with her the first great step
would b e taken in the rationa l handling of this great
pro blem This wo uld mean in the cas e of the feeble
.
,

mi nded woman that instead of sending her to jai l

, ,

or th e workhous e for a given usually short p eriod , ,

that she be committed a s feeble minded to an i n s tit u -

tion Here she woul d ce as e to be a positive source

.

of danger to the community ( mora l and physica l )

but might as a resu l t of education become an actua l
, ,

source of energy a rea l assistance relative l y speak

,

ing Here s he woul d be kept and s o prevented from

.

s p reading dis eas e and depravi ty and a l so prevented

from reproducing If circumstances cou l d b e s o ar
.

ranged as t o adequately protect the situation she

mi ght be paroled with a view to discharge if her c on
duct and e fli cien cy or the so licitous oversight o f
friends re l atives or a charitab l e organization war
,

ranted In this way of deal ing wi th the situation the

.
 M I S C E LLA N E OUS G ROUP S 201

woman is deal t with for what she i s rather than a t

tempting to deal with the act as such and b y s o d oing
being b linded either b y hate or a sickly sentimentality
from seeing the real human p ro b lem and therefore
doing the really constructive thing a b out it .

Those who are not fee b le min d ed need just as in

-

t el
ligen t treatment for the particular thing that ails
them A woman perhaps defective morally might
.
, ,

be driven to p rostitution to earn a living b ecause too

illto work who if rel ieved from her physical illnes s
, ,

would gladl y give up p rostitu tion And similarly .

for every ca se E ach individual would need in d i

.

vidua l treatmen t—the principle for whi ch thi s book

stands .

T HE I N EB RIAT E
Ine b riety, like the other con d itions I have dis
cussed is not a unitary conce p t Persons are i
,
. m
p el le d to drin k for al l sorts of reasons and the drink

ing is on ly the outward sign o f what is going wrong .

A lcoholic indul gence may b e an indication of a b e

ginning psychotic excitement or on the other hand,
,

of a de p ression ; it may be a feature of the early

stages of a dementia p recox or of p aresis ; it may be
a p eriodic a ffair whi ch s eems t o a ffil iate it with the
e p ile p sies ; it may be the final desperation of on e who
h a s fail ed utterly or who is su ff ering from a ho p eles s
illness The p ers ons who drink may be highly i h
.

t ellectual or dee pl y defective and to use the cl as s

,

terms already de fined may be insane criminal or ,

feeb l e minded , or may be paupers prostitutes epi

-

, ,
202 ME NTAL HY GI ENE

l
e p t ic s ,va gran ts o r what not A side f rom all these .

comp licating conditions there a re a grou p of ine b ri

ates as such These whil e not a l i e by any means
.
,
k , ,

a n y more than any other group of peo p le are ma d e

u p of li ke units have in a genera l way simi l ar rea

, ,

s ons for drinki ng al though in each indivi dua l case

,

the reasons are given a specia l turn app lica bl e to

that particul ar person on ly .

I thi n k it we ll b efore proceeding further with a

,

di scussion of the ine b riate to fi rst mention two p c p u

,

lar delusions concern ing alcoho l .

There are tw o conce p tions connected with the use

o f alcohol one o f which has been seriously invaded
,

on the scienti fic side and its position weakened b ut ,

the other of which sti ll holds sway The first of .

these is the conce p tion that alcoho l is a stimu l ant I .

need hardly te ll how thorough l y the props have been

knocked out from under this position In the de .

struction of this I might almost ca ll it su p erstition

, ,

the work of Kraepe l in stan ds out prominently The .

other is the idea that a l coho l is a habit forming drug -

.

This means I take it that it has some s p eci al power

, ,

for creatin g a habit on the part of the individua l and ,

t hat power is greater for some reas on not speci fied , ,

than the habit creating power of milk b eefsteak or

-

, ,

other nutrient taken into the gastro intestina l tract -

.

This second conce p tion is still strong in the min ds of

peo pl e at l arge and I thin occupies a place in a
,
k
great dea l of the thinking of profes siona l men about
a l c oho lism It i s however in my o p inion a s faulty
.
, , ,

a belief a s the be li ef in its stimulating properties ;

204 ME N TAL HY GI E N E

N ow assuming this condition of inefficiency based

, ,

upon co n stitutional organic de fect in the make up of ,

-

the individual how does such a p erson react to such a

,

de fici ency of make up ? The reaction is an e ff ort at

-

findi n g safety — i t is the safety motive the instinct

, ,

for the fami liar the flight to cover s o to speak which

, , ,

drives the in efii cien t individua l to fin d some way of

esca pe from the horrid facts , the overburde n ing op
p ressions of reality .

This path he finds open to him through the use of

alcohol How frequently do we s ee the alcoholic not
.
,

going out among p eople and meetin g with his fellows ,

not mixi ng with the world but retiring b y himself , ,

shutt ing hi mse lf u p in his room perhaps in darknes s , ,

in s olitude and in quiet and drinking himself stu p id

, , ,

unconscious " Here the escape is abso lutely n ec es

m
sary there i s no com p ro i se possible ; reality must
,

be driven out at any cost , even to the p oint of un con

s ci o u s n e s s .

We have of cours e many l esser degrees of esca p e

than thi s We have the j ovia l story telling tipsy
.
,
-

inebriate who escapes from all responsibil ity who

, ,

sits up al l night an d sla p s his friends on the back ,

and laughs and j okes and gives the morrow notice

,

that he cares not what it b rings forth that tonight is ,

tonight and l et the morrow ta ke ca re of itself We

, .

know the typ e but does not the same e xp lanation

,

hold as in the former case ? Is not this man also

esca p ing from rea l ity by not meeting it efii c i en tly ,

not onl y by so crip pl ing hi mse l f that on the morrow

 M I S C E LLA NE OUS G ROUPS 2 05

he is unab l e to face it b ut b y his very words he a b

,

jures it ?
The feeling of in eflficien cy and flight from reality ,

the ear marks of a neurosis are the ear marks of a l

m
- -

c oh ol i s and now we can un d erstand why alcohol has

b een called a stimulant and why it ha s b een called
a habit p roducing drug I t has b een called a s t im
,

-
. u

lant b ecaus e the individua l who is inca p a b le of fac

, ,

ing reality and has had to take alcoho l to escape has ,

had also to have the b est p ossi ble reason for taking it
— namely that it would hel p him to meet reality It
,
.

is a pure fiction of the alcoholic this stimulating ,

property of alcohol A s to the ha b it producing qual

.
-

—
ities of this drug another fi c t i on — the alcoholic can
not get along without his alcohol ; he must fin d a road
that takes him away from reality once in a while at ,

least ; there f ore the fiction of the ha b it Th e alcoho l

m
.

has gripped hi with this mysterious ha b it ; like an

evil s p irit he is in its clutches and therefore he him
, ,

self to himself is no longer res p onsib le H e has p ro

,
.

jec t e d his res p onsib i lity u p on this myt h and there

m
,

fore cal ed his conscience .

All this is tru e too of the various drug addictions

, , .

The fundamenta l underlying reason for the in dul

gence is a lways an exquisitely p ersonal one and s o
the treatment can never get anywhere that lump s all
these p ersons together and deals with them all alik e .

Farm colonies outdoor work general h ygienic

m
, ,

r egi e are all very wel l in their way and have much

to be said for them aside from any a ll eged th er a p eu

206 ME NT AL HY GI E N E

tic advanta ges which they may have b ut such treat ,

ment can never o ff er anything more than a tempo

rary res p ite from th e tyranny of th e neurosis
m
.

We are f a il iar however with the great cl aims

, ,

made by many a gencies pa rticul arl y by thos e of a

,

more or les s religious character It is true that such .

agencies often succeed when a l l other means have

failed Their success is dependent u p on their ability
.

to seize u p on and use the regressive tendency ( dis

cuss ed in Chap III ) in a socia ll y acce p ta bl e and use
.

ful way The ine b riates come through the religious

.
,

ap p eal to renounce their se lf s ufficien cy which has

,
-

always g o tten them into trouble and as little chil ,

dren ( regres sion ) acce p t the guidance o ff ered In .

this way regres sion is made regenerative .

Here again th e individua l should b e treated for

what he is not for what he is not N o good can come
, .

o f locking him up f or a few days in the workhouse .

Th e thera p eutic attack must be by way of the psycho

therapeutic approach .

T H E np m s p r ro

Just a s we have seen that all sorts and condi tions

o f p eo p le are included under each o f the groups we

have di scus sed thus fa r s o it is true of epilepsy ; the

term includes all sort s of condition s —epil eptics
,

include all sorts of p ersons It makes no di ff erence

.

from what angle we approach the prob l em of epi

le p sy from that of ca use p athology cours e of the
, , ,

di sea se methods of treatment or an y other we shal l

, ,
208 ME N TAL HY GI E N E

opini on today is t o see in this flight from reality the

es sential e l ement in the pathological reaction Just .

as i n the phenomena of alcoholism so here too the , ,

p articula r reason in each individual case is exquis

i t el y p ersonal While the general p rincip le of the r e
.

action by unconsciousness is that it is a flight from

reality nevertheles s the reasons which make such a
,

flight necessa ry are difi er en t with each indi v idual .

Treatment therefore which is other than individual

, ,

can hardly b e ex p ected to have any more than tem

p o r a r ily ame l iorating results .

The necessity for intensive study of the individua l

in order to inte ll igently handle the p ro b lem he pre
s ents in order a s I p ut it to treat hi for what he i s
, , ,
m
and not for what he is not is p roba bly nowhere more
,

o b vious than here for this typ e of reaction is found

,

in widely di fferent typ es of p ersons The epile p tic .

( s o ca lled ) may b e a criminal a pauper an inebri ate

-

, , ,

a p rostitute insane or fee ble minded young or old

, ,
-

, ,

sick or we ll and for each of these conditions there

must be a di fferent angl e of ap p roach The de p end .

ency of these attacks u p on demonstrab l e physica l

causes m
a y be great ( head injury b rain tumor , ,

Bright s di seas e ) or negligibl e and treatment must

’
,

va r y acco rdingly .

T HE H O M OS E" UAL
Thi s s ocia l grou p like the others is a co
, ,
m
ple x and heterogeneous on e and one too that ,

we have onl y recently come to study s c i en t ifi

ca ll y Perhaps no group of individua l s have suf
.
 M I S C E LLA N E OUS G ROUPS 209

f er e d from l ess understanding have b een treated

,

with greater lack of consideration than this ,

group The antipathic emotions have hel d almost

.
'

compl ete sway and so have made the scientific

a pp roach to the pro b lem practically imp ossib le .

Th e history o f society s attitu d e towards the homo

’

sexual is much the same as the history o f its attitude

towards the prostitute except that it has if possible
m
, ,

b een more com pletel y do inated by the antipathic

emotions .

Homosexuality has come of l ate to h ave a much

b roader meaning than that usually connote d b y the
p o p ular speech I t means that d egree of attraction
.

for the same sex which turns the individual aside on

the path towards a heterosexual goa l and therefore
away from those activities which naturally l ead to
p rocreation and are there f ore race preservative -
.

Th e term by no means neces sarily connotes actual

concrete acts of s exual perversion In this large .

sense it is readily s een why it shou ld be ta b ooed b y

the herd Its tenden cy is destru ctive to the interests
.

of the herd as a b iological unit and therefore the r e

action against i t The reaction of hate and its con
.

gen er s is the instinctive way of self p rotection and -

must necessarily p recede any judicial intelligent a t ,

t itude b ased u p on scienti fi c knowledge which can only

c ome in the course of devel o p ment when instinct shall

have been contro lled and directed b y reason .

A s a l ready intimated the homosexual gr ou p is a

,

large and com p lex one and we are only begin ning to
be ab le to ap p roach its p roblems with a cl ear scientifi c
21 0 ME N TAL HY GI E N E

vi sion b ut as we are able to do t his we come more

,

an d more to an a pp reciation of how wide l y this p ar

t icular typ e of ine fficiency is distributed Again .

,

therefore we come to appreciate the emphasis which

,

I have a ll a l ong put u p on the neces sity for studying

the individual in order that he may be deal t with for
what he i s rather than p erfunctorily classi fied wi th
this or that s ocia l group just b ecause and for no ,

other reason the accident of circumstance has found

,

him momentaril y identi fied w ith it D istinct h omo .

sexual typ es are found among the insane the crimi ,

nal the feeble minded the epileptic th e vagrant etc

,
-

, , , .
,

etc s o that we must come to realize that it is a ty p e

.
,
'

of reaction not a l a b el to distinguish a given individ

,

u a lfrom a l l others and try in ou r investigations to

,

eva l uate the part it h a s played in th e social in a de

qu a cy of the particular indi vidua l under considera
tion .

Viewed in this way it b ecomes a prob l em like al l

the others and the obj ects of treatment come out
clearly instead of being befogged by a ha z e of emo
tion .

Th e homose xu a l reaction shou l d be corrected if

pos si ble Psychothera p y is the most hopefu l way of
.

a pp roach Fa il ing this the individua l should b e

.

taught to u se his energies as best he ca n based upon

an understandi ng of himse l f The ideal next to .
,

cure woul d be a direction of the energies into socially

,

u sefu l channe l s which direction woul d at the same

,

time a fford an adequate ful filment of the individual .

Homose xual ity, in the broad sense here us ed, i s

21 2 ME N TAL HY GI ENE

of expenditure of energy in a given direction he con ,

s t an tl
y s l
ips from under his r e S p on s ibili t i es an d finds
in vagrancy a permanent way out A s a tramp liv .

ing from day to day on what he can beg wi th no ties ,

that bind no home no peop l e n o fix ed a b iding place

, , , ,

he feels hims e lf free from al l the restraints civiliz ed

society imposes upon its responsible members He .

sinks to a leve l of reaction which does not make de

mands u p on him which he cannot meet In attempt .

ing to deal with the vagrant it is of course necessary

to kn ow th e individual and to bear in mind his l imita
tions tryi ng always to direct h i s energy in to useful
cha n nels at highest e fficiency at hi s l eve l of capacity
for socia ll y adequate reaction .

T H E H O M ELESS U N E M PLO Y ED
The group of unemployed that can b e found in the
l arge municipa l l odging houses o ff ers interesting
p roblems for study Of course everything ima gin
.

able will be found in this group There wi ll be found

.

physica l di sea se of all s orts : tubercu l osis va l vul ar ,

heart disease chronic disease of the kidn eys , blind

,

ness para lysis , syphi l is conditions incident to age ,

, ,

senility various typ es of menta l disease : epil epsy

, ,

alcoho l ism imbeci lity , re l ativel y de f ective types de

,

p endent upon lack of education or l ack of busines s

training or training in a ski ll ed trade ; and a c on s id
er a bl e number wi ll b e found at certain times as a r e

sult of the fluctuation in trade con ditions which c c

ca s io n a l
ly throw l arge numbers of men out of e m
p l oyment at short notice .
 M I S C E LLAN E OUS G ROUPS 21 3

This whole group however im p resses the investi

, ,

gator as lacking in that mental alertness which is

necessary to succes s of even a limited degree A .

more or less diseas ed condition of some organ of the

body is not an adequate exp l anation for failure N a .

ture has p rovided us with very much more of every

organ than we need for any ordinary purpos e If .

this were not s o a great many of the surgical opera

tions which are done every day in our hos p itals would
be quite imp ossible When we b ear in mind such r e
.

marka b le exam ples of sick men as Kant who is said ,

never to have left his home town K onigsb urg, Her

,

b ert S p encer who for years was a b le to work only

,

two hours daily and D r Harp er of the University of

,
.

Chicago who al though a fflicte d with a dea dl

, ,
y diseas e
and su ff ering great p ain insisted u p on working to
the comp letion of a task he had in hand almost u p
to the last hour it seems almost as if the spirit could
m
,

sur ount every o b stacle and that in the mind was

the p lace that we must always look if we wish finally
to kn ow the tru e explanation of any man s in effi ’

c i en cy .

To be sure these men are not fair averag e exam

p les they are the extraordinary exce p tions Still a
, .
,

limi ted exp erience with invali d s will teach one the
extent to which the p syche usually in such i n
stances referred to as the will is ca p a bl e of ov er com
, ,

, ,

ing the handicap of p hysical illness .

Th e
existence of all these grou p s of the socia lly i n
adequate and the very considerable numb ers included
21 4 ME N TAL HY GI ENE

in each ( a survey of L ondon E ngland indica ted that

, ,

one in each fif ty of the po p ulation of that city were

de p endent ) ha s a lways b een a matter for the alarmist
and p ess imist to dil ate upon In the l arge genera l
.

view which I have tried to give of thes e groups I have

tried to show what their exi stence means In fact .
,

the te r m whi ch I have used socially inadequate ex

, ,

press es that meaning They are consti tuted of the

.

p eople who fa l l short in their make up of those quali

-

ties which make it pos sible for them to react in a way

whi ch is satis fying or acceptab l e to the standards of
the society of which they form a part Viewed in .

this way their existence has a decidedly hopeful and

o p t imistic as p ect for it means that society is strain
in g its utmost to g o ahead on the p ath of progres s
and is constantly p ushing its ideals forward just as
far a s the e ffi ciency o f its constitu ent elements wi ll
m
per it How much better off we are with all these
.

groups o f the ine ffi cient than are the Orienta l socie
ties where there is l ittle o r no tendency toward the
s egregation natural or otherwise of the un fit b ut on
, ,

the contra r y where often the ir reactions are erected

, ,

into a something desira b le even to be worshi p ped

,

( the Holy men of In dia ) The ine fficient cl as ses fur

.

nish the concrete evi dence of failure to attain to a c

c e p te d standards of e fli c ien cy and b y that same token

b ea r w itness to the height of those standards Our .

intelligent dea l in g w ith them wi ll hel p to push u s

forward on the path of progress rather by li ghtening
the l oad than b y bla z ing the trai l .
21 6 ME N T AL HY GI ENE

yond th at the nee d need not b e more speci ficall y ex

p ressed In this restless civilization o f ours it is
.

p retty diffi cult to fin d a p lace where one may feel that

he has attained the things which make life worth
l iving and is n o l onger as sailed b y cares and worries
that destroy all of the conditions upon which peace
o f mind m
ay b e based The restles s mul titude seek
.
,

ing f or pea c e of mi nd— for happiness for ful fil ment , ,

— ex p res s a need and so along c omes a whole host

,

of medi ca l reli gious even p o l itica l and socio l ogica l

, ,

s ects of various sorts which minister to this cry for

hel p Some p eo p le get comfort out of rel igion ; some
.

p eo pl e get comfort out of as sociating themse lves wi th

various cha rita b le or reform movements ; fads of all
varieties an d in every sphere of l ife grow up and ,

among them come these s ects o f hea l ers who point

out to the dis s a t is fied— the unhappy—that their
trou b le is due to this or that that it i s dependent ,

upon some p hysica l disorder perhap s of the kidneys ,

or some other organ of the body o r that it is menta l ,

in o r igin and therefore needs some kind of p sycho

, , ,

thera p eutic treatment A certain portion of thes e

.

unha pp y p eo pl e flock t o the standards that are raised

by these indivi duals who claim to know what the mat
ter is with them and how they may be cured This .

attitude is p erfectly understandab l e It i s not on l y .

not strange tha t it is s o but it woul d indeed be, , ,

strange if it were not s o The chronic invalid will

.

al most surely and quite natura ll y take the advice o f

“
a man who says con fidently I can cure you ”
Wh o .

would not ? Would not you or I if we had been pro

 M I S C E LLA N E OUS PROB L E M S 21 7

n oun c ed ho p elessly i ll if we had spent years in fruit

,

lessly seeki ng health only to see it gradually f ailing

us ? Why not at least try t—i t can do no harm and
m
,

then this same man cured S ith and Jones and per ,

ha p s he may cure me It surely is worth the trial

. .

This argument is controlling i f we have no standards

of comp arison that we have made our own b y which
we may judge of the rea l value of the cl aims set forth .

It must b e rememb ered too that many of these p r a c

, ,

ti ti on er s are sincere in their b eliefs and really think

that they can do what they claim and we must also ,

not f orget that they do succeed in doing what they

cl aim at least app arently in a sufficient numb er of
, ,

cases to give some warrant for their faith in them

s elves and for others faith in them
’
.

If we will look over the history of these cures we

wil l fin d that almost everything which the imagina
tion can conjure u p has b een used to cure the ills of
human kind and that almost every ill that can be
imagined has b een reported cured by such means .

Peo p le have b een cured of most everything under

the sun by little p ieces of metal b y b ottles of medi
, ,

cine by salves by electricity by holding on to iron

, , ,

rods that l ed into a tub of bottles and water b y ,

hyp notism suggestion and finally by re l igion and

, , ,

al l these various means of cure have cured ills

equally various an d have a l l cured the same s o rt of
il ls N ow the first p rinci ple that I may l ay d own
.

from this st a tement is that whenever we fin d a cer

tain kind of illness cured by various and divers
means under a l l sorts of conditions and circum
,
 21 8 MEN TAL HY GI ENE

stances we may feel reas onably certai n that nothing

,

in th e agent applied has reall y had anything to do

with th e recovery of the patient ; that th e p atient not
only ca rried wi thi n himse lf the conditions which
.

made him sick b ut he also possessed wi thin hims e lf

,

the p owers which rightly used could make him well ,

and that the most which th e remedies o ff ered could

p ossi bly have done was to awaken within him these
powers and cause him to put them to use A p a r a l .
y
sis which may be cured in difi er en tly either b y a
,

bottle of medicine the a p plication of a magnet or a

, ,

p rayer is certainly not the sort of paralysis which

,

is dependent u p on any material disorder of the body

that we know of ; certain l y not the kind of p aralysis
which requires f o r its ame l ioration the b ringing into
contact with the disordered tis sues a remedia l agent
o f s ome sort ; certainl y it i s quite di ff erent from this ,

and you may easily understand from this exam p le

why it is that I say that the patient contains not only
the conditions which make his disease p os si b le b ut ,

also the power to make himse l f we ll for it is hardl y

,

conceiva bl e that such di ff erent remedi es as liquid

medicine the a ppl ication to the surface of a magn et
, ,

and prayer coul d have some common qua lity which

was res p onsible for the resul t .

It is this cl ass o f cases which I have i llustrated by

,

the patient with para l ysis who are ap p ealed to p ri

,

ma ri l y by a ll so r ts of a l leged cures and it is this

,

cl ass of cases that frequently make an apparentl y

m
good recovery from their sy ptoms under the treat
ment that is given ; it matters very littl e what that
220 M EN TAL HY GI ENE

following the treatment the p aralysis disappears .

T hat hap p ens over and over again and the healer ,

says with some considera b le reason that he is cured

, ,

of paralysis But we must not stop there The

. .

healers treat a l lcas es a l ike Their classification is

.

more pri mitive Paralysis is paralysis Whi l e in

. .

medicine we know that there are very many forms of

p aralysis ; from injury to a peri p hera l nerve ( b y
trauma or toxin ) injury to the spina l cord injury
, ,

to the bra i n ( from many causes and in many l oca

tions ) the p urely p sychogenic typ e without di scover
a ble p hysical organic lesion and these l arger grou p
,

in gs could b e su b di vided and su b divided in ever

smaller grou p s Scienti fic nowledge advances by
. k
seeing di ff erences where before there was onl y like
nes s The hea l er s knowledge from this point of
.
’
,

view is therefore much more primitive and s o his

,

a b i lity to adjust his treatment to each individua l cas e

much less and therefore he must of necessity be much
,

les s competent to handle the pro b lem in the large

des p ite his succes s in individual instances .

Then a gain the type o f reasoning which concludes

,

that because in a certain person the sym p toms o f his

,

illnes s di sa p peared after the a p plication of a certain

remedy ; that therefore that particular remedy was
, ,

the cause of their disap p earance is most dangerous , ,

b ecause mos t l ogica l The concl usion is one of those

.

pitfa ll s of the obvi ous to which we are a l l liable in

p ro p ortion t o the s up e r fic iality of our kn owledge .

I t is the same kind of reasoning that l ed p rimitive

man to be li eve that he could make rain by going
 M IS C E LLA NE OUS PROB L EM S 22 1

through certain ceremonies These ceremonies vary

m
.

greatly b ut for the most p art consist of i i tating a

,

storm an d s p rinkling water on the groun d A fter .

they have b een carefully performed in all details

— —
then it rains sooner or later and the rain is as
sumed to b e the resu l t of the ceremonial It is the .

co n fusing of sequence with e ff ect and is on e of the

most p rolifi c sources of error and of groun dless s u
-

p er s ti t i on s and theories The rain comes following

.

the ceremonial of the rai n maker but is the result of

,

natura l causes over which he has no control what

.
“
ever M any of the re p uted cures a l so come about
”

f ollowing certain f orms of treatmen t —als o as a r e

sult of natural causes over which the individual a p
,

p lying the remedy has no more contro l than the rain

maker .

It therefore fo ll ows that no on e should be per

m
, ,

i tt ed to practice the art of hea ling exce p t he b e

grounded in the struc ture and functions of the human
b ody and the a pp lication of all varieties of remedi al
agents at al l leve l s and it is the function of the state
,

to see that the p eo p le who are accredited by it to

practice the art b e so equip p ed .

The whole su b j ect of medi cal education the equi p

,

ment of the indivi dua l to p ractice medicine is a com ,

p lex one and very naturally the claims of medicine

,

as a pp lied to the lower level s —to the physical and the

—
p hysiologi cal have received attention long b efore
the claims of medicine t o b e a p plied at the p s ych ologi
cal level Th e psycho l ogical l eve l is the last level to
.

come within the ken of the p hysician because it is

2 22 ME N TAL H Y GI EN E

the most comp l ex an d the most di ffi cult to confront

and requires a great deal of knowledge a b out the
l ower levels before it can b e a p proached at a l l .

Therefore it has remained the strongho l d of the

,

charl atans and the faith c ur is t s E ven the most ele

.

mentary instruction is not given today in many of

our medica l co ll eges regarding the di sorders at the
psychologica l leve l and the genera l result is that
,

these di ff erent faith cur is t s pros p er and the p hysi ,

c ia n ,
knowing deep down within himself that the
who l e busines s is nons ense but having no adequate
e d ucation in such matters so that he can de fine
wherein the nonsens e exists is compe l led to defend
,

himself against them b y attem p ting to cast ridicule

up on their methods and if approached for an ex
,

p lanation of what the trou bl e is he is pretty a p t to

b e so weak in his replies a s to he lp the cause of the
o pp osition more than to hurt it The cry of the men
.

tally afflicted ha s b rought the inadequate response of

the char latan and it is because the cry i s un in t elli
,

gent that the answer is inadequate .

In the last few years however there has been a

, ,

n oticea bl e change in the who l e matter of medical edu

cation The C a rnegie Foundation and the A erican

. m
M edical A ss ociation have been making such surveys
of the medical co lleges a s have resulted in their b e
ing grou p ed into va rious cl asses according to the ex
c ellen ce of the instruction given Such a p ublic
.

p ointing out of the clas s to which a medica l co llege

b elongs ha s deflected many students from the cheaper
co ll eges where medica l education w a s at its l owest
,
224 M E N TAL HY GI EN E

gent demand upon him for that class of s ervice .

I have not undertaken to deal with distinct frauds .

There are many claims b y a ll sorts of persons to

cure disease that are p l ainl y and sim p ly fraudu l ent
an d require treatment from that stand p oint b y the

machinery of the criminal l aw It makes little dif .

ference to the p atient however whether the claims , ,

are fraudulent or sincere s o long as the resul t is the

same in either ca se I have merely tried to p oint out
.

come of the fallacious methods of reas oning that

make it p ossible for either or both to make a suc
c e s s ful a pp eal Ignoran ce is the s oi l in which a ll
.

such claims prosper .

In this examp l e is s een perhaps as we ll as any ,

where the infl uence of ign or a n c e as a distorting and

,

destructive factor in conduct But it must not b e .

lost sight of that ignorance is a rel ative term A .

man may kn ow a great deal a b out something and be

very ignorant a b out something else There is a .

saying which em p has iz es this a s p ect of ignorance

, ,

that the p lace to s ell a gold brick is on a co llege cam

pus In that rea lm of conduct where ignorance
.

r u l es p r ejudic e that is opinions controlled by un con

, ,

scious motives rules for it is very rare to fin d a p er

, ,

son s o broadly founded a s not to be suscepti b le from

thi s angle in regions of knowl edge where he is not
fami liar And even such a b road gauged person is
.

after al l pretty help less in a s p eci fic concrete matter

about which hi s ex p erience has nothing to o ff er I n .

a given condition for exam pl e is it the p ro p er thing

, ,

t o O perate ? an d shou l d the operation b e done now

 M I S C E LLA N E OUS PROB L E M S 2 25

or ought there b e a little f urther delay ? He h as to

hand over the decision to someone else , the b est he
can do is to choos e with all the k eenness of vision of
which he is capab le who that someone else shall b e .

FATIGUE
In speaking of fatigue we are still using a term of
,

very va gue connotations and dealing with a condi

,

tion that a dmits of measurement only with the great

est of diffi cu l ty N ot only this but in the p resent
.
,

state of our knowledge it is practically im p ossible

,

to state wherein th e fatigue is resident what p art ,

of the individual rea l ly is fatigu ed and wh a t are ,

the mechanisms chemical physical and p sychic of

, , ,

that fatigue The general gros s fact which seems to

.

issue f rom this com p lex situation is that human b e

ings worked under given con di tions tend to show a
, ,

gra dual falling ofl in the e ffi ciency of their work and ,

that this falling ofi in e fficiency can be prevented by

changing the condi tions more p articular ly by in
, ,

creasing the opportunities for rest and that fur , ,

ther , when human b ein gs continue to work under

conditions which show a gradua l fal ling off in effi
c i en cy other manifestations tend to come into evi
,

dence namely various kinds and descri p tions of d is

, ,

t ur b an ces of health So that wi th our p resent

.
,

knowl edge it would seem more accurate and p er

, ,

ha p s wiser to deal with the human b eing as if he

,

were a machine and with his effi ciency as measured

,

b y his out p ut a n d endeavour to fin d what the con d i

,

tions are which lower his e fficiency, either impairing

226 M E N TAL HY GI EN E

it temporaril y or tending to impair it p ermanentl y

, ,

and then endeavouring to discover what the condi

tions are whi ch will prevent this temporary or per
m
manent i pairment and so increase the e ffi ciency ,
.

I have b een temp ted to say what I have said which ,

is more p articula rly a p lea for greater defin i t en e s s

in the use of terms by looking through the literatu re
,

o f fatigue pa rticu larly in connection with various

,

occu p ations and noticing with what l ittle regard

,

for accuracy the term fatigue and certain other terms

were used I refer more p articularly to the condi
.

tions which are presumed to be the results of

mental fatigue I fin d numerous papers some of
.
,

them b y well known men showing the prevalence and

-

the increase particularly of neurasthenia and hys

,

teria in certain occu p ations and I note the statistics

, , ,

p articularly those o f foreign sanitaria for the work ,

ing clas ses showing the immense increase in nervous

,

diseases that have b een admitted to thes e sanita ria

in recent years There a pp ears to be very l ittle in
.

any o f this literature that at a ll adequate l y accounts

for these con d itions .

I n the rea l m of the neuroses and the p s ych on eu

ros es such particul arly a s neura s thenia and hys
, , ,

teria the pa rticula r character of the work or its

, ,

severity cou l d by no p ossibility O p erate if our p res

, ,

ent ideas of these conditions are correct as adequate ,

causes Hysteria for examp l e is a p urely mental

.
, ,

d isease dependent u p on purely mental causes ; in

,

o the r words psychogenic in o r igin Work of any

, .

character or description or o f any degree of s ever ,

228 M EN TAL HY GI ENE

rosis or it may be a secondary neurosis follow ing

u p on other il l
nesses such as prolonged sic nes s of
,
k
some kind or fo l l owing an acute illness such as
m
, ,

typhoid fever As a pri ary neurosis it may be de

.
,

scri b ed a s a primary fatigue neurosis although it ,

must b e realiz ed that the be l ief that it is due to

fatigu e and that the sym p toms are dependent upon
,

the elaboration of toxic fatigue su b stance s is p urely ,

hy p oth etical E ven admitting the truth of a l

. lthese
things however there is a b so l utely n o warrant if
, , ,

our present concepts of this condition are correct ,

and they are being verifi ed every day for b eli eving ,

that occupations of any kind o r of any degree of ,

severity can b e other than purely adjuvant and un

,

im p ortant causes of thi s condition as in hysteria .

We see in the l iterature for examp l e that a great

, ,

many of the te l e p hone girl s are getting neurasthenia

and the cause i s attributed t o l ong hours of work ,

the extreme e ff o rt of attention that is necessary b e

caus e of the character of the work, and its constant
annoyance and irritating character Al l of these .

things are true b ut if the modern hypothesis of neu

,

r a s the n i a t o which I have referred is c orrect they

, ,

ca n not be the fun damenta l causes T o speak .

b roadly we can only understand the neurastheni a in

,

such cases by thinking of these gir ls a s individuals

who have been prepared by nature up to a certain ,

p oint to fu lfil a certain function and then becaus e

, ,

o f the exigencies o f life o r what not al l o f the ener ,

gies which have been deve l oped in that direction are ,

so to speak sidetracked and at a b out th e period of

,
 M I S C E LLA NE OUS PROB LE M S 229

pub erty when nature might expect p hysiological and

,

psychological ful filment the individual is called,

u p on to make a complet e readjustment to fin d en ,

ti r ely new avenues of outl et of nervous energy to ,

concentrate u p on entirely alien interests N ow some .

p eo p le are so constituted that they can do this thing ,

s o they succeed Others are so constituted that they

.

can not The ybecome neurasthenic or develop other

.

neuroses while certain others and they are perha p s

, ,

the most f requent occu p y a bor d erland position

,
.

Thes e girls under favoura b le conditions of em p loy

,

ment with p lenty of op p ortunity for rest good food

, , ,

good housing and all that sort of thing manage to

, ,

get along With prolonged hours of work and irri

.

tating conditions p erh a p s coup led with unhygienic

,

and insanitary living they break down So it will b e

,
.

seen what I mean b y f undamental causes and how I

regard the usually attributed causes as only adju
vant I t will be seen also why I be l ieve the problem
.

is deeper than the individual and strikes at once at

the social conditions brought about b y the various in
dus t r i e s and occu p ations .

I might speak of other conditions but these two ,

are su fficiently illustrative Hysteria surely and in .

,

al l probability neurasthenia b elong to the clas s of ,

diseases which are not de p endent u p on the in t r oduc

tion or the action u p on the body of some specific mor
b i fic agent They are essentially social diseases
.

which de p e n d f or their existence upon the malad

justment of the individua l to his social surroundings ,

his inability to fit into the demands that are made

2 30 ME N TAL HY GI ENE

u p on him becaus e of his relations to other peop l e ,

actuall y or prospectively and as such can not be de

,

p endent for their e xistence upon long hours of work

o r upon th e character of that work Thes e con s id
m
.

e r a t io n s
,
however do n ot make it any the l es s i
,

p o rtant that they be considered in connection with

the various industries nor does it make it obvious
,

why there has been such an increase in th e number of

thes e di seases A moment s reflection however I
’

k
,
.
,

thin w i l l b e convincing if my premi ses are a cce p ted

that their im p ortance li es not in the fact of their
,

association with any pa rticular kind o r character o f

work s o far as the fatiguing qualities of that work
may be concerned but that they are expressions of
,

cau ses that are much more wide ly operative socia l ,

causes which have invaded and changed the social

condi tions under which the peo ple live an d evident ly ,

changed thos e conditions di sadvantageously s o as

t o make possi bl e the outcro p of thes e dis eases The .

investigators of industria l conditions should realize

this factor in the situation a s exem plifi ed by the
p resence of this clas s of diseas es .

M y pl ea then is for the recognition of what I have

, ,
“ ”
termed social diseas es for a realiz ation that the
,

p ro bl em o f the various industries as that pro b lem

,

deals with the question of the health of the workers ,

i s a broader p roblem than the prob l em of " ordinary

p hysica l dis ease It is a prob l em which touches the
.

who l e question of socie t y and which p resents for

,

consideration th e neuroses and the psychoneuroses

a s in dications of diseas es which is not individual ,
23 2 M EN TAL HY GI ENE

makes i t a lmost humanly impos sible to discern c l ear

outlines M arriage is man s e ff ort to s olve the
.
’

s exual question and in the solution ha s come to em

,

b ody his highest aspiration his most earnest e ff orts

,

toward b etter things Its history has b een on e long

.

cours e of tria l and error fi lled with the tragedies

which b l inding emotions have brought a b out N ow .

that monogamous marriage ha s come to be fe l t as a

final stag e in the large evo l utiona l s eries of e ff orts
the question of whether it sha l l be p ermanent or not
has arisen and if it may be dis so l ved then the ques
,

tion is upon what grounds ?

,

The controversy which has been waged about the

divorce question ha s been a bitter on e I sha l l only .

p oint to on e or tw o e l ements in it which show the

lack of a b ility to grasp the psychological factors .

Progres s takes place only by the expenditure of

tremendous amounts of energy for every ste p gained
and the old forms tend to b e retained inde finitely
even when the new cu stoms make their meaning no
l onger evident Words and cu stoms signify this on
.

all sides We use the word p a lladium to mean a safe

.

guard f or something p recious b ecause the statue of

Pallas was su p posed to safeguard the city of Troy ;
we throw rice ( seed ) after a married coupl e sup
p os e dl
y for l uck but with the dee p er meaning to in
sure their fruitfulness ; we light b on fires on a ll great
occasions oblivious that we are em ploying an ancient
s ymbo l of p uri fication etc etc So in mar r iage there
,
.
, .

sti ll remain elements in the ceremonial which hark

back to the old practice of wife capture , and mar -
 M I S C E LLA N E OUS PRO BL E M S 2 33

r i a geis still a means for legally sub ordinating the

woman in some instances to the l evel of a chattel
,
. .

L ike all customs it tends to stay in the region of the

f amiliar it is smitten with the plague of apathy
,
.

I t will take a long time to develop the p ossibilities

of a monogamous marriage to the point where the
roadway lies p lai nly be f ore him who enters u p on it
with the end and o b j ect at all clearly sketched against
the horizon It wi ll take endless strivin g and a
.

learni ng over and over aga in that love must be care

fully and constantly tended and nourished by un
remitting giving and only so can grow to a ripened
maturity G eorge M iddleton is worth quoting in
.

what he says of marri age in the I ntroduction of

“The R oad Together ” .

“The S p iritual leve l which any marriage achieves

de p ends largely u p on the quality of those who make
.

it Whatever its social im p ort o f which few are

.
,

d elib eratel y conscious it is es sentia lly an a ff air of

,

individuals A s they are and as they react t o each

.

other so wi ll the marriage be Since it is only in

, .

marriage that society o fi er s free and complete ex

p ression b etween them it is there that the individual
,

man and woman are most tested most realized and , ,

most o ff ended .

“I f one considers the strangenes s of sex— with its

vagrancy and variation— and the tremulous psychic
inheritances which uncontrollab l y veer our acts and
emotions on e can onl y have deep charity when mar
,

r i a ge ends in di si llusion and infinite wonder when

,

it reaches rich fu lfil ment Y et marriage endures .

234 M E N TAL HY GI ENE

s omehow betw een these two extremes Its bonds are .

obvi ous when based u p on re ligious conviction the ,

-

res p onsi b ili ties of ch il dren the fear of admi tting

,
”
fail ure and the pressure of convention
,
.

To discuss the who l e question of divorce would b e

t oo ambitious an undertaking for the l imi ts im p osed
b y thi s book I ca n only revert t o the general p rin
.

c ip l
e th at the organiz ation o f society is b ecoming

ever more com plex is develo p ing in every directio n

, ,

and correspondingly each of its component in s titu

tions must res p ond t o the l arger movement A con .

sideration of ma rriage s o l e l y from the p oint of view

o f a contract and the right t o dis so l ve it on l y u p on

such grounds as are now included in the statutes

( adultery impotency crue l and inhuman treatment
, , ,

ha b itual drunkennes s ) can n o l onger be c on s id

ered suffi cient f or the needs of present day s ociety
k
.

A dultery inhuman treatment habitual drun ennes s

, ,

may have been a suffi cient catalogue of ca uses for

m
divorce once when arriage was still in the akin g m
and had incorporated onl y the s implest and most con
crete ideals b ut t o continue to hold them over against
,

the possib ilities for human development and useful

nes s today is t o put it mildly t o write down the l aw
m
, ,

again as hopeles sly in the rear of and as i peding

progress much more than a safe conservatism war
rants .

The more thoughtfu l have for a l ong time fe l t that

, ,

the who l e matter of marriage as l ega lly dealt with

, ,

ne eded remodeling along the lines of present day

possibil ities of deve l opment M arr iage has been fe l t
.
23 6 MEN TAL HY GI ENE

p arallel of l ogic when he suggests that inasmuch as

it ta kes the cons ent o f both p arties to enter the mar
r i a ge re l ation it should take the consent of b oth

p arties t o continue it and E l

,
l en Key reminds us that
b roken engagements were at one time considered to
be as humiliating as divorce is now .

As regards the welfare o f the child it wou l d seem

that a hous e which is no l onger a home in the true
sens e is not a fitting p l ace in which to rear a chi ld
and that there does not seem to be any go od reason
why adequate p rovision may not be made and better ,

p rovision for that for the care of the chil d without

,

keeping the parents forcibly together To insist that

.

the parents make reasonable and proper provision

for the care of the child is a proper function of the
State th rough its judicia l authority .

The feeling thus s eems to be growing that the

whole marriage situation needs recasting and that
divorce should re p res ent in its greater freedom a
l arger pers ona l l ib erty a l i b erty not that makes for
, ,

l icens e b ut a liberty that is a s great a s is consistent

,

with the largest o pp ortunity for personal expres sion

and s o willtend to rob l icense of its excu s e .

I t sho uld never be l ost sight of that in a ll intimate

m
hu an re l ations , particul arly that of marriage , a
great dea l of t he incapac ity to adjust , and so a great
dea l of the unhappiness , resu l ts from defects in the
in dividua l of a neurotic nature and that the proper
way of dealing with such malada p tations is by mod
ern methods of therapeutics ( p sychoana l ysis ) a d
dres sed to the individua l A very l arge number of
.
 M I S C E LLAN E OUS PROBL E M S 2 37

unhappy marri ages are de p endent u p on such con

di ti on s D ivorce under such circumstances while it
.
,

might relieve would not touch the basis of the dil

,
fi
culty nor prevent its recurrence at the next favour
able op p ortunity It woul d b e a make shi ft not the
.
-

real so lution .

T HE WO MA N M OVE M E N T
The distorting mechanisms are here quite the same
as thos e that prevent clear vision in the matter of
d ivorce becaus e we are dealing again with a pro b
,

lem which is eminently a sexua l one , and the s l ogan

“woman s p lace is in the home s erves equally a s a
’

distorting rationalization to deflect attention from

the rea l issues and put a premium on l eaving things
a s they are— the dry rot that ca ll s itself conserva
m
tis . So good a rational ization is it in fact that it
serves yet to delude many intell igent and fair minded
p eople I n these latter it pro b ably expresses a satis
.

faction with present conditions for which they are

glad to get such a respectable ex p ression .

The woman movement should be l ooked upon p ri

maril y as a movement to gain for woman a larger
world in which to fin d expression She has de .

v elop e d l ong since , beyond the possibi l ities which

,

present to the average housewife and her unem

p loyed energies seek new fi e l ds to exp l oit M odern .

p rogress has not onl y pl a ced education within the

reach of woman but it has taken over a vast quantity
of her activities s o that she no l onger h a s the making
of cl othes , the weaving of cl oth an d like things to do .
238 M EN TAL HY GI EN E

The organ i z ed productivity of the f actory and the

de p a rtment store not only do all of this work for her ,
but do it vastly better than she cou l d do it and con ,

s i de r in g its qua l ity chea p er In thi s and many

,
.

other ways woman ha s had her work taken away

from her and so it has become i ncreasingly necessary
that she shoul d fin d out l ets f or these unused energies .

Her cry for the vote i s mere l y the erection of a

standard under which to marsha l her forces It i s .

not the vote primari ly that she wants it is an ade ,

quate outlet for her energies in satisfying self ex

m
-

“ ”
pression and the vote is only the sy bol for this
, m
great need far greater than the sy bol at its surface ,

value indicates .

In the woman movement woman i s at l ast fin ding

hersel f R e l eased from the drudgery of the house
.

wi fe by the genius of modern business enterp ri se her

energies are made avai l ab l e for better and higher
things T o attem p t to prevent her from rea l iz ing
.

herself and to succeed wou l d be a tragedy Her s uc .

ce s s means the raising of the who l e l ove story to a

higher plane the removing of it forever from the
,

barter of the marriage mart and because woman is

,

independent a demand for something more than

board and l odging When man has t o meet woman
.

a s an economi c equa l then marriage wi ll in tr uth b e

free and the natura l instincts which are a lways s eek
,

ing for expression at ever higher level s can be ,

.

t rusted to m ake f or an improved eugenic mati ng .

In fact the woman movement i s a distinct and to my ,

min d the most important becaus e most hopeful step

, ,
24 0 MEN TAL HY GI ENE

catch this wonderful moving thing we call life in

,

a fo rmula to fix it in a s eries of words past any p os

,

s ib i li ty of misunderstanding or change is at times

a l most pathetic An e ff ort like the following shows
.

most painfully how ela b orately the law can fail and
unfo rtunate ly tends to ma e l aw itse l f a lmost r idi cu k
lous C oupled with a growing tendency to evade in
.

every pos sibl e way the real issues and lay weight
u p on the unim p ortant unessentia l technica l detail s
, ,

i t has brought the law into much disrepute s o that ,

it may have t o be co rrected by very radica l means .

The law has al ways been dangerous l y wedded to the

p ast ; it must l earn to l ook ahead as well as beh ind .

The examp l e in point is taken from th e N ew Y ork

State C rimina l C ode and runs as follows
1 1 41 O b scene prin ts and a rticles
, .

1 A pers on w ho se ll
. s l ends gives away or , ,

shows o r o ffers to s ell l end give away or show or

, , , , ,

has in hi s pos session with intent to se ll l end or give ,

away or t o show or advertises in any ma nner o r

, , ,

who otherw ise off ers for l oan gift sa l e or di s t r i bu , ,

ti on any obscene lewd l ascivious fil thy indecent or

, , , , ,

disgustin g book magazine pamphlet newspaper

, , , ,

story paper writing paper picture drawing p ho

, , , ,

t ogr a p h figure or image or any written or printed

, ,

matter of an in decent character ; or any article or

inst r ument of indecent or i mora l us e or purpo rt ing m ,

to be for indecent or immoral use or purp os e or who ,

designs c0 p ie s draws photographs p rints utters

, , , , , ,

p ublishes or in any manner manufactu res or p re

, ,

pares any such book picture , drawi ng maga z ine , , ,

 MIS C E LLAN E OUS PROBL E M S 24 1

p amp hlet , news p aper sto r y paper, writing pap er , ,

fi gure image matter, article or thing or who writes ,

, ,

prin ts , pu b lishes , or utters , or causes to b e written,

printed , published, or uttered any advertisement or
notice of any kind giving information di rectly or , ,

indirectly, stating or purport ing s o to do where , , ,

how, of whom , or b y what means any, or what pur

ports to be any, obscene lew d l ascivious fi lthy, dis , , ,

gusting or indecent b ook picture writing pa p er , , , ,

figure image , matter article o r thi ng named in this

, , ,

s ection can be purchased obtained or had or who ,

has in his p ossession any slot machine or other me ,

ch a n i c a lcontrivance with moving p i c tures of nude

o r partly denuded fema l e fi gures which pictu res are

l ewd, obscene indecent or immoral or other lewd

, , ,

obscene indecent or immoral drawing image article

, , ,

or o b j ect or who shows advertises or ex hi b its the

, ,

same or causes the same to be shown advertised or

, , ,

exhib ited or who buys owns or holds any such ma

, ,

chine with the intent to show adve r tise or in any ,

manner exhi b it the same ; or who ,

“2 Prints utters p ub lishes s e lls l ends gives
.
, , , , ,

away or shows or has in his possession with intent

,

to sell l end give away or show or otherwis e o ff ers

, , ,

for sale loan gi f t or distrib ution any book , p am

, , ,

p hlet magazine news p aper or other p rinted p aper

, ,

devoted to th e p ublication and p rinci p ally made u p ,

of criminal news po l ice rep orts or accounts of crim

, ,

ina l deeds or pictures or stories of deeds of blood

, ,

shed l ust or crime ; or who

, ,
“3 In any manner hires emp l oys uses or per
, ,
.
,
24 2 M EN TAL HY GI ENE

mi ts any minor or ch il d to do or assist in doing any

act or thing mentioned in this section or an y of the ,
,
m
“Is guilty of a mi sdemeanor and upon con v ic

m
, ,

tion shall b e sentenced to not l ess than ten days nor

,

more than one year imprison ent or be fined not less

than fif ty dollars nor more than one thousand do l
l ars or both fin e and imprisonment for each o fi en ce .

The reiteration of the prohi bition be l ongs to that

p sychological p henomenon of infanti l e type which
s eeks to bring things to p as s b y repeated emphatic
a ffi rmation ; if on e on l y thinks hard enough it really
must be s o It is a common way of de luding onese l f
. .

D isagreeable things are refused be l ief unti l they

for c e themselves upon attention and then often it is
too l ate to apply a remedy In the matter of the
.

l aw it is the same sort of error as was po int ed out

in the l ega l de finition of crime ( Chap V ). .

Of course it will a lways be neces sa r y t o attempt

a formul ation of results l egal a s well as scienti fic
m
,

only it should a lways be rememb ered that no f or u

l ation can be perfect and that as time p asses its i m
perfections become greater Then such a stupid r e
.

sul t as occurred in the tria l for blasphemy , men

t i on ed at the beginning of this section coul d not c c
,

cu r .

There has a lways been controversy whether speech

s houl d be free or under certain restrictions The .

trouble is th at restrictions often proceed from u l te

rior ( unconscious ) motives and freedom is often
,

used for ulterior ( un c onscious ) ends Without a t

.

tempting to solve this question a s I have not at

,
24 4 M EN T AL HY GI ENE

r a ign e d Sex relations which have not been legi ti

m
.

i zed spring at once into their rea l antisocial sig

n ifican ce upon th e appearance of the i ll egitimate

c hfl d .

It of cours e strikes on e a s un reasonabl e an d un

just th at the chi ld shoul d be made to suff er But .

such is the cours e of events E xpiation has t o fin d

.

its ou tl et The custom has been recorded of hang

.

ing the thief fi rst and investigating afterward such ,

is th e neces sity for expiatory forms of expression .

It is only in a l ater developmenta l stage when it b e

comes possi ble to wait and adjust the hanging to the
actua l thief Such waiting imp lies the possib il ity o f
.

repres sion because if the thief cannot be found then

the feeling wil l fin d no outl et and s o can only be ex
p ect ed at a re l ative l y l ate stage in s ocia l deve l op
ment It wi ll require a littl e further deve l opment
.
,

for which I think we are about ready to l egitimi z e by

,

statute the i ll egitimate chi l d and thu s give him an

equa l chance before the l aw to make good in the
game of l ife To argue that this woul d tend to fur
.

ther i lli cit re l ati ons I thin k can on l y b e a r a tion a l

iza
tion for a continuation in the present state of a ff airs .

The instinct which prom p ts such rel ations is surel y

not intended to further such resu l ts .

To argue as s ome people do that every suggested

change in the estab lished order o f things p a r t icu,

lar l
y if it has t o do with se xua l matters and aims at
a greater freedom of pe rs ona l expression is going at
once to p l unge society in an orgie of s e xu a l pro is m
 MI S C E LLA N E OUS PROB L E M S 24 5

cui ty is to have very little faith in human nature and

l ess realization of the nature of the struggles which
are t aking p lace in men s b osoms and which only
’

c ome to outward expression in such suggestions .

M ilton s b e lief a lready referred to that it is too

’
, ,

rigid restrictions which lead to license I believe

shows a dee p er insight into human nature M an is .

always striving for better and higher adjustments .

In so doin g he is b ut the medium through which the

great creative energy o f the universe is mani festing
itself The disturb ances which mark hi s course are
.

b ut the outward evidences of such strivings A .

broader a pp reciation of the mechanisms by which

man proj ects his instinctive shortcomi ngs u p on
others wo uld relieve th e illegitimate chil d of a l ega l
disabil ity for no faul t of his .

SO CIAL H YGIE NE
The social hygiene movement has arisen in an ef
fort to control the exercise of the s ex instinct and
hel p force it into socially use f ul ways of ex p ressio n .

It has met with the tremendous o pp osition which a l l

e fforts must which try to b ring into the fi eld of clear
conscious awarenes s our instinctive tendencies and ,

it has su cceeded in s o far as it has succeeded in doing

s o The proces s of deve l opment is a p roces s in the
.

human ani ma l of socia l izing instincts and the socia l

hygiene movement has hel p ed to get p eople to recog
nize their sexua l instinct consciously f or it is only
,

when we can dea l consciously with our instincts that

24 6 M EN T AL HY GI ENE

we c a n bring them under the contro l of inte lligence

and di rect their use Othe r wise instead of running
.
,

o ur instincts our instincts run us .

The e ff ort made in thi s movement to turn the se x

u a l inst inct into channe l s o f greater usefu l nes s is
made ostensibly to prevent venerea l dis ease and the
thousand and one i ll s that are tracea bl e to this
source It brings to vi ew in spite of a l l sorts of a t
.
,

tempts to esca p e seeing the unl ovely picture of the

,

havoc wrought by the misdirected s ex instinct In .

this way it c c operates with nature for nature by

-

, ,

exacting the penal ty of venerea l disease is co n ,

s t a n tl y tending to cut o ff the operation of the s ex

i nstinct at th ese l ower leve l s of manifestation ( pros
t i tut i on ) and s o save its energi es f or better uses
which shall be trul y creative race preservative ,
.

Venerea l dis ea se tends to do this not on ly because it

,

causes su ff ering but becaus e it exercises a true s el ec

tive activity eliminating by death a great many
( sy p hi lis of the centra l nervous system ) and in count
less numbers cutting ofi the germ p l asm by steri lizing
in fla mm a t i on s ( in fl ammatory occ l usion of the Fa ll o

p ian tubes ) . The far reaching and radical resu l ts

o f venerea l infection in thes e regards have not b een

at al l adequate l y stu died .

Of cours e the way of nature in this as in other

matters ( tubercul osis ) is tremendously wastefu l and
much good materia l is destroyed in reachin g the bad .

It is only the genera l resu l t that is t o be commended .

It remains t o be s een whether man , by the use of

his inte ll igence can do better
, .
248 ME N TAL HY GI E N E

N ot onl y has hygiene been stressed in this work of

studying the dangerous occupations but the attack
ha s come to be made directly from the menta l aspect
of th e pro bl em although, a s is s o often the ca se it ,

would ap p ear otherwise For examp l e it is gener

.
,

ally concl uded that efli cien cy is at its l owest ebb after
a ho l iday and a l so after l un ch if some alcoho l ha s
b een taken with the mea l These are the times too
.
, ,

when in factories accidents are most apt to occur .

Whil e this and similar probl ems have been attacked

under the designation of p rob l ems in e ffi ciency they
are easily seen to be primarily psycho l ogica l p rob
lems M any a s p ects of this l arger pro bl em have
.

received attention of course vary ing in each partien

la r cas e such a s th e prohib ition of a l coho l not only
,

during working hours b ut a l together , the relation of

Sunday and holidays to e fficiency , the va lue and best
u se of rest periods durin g the working day, pro
vision of amusements , erection of dwel lings and
renting at a reasona ble price estab lishment of c c
,

operative stores , se l f government among employ é s ,

-

p ro fit sharing pl ans schemes for rivalry between

,

grou p s of workingmen , etc .

A l l these various movements are indications of a

growi ng socialism in the best sense The man who
.

em ploys l arge numbers of peop l e and pro fits by their

la b ours and is permitted t o do s o by the herd by the
granting of a franchise , the issuance of articl es of
incorp oration or in other ways directly or indirectly,
there b y a ssumes an obligation towards the herd and
that particula r group of its individua l s who become
 MI S C E LL AN E OUS P ROB L E M S 2 49

his emp loyé s That res p onsibility means that b e

.
,

ing in the p osition of power he sha ll b e looked to to

,

take care of the hea l th menta l and p hysica l of his

, ,

emp loyé s to interest himse l f in their welfare and

,

in every way do thos e things which not onl y may

make them b etter employ é s but better citizens The .

herd d emands of the facto r y that it s erve as a socia l

centre as a centre of social usefu lnes s in return for
,

the p rivileges granted b y society .

VO C AT IO N AL PS Y C H O LO GY
I n connection with the question of dangerous
trades and similar questions has arisen the dep art
ment of vocationa l psychology In its genera l .

reaches it attemp ts to fit the man and the jo b by a

study of the man and a ma pp ing of his qualifications ,

and s o learning his ca p acities Its cruder ap pli ca

.

tions are for exam p le the determination of the c a

, ,

p a c i ty of the indivi d ua l a s to the ra p i d ity with which

he can make certain movements required b y certain
machinery and then either turning down the par
t i cul a r a pp licant for work on a certain machine or ,

els e slowing down the machine and so making the

man and the machine in t er m em b er In this way are
.

many accidents avoided which de p ended upon a ma

chine working a t a speed to which the worker could
not adjust .

From this sort of work this branch of psychology

has b ranched out in an efi or t to determine more
su b tl e is sues to fit men to complex si tuations I n
, .

this way have deve l oped such probl ems as the p s y

2 50 ME N TAL HY GI ENE

c hol
ogy o f advertising and such e ff orts as the e ff ort
to work out the desira b le traits which a salesman
S hould have Of course each occupation each b usi
.
,

nes s ha s its particular prob l ems and therefore its

particul ar ways in which p sycho l ogy can be a p plied .

A t present thi s i s a new and l arge l y fallow fi eld of

endeavour .

N ot onl y i s voca tiona l psycho l ogy of va lue in fit

tin g the man and the j ob b ut it also has a function ,

whi ch is on e of its pos sibilities for futu re develo p

ment of determining the ca pacity of the individua l
, .

We have means n ow of te lling something of a man s ’

muscular strength and by stu dy under increasing

demands something of hi s ability to withstand
fatigue W e can even te ll something of the museu
.

lar capacity of the heart and the probabilities of its

standi ng up under stres s In other words we have
.

devel oped the a b ility to measure the capacity o f

some organs but not of the mind To be sure we can .

s a y in cases of marked defect that a given b oy will

never be ab l e t o do more than run errands or answer

the door hel lor such simi l ar occupations but to tell,

whether a given p e rson ha s menta l qualities which

m
would enab l e hi t o succeed in a given trade or pro
f e s s i on i s a question for the futu re of voca tional
psycho l ogy It i s however an i portant direction
.
, , m
for deve l opment .

FADS
Th ere are from t ime to time outcrops of p ecul
,
ia r
fashi ons in a r t li terature music , or soci ety i s seiz ed
, ,
252 M EN TAL HY GI E N E

suspec ted It must not be l ost sight of that a ll

.

p henomena whi ch have to do with the conduct th e ,

behaviour of the indi vidua l as a whole are psycho

l ogica l s o that from t hi s point of view we can um
, ,

der s t an d the wide preva l ence of the menta l in the

various socia l p ro bl ems that look at first sight to be
merely probl ems of sanitation , fatigue hygiene p o , ,

lice regu l ation or what not .

S omehow s ome way the tendency o f a ll l ife i s up

,

ward forward on the path of develo p ment evol a

, ,

tion It i s only b y bearing in mind that there is such

.

a forward urge which ha s of neces sity to encounter

and overcome obstacl es that we can understand the
psycho l ogica l co n flict The menta l phenomena as
.

we see them are the resul ts at the psycho l ogica l l evel

,

o f reaction of th e conflict between this forward urge

,

and th e backward staying tendency The fads and .

fancies of men are fee l ers which he tentativel y

th r usts forward into the worl d to fin d out if he can
safely go in that direction Or more a p tly l ike the
.
, ,

p s ue dop odia of an amoeba which is gradua l ly ex

k
tended to be quic l y wi thdrawn if it meets an un ‘

favoura bl e reception or into which on the contrary , ,

if the conditions are foun d to be favourab l e the ,

whole anima l trans l ates its e lf .

The meaning of thes e and other phenomena can

only be understood by medicine when its strict in
dividua lism is l aid aside and it is rea l i z ed that there
i s a socia l a s well a s a tis sue patho l ogy A s physi .

c ian s come more and more to take up these larger

is sues , a s the physician comes t o represent the inter

 M I S C E LLA NE OUS PROB L E M S 253

ests of the herd as we ll a s the interests of his indi

vi dual p atient we can speak of the s ocia liza ti on of
mdi i
,

e c ne .

W EAL T H
M oney is the energy symb o l of
modern society
which stands for human e ffort Work is r ep r e .

s ented in money and then money becaus e it can com

m
,

mand becomes a symb ol of power and is a ccu u

,

l ated for its own sake becaus e it confers p ower I t .

wou l d seem that the best societies are on the point of

su p erseding money as the one and only energy sym
b o l which will be recogn ized and that there is a grow
in g tendency to look deeper than is sufficient to s ee
the singl e fact of wealth A s has been implicitly
.

emphas iz ed a ll through this book the new value ,

s eems to b e a socia l value— s oc ia lus eful

n es s s eems

to be coming to be a more and more recognized and

a p preciated va l ue .

Of cours e the indi vidua l and the community stand

in reci p roca l re l ations one to the other and what
, ,

a ff ects one a fi e ct s the other But their interes ts

.

often cross s o that quite naturally we find that there

are times in the history of a p eo ple when the cl aims
of first one and then the other is in th e ascendant .

With us individual ism has been dominant for a l ong

period and p erhaps such an enormous force as a
wor l d war was necessary to make us turn to pro b
lems of nation wi de c o o p eration for the common
- -

good Under thes e circumstances a redistribution

.

of wea l th on a more or l ess extensive scal e is in

evitabl e and much which is he l d n ow by right of pri
2 54 M E N TAL HY GI EN E

vate ownership will fin d its way to the possession in

m
co mon of the herd The distribution of wealth
.

follows the swin g of the p endulum between indi

'

v i dua l
is m
and col l ectivism M oney, therefore , par
.

takes of the properties of b oth .

The va l ue of money therefore is not intrinsi c

, ,

that is th e de lusion of the mis er Its val ue l ies in

.

what on e is able to do with i t— a s an energy symb o l

.

it attains its rea l va lue when its potential energy is

made kinetic For the individual therefore its
.
, ,

value is a s a means which enab l es him to expres s

himself and from the stand p oint of the herd
,

it attain s value when such forms o f e xpression are

chosen a s have s ocia l us eful ness From this point
m
.

o f view it is eas y to see that arbitra ry li its ca n not

be p laced u p on the amount o f money which a given
individua l needs Persons of limited ca p acities
.

need much l es s than persons of great ca p acities

m
.

The l i i ted individua l may not only b e wel l satis fied

with very little but he may we ll b e much better o ff
with an income whi ch fi ts his needs ( by this I mean
h i s inner needs — his needs f or expression ) than one
materia lly in exce s s o f thes e needs The person of .

l arger capacities on the other hand may we ll fin d

, ,

hims e lf cramped by an income that woul d l itera ll y

s eem s tupendous to t hos e of sma ll er vi sion When .

such a l arge cal ibred man engages in enterpri ses

that employ thousands o f men and s o becomes in a ,

way responsi ble for a considerable group he a c

, ,

qui res s ocia l responsibil ities which i f he discharges

,
256 MEN TAL HY GI EN E

may have l ittle that is more de finite or useful at the

other end
Of course some of these peop l e are tired and are
takin g an oppo rtunity for a we ll earned rest N at .

ur ally I do not refer to them .

T his examp l e of the ra il road j ourney may b e taken

a s an il lustration of how many people go through
life interested onl y in s ensationa l occurrences or
,

such imme diate matters a s b odily needs work ing b y ,

k
the clock and only l ooking for the time to qui t s ee ,

ing in a ll wor onl y drudgery and not op p ortunity

k
,

s ee ing only idl eness p l easure freedom from care

, , ,

s ensation .

Al l this id l eness a ll this l ack of interest in spite

,

o f the fact that the tiniest speck of dust contains t h e

mystery o f the uni vers e that any one of the hun

,

dreds of b uzzing crawling bugs that on e may see

m
m
,

on a su er s day will prove on the most casual

’

observation to be bewilderingly beautiful and on

more carefu l s tudy equally wonderfu l E very .

breath of air and every sound asks a thousand ques

tions and every rock can tel l a story more f a s c ina t
ing than can be found in any of the popu l ar maga
z ines whil e nothi ng that man can do in the way of
,

creating a s ensation equa l s in power magni ficence ,

and grandeur the thunder sto r m W hat is the mat .

ter ? One is tempted to b l ame th e educational

scheme which sends out into this wonderful world
“
s o many who have eyes to see and s ee not and ”
,
“have ears t o hear and hear not ”
, .
 MI S C E LLA NE OUS PROB L E M S 2 57

The difficulty however is that in order to see and

, ,

b e a b le to a pp reciate an d have s ome understanding

of all these wonders an d b eauties that surroun d us
o n every hand that it is necessary to do some study

ing to rea d scienti fic b ooks go to lectures in short

, , ,
”
to work .Aye there s the ru b
,
for work is just
’
,

exactly the thing all these idl ers are trying to esca p e
from Work means ex p enditure of energy continu
.
,

ity of e ff ort contact with reality overcoming of oh

, ,

s t a cl
e s progress
, Idleness on the other hand gives
.
, ,

o pp ortunity for p hantasying for day dreaming an d ,

air castle b uilding in S hort a ff ords the o pp ortunity

,

for reverting to the childish ways of gaining p leas

ure and conquering the world which shoul d have b een
renounced In this way the b ad habit of d reaming
.

through li f e is starte d until finally the victims are

quite una b le to b ring themselves to any useful kind
of exertion U nfortunately t oo there goes along
.

with this tendency the tendency to criticiz e others

( a p rojected s el f criticism ) a tendency to see in
-

work an imp osition b y someone else rather than as

a glorious op p ortunity for self ex p ression H ow -
.

many p eo p le have wasted fin e o pp ortunities an d

p erha p s exce p tional endowments in fussing b ecause
someone wa s p ai d a little more or given a few more
p rivileges than they were when if they had atten d ed
to their work they might easily have risen to the to p
o f their p ro f ession when every emolument would

have b een theirs .

What all these p eo p le need is the p ower to l ove ,

258 M EN TAL HY GI ENE

us ing l ove in th e broad sense of unres erved gi ving ,

be it to a person a ta sk an ideal Of love Ha ll ,

3
,
.

writes “ Onl y when we have found some cause or

,

end that so transcends s elf that love and loyalty to

it woul d certainly p rom p t us u p on emergency to face
the G reat Terror in hi s most hideous form has the ,

true life of the race b egun consciously in us Only .

then are we com p lete men and women Onl y then .

have we attained the true maj ority of humanity and ,

a re we rightly oriented in a mora l universe Thus .

alone we can take the first c onscious step toward en

tering the Kingdom This mus e of death is not that .

of Stoic philosophic resignation to the inevita b le

m
,

nor is it the b lind instinctive gregarious i p ulse ,

that might prompt self s a cr ifice in a sudden emer -

g e n c y It is. a higher full b lown consciousnes s of ,

-

what life means of man s place in his wor l d and his

,
’
,
”
duties to it .

L ove in this sens e i s l ife and the idl enes s which

spends itse lf in wishin g rather than doing i s death .

O LD AGE — DEAT H
In the natu ra l course of events old age and death
close the story in each individua l cas e E ven this .
,

however l ike a ll other statements needs qualific a

, ,

tion A ge as I have a l ready shown is a relative

.
, ,

term “ Forty i s the o l d age of youth ; fifty i s the

.

”
youth of old age Such a statement a s this ho w
.
,

8 Hall G S ta n l ey . :
“J e su s Th e Christ in t he L ight of Psycho l ogy .
, , ,

Dou bl ed a y P a ge , Co .
, N ew Y ork 1 91 7 , .

4 Victor H ugo .
26 0 ME N TAL HY GI ENE

tendenci es into a clear smooth eddy of ca lm repose ,

,

and wi th the du lling of the keen zest for li fe come s

a growin g kin dlin es s and b enevo l ence In propor
m
.

tion as a an has lived broadly and deeply unh am

pered by the i n fantil e neurotic fix a tion s which have
interfered with hi s deve l o p ment a l ong restricted
lines in proportion as he has experienced l ife to the
,

full in a ll its va ried man ifestations its griefs a s ,

we l l a s it s j oys in proportion a s he has succeeded i n

,

fully e xpres s ing so to S peak emptying himse l f, he

, ,

wi ll ap p roach the end calml y the desire to l ive gr ad

,

ual l y s li pp ing away until he passes from l ife with

a s l ittle consciousnes s a s he wa s born into it This .

is as it shou l d be The p atho l ogy of old age natur

.

ally ea n not be di scuss ed here

m
.

But how does death come about ? The on ocel lu

lar microorganisms are practically s p eaking i , ,

m
mo rta l ; death i s an attribute that only be l ongs to
more highly organized beings D eath a s a matter .
,

of fact i s an acquired character which has been de

,

v elop e d in th e cours e o f evo l ution because o f its

value to the race But how ? .

I have spoken of age as an accumul ation of past

and indicated how this past fina ll y cl ogs further
p ro gress In some way then the past has to be got
.

“ ”
ten rid of s l oughed off as Ha ll would say N ot .
,

only all that obvi ous l y interferes with p rogres s may

b e traced t o an accumulated past but l ess o b vious
mora l qua lities even s in itself can l ikewise be s o
,
“ ”
considered All s o cal led wrong conduct can b e
.
-

shown t o belong to types which at on e time in th e

 MI S C E LLAN E OUS PROB L E M S 26 1

cultural history of mankind were considered

“right ” ways of acting .

D eath therefore can b e seen to be inevitab le b e

, ,

cause the constantly accumulating past clogs the

mm
machine more and more unti l finally l ife itself b e
comes i s s ibl
e But if that were all d eath would
.

have no meanin g To s erve its p urpose to the race

.

it must b e necessary that in dying man should b e

a b le to ris e Phoenix li k e from his ashes and reborn
, , ,

take u p again the life of the race .

This is precisely what hap p ens The germ p lasm .

has a l l the properties of p erennial youth of the

monocellular organism It is the soma which r e .

s p on ds to the com pl ex environment by an ever in

creasing s p ecia l i zation of its several p arts until like ,

the balance of p ower in E uro p e things can go no ,

further I t is then that the soma dies but the germ

m
.

p lasm p rotected from the very fi rst from the eces

,

s i ty of speciali z ation l ives on and carries forward

,

the li f e of the race .

L i f e and death therefore can b e s een to b e b ut

, ,

reci p roca l aspects of the same p roces s of p rogress

ive devel op ment W ithout on e the other could not
.

b e and death is as necessary for life as life is for

death If we could vi ew this earth from some far
.

distant point in s p ace as did " ueen M a b until it

6

“
seemed the smallest l ight that twi nkles in the
”
heavens then p erha p s the horror of this great
world war would sink into its pro p er p erspective and
we would see that this great struggle was born of
0 S h ll y
e e .
26 2 MEN TAL HY GI E N E

the dire neces sity of destroying the ba l eful influence

of an accumul ated past which b l ocked e ff ectually
further p rogress and then we would understand that
after all perha p s it wa s allfor the best and the world
wou l d emerge with a new impetus to growth for :
“One generation pass eth away and another genera
tion cometh ; b ut the ea rth abideth forever The sun .

also a riseth and the sun goeth down and hasteth to

, ,

hi s place where he arose The wind goeth toward .

the south and turneth about unto the north ; it

,

whirl eth about continua ll y and the w ind returne th ,

again according to his circuits All the rivers r un .

into the sea ; yet the s ea is not full ; unto the p lace
from whence the rivers c ome , thi ther they return
” 7
again .

7 E cc l es ia st es i , 4 , 5, 6 , 7
.
26 4 ME N T AL HY GI EN E

of th e afll
ic t e d
person but quite genera ll y of others
in his immediate envi ronment and also to a tre
mendons wastage of energy .

This book is of cours e not th e p l ace for a detailed

discussion of the neuros es The reader must re f er .

to s p ecia l works for such inf ormation ‘

It wi ll b e .

o f advantage however to b riefly outlin e the indi

, ,

vidua l psychi ca l deve l opment and the b road prin

c ip l
e s of treatment of di sorders in this region not ,

onl y becaus e this is a work dealin g with the prin

c ip l
e s of menta l hygiene but because in the orderly,

deve l opment of the subj ect it would appear t o belong

here .

In the cha p ters H and III on Underl ying C once p ts

and M enta l M echanisms I deve l o p ed the p s ycholog
ica l approach t o the various prob l ems I s a b se .

quentl y appl ied thes e mechanisms in the considera

m
tion of the severa l prob l e s with su fficient thorough
ness I be l ieved t o serve in ai ding the reader t o com
,

p rehend them from the point of view from which I

p resented and discussed them In dea ling with .

these minor mal adjustments however it i s n o l onger , ,

of much help to rest in such general statements while

the neuroses thems e l ves o ff er admirab l e materia l
for the i ll ustration of the deeper l yi ng mechanisms 3

some understanding of which i s essentia l in order

that a true comprehension of the mean ing of menta l
hygiene may be had .

1 speci a ll y J llifl a n d White

S ee e e
‘
e :
“Di s ea s es
f t h N e rvous S ys O e

t em Lea F bige r Phi la d elphi a 1 91 7

”
e

m ech an isms th e r ea de r is r eferr ed

.
, , .

2 For a fu ll e r d i scussion of th s e e
“
to my M ec ha n isms of Cha r a cte r Form a tio n
”
.
 THE N E UROS E S 26 5

I have b riefly indicated in the first two chapters

, ,

the tremen d ous heritage from the p ast that each one
of us b rings into the worl d and with which we start
the battle of life This is a heritage of
. years
a s humans alone to say nothing of the millions of
,

years b ack of that during which the S implest mono

cellular structures were evolving into an d throu gh
the metazoa t o their present day goal in man It
-
.

must b e true therefore and a little reflection will

, ,

serve to convince us that it is that the various in,

di dua l
v i s of the human s p ecies — —
homo sapiens are
vast l y more alike than di ff erent that they have , ,

literally thousands o f points of resemblance to one

,

of di ff erence It must a l so b e p erfectly plain that

.

such p oints of dissimilarity a s exi st must have refer

,
m
ence in the ain o nly to that relatively infinitesima l
,

part of us which belongs to us in d ividually which is ,

the p roduct of our individua l rather than our rac ia l

develo p ment.

In the discussion of M ental M echanisms ( Chap .

III ) I have shown how thi s tremendous p ast so far ,

a s it concerns the psyche constitutes the unconscious

,

and how the unconscious is adde d to in each indi v id

ual li f e by the accumulation of all the p sychic mate
rial which has b een lived p ast and lived through s o
that as soon as a p sychic reaction ha s served its p ur
pose i t sinks into the re gion of the unconscious and
, ,

as an added bit of acquired e fficiency becomes a new

resting place for further su p erstructures .

The p syche quite l ike the b ody reca p itulates the

, ,

past b oth individua l and racial in its development

, , .
26 6 ME N TAL HY GI EN E

If th is recapitu l ation be compared to the s tr a t ifica

ti o ns o f the earth crust a s does J ell
,
i ff e then it is
,

p ossible t o refer symptoms of mal adjustment as

—
they occur at the p sychologica l level menta l dis
eas e— to de fini te strata in the history of the indi
vidua l In the same way we can speak of cert ain
.

types of ma ladjustment as being characteristic of

certain strata of development just as certain fossils
a re characteristic of certain geologica l strata Of .

course this is all s omewhat hyp othetical because the

p sychi c deve l opment ha s n ot been worked out with
a degree of thoroughness anything l ike s ufli cien t to
ena bl e us t o do this in any detail b ut the b road gen
era l l ines have been l aid down and s o far as they are
clear the princip l e ap pl ies .

I Sha ll t r y in this C hapter to sup pl ement what I

, ,

said of menta l mechanisms in C hap III and t o elab

.

orate that discu ssion suffi ciently to make under

s t an dab le those re l ative l y more super ficial and con
,

tinning the geo l ogical figure recent distur b ances of

,

adjustment compris ed un der the c lassi fication of the

neuroses In th is way I sha ll have covered the dis
.

orders of the mind a ll the way from the most deep

s eated of biol ogi ca l types of fai lure to thos e defects
which depart only in minor degree from the normal .

I have pursued what may seem t o be the reverse of

a l o gica l order but I di d s o because the wider de
pa rtu res from the norma l are more easi l y ap p r ec i
ated a s such whil e the l esser degrees are more difliz
cult to understand unles s approached with the knowl
edge gained from more serious situations F rom .
26 8 M EN T AL HY G I E N E

easily seen softens the boy so to speak — may easil y

m
~

, , ,

make hi al together too tender to b ear the average

diffi culties of lif e s o that when he grows up he is
,

quite incapabl e of a djusting to the rough treatment

that reality ordin a rily gives us He may b ecome .

wholly ine ffi cient quite incapa b le of leaving the

,

home and going out into the worl d at a l l and sim ,

p ly remain a chil d in the household cared for by the ,

parents sup p orted looked after a s he always had

, , ,

b een in his infancy in which ca se he not in frequently

,

makes spasmodic e ff orts t o break away from th e

control o f the parents and perhaps at such times
, ,

curses them and is abusive and blames them for his

inva l idi sm Thi s i s not an uncommon picture On
. .

the other hand he may go out into the world and be

,

quite efli c i en t but b e thin skinned and ve r y easily

k m
-

hurt at al l in ds of c r it ci s or again be extreme l y

m
, ,

irritable and i patient in the face of any sort of r e

s i s tan c e or diffi cu l ty and be s o disa greeab l e that
hardly anyone can get along w ith him He is accus
t om
.

e d to having had his ways made smooth — h e ,

cannot stand life when it is rough So that a ll thes e

defects of character are traceable to what h a s been
called a fix ation at a ce rtain point in the develop
ment of the individual in this ca se a fixation in de
,

p e n d e n c e on the family dependence u p on too great

,

an exhibition of tenderness upon the part of the par

ents whi ch while it was brought about in this case
,

through the physical illnes s of the chi l d it wi ll b e ,

understood is th e sort of danger to which any chil d ,

particul arl y an onl y chil d may be expos ed i r r es p ec

,
 THE N E UROS E S 26 9

tive of physica l i l lness I think all are fami liar with

.

instances of t hi s sort Such a person when he mar

.
,

ries will be p retty a p t to pick out a woman that r e

,

s emb les hi s infantile image of his mother H e will .

marry not as adults should marry in order to j oin

, ,

their lives to a p artner wi th whom they exp ect to

meet the pro blems of l ife in a more e fficient manner
b eca us e of mutu a l understandi ng and hel p fulness ,

b ut he wil lmarry a woman in whom he sees a gain

his mother in order to regain the l ost p leasures
,

which he has always missed since he was separate d

f rom her perha p s b y her death and s o he carries his
, ,

weaknes s along with him into his adult li f e and his ,

i n efli ci en cy in all sorts of ways can b e traced to it .

A quite simil ar cri ppling is b rought about in a

difi er en t way In thos e cases in whi ch the mother
.
,

has b een aggrieved p erha p s widowed or deserted

, ,

and the b oy is the only child This situation results .

again in the mother devoti ng too much tenderness

to the chi ld She is trying to gain that exp ression
.

through him which she should have gained in other

ways T his t oo softens the boy robs him of his
.
, , ,

V irility .

L et me take another typ e of inefficiency ,—that

mediated b y the b oy s relation to his f ather — Sup
’

p os e the father had b een a very overb earing perha p s ,

a cruel father and hus b and —su pp ose in his domi ,

nation of the family he had b een unreasonab l e arbi ,

t r a r y to th e last degree and had p erhaps over and ,

over again during the early years of the child s l ife ’

,

beaten him sometimes for things that he had never

,
2 70 M EN TAL HY GI ENE

done If we realize that the father norma lly r ep r e

m
.

s ents authority in the fa ily we can easily see how

a child will often grow u p to hate the father as re p
resenting this source of authority and in l ater life ,

will continue t o hate al l sour ces of authority not ,

only perhaps as represented in the heads of gov

m
, ,

er n en t s and in government itse lf , but in more

su b tle ways will show his incapacity for fitting into

the esta blished order of things He wi l l a lways be .

the protestor the rebel reformer agitator advocate

, , , ,

of new ideas etc A S an iconoclast the results may

,
.

b e unfo rtunate as on e whose respect for authority

,

has b een tem p ered s o that he is not bl inded by mere

,

statement b ut i s ever ready t o give the new idea a

hearing the qual ity may be of great va lue
, .

These are some of the ways in which peop l e fai l

to live at their best because of early fix a tion s b e
, ,

cause of defects in the orderl y p roces s of develop

ment at s ome p o int L et us l ook at the prob l em
.

from a littl e di ff erent angl e

C HARA C TE R T RA I T S
I have been speaking up to this time of the indi , ,

vidual as a whol e of his relations to his parents for

, ,

example It will be remembered what I said about

.

the w i ll to power about the desire that the in dividual

,

h a s to attain to the maximation of his ego ; it is

equall y tru e of every portion of the individua l that
that part icul ar portion desires to use the ps y cho
m
,

l ogi ca l ter to attain the fullest expression of its

,

p ower E very particular component of the indi

.
272 M E N T AL HY GI EN E

ever p ower t o comm and i s strongly in evidence .

Here are a few rami fications of this particular in

s t in c t
. I want to cal l attention to one s p ecia l feat
ure of it however which is of very great impor
, ,

tance The di ff erence b etween this cruelty instinct ,

.

a s we see it in a Jack the ri pp er and as we see it in a

- -

res p ectable busines s man quietly going a b out hi s

work and being a usefu l memb er of society is that in ,

on e ca se the instinct is s ocialized or a s the p sycho ,

analysts more frequentl y say su b limated and in , ,

the other cas e it is not In one case it has b een .

mou l ded to conform with the socia l requirements ,

i n the other cas e it pres erves its origina l instinctive

and infantile characters in opposition to those r e
q u imr e e n ts Here we have an illustration a most
.
,

important on e an illustration of the s ociali z ation of

,

instinct the proces s by which al l develo pment is

,

made possibl e This example shows how it is pos si

.

ble f or the conflict b etween the unconscious and the

conscious between the instinctive tendency and the
,

s ocial requirements to b e solved b y satisfying b oth

,

demands The higher demands of the socia l r e

m
.

q u i r e e n t s are met e fficiently b ut only because in

,

meeting them the individua l derives a certain pleas

ure in doing s o because he can meet them in a way
,

that satis fies his unconscious instincts because the ,

pleasure b oth of the instinct and of the socia l r e

qui r em en t s has the same origin .

This princi pl e n a me l y that the conflict can on l y be

, ,

reso lved when b oth contending factors a r e satis fied

is of very great importance and ha s great p ossi b il i
 T HE NE UROS E S 2 73

ties of application to p ractical p roblems For ex .

amp le i h the large social p ro b lems which are now

,

p ressing for solution T ake f or instance the p ro b

.

lem of lab our and ca pital T here have been many ef

.

forts to kee p lab our s atis fied b y surroundi ng the la

m
b our in g an with all sorts of luxuries in the way of
m
,

club houses gy nasiums libraries etc etc When

, , ,
.
, .

ever thes e means have taken on a pure ly p a t er n alis

tic character and reso lved themselves into gifts pure
and sim p le the l abou r ing man has felt that they were
merely a bribe for his quiescence and has never had
any compunction about throwing them all overb oard
in contending for a p rinci p le That which is not
.

earned and s o deserved has no va lue L abour and .

ca p ita l are not concrete entities in opposition to each

other but the o pp osite terms of a re l ation and no s o
l a tion of their difficulties wil l ever b e a tru e solution
which does not equally advantage both and in addi
tion raise the whole relationship to a higher plane
o f e fii ci en cy a higher level of social va l ue
, .

SO CIAL I" AT I O N O F I N S TI N CT S
It is this socializ ation of our instincts which is th e
i mportant fact o r in our psychologica l deve l opment
—the develo pment of what has been a p tly termed the
herd in stinct M onocellular organisms are to all i n
.

tents and purpos es al l s uffic i en t unto themse lves

,
-
.

They p erform a ll of the functions of nutrition and

reproduction without relation to other indi viduals
of their species and they are practica lly immort al

they die only as a result of accident A t a little .

274 M EN TAL HY GI EN E

l ater stage of evo lution they form loose l y organiz ed

communities in which we can already see a beginning
di fferentiation of th e component ce lls into those
which perform primaril y the f unction of digestion ,

those which occupy a position at the surface and

have t o fee l out , s o to speak, the envi ronment , and
thos e which are more es sentia ll y engaged in rep ro
ductio n AS the pro cess of evolution produces still
.

more comp l ex animals and p l ants this specia l ization

o f the individua l ce ll ular components continues until

k
in the highest organism we fin d ce ll s which , li e the
nerve cells of the higher animals have no power at
,

a ll to live except a s com p onent p arts of th e whole

organi sm, and n o power within themse l ves of re p ro
ductio n A nerve cel l once dead is never replaced
.
.

With this highly deve l oped individuation has gone

along hand in hand a corresponding renunciation of
immort al ity
A quite ana l ogous proces s is seen in the deve l op
ment of human s ociety Primi tive man is relatively
.

un di ff erentiated E ach individua l is ab l e to per

.

form the functions of any other individua l A s s o

.

c ie ty became more com pl ex the state of a ffairs

changed unti l today we fin d s ociety com p osed of a
large numb er of groups each p erfo r min g highly s p e
c ia liz ed functions , which whi l e they p ermit of the
,

greates t individua l deve l o p ment and e ffi ciency are

,

only made possible because of the re l ativel y sub or

din a t e r Ole which they p lay t o society a s a whole .

A b o li sh the social grou p and its comp onent members

,

would at once have to revert to their primitive and

276 M E N TAL HY GI ENE

forms of gratifi cation fit it is the fina l measure of a l

,
l
forms of p l easure whether experienced in concrete
sensations or in the highly subl imated forms of ex
pression o f the creative imagination In its l ast .

ana l ysis the p l easure com p onent founds in sex In .

other words th e p l easure of the p l easure motive for

,

conduct u p on b eing reduced to its u l timate is found

to be identica l wi th s ex pleasure Sexua l ity i s th e.

p l easure premium of the pleasure motive .

The signi ficance of this if tru e is ve r y great and

ha s t o do with the who l e prob l em o f the socia liz ation
of our in stincts in a most intimate way The prob .

l em at basis is a pro b lem in energy redistribution .

Primi tive man , l ike th e child is much interested in

,

his own body , his ow n sensations he i s — “ auto

”
erotic . He wastes enormous amounts of energy in
concrete s ensua l ity energy which brings no ben efi ts
,

to th e group The proces s of civilization has as on e

.

of its objects the deflection o f this energy that would

otherwis e be wasted from s exua l ity to activities

,

which are usefu l to the herd— the socia l ization of the

energy which othe r w ise wou l d flow into use l es s
forms of instinct gratification I may s a y paren .
,

thetica lly that in the neuros es thi s energy is still

, ,

bound up to infantil e sexua l ways of pl easure seek

in g that is ways which in the course of individua l
, ,

deve l o pment should have been l eft behind a s having

,

served their purpos e by a ff ording ste p s in the proc

e s s o f at t a ini ng adul thood and the obj ect of psycho
,

ana lysis i s t o free this energy s o bound up so that

m
it a y be emp l oyed to fu rther socia ll y usefu l ends .
 TH E NE UROS E S 2 77

Thi s aspect of the su b j ect o f p sychoanalysis has been

strangely overlooked by the critics .

I can p erhaps i llustrate this b etter b y the example

of the nutritive instinct In the old days in the
.
,

M iddle Ages in early R oman times and still more

, ,

promi n ently among primitive men the functions of

,

nutrition were carried on only with a relatively

great waste of energy Food was not taken with
.

anything like the present regularity periods of a o,

tua l want alternated with periods of gluttonous

over indulgence The food itse l f was p oorl y p re
-
.

p ared the meat often raw or b urned and of course

, ,

much more f requently than in these days infecte d ,

.

I t thus made much greater demands u p on the diges

tive a p paratus than does now our we l l p re p ared -

we ll cooked and regularly served nourishment Al l

-
.

of thes e ways of wasting energy in nutrition have

been attacked and the p roces s today is much more
economica l and e ffi cient so that the ener gy that used
,

to leak away b y these devious paths i s now available

for something e l se Whether some day we shall de
.

v el op this p roces s to such a high state of e fficiency

that we shal l b e able to simp ly take an occasiona l tab

l et and go on with our work I do not know b ut there
are reasons for b elieving that this wil l not be so b e
cause of the considera b le tendency which eating it
s elf has shown to develo p and to take on social ends .

The wel l a p pointed dinner ha s become a s ocial fun c

tion of great im p ortance It serves as the meeting
.

place for p ersons a ll ied by common interests and also

as a mediu m for en l arging one s socia l contacts
’
.
2 78 M EN TAL HY GI ENE

The dinner too is not infrequently an occasion of

, ,

great sign ificance not only socially but in the larger ,

pub lic sense Afi a i r s of state are not infrequently

.

b orn on such occasions Without going further with

.

this i ll ustration I may add that the waste co nserva

, ,

tion and s ocializ ation of sexu ality para ll els tha t

,

o f the nutritiona l development and in their failure

we recognize the sensualist and the glutton as kin .

The way in which this bound up energy is freed -

i s b y the p rocess known as su b limation I have a l .

ready ill ustrated this Of course the pos si ble illus

.

t r a t i on s are a lmost in fini te for they include eve r y

activity of man For exam pl e according to this
.
,

theory the curiosity whi ch makes a man a scientist

l et u s say a microscopist— is traceab l e to that ear ly
curiosity in looking—peeping— which had its o b j ect
in seeing forbidden s exua l o b j ects or acts The i . m
mediate s exua l element in the curiosity is sub limated
into a socia lly usefu l purpos e to which the original
pleasure is stil l attached and for which it fu r nishes
“
the drive We know too the Pee p ing Toms who ”
.
, ,

stil l show this same form of pleasure seeking but

have been unable to advance their way of obtain ing
p l easure to a socially acceptab l e means .

In this way man retains the p l easure premium

which wa s origina lly attached to a concrete ly sexual
motive for a pp lication to an end which has va lue for
,

t h e herd . In other words it is on l y when there is

,

behind a given activity that dri ve which a l one sex a ,

a l ity can furn i sh that acc om p lishment is assure d

,
.

W e can understand from this illustration what is

280 M EN TAL HYGIE NE

di dst conce ive thr ough the c a r s Thi s concept is .

,

incidentall y much older than C hristiani ty Of

, .

co u rs e these i ll ustrations if followed up would be

,

f ound t o have many exceptions but these again

wo uld often be seen to have fair l y obvious reasons .

N atural l y if the theory that a ll pleasure found in

,

s ex i s tru e we might expect to fin d il lustrations

m
, ,

without end in every rea lm of hu an endeavour .

This might easily be done but it is not my purp ose

to attempt to prove the theory in this place but
s im ply to state it and give sufficient il lustrations s o
that it may be understood The pragmatic S ign i fi
.

cance of t he theory i s t hat man i s constantly s exual iz

i ng hi s environm ent in order s o to S p eak to desex
m
, ,

ua l i z e hi self to the extent that his energy is bound

,

up in infantil e s exua l ways of pleasure seeking and

, ,

therefore render availabl e s o much the more energy

for ad ul t socia l ends T his is a pro blem as wil l
, .
,

be s een in efli c i en cy and economy in which the

,

constant e ffort is t o use that energy which would

oth erwis e be dissipated in relatively useless forms
of activi ty by retain ing the p l easure premi um and
attachin g it t o higher ends .

A few illustrations in pas sing to hel p clear u p

what may otherwi se be I fear rather o b scure
, , .

There are t w o ways in which in eflicien cy may try to

‘

avoid rea lity—by li v ing in the future or in the

past The best examp l e of the former tendency is
.

o ff ered by the M iddle A ges a peri od in wh ich the ,

control l i n g ideal s were re ligiou s and the pres ent li f e

upon earth was thought of not a s capa b le of b eing
,
 TH E NE UROS E S 2 81

made a valuable thing in itsel f but as hav ing its

,

only worth in the extent to which it contri b uted

and pre p ared for the li fe to come Our patients
m
.

give us a ll sorts of examp les of their attach ent to

the p ast One of my p atients during al l his early
.

l ife fo und it almost impossib le to leave his home

for as sure as he did he was made il l b y the unac
customed food and had to return Another coul d .

only eat the food he had l earned to l ike as a chil d .

An other engaged p assionately in the study of the

dead languages and ancient history M any p ersons .

dres s or ta lk or develop the mannerisms of a p ar

ent and not infrequently even their illnes ses Those .

who l ive in the past s eek to return to their in fa n

;

til e dependence upon their parents and thus seek

protection from the burdens im p ose d by reality .

Those who only live in the future may only lay aside
the burden because M ic a w b er w i s e they are sure that
,
“s omething will turn up ” or l ike the men of the
,

M iddle Ages they proj ect their inf antilism into a

Paradise where all their wishes come true and where
they fin d again in the Hol y Famil y the idealized
, ,

parents of their childhood In either case the ia

.

div idua l withdraws hi s energies from the p resent

task and to that extent becomes ine fficient in deal
ing with reality and if you wi ll assume with me
,

that the attachment to the p arents has a sexual

b asis as indicated in the term incest comp lex you
, ,

wil l understand what I mean when I s p eak of r e

n oun c in g infantile pl easure motives infantil e ways,

of pleasure seeking so that the energy bound u p

,
282 M EN TAL HY GI ENE

in such activities may be freed for socia lly useful

forms of conduct .

The story then wou l d read s omething like this

A t first the chil d i s wholly in terested in hi s ow n
body is auto erotic By an im ense n umb er of ex
,
-
. m
p er i en c e s in comi ng in contact with reality in the
sha p e of hi s physica l envi ronment he fi na l ly s uc
c e e ds
, though not ful ly in di ff erentiating himse l f
,

from the environment in maki ng the distinction b e

,
“ '

”
tween the I and the not I “ ”
When he has got
-
.

ten the proces s well under way he fin ds himself

strongly attached in hi s love to the memb ers that
constitute his imme diate famil y group Thi s is the .

period of deve l opment made p ossi bl e by his de p end

ence upon the family Finally thi s attachment too
.
, ,

h a s t o be given up s o that he may come to fi n d an

obj ect love outside the famil y and found hi s own
centre of infl uence and authority with othe r s in like
manner dependent upon him His growth from this
.

p oint continues in an ever widenin g circle as he i s

able to more and more give of his energy to the
larger socia l group and extend further and further
his infl uence in s ocially usefu l ways This con .

stant tendency from this point of vi ew seems to r e

, ,

sult in a constant narro w ing of the in dividual and

a corresponding broadening of the group but this ,

i s not s o ; it furthers itse l f because the rewards

which c ome t o the individua l are fully equal to if
not much greater than the sacr ifices which he makes ,

s o that as a matter of fact b ecause society gives

,

back t o the indi vidua l quite a s much a s he gives it ,

284 ME N TAL HY GI ENE

grow up , or ,
a s ex p ressed in Chapter III as the ia ,

s t in c t f or the fami liar or the safety motive for

,

conduct .

In the early part of this chapter I have compared

the di ff erent periods of psychic development to the
geologic strata of the earth s crust One of the ’
.

strata which I have already mentioned is the period

o f animi sm whi ch is common to the child and to

primi tive man I t not infrequently outcro p s in the

.

ad ul t apart from severe mental cri pp ling and is com

m on ly in evidence in the p sychoses I have given .

ill ustrations of t his animistic typ e of reaction in

C hap III. .

T HE ORG AN I C B AS I S O F MA LAD J U S TM E N T
I have a l ready said t hat it i s as tru e of the parts
of an individual a s it i s tru e o f the individual as a

whol e that they are each striving after the fullest

,

power , th e greatest sum of expres sion This state .

ment is equally tru e of the severa l organs of the

b od y From the poin t of view of the liver the body
.

shoul d b e dominated b y liver n ot central nervous ,

system and would if the liver coul d have its way

, .

The orderl y growth and devel opment of the indi

vidua l is conditioned by a balance of p ower which
insures that each part shalldevelop just t o that de
gree which w ill best serve the purposes of the who l e .

All a l ong the biologica l p athway progres s has only

been pos si bl e becaus e each unit besides preserving ,

its ow n integrity has b een willing s o to S peak to

, , ,

give something to the l arger unit of which it formed

 THE N E UROS E S 2 85

a p art E ach cell b esides p reserving its own life

.

must give u p p art of its activities to hel p in the a c

t iv i t i e s of the organ of which it is a p art the organ ,

must do li kewi se with res p ect to the larger unit the ,

individual and the individual must re p eat the pro

,

ces s as a mem b er of Society— the herd The liver .

,

for examp le b esides preserving itself as liver stores

,

u p glycogen to be used b y the muscles when the indi 4 .

vidual is in danger and gives of this store for the

,

larger whole ; the man p ays his taxes and S imilarly

helps the problems of s ociety of which he is an inte
gral p art It thus comes a b out that in the p rocess
.

o f the succes sive integrations to p rogressively larger

ends what we call p ers onality character is sues as an , ,

end result but de p end ing u p on all these b odily p ro

cesses which underly it T herefore according to .
,

A dler character traits ultimately are reducib le t o

,

terms of organic structure and s o defects of char ,

acter depend up on organ in f eriority .

If the tendencies of the individual as a whole that ,

is a llof his energies be called by a single name we

m
, ,

may use the term li b ido then the i p lication from , ,

what has b een said thus f a r is that a given individual

may retain evidences of his infancy only in certain
zones of his conduct his gastro intestin al mouth ,
-

, ,

ear eye skin genital T hese then would be called

, , ,
.

p artia l lib ido trends or strivin gs ,

.

The Adlerian concept would sub stitute for the

Freudian theory of lib ido fixation as an ex planation
f or a given defect of character the theory of an i n
f er i or organ H e b elieves that an inferior organ
.
28 6 M EN TAL HY GI E N E

gives a sense of insecurity in feriority against which

, ,

the neurotic tries to protect himsel f b y so ordering

hi s life s o regul
, ating hi s every act that he may fin d
that s ecurity of which the fee lin g of inferiority has
ro bb ed him This efi or t t o find security i s the fi cti
.

tious goa l of the neurotic w h o fail s in attaining the

ma ximation of hi s ego because hi s e fforts are di
r e c t e d along thi s f alse p ath H e is not free to deal
.

with reality at his best but must a lways subordinate

,

the demands of reality to the inner need of satisfy

ing his craving f or s ecurity The neurosis or p s y
.

c h o s i s is therefore a constructive creation a com p ro ,

mise a compensation p roduct which however fails

, , , ,

b ecause of its false direction His theory summed

.

u p in a few words reads : The neurotic constitution

founds in an inferi or organ ; the inferior organ pro
duces a fee l ing of inferiority ; the fee lin g of i n ferior
ity creates the fi ctitious goal of the neurotic whose ,

sym p toms result from an e ff ort to mould rea lity

along the fal se p athway that leads to safety .

L et me give an exam ple of such infantil e and

a socia l ways of using l et us s a y the ear libido The
, , .

typ e of pers on is well known who is always listening

to hear scandal of his ass ociates Y ou know what a .

despicab l e typ e of in dividua l such a p erson i s from

the standpoint of the usual s ocial evaluation He .

does not listen t o hear s omething good b ut always to

hear someth in g bad and the worse the better Thi s
, .

i s a s omewhat less obvi ous p l easure seeking device

than that of the person who is a ll attention at the
28 8 M E N T AL HY GI ENE

at once the suggestion of the paranoiac wi th hi s ha l

l uc in a t i on s of hearing and his de l usio n s of p e r s ecu

tion .

The inferior organ in thi s ca se the organ of hear ,

ing can therefore be s een to be asocia l in its tenden

,

cies becaus e it hangs on to infantile ways of pleas

ure seeki ng which should be abandoned a s the indi
-

vidua l grows t o adul tho od in favo ur of activities that

minister more to the l arger good The individua l, .

after a ll can onl y i nclude what is under centra l con

,

tro l the dynamic or meta b olic gradi ent Child calls

, ,

it speakin g of the physio l o gica l i ndividu al A

4
.

group of cells may esta b lish their ow n independent

gradient and s o break off from the main body and
set up a government f or themse lves This we rec .

ogni z e as on e of the determiners of tumour forma

tion A s imil ar independence at the p sychol ogica l

.

l evel makes the individual in the particular region ,

involved asocial A socia l conduct may therefore

, .

fo und in organ inferiority .

PS Y C H OAN ALY S IS
Psychoana lysis had its origin in an e ff ort to
help sick individua l s Un l ike academic psychology .
,

which for a generation had been dea l ing with arti

fi cia lhuman bein gs created in the l aboratory , and
before that with metaphysica l prob l ems , p s ychoa n
alysis from the fi rst w a s confronted with the pro b
lems growing out of actua l human S ituations taken
4 0 m
mC M :
“The Ba sis of Physio l ogical I n di vi d ua l ity in Or
m p ril
, . .

ga n i s s,
”
S cien ce , A 1 4 , 1 91 6 .
 PS Y CH OA N AL Y S I S 2 89

from life as real human b eings really live it and

know it an d S O was intensely humani stic from the
very fi rst .

Psychoanalysis is just what the word s ign ifi e s ,

i t i s an analysis of the psyche a p ul l

ing apart a di s
, ,

s ection of the human sou l for the purpose of finding

out of what it is composed Thi s p rocess of di s s ec
.

tion or analysis is the way in which f acts have to b e

wrested from nature for she does not disclose them
,

easily —they must literally b e torn from her N o

, .

matter how beautiful the flower if we wish to know ,

its structure it must fi rst be torn a p art and that ,

whi ch app ea l ed to us as beauty b e destroyed alb eit

to reach the knowledge of a greater b eauty in the
wonders s o disclosed To the uninitiated the dis
.
,

memb ered flower is no longer beaut if ul b ut to the ,

botanist who sees the l arger truths discovered in its

structure the beauty i s only enh anced
, .

Pull ing apart dissection analysis results in ugl i

, , ,

nes s to the untrained eye T o the l ayman a dis

.

s ec t ed human body while it may excite curiosi t y or

, ,

even wonder ca n never be beautiful ; and s o it is

,

with the human s oul To the un p re p ared a human

.

s oul from which its surface has been removed and

,

which thus di scl oses its inner structure is an ugly ,

S ight ; b ut as in the examp le of the botanist the ,

trained o b server can only be thrilled with the won

der f ulbeauty of the marv ellous adaptations which
are there disclosed to V iew .

The history of the psychoanalytic movement in

the past few years is not unlike the history of the
290 M EN TAL HY GI ENE

dis s ecti on of the human body Science has always

.

had to fi ght its way against prejudice but in these ,

t w o directions the dissection of the body and the

,

di s section of the mind the prejudi ce s eems to be of

,

s imil ar character The tremendous opposition that

.

had to be overcome be f ore human dissection was

rendered p os si b le seems to me t o be in n o small part
de p endent upon the antagonis whi ch man has ofm
having the secrets of his inner se lf laid bare The .

human body was considered to b e sacred to be in ,

violate and dissection w a s a matter of desecration

,

becaus e man felt that the very citade l of his person

a lity was being invaded It i s the same thing with
.

psychoanalysis only perhaps the invasion is still

,

more undesirable for it is no longer s im p ly the b ody

,

that is invaded but the very innermost of hi s being

, ,

and to cap the climax psychoanalysis has dared to

,

inquire into that most p ersona l of a ll elements in

ou r make up — s exua lity N aturally we mi ght ex
-

, .

p ec t a tremendous op p osition to this movement .

W e have s een tha t a s man ha s deve l oped he has

had p rogressively to give u p more and more of hi s
primitive in stinctive tendencies a s the pri ce for a
,

hi gher civili z ation with al l of it s inestimable benefits .

A s these instinctive tendencies have b een overcome

they have been relegated to the unconscious and out
of the succes ses attained in the overcom ing have

been forged the wea p ons with which to win a new

victo r y S imply because thes e cravi ngs have b een
.

overcome and buri ed in the unconscious does not

mean they have ceased to e xi st nor that they have
2 92 ME N TAL HY GI ENE

the words of Freud : " “Psychoanal ysis originated

on a medicalb asis a s a method of trea t ment for cer

ta in nervou s mal adies which are ca lled functio n a l

and in whi ch there is recogni z ed with const a ntly in
creasing certa inty the result of di sturbances of the
a fi e c t ivi ty It atta ins its obj ect of removing the ex
.

pres sions of such disturbance s the sym p toms by

p resu p posing that thes e s y m mm
, ,

p to s a y n o t be t he

on l y p os s i bl e a n d fin a l outco e of ce r ta in en ta l m m
p r oces s e s
7
and w,
ith that in view , exposes the h istory
of the deve l opment of the symptoms in the memory ,

reawakens the processes lying underneath these

symptoms and a ff ords them a more favourab l e out
l et under the guidance of the physician For .
,

today, we kn ow that the patho l ogical symptoms are

often nothing else than substitute formations for
bad i e unsuitable tendencies and that the c ondi
, . .
, ,

tions of the sym p toms are estab l ished in the years

of chil dhood and adoles c enc e —a t the same time in
which the in di vidua l i s the obj ect of education
whether the ma l adies actua ll y appear in youth or
only in a l ater peri od of l ife .

“E ducation and therapy now app ea r in a r eci r o

p
ca l relation to each other E ducation wi ll take care .

that from ce rta in dispositions and tendencies of the

child nothing harmf ul t o the in div idualor s ociety
,

shal l proceed Thera p y wil l come in to play if thes e

.

same di spositions have already ca used the unwi sh ed

for resul t of a patho l ogica l symptom .

O Pfl s te r l c p v
I ta l ics mi
.
, . .
, .

7 ne .
 PS Y C H OA N AL Y S I S 293

Here is the key to the situation An analysis is .

for the p ur p os e of reconstructing the psychological

history of the patient s o far as that history b ears
u p on the formation of the symptoms A S soon as
m
.

we do thi s we invaria b ly find that the sy p tom rep

resents symb olizes a form of instinctive activity
, ,

whi ch b e l ongs to the p eriod of infancy and should

have been renounced as the child grew to adulthood
but which becaus e of some s p ecial em p hasis has b een
retained T o show the im ense p ractical import
. m
ance of this p sychoanalytic p oint of view I here r e
peat the list o f di sorders cited in C ha p II and taken .

from the recent literature which were found to b e ,

mental in origin although for the most part they

were a p parently physica l disorders I t hi n it wil l k
m
.

be a d i tted that many of most of thes e ailments

would b e a p t at least to be treated by other than p s y
ch ol ogi c a lmethods This li st includes many forms
m
.

of asth a sore throat diffi cult nasa l breat h ing

m
, , ,

stam ering headache neurasthenia b ackache ten

, , , ,

der spine “weak heart ”

fainting attacks ex op h
m
, , ,

tha l i c goitre a p hon ia spasmo di c snee z ing hic

, , ,

cough rapid res p iration hay fever gastro intes

, , ,
-

t in a l disturb ance ( constipation di arrhoea in di ges , ,

tion colitis gastric ulcer ) ptosis of kidney dia b etes

, , , , ,

disturb ance s of urination ( pol yuria incontinence , ,

p recipitancy ) menst r ual di sorders auto intoxica

, ,
-

tion ( from l ong continued digestive di sturbances ) ,

nutritiona l di sorders of Skin teeth hai r etc etc , , ,

.
,
.

Th e list might be indefinite l y p rolonged I will .

briefly add ex a mples of ap p arently p hysica l dis order

294 MEN TAL HY GI EN E

for pur p oses o f il lustration which p roved on an aly ,

sis however to b e p sychological in origin

, , .

Of th e vas omotor dis orders I cite the ca se of a8

fif teen year ol d girl who during ana lysis exhi b ited

swollen li p s Thi s had occurred once fiv e years b e
k
.

fore when a student had tried to iss her but S he had

successfully resisted him A s i il ar attem p t had . m
been made before the later recrudescence of the
sym p toms .

A s an example of a ski n eruption is the case of a

young woman who had areas of erythema on both
9

forearms Thes e areas did not tan on ex p osure to

.

the sun a s did the rest of the ski n An alysis showed .

that the erythematous areas were the pla c es which

had been grasped by the mother in Ia w in a very - -

emotional scene b etween them The e r ythema dis .

a p peared following the analysis and the skin in that

area then tann ed on exposure .

C ertain ca ses S how we ll that di sturbances of men

s t r u a t i on dysmenorrhoea and suppression may b e
m
,

p urely p sychogenic due often to a ti i d p rudish , , ,

neurotic mother who scares her daughter over

the onset of the new fun ction or leaves her in ,

i gnorance to conjure up her own fears on its ap p ear

ance Subsequent l oca l treatments curettage ven
.
, ,

tral sus p ension etc not only may not help b ut may
,
.
,

aggravate the anxiety make the patient decidedly ,

worse b eca use of course they do not go to the root of

the trou ble b ut only dea l with results .

8 P fis t e r , l c p
.
, . 32 .

9 Ca se comm un ica t d by e Dr . E . J . "e mpf .

296 M E N TAL HY GI ENE
“a s they were then upon that other occa sion when
they tried to vacc inate him That is he wishes .
,

that he may succeed b y hi s obstinacy, in thwart

,

ing the des ires of his father a s he succeeded b e

m
fore The treat ent of such a condition by caus
.

ing the di sagreeab l e sensation in the arm to di s a p

pear by suggestion ou the theory that that is the
di seas e can at once be seen to b e entirely in adequate
to the situ ation It leaves untouched the charac
.

ter defect which is to react by obstinacy to disagree

"

abl e situations In this respect the boy i s retaining

.

an infantil e way of dea l in g with th ings he does not

l ike and needs t o be helped to grow u p to develop on ,

t hi s side of hi s character Unl es s the treatment is

.

d irected to such ends it mi s ses its goal .

The difficul ty ha s been in the past , that p s y

,

ch ol ogy has never employed itse l f with s uch que s

'

tions Intrenched in i t s laboratories it has car

.

ried on its work far removed from the every day -

l “
if e of the man in the street ”
But now that is .

exactly what psychoanalysis i s demanding of it .

Why John Smith does not get a l ong with his wife
has a lways been a matter of a b sorbing interest t o
the neighbourhood but psycho l ogy has never dig
,

n ifi ed such a pro bl em with its attention W e are .

finally coming to see however that it is because we

, ,

do not get along with our wives because we are not ,

interested in our work because we are not a p p r e

,

c i a t ed by our chief or are imposed upon by our

,

ass ociates b ecause we get too tired slee p too l ittle

, , ,

dri nk t oo much becaus e our sala ry is too small or

, ,
 PS Y CH OA N ALY S I S 297

we cannot save or the other fellow who does not do a s

,

good work as we do gets more or a thousand other ,

reasons none of whi ch for a moment cause the suf

,

ferer to seek the advice of a physician we are ,

fin ally coming to see that it is just such thi ngs as

these that make the di fi er en c e between a ha pp y l ife ,

fill ed with usefu lnes s and failure Of such pro b , .

lems from the point of view of the educator P fi s t er

says 1 1 “ Of the analytic educationa l work with
p u p ils who without being really ill still because
, , ,

of inner in hi bitions make themselves and their fam ,

ili es unhappy there is almost no mention anywhere

, .

How the hitherto uno b served im p ressions of chil d

hood control the who l e later deve l op ment of the
normal individual even to the p eculiarity of hi s ,

styl e his choice of a vocation and of a wife as wel l

, ,

as the most insign ificant subordinate a ffairs fin ds ,

too l ittle discus sion The enormous loss of love for .

fellowmen and of power for work which many ia

div i dua l s su ffer mostly without knowing it as a , ,

resul t of unfavoura ble educational influences have ,

not u p to the present time b een given their p ro p er

, ,

weight in the literature C ountles s numb ers of .

p ers ons who b ring heart b reaking grief to their -

parents and other p eo p le and cannot hel p b ringing

it beca use they are under neurotic obs essions can ,

by the aid of ana lysis be changed into agreeable ,

useful individuals ”
Unles s psychol ogy is wil l ing .

to busy itself with such prob l ems it may we ll be

cal l ed u p on to justify its e xistence .

1 1 Pfis t e r , l . c .
, p . 1 4 .
298 M EN TAL HY GI EN E

Psych oanal ysis is essentially an educational pro

ce du r e
. Its o b j ect is to clear away the rub b ish
whi ch is o b structing the p athway of the patient s o
that he may have a chance to go forward T his is .

precisely what education tries to do M ost em .

pha tica ll y neither should try to impose ideals upon

others but only make the way free to permit the
full est development of the p ersonality .

The p sychoanalysts believe there are shorter cuts

to the neuroses than by way of heredity Here are .

a cou p le of remarks b y parents which rece ntly came

to my attention One mother says that a child
.

has no morals until after nine years of age B e .

fore that they are just little anima l s and s o of

cours e there i s nothing to do about it A fin e .

formul a t o re li eve the parent from a l lr es p on s ib il

ity and sanction a p rogram of do nothingness An
-
.

other parent b elieves in teaching ch ildren a b solute

o b edi ence that is in completely subj ecting them to
, ,

her wi ll irres p ective of their natural tendencies A .

fin e t hin g for the parent surely but what of the

,

child " How can one expect a child in either one of

thes e households to deve l op how is it going to be
,

p os sible to get any chance at al l and as a result

,

must it n ot almost surely happen that thwarted, ,

in its natural avenues of exp ression it wil l seek the

b yways—an d that i s th e stuff out of which the
-

neurosis and future in efficiency and un happines s

is b ui l t
.

From the ca ses thus far it wi ll be evident that the

theory that accounts for the later neurosis assumes
300 M EN TAL HY GI EN E

attri butes of life are traceab l e to the s ingl e prop

e r ty o f p roto p lasm— irritabil ity
. After a ll it is of
less p ractical importance to answer the question
“whence ” than to answer the question “whither ” .

It is only a matter of detai l how we rep l y to the

query “ whence ”
for in any ca se we have all
travelled the same evolutional pathway It is .
,

however of the vastest importance to the individual

,

that he should b e a b le to make the b est use of hi s

o pp ortunities that he should b e a ble to answer the
,

“ ”
question whi ther in a sati sfactory way .
 CHAP T E R "

SUMMARY

In thi s fina l summ ary it will be my o b j ect to gathe r

u p al l the various threads whi ch I have followed in
the preceding chapters and attemp t to show how
they are related in the vast and intricate p attern
of human activities . I can not of course ho p e to
do thi s in any at al l adequate way for the b eauty
and the comple xity of the pattern must always far
exceed the capacity to describe it I will n ev e r t he
.

less attemp t to present thos e salient elements in the

pattern which are of immediate and pri e impor m
tance for the prob lem in hand .

From the material Osborn has given us in his

M en of the Old Stone A ge we may picture primi
”

tive man in form a pp earance and intelligence

, ,

closely resemb ling present day Simians A crouch .

ing ha l lstooped anima l of great strength with r e

, ,

ceding forehead and ferocious face with enough in

,

t ell
igen ce to p ick u p and use a stone as a wea p on
o r perhaps to rude l y form it by chi p ping it with a n

other b ut proba bly not enough to fas hi on clothes to

,

protect him from the cold Such men pro b ab ly

.

early grou p ed themselves together in small bands ,

p robably driven to do s o to p rotect themselves the

better against the wi l d f erocious animals with
,

3 01
302 MEN TAL HY GI ENE

which they had to contend although some social p s y

,

ch ol ogi s t s would hold that it was because they were

possess ed of a gregarious instinct W e can imagine

.

such a group in one of the caves they frequented ,

both for safety and f or protection from the cold,

gathered a b out the ca rca s s of an ani mal which they
had hunted t o the death In such a grou p could
.
,

we revive it we woul d probably o b serve noisy quar

,

r ellin g over specia ll y desired parts o f the animal ,

and after their hunger was appeased proba b ly a

simil ar typ e of b ehaviour on the part of the males
f or the posses sion of the females in the end domi
,

u s ted b y the largest and most powerf ul much as ,

we c a n s ee the same reactions today in any cage of

monkeys In such a group the primitive instincts
.

hold sway and it is out of such materia l that a

f uture hi ghl y com p lex soc iety with a l
lits infinitely
complex relations hi ps must b e deve l op ed
m
.

If we will examine this p ri itive community with

a little more care we wi ll see that it owes its exi st
ence t o factors with which we are perfectly famil iar .

If for exam p le the strongest man were to take all

, ,

the food the others would starve and s o such con

,

duct which we re cogniz e as selfi sh would tend to

, ,

the destruction of the herd and therefore of the a d

vantages whi ch such grou p ing o ffered Simil arly
.
,

if in their quarrels the strong killed the others the

same resul t would tend t o issue namely the de s t r uc
, ,

tion o f the herd From the very fi rst therefore it

.
, ,

is evident that in order that the social grou p may

continue in existence an d function the individual
304 M EN TAL HY GI EN E

of the individua l and of th e herd may be O pposed .

If for example the strongest man in a sma ll group

, ,

took all the food for hi ms el f the others woul d per

ish The emphasis in thi s il l ustration however
.
, ,

needs to be put upon the fact that whil e he who

by his s e lfi shness had thus appropriated all of the
means of subsistence might superfi cial ly be s up
posed t o have profited by s o doing still any profi t ,

w hich accru ed from such conduct could only be

temporary Furthermore the matter does not
.
,

stop there N ot only is the pro fi t but temporary but

.

fol l owing thi s temporary period of pro fit the r e

s ult s are destructive N ot only has the herd been
.

destroyed not on ly has the survivor l ost all the

,

bene fits which as s oc iation together for a common

purpose gave hi m
but and here is the matter of
, ,

p rime sign ificance the survivor ha s l ost that mi lieu

,

in w hich and in whi ch alone he cou l d deve l op his

, ,

o w n individua lity The whole development of both

.

the indi v idual and of s ociety can thus be traced in

the constant cl ash and interp la y of thes e tw o e l e
ments .

In genera l it may be said that a s both the in

dividual and s ocie t y deve l op that they do s o only
because man has been ab l e more and more to give
u p the imm ediate satisfaction of hi s desires to ,

p ut off their fulfi lment until a more opportune time

m
.

H e has been a bl e to sacrifice hi s im ediate wi shes

and put off their fu lfil ment into an ever rece ding
futu re and occu p y his energies meantime in s ome
thi ng else—sub limation Taking the examp l e al
.
 S UMM A RY 305

ready used he comes to a pp reciate the distinctions

,

of meum and tuum and instea d of taki ng what he ,

wants f rom hi s fellow he respects his ownershi p

and sets a b out in c onstru ctive ways t o earn the
p ower to purchase it from him .

I n this progress from the simplest group to the

more complex with th e contemporaneous conflict
b etween the individual interests and the interests
of the herd man feels fi rst and acts u p on impulse and

as a res ult of emotion long before he learns to

think with the use of clear cut ideas and carefully
checked u p judgments Feeli ngs are the more .

homogeneous and crude res p onses at the psycho

logical level which precede in development thos e
res p onses to which we give the name intellec t ual 1
.

The emotional ty p e o f response is not only more

general and homogeneous that is lacki ng in , ,

s p ecifi city b ut it is characteriz ed b y an a b s ence of

,

p roj ection and a relation of the stimulus to the

body rather than to an external o b j ect and it is ,

also a whole or nothing typ e of reaction 2

It i s .

only slowly through coun tless ages of trial and

,

1For certa in vi de c s th a t this p hy l og etic succ ssio i s r ep r e

e n e en e n

sen ted i l ik m n r in th structur

e an n e d t h fu ctio s of t h e hu
e e an e n n

m br i n s ee t h e a uthor s M ch isms of Ch a r ac ter Forma tion

an a
“ ’
e an .

By t h who l e or n othin g r es p o s
2 e is m ea t th a t th ere is a n n e n

a b s en c e of t h a pp r ci a tio e of d gr ee For exa m pl i n c rt i

e n e e, e a n

p atho logica l co ditio s t he a pp l icatio of xtr m es of h ea t or cold

.

n n ,
n e e

a e i t n s l y d i sa gr eea bl e
r n e e Th e d isa gr e bl e f ee l i g how eve r d o s
. e a n , , e

n t b g in with m in or d egr ee s of t h
o e stimu l us b ut wh e it ha s r ch d e n ea e

a c rta i e d g ee of i t en sity t h e f l i g of d isa gr e bl e ess i its

n e r n ee n ea n n

fu ll st i te sity l eap s su dde l y i to co scious ss E ith er t h er e is

e n n
‘
n n n ne .

n o such f ee lin g or el s e t h e f ee l i g is p r e se t i n fu ll forc e n n .

306 MEN TAL HY GI ENE

error an d b y way of the path of tremendous suff er

ing that the originally extensive a ff ective rela , ,

t i v el y undi ff erentiated whole or nothing type of r e

s p on s e related primarily to the body is replaced in

p art b y the re l atively intensive di ff erentiated pro, ,

j e c t e d variety .

I f we wi ll bear these characteristics of emotional

response in mind in comparing the reactions of
p rimitive man with present day intellectual types
of reaction we wi ll get a useful viewpoint on man s ’

b ehaviour in its genetic s ett ing For examp l e we .

,

will understand anew the ty p e of reactions descri b ed

in a p revious cha p ter ( Chap V ) in the discus sion
.

of the crimin al a s sca p egoat 3

These reactions are
.

reactions against evil and sin in general by attem p t

ing to transfer them to s omething or s omebody
and then by destroying that something or s ome b ody
getting rid of them The extremely genera l typ e
.

of these reactions i s seen in the fact of the choice

o f scapegoats . An imals or men are not chosen b e
cause of a n y relation which they may b ear to the
evi l it is desired to be rid of but for entirely di fi e r en t
reasons—usually because they are captives or con
m
de n ed crim inals Then again it is seen in the
.

p eriodica l ceremonials for the e xpulsion of evils

which are indulged in whether there i s s p ecial need
for them or not L ater in the development a s I
.
,

p ointed out there is a tendency to choose as a human

,

sca p egoat a condemn ed crimina l But this is a r e .

action against human sacrifi ce and hardly a nearer

3 Sec F a m Th S c p go t
r r : e a e a .
308 MEN TAL HY GI ENE

Perhaps the most i p ortant characteristic of them

emotional res p onse however is the l ack of p r ojec
, ,

tion .
6
We have seen ( Chap III ) that from the very .

fir st the tendency is for the ba b y to be se lf suffi cient -

to keep within h imse lf that reality has t o come ,

repeatedl y kn ocking at the door and really to cause

pa in and s ufi e r in g before it receives adequate rec
ogni t i on It is only a s a result of such repeated de
.

mands that man finally l earns to project hi s i n

t e r e s t s outside of his ow n body and to take inter
est i n reality E ven after he does this however the
.
, ,

proj ection mechanism i s sus ceptib le of serious dis

t or t i on s which nevertheles s s erve a purpos e in evo
,

lut i on and only become patho l ogica l when they r e

tard progres s A s we have seen ( Chap H I ) when

.
, .

thi s proj ected interest meets with an obstacl e it is

felt as though it came back from the outside worl d
in the form of a destructive in flu en c e—hate if it ,

comes from an individual quite often some mys

m
,

t er i ous and alefi c en t force , if from an inanimate

obj ect .

The proj ection mechanism is the mechanism with

m
which a n comes in contact with feels out rea lity , , .

It is also the mechani sm through which he comes

to the fi rst e fforts at repres sion of hi s ow n in s tin c
tive tendencies through the deve l opment of the
antipathic emotions That is he projects his own.
,

instinctive tendencies upon the persons of others

G Pr is h re used in t he sen se of obj ctiva tion which is
o ec t i o n
j e e

p os si bl y the b tte r te rm p roj ection ha s a techn ica l sign ifi can ce in

,

e as

p sychia try ( see Chap III ) . .

 S UMMARY 309

and then proceeds to kill or otherwise do away with

those others It is the princi p le of the sca p egoat
.
,

but man never sus p ects that t hi s is the meaning of

s o many of hi s hates and anti p athies The memb er .

of the tribe who o ffen d s a tri b al law or custom is

forthwith kil led and b y s o doing the trib e is saved
from hi s further disintegrating influence b ut in a d ,

dition for those who took p art in the killing actually

, ,

or b y len d ing their symp athy a similar delinquency ,

is rendered much more imp ossib le the prohi b ition ,

is greatly increased—reinforced .

That we are still a long way from having evolved

an intellectual typ e of society I think all will a d
mit W e are stil l a l
. most entirely controlled by our
feelings and such reactions as I have just outlined
are l argely in evidence in our everyday life The .

petty j ealousies and ant agonisms of any grou p of

people who are c l osely as sociated are instances in
p oint In fact perha p s it is not desirab le that we
.

should be entirely controlled by ou r intelligences ,

b ut it certainly is desira b le that our feelings should

devel o p beyond the infantile typ e whi ch makes such
reactions possible .

Finally however man does come to have s ome

, ,

measure of contro l over hi s instinctive tendencies

as a resu l t of the development of what we cal l his
intelligence The energy transformations which
.

occur at the level of intelligence are mediated b y

ideas whi ch act as sym b ols for energy at thi s level 7
.

7 For t h sym b o l a c rri r of

e srgy a th e
“
uthor s M ch isms
en e s ee e a
’
e an

of Ch aracter Form a tio ” n.

31 0 ME N TAL HY GI ENE

The idea becomes then a much finer too l than the

feeling f o r cutting i nto real
ity and so develops a c
c or d in gl
y .
8

I t is p erhaps becaus e the idea is a

much more so

e fficient tool than the feeling that it ha s develo p ed

s o much more ra p idly We have a rich language.

of idea s but our ca p acity to describ e our feelings

by words is very limited b y comparison .

With the material of his instincts his fee l ings his , ,

ideas and finally his ideals we s ee man struggling

with the great pro b lem of his nature , the conflict
b etween his s elf p reservation ( nutritional ) and his
-

race p reservation ( sexual ) tendencies proj ected into

-

the larger issues of in dividuali ty versus s ociety .

On t hi s great battle field the victory goes in the

main to thos e best fi tted to survive The great gen .

eral average of resul ts is in the l ine of p rogress b ut

in reaching this average much that i s worth w hile
must neces sarily go down to destruction All al ong .

the line of p rogres s those who wander t oo far from

the path of succes s fail comp l etely while in between
is every degree of fail ure or of succes s depending
u p on the angl e from whi ch on e chooses t o consider
it .

It is neces sary t o vi ew the questions of socia l in

adequacy as I have called them from this broader
, ,

horiz on in order t o adequate l y appreciate the mean

This sta tem n t is r ath er l oose l y p hr a sed In stea d of an i dea
8 e .

be i g a too l to cut in to r ea l ity in this sen se th a t is tha t it is m d

n a e

ovo for th t p ur pose it r p r se ts a r ea ction a t t he p sycho

.
, ,

de n a , e e n

l ogica l l ev l which is succ sfu l i p ro p ortio to t h succ ess o f wha t

e es n n e

w e t b for a d out of which t he i dea w s born

n e e n a .
31 2 M EN TAL HY GI ENE

namel y animi sm There probab l y co uld be out

, .

lin ed a n um b er more J ell iff e "

woul d de fine on e
.

such s tage a s that in which animals a pp ear in the

unconscious symbo l isms with great frequency as
typ ifi ed in Ovid s M etamor p hoses Another s ta ge
’

m
.

might easily be a sadi stic ( cruelty ) stage a s s y

bol iz ed b y the Inq uisition Others could eas ily b e .

suggested and for each stage t o carry out the geo ,

l ogical fi gure a l ready employed there would be s p e ,

c i a lvariants just a s S pecial fossil s are found in par

t i c ular geologica l strata This way of l o oking at .

the phenomena gives on e at once a b readth of hori

z on and at the same time furnishes a scheme into

which can be fitted particular and unusual instances

in a hel pfu l way a way that gives them meani ngs
, .

In addition to thi s way of classifying the material

i t is nece s sary als o to attempt to evaluate the seri
ou s n e s s of the reaction in a particular instance and

note whether it is for the most p art de p endent u p on

defects resident with in the indi vidua l or causes ex
ternal to hi m
B oth etio l ogies may produce a con
.

dition which outwardl y a p pear the same I n the .

on e cas e the person reacts with sym p toms which

S how his l eve l of devel o p ment in the other cas e ,

outward circumstances which he cannot adjust to

drive him back within hi self to the same level m .

One pers on may deve l op a stupor as result of a

9 J el
lifl e , S
'

E an d B rin k
of A im a l s in
L Th e Rol e n t h e Un
a rks on Th riomor p hic S ym
~

co n scious with some r em

.
, , .
.

bo l ism e as seen
in O vi d
,

The Ps yc ho ana l
y ti c Revi ew J u l y 1 91 7
”
.
, , ,
 S UMMA RY 31 3

gum boil another only when faced with the hopeles s

,

ness of a long term in prison .

Then again a s to the seriousnes s of the reaction .

T his may be shown b y the necessity for esca p ing

from rea l ity A man who occasionally drinks too
.

much when out with a crowd of men having a good

time is not other thi ngs being equal nearly s o
, ,

s eriously involved a s one who from time to time

b uys a supply of whi skey and then goes to his
room pul l s a l
,
lthe shades down s o a s to darken it
thoroughly goes to bed and alone proceeds to
m
, , , ,

drink hi self into unconsciousnes s .

Having outlined the nature of the problem of s o

c i a linadequacy in its multitu di nous ramifi cations
-

and reached some understanding of what it means

both in the l arge and in its p articular manifesta
tions there remain a few thin gs that I wish to s ay
,

a b out the way thes e p ro b lems should b e approached

in order to insure the b est resul ts
m
.

I have inti ated all through the book that if we

are to really accom p lish lasting results for b etter
ment the a pp roach should b e with love using that ,

word not to mean anything approachin g sentimenta l

i sm but in its broader sens e as O pp osed to hate
, .

A s already indicated the mechanism of p r ojec

tion or p erhaps better obj ectivation transferring
, ,

our interests t o and seeing them in the outside

world is the mechani sm by which we come into c on
,

tact with reality L ove is the indication of succes s

.

while hate is the reaction whi ch in dicates a cer

31 4 M E N TA L HY GI E N E

tain measure of failure L ove is p ositive and goes

.

ahead hate is occupied with trying to avoid certain

,

o b stacles o nly, by o b j ectifying them and then de

stroying them L ove i s the p ath o f interest which
.

takes us out of ourselves hate is the p ath that turns

,

us back within L ove is creative hate destructive

.
, .

W e have s een h ow the constru ctive attitude as a p

plied t o th e insane has infini tely ameliorated their
condition in recent years and led to studies which
are throwing ever more light upon the meanings o f
s o called insane reactions
-
We have seen also how
.

the attitude of hate has equally retarded any such

m
s i il ar progres s in humanitarian endeavour o r
scient ific enlightenment in the case of the s o called -

crimi na l classes I t behooves us therefore to take

.
, ,

stock of ourselves t o l ook within and s ee whether

,

our ow n attitude does n ot need orientin g towards the

p roblem if we are to get the best results .

If we wil l do thi s it will be a p parent that our

attitude ha s to be planned on a higher p lane of con
duct than that I have referred to as typ ica l of the
attitude towards the crimi nal In other words noth
.
,

ing wi ll be accom pl ished s o l ong as the attitude is

o n e o f hate o r to us e les s harsh terms the p roducts
, ,

o f attem p t s to rationali z e our hate retri bution or,

puni shment S o long a s thi s i s our attitude towards

.

any p roblem nothing can be accomplished because

we are not objectifying our best but our worst we ,

are reall y only treating ourselves to a certain

amount of s elf indulgence— small on the average
-

but a veritable orgy when a lynching is the form of

31 6 ME N T AL HY GI E N E

and can never b e decided unles s the level of the con

fli c t can be transcended 1 0
.

In order to transcend the l eve l of the conflict in

dealing wi th the socially inadequate classes the
p ro b lems must be rescued from the di stortions of
emotional ism either in the form of hate ( moral in
di gnation ) or s entimen talism Thi s can be done by
.

dealing with the whole th ing on the l evel of s c ien

t ific interest ( love ) which wil l be able to see the
facts in their rea l s ettings an d give them their true
values When this is possi b le a l
. lsort s of ways of
hel p i ng become vi sib l e and pro bl ems whi ch b efore
s eemed insolu ble take on new aspects This is the .

attitude which i s sorely needed with respect to such

prob l ems as prostitution and until it can be attained
they will wait in vain for anyth ing which promises
a s olution or if not a s ol ution an improvement over
p resent condi tions .

It is to this end that I have used the term socia l

inadequacy in place of such terms a s th e depend
ent defective and de linquent clas ses beca use it
, ,

does not ca rry any sus p icion o f moral delinquency

or mor a l judgment as does for example the term
, ,

de linquent This is perhaps a sma ll device b ut an

m
.

“
i p ortant on e for after a ll a science is a we ll made
”
l anguage .

T o s ee man a s a s ocia l anima l and his fail ures as

forms o f s ocia l inadequacy ; to a p proach these pro b
l ems free from prejudice an d with a ful l a p p r ec ia
1 0 For a d iscu ssion of t h r e so l uti on o f
e th e con flict s ee
“M ech
a ni s ms of Cha r a cte r Forma tio n
”
.
 S UM M ARY 31 7

tion that in each instance the fail ure has back of it

causes adequate to exp lain it ; then to attempt to
b ring to bear upon the problem those forces whi ch
are best calculated to bring about resu l ts which are
constructively of the h ghest value to both the i n
i

dividua l and s ociety ; and then to b e able to a pp ly

the princip les worked out in dealin g with individual
cases to the larger more general issues—these are
,

th e prob lems of M ental Hygiene .

320 IN D E "

d uca tion 3 1 2 92 Ha ll G S 37
t 1 22 ; k
E
of con d u ct
. .
, , .
, .
,

E d w a r ds Jo n a th a n des cen d an ts
, ,
Ha e, i d n

of 1 73 ; gra n dmoth e r of
, , h a ted 1 2 3 , .

1 73 . H te vs l ov
a 44 45. e, , .

E l l is vel ock 2 35
Ha H ea l th x i
E motiona l r es po n se
.
, , .
,

305 , 3 07, H red ity 52 1 6 8

Hom e l e ss u em p l oy d 2 1 2
,
e , , .

308
ti pa thic H om
. n e ,
.

E motion s , an , 46 , 51 , ose x ua l ity 2 09 ; treatm en t ,

3 08 . of 2 1 0
, .

En e rgy tr an s form a tion s 309 H ormo e 1 4

H os p ita l 89 ; g
n

ra l a d m
, .
, .

E vi ron m t an d i d i i d u l
n e
en n v a , t , en en e , n

la t ion s of 1 3 ; di sti ctio s be , n n ta l d isea se 1 04 1 06 1 08 ; , , ,

tween 1 8 i d a 70 ; mun ici pa l 1 04 ;

e

E p i l e p sy t h p sycho p a t hic 92 1 04 ; S ta te
,
.
, ,

term 2 07; m ea n
, e , , , ,

in g of 2 07 91 92
E p i l p tics ty pes of 2 06
, . , .

e , , . y i
H ge a , l .

E ugen ics 1 70 1 8 2 H yst r

e ia , 22 6

E vo l utio n soci a l xi
. .
, ,

.
, ,

I d ea 1 6, .

Fa ctory 1 2 ; w lfa re w ork 3 I d a l of kn ow l edge 76 8 1 8 8

Id ti fi ca tion 5 1
, , e , . e , , , .

Fa d s 2 50
, . en , .

F a i l ures in life v I dl en ess 2 55

Ign oran ce 6 7 22 4
, .
, .

F a ith v
I ll egitima cy 2 43 ; ex p i a tion a
, .
, , .

Fa mi l y rom an ce 4 3 , .
, n d,

F tigu e 2 25
a , . 2 44 .

Fea r 6 7 I divi d ua l in d istin ct e ss of out

n

F ee bl e min d ed
, .
, n
-
t j ust chi l dr en no ,
l i es of 1 9
n , .

1 6 5 ; co mmitm en t of 1 8 7 ; t h I d ivi d u a l a d en viron m e t r e

n

con ce p t 1 59 1 6 6 ; d uca tio

, e n n ,

, , e n l a t i on s of 1 3 ; di sti n ctio s be , n

of 1 88 ; i n stitutio ca r e of twee 1 8
I n d ivi d ua l en vi ron men t re l a
, n ,
n, .

1 8 6 ; an d t he l aw 1 8 9 ; mu l ti
pl ica tion of 1 82 ; s gr ega tio ,
,

e n tion 7 1 9 , , .

of 1 8 7; vi a b i l ity of 1 8 1 In d ivi d ua l iza tion 95

I d ivi d u a l soci e ty dish a r m
, , .
, .

F bl e mi n d edn ss
ee -
c a use s of e , , n on y ,

1 59; m ena ce of 1 80 1 8 3 ; 77
I ivi d ua l soci ety r el a tion 20
.
, ,

re l a tive 1 8 2 1 8 4 ; r emed y for

, , ,
nd , .

1 85 . I n bri ety 2 01 a n urosis 2 03

e , e , .

Fe rn a ld Wa l te r E 1 8 3 In sa n e 6 0 6 2 ; con d uct 6 5
types of con d uct 6 3 ; vs
, .
, .
, , ,

Fr aze r J G 1 32
crimi n a l 1 2 3 ; a n d hos pita l s
.
, .
, .
, .

Fr eu d i an th eory 28 5 , .
, ,

1 02 ; i n M i ddl Age 6 6 ; p er e fii

Gen d r 2 79e , . s on 6 1 ; th e wor d 6 0 , .

G e rm pl a sm 1 9 , . I san i ty 6 4
n , .

G r ega riousn es s 2 6 , . I sti n ct vs rea l ity 39

n .
, .
 I ND E " 32 1

I stin ct for the a a , 38 , 3 9, f mi l i r M t a l vs p hysica l ix

M i ddl to Ge org 2 33
n en .
, .

4 0, 43 , 44 , 5 0, 52 , 5 3, 54 , 5 6 , e n, e, .

5 9, 1 2 8 .
M i l t o 2 35 n, .

I n stin ctive co d uct 2 7 2 8 n , , . M i d p h om

n , of 8 ; stru e en en a ,

I n sti n cts soci l iz a tio of 273, a n ,

. tu e x ; u soun d 6 1
r , n , .

I n e t gr a tio 1 3 20; l v l s of 2 6 n, ,
e e , . M o y va l u of 2 54
ne , e , .

I n e t ll ig ce mea suri g sca l es

en n ,
M or es 1 35 , .

1 6 2, 1 6 3 .

Ne ur a sth n i a 2 2 7 e , .

J el
lifl e, E , 25
‘

S . . . Ne uro s 2 6 3 n ,
.

Jor d a n , Da i a v d S t rr 1 6 4 ,
. Ne rvous system 2 5 ,
.

Ju d ge, 1 4 9 ; vs p riso er 1 4 1. n , . N on r stra i t 71

-
e n , .

J ury , 6 1 ; e v r d ict of 1 25 1 2 6 , , , N urs s for i san e 70

e n , .

1 2 9, 1 53 . N utrition 2 1 , .

J usti c tio fi a n , 57 .

O ccu p a tio s da n g rous 2 47; di n , e ,

" l r Hel en 2 4
ele , ,
.
v rsio a l 1 1 5
e n , .

" i n dlin e ss in tr ea tmen t of in O p i io s i sti ctiv 2 8 ; r esu l t

of x p ri c e 2 8
n n ,
n n e,

sa n e, 71 . e e en , .

Organ i f riority 2 85 ; strue n e ,

La bour , 1 , 2, 3 . tur e x , .

La w , 1 2 8 ; a st tutory , 1 76 , 1 77, O sborn H F 301 , . .

, .

1 78, 1 79, 1 8 0 . O sbor T M 1 40 1 4 1

n e, . .
, , .

La w , 1 46 schoo l s . O w Rob rt 3
en , e , .

La w s 5 , .

Le v er 1 4 ,
.
P ge 6 9 72
a , , .

L i b i d o 2 85 ,
.
P st t h e histori ca l of
a , , th e
Livi n g con dition s , im p rovem e t n p sych e 35 , .

of , 6 .
Pa ten t m ed ici s 2 1 5 ne , .

Love , 31 3 ; vs h a te
.
, 4 4 , 4 5, 50 .
P th of o pposite s 4 4
a , .

n
“
P a ti e t fi d i g t he shut n n in ,
,

M a l ad justm e t organ ic b a sis n 1 00

P ati en t —i stitution d ish a mo y
, .

of 2 84
p rimitive 2 74 2 76 301
, . n r n ,

Ma n, , , , .
77
Ma rri ag 2 32 P a u pe r 1 92
M n s s an a in corpor e sa o x P u p erism a p sycho l ogi ca l f i l
e, .
, .

e n , , a , a

95 . ur e , 1 94 .

M ta l d isor d rs 30
en e ,
. Pa u p rs type s of 1 94
e , , .

M ta l el m t in di s a se 1 1 2
en e en e ,
. Phi l thro p y p eriod of
an , , in ca re
M e t a l hygi
n vi 7 30; mov en e, , , e of i s an 83n e, .

me t ob j ct of 32 ; N tio l
n , e ,
a na Physica l vs me ta l ix . n , .

Committee for 6 8 94 ; p rob , ,

Pi l 6 8
ne , .

l ems of vi ,
. Pith ca throp us 2 9
e n , .

M en tal m ech an isms 34 , . P l ea s ur e motives 2 8 1 , .

322 I ND E "

P l ea sure p r emi um 2 78 2 80 , , . Rea d justmen t 36 , .

P l ea sur e s e ki g i fan ti l e 2 8 1 Rea l ity vs in sti n ct 39

on r la tive un im portan ce
e n ,
n ,
. .
,
.

Pr eju d ice 22 4 , . Rea s , e

Pr ven tive m ed ic i 30 of for eve ry da y con d uct 2 8

Primitive comm
e n e, .
, , .

un ity 302 R fl ex 1 5
e

Primitive m
,
.
, .

an 2 74 2 76 3 01 , , , . Rei l 6 8 , .

Priso n l a bour 1 4 4 , . Re p re ssion 31 5 , .

Prison re form 1 37 , . Re s po n si b i lity 1 27 , .

Priso n er vs j u dg 1 4 1 . e, . R v en ge 1 36
e 1 37 , , .

Priso e r r h a b i l ita tion of 1 4 0

n e
,

1 4 3 ; tr ea tm en t of 1 2 9 l3 9 , ,
,

.
,
Sa f ty motive 38 3 9 40 43 44
e , , , , , ,

5 0, 5 2 , 53 , 5 4 , 5 6 59, 1 28
Proj ction 46 308
e , .

,
S lm T
W , 1 81
.
,

Prostitution 1 95 ; f bl e mi d d ee -
n e
a on , . . .

ss a n d 1 95 ; h a t an d 1 97 ; S a n ita tion 1 ; obj ects of 3

Se l f p r e se rva tion 3 1 0
.
, ,
ne , e ,

1 99 ; r p r ssio
-

an d t h law , .

e e e n

of 1 96 ; trea tm e t of by in
,

n
S el f p r es erv a tive a ctiviti es 2 1
-

, .

di v i dua l
iza t i on 2 00
,
S ex u a l ity 2 75 , .

Psy ch e reca p itu l a tes S oci a l agen ci e s 93

.
,

the p a st , .

26 5
,
S oci a l custom 1 6 , .

S oci a l d is ea se s 230
.

Psychi a tri st in gen ral hos p ita l e , .

1 06
,
Soci a l hygi en e 2 45 , .

S oci a l i n a dequ a cy sta ge s of 3 1 1

.

Psy chi a try for en sic 1 1 0; t a ch e , , .

i g of
n 1 1 0 1 1 4;
,

i l
aw
,

n
Soci a l l eve l f a i l ure a t 2 3 , , .

schoo l s 1 4 7
, ,
Soci a ll y in a dequ a te 2 3 , .

S oci a lly i n effi ci en t c l a sse s 22

.
,

Psychoan a l ysis 2 6 3 2 88 ; i s ed u
S oci a l p sycho l ogy 20
.
,
, ,

c a t io n a l 2 98
.
,

Soci a l r e form 2
.
,

Psychoge ic d isor ders 2 93 2 94 ,

.

Psycho l ogi a l ty pe s of rea tion

n
Soci a l s ervic e 93
.
, ,

, .

c c

21
,
S oci a l settin g 99 ,
.

Psycho p a thic wa r d s 1 04 1 1 1 Soci ety d uty o f in d ivi d u a l to

.

, ,

2 2 ; h ea l thy x ii ; i ll xi ii
, ,

c o structio of 1 09 , , .

Psych ose s of p rison e rs l39

n n
Speech f r ee 239
.
,

, , .

S ta te ca r e 89
.
, ,

Psychosis 8 5 , .

S te ri l i za tion 1 75 1 84 ; l egisla
, .

Psychoth era pe utics 1 1 5 , ,

tio 1 76
.
,

Pu bl ic h ea l th 5 n, .

S tructur a l i za tion of mi n d
.
,
, x; ,

" ua k ers 6 9
x1 .

S ubl im a tion 2 78
.
,

" ua r an t in e 5
S ym p a thy 1 2 1
.
,
, .

.
,

Ra c e p r s rv
e e a tion 31 0 Trin i l r ace 2 9
Trott r
.
,

tio a l iza t io 57
.
,
Ra W
tion ty pe s 1 1 ; physica l
n n, .
e , .
,
28 .

Reac , ,

1 1 physico ch emica l 1 2 Unco n scious 2 7 2 9 34

psychol ogi ca l 1 3 ; sen sori U con scious motives for
-
, , , , .

m
,
n con

o t or 1 2 ; socia l 1 3
, , . d uct 2 91 ; W ish es 38
, , .
HE fo ll owi pa ges co ta i n dvert i sem e ts of b ooks
ng n a n

by t h e sa m au t hor or o ki dr d s ubj ec t s
e n n e .
The In ter p r e tation o f Dr ea m s

BY PRO F ES S O R S IGM U N D F REU D , MD . .

, LE D .

F ormrly Pr
e f s r of N ervous an d M ental Diseas es in the Un iv ersity
o e so

of Vi enn a

T r an s lat ed by A A . . BRI LL, Ph B . .

,
MD . .

Chie f of uro l ogic al Depa r tme n t Bro nx H o s p ita l a n d Dis p en

the N e
in i ca l A ssistan t in Psychi atr y an d N eur ol ogy C o ll ege
sa r y Cl

o f Physic ia n s an d S urgeon s N ew Y o rk
,

o th, 51
Cl 0 M .
, i n dex , l
i ter a r y ind ex , 871 0,

The gener al advan ce in t he s tu dy o f ab n o r al m mnt e l

a

p roc es s es ha s called p ar t i cul ar a tt ention t o t he dream , who s e

r iddle has been s olv ed by Pro fes s o r Freud t he no ted n eu ,

r ol ogis t at the Unive rs ity of Vienna in co nnection with his ,

s tudy o f nervous a n d m e n tal di s ea s es Pro fes s o r F r e ud as

s erts that drea m s a r e p er fec t p s ychol ogi c al m ech anis m
.

s an d

a r e neithe r foolis h n or us el es s He fo und that dr eam s

when analyzed by his m etho d ex p o s ed the mo s t i n tim

.

, ate

reces s es o f p ers onality an d that in the s tudy o f n er vous

and m it is m ain ly thro ugh dream
, ,

ental dis eas es s that the

s ym m
,

p to s o f t he di s ea s e ca n b e e x p l ai n ed an d cured This
ep och m akin g boo k furn i sh es m
.

-
any us e ful a n d in teres ting

c ontribution s t o t he s tudy an d trea tm ent o f nerv ous an d

m ental dis ea s e s an d is m o s t valuable to phys icians and

p ys cholo g i s ts .

TH E M AC M I LLAN C O M PAN Y
Pub l
i s h er s 64 6 6
-
t
Fif h Aven ue N ew Y r o k
Psyc hop athol
ogy of Eve r yday Life

BY PRO FE S S O R S I GM U N D F RE U D , LL D . .

T r an s late d by A . A . BRI LL , Ph B . .
, MD . .

Cl m
oth, de y 871 0, 338 M .
, in dex ,

Thi s b ook, which is lar gely c on cer n ed with p s ychologica l

ca us es o f tho s e s light l ap s es o f t o n gue a n d p en an d m em or y
t o which ever y on e is s ubject is p er hap s o f a l lF r eud s
’

, ,

books the b es t a dap ted for t he gen er al rea der in addition

any p hen om
,

t o t he s ci en ti s t It s heds a fl ood o f light o n m

e n a which m
.

os t p eop le a r e ap t t o r ega r d a s in s ign i fican t ,

but which a r e really full o f m ea n in g for t he s t uden t o f t he

inn er li fe .

A valuable con t r ibution t o t he p sychoan alytic literature

availabl e in our o w n la n guage i s m ade by t he t r a n s lati on o f

thi s im p o r t an t a n d p op ul
a r wor k the m o r e c a r e fully

t he book is s tudied t he m or e is on e imp r es s ed wit h the p r o

foun d gen ius o f the a uthor which gui des ev er fa r ther in t o
tho s e unex p lored dep ths to which he ha s giv en us t he op en

in g k ey .
”
Jour n a lof N er v ous an d M en ta lD is ea se .

The bo ok is t i i it is us e ful an d wil

a s en ter a n n g as lb e ,

valuable not only to the p hys ician an d p r o fes s ion al p s yc hol o

”
gi s t b
,
ut t o p as tors p are n t s a n,d s o ci alwo r kers B os ton .

T HE M A C M I LLAN C O M PAN Y;
Pub l
i s h er s t
6 4 6 6 Fif h Aven ue
-
N ew Y k or
THREE IM P OR TAN T B O O" S B Y
H EN RY H GO DDA RD
Dir ecto r o f t he Re s ea rch La b or ato r y o f the T r ai n i n g S ch oo l at V in e
.

l an d N J f or F eeble M i n ded Gir ls a d B oys

, . .
,
-
n

Feebl e Mi ndedn ess : It C u -

dC qu n s a ses an o ns e e ces

Cl h 599 p ot ages ,

I t d iff rs f ro mmost o f thos i h fi l d i h t it is wh t m b

,

t rm d sourc stu d y I st d o f h su b j ct o f
e e n t e e n t a a ay e
r li zi
f b l mi d d ss p r s ti
e e a e . n ea g en e a ng on t e e
r um ts for this th ory d th t d
co l u d i g with v u s p cu l tio s D Go d d rd iv s f cts T h
ee e -
n e ne , e en ng a g en e an a an

book is so com p r h siv i sco p d h c s s x h ibit such v ri t

nc n ag e e a n ,
r . a g e a . e

i f r u tly wi l l h p r t h t ch r d ll
e en e n e an t e a e e a a e y
f d isor d rs th t
who h v to d o with i corri i b l d l i u t or u f or u t chi ld r
o e a n ot n eq en t e a en , t e ea e , an a

cou r ch r ct ri stics sim i l r thos d ispl y d by h su b j cts

a e n g e, e nq en , n t na e en

d iscus d by D Go d d r d T his work th r for co i s thorou h

en n te a a e a to e a e t e e

co si d r tio o f this vit l su bj ct which

se r . a .
, e e e, n ta n a g
so i r sti ly
s“ t d i h c s o f si l f m i ly i h uthor s f orm r b o k
n e a n a e w as n te e ng pr e

T h " l l ik kF mi ly
km
'

k
en e ,
n t e a e a ng e a , n t e a e o ,
”
e a a a .

The " al li a Fa il y
AS m H m Fm a r unv i n s ar on y or aou as s

C lo h 8
-

or stri k
t 1 1 0,

N m x m p l o f h su p r m f orc o f h r d i ty cou ld
,

o i e ng e a e t e e e e e e
b d sir d —Th D i l
”

most i l l umi t i d com p l t o f l l h stu d i s i h r d ity

e e e e a
“
.

T he
h d sc t o f
na ng an e e a t e e n e e
th t h v v r b m d with h vi w o f showi
m t ldfii
t
—B ll i f h M di l d C hi l
a a e e e e en a e, t e e ng e e en
"
en a e c en cy . i lF u et n o t e e ca an r ur g ca ac u ty

f“M l d
T his is h m ost co vi ci— o f h socio l o ic l studi s b rought out
o ar y an .

by“h u ics mov m t Th I d p d

t e n n ng t e g a e
”

D G od d r d h m d l so h d —
t e e ge n e en . e n e en en t .

h tr i i g
’
fi d
‘
d h h
bl s him to uti l i his d i ov ry to h utmost A mi
r . a as a e a n ; an e as a a t e a n n
which
l f P y ho lo
en a e ze sc e t e . er ca n
Jo ur na

m m
o s c gy .

The Cr i inall bec il e

Il
l d Clo h m us tr a te t re o,

T hi s i l ysis o f thr murd r c s s i which h B i t t sts

, ,

w r us d cc pt d i court d h ccus d d ju d d im b ci l s i
s an an a ee e a e , n t e ne e

h l l s s ( sci ti fic lly moro s ) T hr o f d f ctiv s

e e e , a e e n an t e a e a ge e e n

i l lustr t d i h thr c s R s p si b i l i y is d i scuss d T h b k

t e ega en e en a ,
n . ee ty es e e e ar e

is im p ort t to llp r ctitio rs i p sychi try stu d t o f f bl mi d

a e n t e ee as e . e on t e . e oo

d s ci l p ro bl ms d to crimi l l wy rs
an a a ne n a , en s ee e -
n
e d n e s s an o a e , an na a e .

T HE M A C M I LLAN CO M PAN Y
P bl i h 6 4—
6 6 Fif th A
u u s York
er s ven e N ew