HU 755 P76 A^ i§ ^B A^ — = ^ ^ 11 ^ 3 ^ ^9 = ^a 8 = CO ^^^H 1 — : ^ 2 ■— ^ ^^^1 8 — w^ 8 ^H Pollock Eugenics as a Factor in the Prevention of Mental Disease THE LIBRARY OF THE UNIVERSITY OF CALIFORNIA LOS ANGELES , » » » » • • 1 > > * % 1^.^ — — > — «^ >. ^ 4 •»• , :. ; :'•. •«. PJ. M ^ M J I I tj I ».. ,1 I I I 1 il l Eugenics as a Factor in the Pre- vention of Mental Disease ;•• It By HORATIO M. POLLOCK, Ph.D. Statistician, New York State Hospital Commission 01- LLERARi", fi5«S3 THE NATIONAL COMMITTEE FOR MENTAL HYGIENE, Inc. 370 Seventh Avenue New York City 1921 ••• V • « • • • • « • The National Committee for Mental Hygiene FoDNDED 1909 Incorpobated 1916 370 SEVENTH AVENUE, NEW YORK CITY President Executive Committee Db. Walter B. James De. William L. Russell, Chairmaa Vice-Presidents ^«- ^^^'^^ ^^^^ Charles W. Eliot Stephen P, Duqgan Db. Bernard Sachs !*»• Walter E. Fernald Dr. William H. Welch IMatthew C. Fleming Treasurer ^=- '^^^^^ ^' ^^^^^ Otto T. Bannabd Dr. George H. I^rby Committee on Mental Deficiency Committee on Education Db. Walter E. Fernald, Chairman Dr. C. Macfie Campbell, Chairman Edith M. Fubbush, Statistician Executive Officers Db, Thomas W. Salmon, Medical Director Db. Frankwood E. Williams, Associate Medical Director Dr. V. V. Anderson, Associate Medical Director Db. Clarence J. D 'Alton, Executive Assistant Clifford W, Beees, Secretary GENERAL PURPOSES The National Committee for Mental Hygiene and its affiliated state societies and committees are organized to work for the conservation of mental health; to help prevent nervous and mental disorders and mental defect ; to help raise the standards of care and treatment for those suffering from any of these disorders or mental defect; to secure and disseminate reliable information on these sub- jects and also on mental factors involved in problems related to industry, educa- tion, delinquency, dependency, and the like; to aid c^-service men disabled in the •war, to cooperate with federal, state, and local agencies and with officials and with public and private agencies whose work is in any way related to that of a society or committee for mental hygiene. Though methods vary, these or- ganizations seek to accomplish their purposes by means of education, encouraging psychiatric social service, conducting surveys, promoting legislation, and through cooperation with the many agencies whose work touches at one point or another the field of mental hygiene. When one considers the large groups of people who may be benefited by or- ganized work in mental hygiene, the importance of the movement at once becomes apparent. Such work is not only for the mentally disordered and those suffer- ing from mental defect, but for all those who, through mental causes, are unable so to adjust themselves to their environment as to live happy and efficient lives. [Reprinted from Mental Hygiene, Vol. V, No. 4, October, 1921, pp. 807-812.] EUGENICS AS A. FACTOR IN THE PRE- VENTION OF MENTAL DISEASE* HORATIO M. POLLOCK, Ph.D. N^\ Statistician, New York State Hospital Comviission \ ■^ nnHE burden of mental disease is each year becoming 1 -■- heavier. State hospitals for mental disease throughout ^ the country are overcrowded, and the construction of new hospitals does not keep pace with the increase of patients. Fairly complete censuses show that the number of patients with mental disease under treatment in institutions increased from 74,028 in 1890 to 232,680 in 1920. The rate per 100,000 of population increased from 118.2 to 220.1. Careful esti- '^ mates based on statistics of the New York State Hospital v>^ Commission indicate that approximately 1 out of 25 persons ^4vbecomes insane at some period of life. The economic loss to the United States on account of mental disease, including loss of earnings as well as maintenance of patients, is now over $200,000,000 per year. Although much of the apparent K increase in the prevalence of mental disease may ]je due to V causes that do not involve weakened resistance to the stresses of life, the load born by the public is clearly becoming more oppressive. Associated burdens are those of mental defect, epilepsy, . dependency, and delinquency. These combined cause an 1 economic loss even greater than that caused by mental dis- ^ ease. Taxpayers are groaning under excessive loads and calling in vain for relief, but their cries are faint compared with those of the persons whose relatives are mentally diseased or defective. As less than one-fourth of those who develop psychoses can be cured by present methods of treatment, we cannot hope for any permanent relief by treating patients in hos- pitals. The most skillful treatment should of course be given, * Read before the Section on Eugenics and the State of the Second International Eugenics Congress, New York City, September 26, 1921. 1 2 THE PREVENTION OF MENTAL DISEASE but the problem must be attacked in other ways before any adequate solution can be hoped for. The fact of inheritance of the neuropathic constitution may be taken for granted. Much evidence has been adduced to prove that such inheritance occurs in accordance with Mende- lian laws, but the subject is so complicated that more com- prehensive studies must be made before we may consider the matter as settled. The application of skillfully devised measures of intelligence has shown us that there are many grades of intelligence between the idiot and the super-aver- age. The so-called normals represent many types, the ex- tremes of which are as far apart as the moron is from the low-grade normal. Recent studies of temperamental abnorm- alities have also revealed a wide varietj^ of types and com- binations. These abnormalities or marked peculiarities seem to be more or less dissociated from intellectual capacity. Children with super-average intelligence are frequently seclusive and morons often seem to be temperamentally normal. It becomes difficult, therefore, to establish standards of normality and to draw fixed lines between the normal and the neuropathic. This is especially true in studying family histories, when judgment must be based on reports of un- trained observers. Mental disease may occur in a person of almost any type of intellectual or temperamental make-up. This fact was clearly demonstrated during the recent World War. Men of strong intellect and of exceptional poise who had withstood the strain of intense warfare for several months at last succumbed w^hen weakened by wounds and deprivation of food and drink. These were extreme cases, but they illustrate the important principle that all men have limitations and may develop a psychosis or expire when their limit is reached. Psychopathic personalities give way to the common stresses of life, while stronger personalities yield only to extraordinary mental strain. It is evident, therefore, that the whole etiology of a case of mental disease must be carefully studied before the related family stock can be safely discredited. The data we have collected in the New York State Hos- pital Commission relative to the family history of patients seem to indicate that slightly more than half of our ascer- THE PREVENTION OF MENTAL DISEASE 3 tained cases have no discoverable hereditary basis. If more thorough inquiries were made, the proportion of patients with unfavorable family history might be increased, but the significance of the history in relation to the family stock is open to question in many cases. In our hospitals for some years past, we have studied both the intellectual and temperamental make-up of the first ad- missions and have tried to apply uniform standards through- out the service. In 1920 it was found that of the ascertained cases 61 per cent were temperamentally normal and 88 per cent were rated as intellectually normal. Only about 7 per cent of the patients were both temperamentally and intellectu- ally abnormal. The proportion of patients mth abnormal make-up varied considerably in the different groups of psy- choses. For example, in the dementia-praecox group in 1920, 61 per cent were rated as temperamentally abnormal while in the manic-depressive group only 33 per cent were so rated. The absence of marked abnormalities in individuals prior to the onset of the psychosis cannot be construed as conclu- sive evidence that there are no hereditary defects in the make-up, neither can the development of the psychosis be taken as proof of a defective constitution. All the facts in connection with the onset of the mental disorder and previous reactions must be brought together before the constitutional make-up of the patient can be positively determined. Psychiatrists have recently emphasized the connection between bodily states and behavior and the importance of the sexual and endocrine organs in relation to the psychoses. What part of the disorders related to these organs is due to hereditary and what part to environmental factors have yet to be determined. Notwithstanding these and many other complications, there is abundant evidence that mental disorders occur much more frequently in some family stocks than in others, and that prolonged inbreeding of degenerate stocks is productive of most disastrous results. With the limited knowledge at hand, what is to be done to lessen the burdens imposed on society by the prevalence of mental disease! Three lines of action are suggested : 4 THE PREVENTION OF MENTAL DISEASE 1. Environmental stresses may be lessened and natural resistance strengthened. 2. Procreation of defective stock may be checked. 3. Procreation of normal stock may be increased. The methods now in use to prevent physical disease may be applied to a considerable extent in preventing mental disease. They include the dissemination of knowledge of hygiene and sanitation, prompt treatment of incipient diseases, segrega- tion of those suffering from contagious diseases, and im- munization of those liable to exposure to pathogenic germs. Another line of attack consists in safeguarding the public from injurious food and artificial beverages and from pol- luted air and water. The abolition of the liquor traffic and the movement to check the spread of syphilis are examples of effective work along these lines. Economic and social stresses should be lightened for those unable to withstand them. It is far easier to relieve an over- burdened man by taking part of his load than to wait until he is exhausted and then carry him together with his burden. Physicians, parents, and teachers should be alert to detect signs of mental disorder and apply the proper remedy before complete breakdown occurs. Mental clinics and social workers are of large service in giving treatment in incipient cases. Many a case of mental disease is averted by adjusting the environment to the indi- vidual and by giving him a clear understanding of his mental difficulties and the best methods of meeting them. Wide ex- tension of mental-clinic work is clearly indicated. The new science of mental hygiene is teaching us that indi- viduals with unfavorable heredity may do much to overcome their constitutional tendencies and to preserve their mental health. It is of the highest importance, therefore, that mental hygiene be taught and practiced in the public schools along with physical hygiene. A decade ago sterilization of defectives was widely advo- cated and laws making provision for it v/ere passed in several states. These measures have availed little because they have not been supported by active public sentiment. Judging frona the present outlook, we cannot hope that sterilization will soon be an effective means of preventing mental disease. THE PREVENTION OF MENTAL DISEASE 5 Segregation of the mentally defective and epileptic is the prevailing method of limiting procreation among these classes. Its eugenic value is beyond question, but the enor- mous cost limits its application. As a rule the mental de- fectives and epileptics cared for in institutions are of low- grade. These, if left at liberty, would multiply far less than those of higher grade. Much is to be hoped from the colony plan of segregating mental defectives, as colonies care for high-grade defectives and under wise management become self-supporting and may be increased ^\dthout limit. A new departure has been made by the state of New York in establishing a separate institution for defective delin- quents at Napanoch. This troublesome group has been a serious problem in the jails and prisons of the state, and heretofore there has been no satisfactory way of dealing with them. Their segregation should have large eugenic signifi- cance. Segregation of the insane is fairly complete, but as only about one-fourth of the first admissions are under thirty years of age on admission, its value in preventing procreation in this group is not as great as would appear when only the number of patients under treatment is considered. Over- crowding and the expense of maintenance cause patients to be promptly released on improvement of their mental condi- tion, regardless of the eugenic factors involved. Something can be done to lessen reproduction among the unfit by enlightened public sentiment and by better marriage laws. Marriage of persons with marked intellectual or tem- peramental abnormalities should be entirely prohibited. To prevent the marriage of normal persons with those carrying a neuropathic taint more knowledge of family stocks must be made available. At the present time genealogical records of the average family are woefully meager and com- paratively few are available for public inspection. If we are to improve the race by better marriages, genealogical or eugenic bureaus must be established in cities and villages. Data concerning family stocks should show the defects as well as the excellencies and achievements of the individuals recorded and be available to interested parties. Love is proverbially blind, but few normal persons would 6 THE PKEVENTION OF MENTAL DISEASE be rash enough knowingly to join fortunes with a neuro- pathic or degenerate family stock. Unfortunately very little thought is now given to the eugenic significance of marriage and few signs warn impetuous youth of the danger ahead. Eugenic bureaus, by collecting data concerning family his- tories and by emphasizing the importance of family stock, would naturally promote marriages among persons of good stock and thereby increase procreation of a desirable kind. The increase of good stock would raise the general level of the race, even if there were no decrease of poor stock, but we may safely assume that more definite knowledge would gradually lessen reproduction among the unfit. The elimination of mental defects and diseases is after all principally a matter of education. We must learn by careful research what should be done and what should not be done and then disseminate the information so that it will be shared by every household. Action will slowly follow knowl- edge, but ultimately a more perfect race will be evolved. 65883 xMENTAL HYGIENE QUARTERLY MAGAZINE OF THE NATIONAL COMMITTEE FOR MENTAL HYGIENE, INC. PcBLicATiox Office : Editoeial Office : 27 COLUMBIA STREET, ALBANY. N. Y. 370 SEVENTH AVENUE, NEW YORK CITY EDITORIAL BOARD Tbouas W. Salmon, M.D., Medical Director, The National Committee for Mental Hygiene Frankwood E. Williams, M.D., Associate Medical Director, The National Committee for Mental Hygiene Walteb E. Feenald, M.D., Superintendent, Massachusetts School for Feebleminded C. Macfie Campbell, Director; Boston Psychopathic Hospital Stephen P. Duggan, Ph.D., Professor of Education, College of the City of Neiv York Stewart Paton, M.D., Lecturer in Neuro-biology, Princeton University Vol. V, No, 4 INDEX October, 1921 The Significance of the Conditioned Reflex in Mental Hygiene William H. Burnham 673 The Elementary School and the Individual Child Esther Loring Richards 707 Extra-Medical Service in the Management of Misconduct Problems in Children Marion E. Kenworthy 724 Mental Hygiene and the College Student — Twenty Years After Anonymous 7o(» Mental Hygiene Problems of Normal Adolescence Jessie Taft 741 Suicide in Massachusetts Albert Warren Stearns 752 The Function of the Correctional Institution Herman M. Adlcr 778 What Is a "Nervous Breakdown" ? Alice E. Johnson 784 Mental Hygiene and the Public Library Mary Vida Clark 7P1 Inadequate Social Examinations in Psychopathic Clinics Dorothy Q. Hale 794 Eugenics as a Factor in the Prevention of Mental Disease Horatio M. Pollock 807 Mental Hygiene Problems of Maladjusted Children As Seen in a Public Clinic. . .A. L. Jacoby 813 Speech Defects In School Children Smiley Blanton 820 Extra-Institutional Care of Mental Defectives Earl W. Fuller 828 Abnormal Psychology Barrington Oates 836 Abstracts : The Problem of a Psychopathic Hospital Connected with a Reformatory Institution. By Edith R. Spaulding 837 A Psychological Study of Some Mental Defects In the Normal Dull Adolescent. By L. Pierce Clark 840 The Social Worker's Approach to the Family of the Syphilitic. By Maida H. Solomon .... 84;: Some Practical Points in the Organization of Treatment of Syphilis in a State Hospital. By Aaron J. RosanoflP 844 The Mental Clinic and the Community. By Everett S. Elwood 846 An Analysis of Suicidal Attempts. By Lawson G. Lowrey 846 Book Reviews : Psychopathology, By Edward J. Kempf Bernard Oluecl; 848 The Unconscious. By Morton Prince William A. White 84!> A General Introduction to Psychoanalysis. By Sigmund Freud Bernard Olueck 851 Sleepwalking and Moon Walking. B. J. Sadger O. Macfie Campbell 851 From the Unconscious to the Conscious. By Gustave Geley William A. White 855 Suggestion and Auto-Suggestion. By Charles Baudouin Bernard Olueck 856 Psychology and Psychotherapy. By William Brown C. Macfie Campbell 857 Our Social Heritage. By Graham Wallas Miriam C. Could 858 August Strindberg : A Psychoanalytic Study with Special Reference to the CEdipus Complex. By Axel Johan Uppvall Frankwood E. Williams 86J Notes and Comments 878 Current Bibliography Dorothy E. Morrison 891 Directory of Committees and Societies for Mental Hygiene 894 Members and Directors of the National Committee for Mental Hygiene 895 Mbktal Hygiene will aim to bring dependable information to everyone whose Interest or whose work brings him into contact with mental problems. Writers of authority will present original communications and reviews of important books ; noteworthy articles in periodicals out of convenient reach of the general public will be republished ; reports of surveys, special investigations, and new methods of prevention or treatment In the broad field of mental hygiene and psychopathology will ho presented and discussed In as non-technical a way as possible. It is our aim to make Mental Utoienh Indispensable to all thoughtful readers. Physicians, lawyers, educators, clergymen, public officials, and students of social problems will find the magazine of especial interest. The National Committee for Mental Hygiene does not necessarily endorse or assume responsi- bility for opinions expressed or statements made. Articles presented are printed upon the authority i)f their writers. The reviewing of a book does not Imply its recommendation by The National Committee for Mental Hygiene. Though all articles In this magazine are copyrighted, others may quote from them freely provided appropriate credit be given to Mental Hygiene. Subscription : Two dollars a year ; fifty cents a single copy. Publication Office : 27 COLUMBIA ST., ALBANY, N. Y. Correspondence should be addressed and checks made payable to "Mental Hygiene," 27 Columbia St., Albany, N. Y., or to The National Committee for Mental Hygiene, Inc., .170 Seventh Avenue, New York City. Copyright, 1918, by the National Committee for Mental Hygiene, Inc. 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