COLUMBIA LIBRARIES OFFSITE 
 
 HEALTH SCIENCES STANDARD 
 
 HX00033421 
 
 WHO IS INSANE? 
 
 ' '' I' 
 
 STEPHEN SMITH 
 
 
 
Columbia Winibtvs^it^ 
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 CoUese of l^^viitiansi anb ^urgeonst 
 
 3^ef erence Hibrarp 
 

WHO IS INSANE? 
 
WHO 
 IS INSANE? 
 
 BY 
 
 STEPHEN SMITH, A.M., M.D., LL.D. 
 
 COMMISSIONER IN LUNACY OF THE STATE OF NEW YOEK 
 
 1882 - 1888 
 
 Mew Wovli 
 
 THE MACMILLAN COMPANY 
 
 1916 
 
 All Rights Reserved 
 
Copyright, 1916 
 By STEPHEN SMITH 
 
 Set up and electrotyped. Published January, 1916 
 
'0 % Mtmnr^ tsf 
 
 
WHO IS INSANE? 
 
 FOREWORD 
 
 IN the year 1882 I was appointed the State 
 Commissioner in Lunacy of New York by 
 Gov. Alonzo B. Cornell. On assuming the 
 duties of the office the Governor informed me 
 there was a popular and growing belief that 
 many inmates of the Asylums for the Insane 
 were sane but have never had an opportunity 
 to relate their grievances except to officers who 
 gave little or no credence to the patients' state- 
 ments. Therefore, he advised me to keep con- 
 stantly in mind when visiting an Asylum the 
 question, "Who is Insane?" In carrying out his 
 instructions I became quite obsessed with these 
 three words and hence the title of this Book. 
 
 The insane of the State of New York, in cus- 
 tody, were at that time about 12,000 in number 
 and were confined in State Asylums, in County 
 Asylums, in Poor Houses and in private insti- 
 tutions. They were found in every condition 
 hitherto known in the history of this unfor- 
 tunate class from that of the pauper of the 
 County Alms House, in filthy cells and stalls, 
 shackled hands and feet, and fed like swine, 
 to the kindly care, good food, clean, sanitary 
 dormitories and freedom from cruel forms of 
 restraint, of those in the palatial State Asylums. 
 
8 WHO IS mSANE? 
 
 The most important reforms effected by my 
 service were: 1. The introduction of the 
 Training School for Attendants; 2. The crea- 
 tion of a State Commission in Lunacy; 3. The 
 removal of the insane from County to State 
 care. The Training School raised the grade of 
 qualification of attendants and has become a 
 permanent feature of State institutions for the 
 insane. The Commission in Lunacy has so re- 
 organized the service of the former State Insti- 
 tutions for the Insane as to change them from 
 Custodial "Asylums" to Curative "State Hos- 
 pitals." The "State Care Act" permanently re- 
 moved the insane from the beastly quarters and 
 care of the "Poor-Houses" to the humane treat- 
 ment of the State. 
 
 These three reforms have raised the standard 
 of care and treatment of the insane in the State 
 of New York to the highest grade yet attained. 
 Nor is this reform limited to the "State Hospi- 
 tals" of this State, but fortunately, their exam- 
 ple is being copied so widely as to give the 
 assurance that the time is not distant when the 
 institutions for the insane in this country will 
 take the first rank. 
 
 This Book is a commentary on my experi- 
 ences as an official visitor of the Institutions 
 for the Insane and the Charities and Reforma- 
 tories of the State. Its intent and purpose are 
 to illustrate with as few technicalities as possible 
 the illusive nature of insanity, its origin in the 
 
WHO IS INSANE / 
 
 derangement of the functions of the brain-cells, 
 the extreme impressibility of these cells and our 
 power to increase or repress their activities. In 
 these facts, which modern science has devel- 
 oped, are found the scientific principles on 
 which the prevention of insanity, and its suc- 
 cessful treatment, must be based. The same 
 principles are shown to be applicable to the 
 education of the mentally defective classes and 
 to the reform of criminals. 
 
 This Book should prove helpful in the preven- 
 tion of insanity at the different periods of life 
 and hopeful of the time when biology shall be 
 able to completely unfold the mysterious mech- 
 anism of the brain, physiology to explain the 
 function of every nerve centre and psychology 
 to interpret the significance of all mental phe- 
 nomena. The Author. 
 
 January, 1916, 
 
CONTENTS 
 
 PART ONE 
 
 Who is Insane and What is Insanity? 
 
 Chapter Page 
 
 I. Who is Insane? 17 
 
 11. Is There Any Sure Sign of Insanity? 31 
 
 III. The Diagnosis of Insanity at Sight. . 41 
 
 IV. What is Insanity? 59 
 
 y. How We Become Insane 71 
 
 PART TWO 
 
 Critical Periods of Life Predisposing 
 TO Insanity 
 
 VI. Childhood 95 
 
 VII. Adolescence 107 
 
 yill. Mid-Life 119 
 
 IX. Climacter 127 
 
 X. Old Age 137 
 
CONTENTS— Continued 
 
 Chapter Page 
 
 XL The Prevention of Insanity 147 
 
 XII. The Susceptibility of the Insane to 
 
 Curative Measures 153 
 
 PART THREE 
 
 Care and Treatment of the Insane 
 
 XIII. Mechanical Restraint 171 
 
 XIV. Custodial Care 177 
 
 XV. Curative Treatment 183 
 
 XVI. Cure the Curable 193 
 
 XVII. Use the Usable 199 
 
 XVIII. Voices from the Asylums 209 
 
 XIX. State Care of the Insane 219 
 
CONTENTS— Continued 
 
 PART FOUR 
 
 The Lesson Applied to the Feeble-Minded 
 AND Criminal 
 
 Chapter Page 
 
 XX. Extend Curative Methods to all the 
 
 Dependent Classes 233 
 
 XXL Teach the Idiot and Feeble-Minded 
 
 Self-Care and Self-Support 239 
 
 XXIL The Treatment of the Criminal. ... 249 
 
 PART FIVE 
 
 A New Institution — The Dawn of a 
 Better Day 
 
 XXIIL A New Institution 271 
 
 XXIV. Eugenics 283 
 
PART ONE 
 Who Is Insane and What Is Insanity? 
 
I 
 
 Who Is Insane? 
 
Who Is Insane? 
 
 HO is insane? No one, or every 
 one, according to the persons 
 questioned. No one in an asy- 
 lum will admit that he or she is 
 insane. Each in turn would re- 
 sent such an insinuation. Cer- 
 tainly no one out of an asylum 
 will assent to the charge of being insane. And 
 yet the sane and insane readily rec- 
 No One or ognize the insanity of others. An 
 Every One intelligent old lady, once the head 
 of a Ladies' Seminary, wished to be 
 discharged from an asylum alleging that all the 
 patients in the Hall believed her sane. 
 Seven women were privately asked their 
 opinion as to her sanity, and all declared 
 she was very insane, while asserting their own 
 sanity. When informed of the result of the test, 
 the old lady accurately described the special pe- 
 culiarities of each of her accusers, but could not 
 realize her own condition. 
 
 So it is in every community. The private gos- 
 
 17 
 
18 WHO IS INSANE? 
 
 sip is much concerned about those who are 
 called "strange," "peculiar," "deranged," "un- 
 balanced," "light-headed," "a-little-off," "out-of 
 gear," "wrong-in-the-upper-story," "cranks." 
 Few, if any, escape for a life-time one or the 
 other of these epithets. Without, as within the 
 asylum, no one recognizes his or her own mental 
 deviations, but readily detects the aberrations of 
 others. It is an apt illustration of the old pre- 
 cept, "Let me pull out the mote out of thine eye, 
 — and, behold, a beam is in thine own eye." 
 
 N the world at large, every advanced thinker, 
 
 enthusiastic reformer and popular teacher is 
 
 almost certain to be classed with the insane. 
 
 The friends of the Master said: "He is beside 
 
 himself"; St. Paul was declared "mad" by the 
 
 highest judicial tribunal; 
 Advanced Thinkers Luther was charged with 
 Classed as Insane hallucinations; Napoleon 
 
 had his guiding star; Byron 
 was "erratic"; Wilberforce and Garrison were 
 "fanatics." "Genius is a neurosis," says a French 
 authority, and Dryden wrote, "Great wits are 
 sure to madness near allied." 
 
 "The popular judgment of the insane is largely 
 based on unjust prejudices," said an eminent 
 alienist. It is true, whatever may be the expla- 
 nation, that we have an instinctive dread of the 
 insane, and shrink from contact or association 
 
WHO IS INSANE? 19 
 
 with them. The sudden discovery that our com- 
 panion, with whom we may have had an agreea- 
 ble and profitable conversation, has an illusion, 
 delusion or hallucination, however harmless, 
 gives us at once an undefinable sense of discom- 
 fort, or, perhaps, of insecurity. We wish to es- 
 cape his presence. His sane and sensible opinions 
 on all current topics weigh nothing in our esti- 
 mation. Failing in one particular mental func- 
 tion, we cannot believe that his judgment is re- 
 liable on any subject. 
 
 WHILE this feeling on our part is appar- 
 ently instinctive because so universal, 
 yet with many it has been intensified in child- 
 hood by that terror of the neighborhood, a 
 crazy man or woman, whom the friends per- 
 sist in retaining at home, confined in a garret 
 
 or other out-of-the-way 
 Popular Pre judice place. "Run, boys, old Je- 
 Against the Insane rusha is coming," was the 
 
 frequent signal of alarm in 
 our boyhood days when one of our number saw 
 the truly frightful figure of a woman, roaming 
 in the fields, her outer dress thrown over her 
 head, and a butcher's knife thrust under a belt 
 about her waist. She proved to be a "terror by 
 night" to all of the children of that vicinity dur- 
 ing their lives, for she appeared ever after in 
 all of their disturbed dreams. 
 
20 WHO IS INSANE? 
 
 Many have their fear and dread of the in- 
 sane intensified by the occasional horrible 
 crimes which they commit. Without reason 
 we are disposed to accept the one act of a sin- 
 gle person as characteristic of the reliability 
 of ten thousand of that class. 
 
 When, however, we are brought into more 
 familiar contact with the insane, and become 
 interested in their special peculiarities of 
 thought and action, a strange fascination may 
 take the place of fear, giving rise to an intense 
 desire to analyze and interpret their mental op- 
 erations. Even "Old Jerusha" ceased to be a 
 terror when we became more familiar with her 
 history. 
 
 Personally, I came to be greatly interested 
 in her visits to our home, though these visits 
 were often made at midnight. She was very 
 fond of my mother, and her tap on the door 
 with the handle of her knife awakened me to a 
 sense of security, rather than fear. Mother al- 
 ways cheerfully responded to her knock, in- 
 vited her to come in, prepared a cup of tea, and, 
 together, they discussed current neighborhood 
 events. It was only when the course of their 
 conversation brought to her thoughts her be- 
 trayer that Jerusha showed any considerable 
 mental disturbance. At the thought of him, 
 she would seize her knife, and, brandishing it 
 over her head, excitedly exclaim: "If I ever 
 
WHO IS INSANE? 21 
 
 meet him I'll bathe this blade in his heart's 
 blood!" A touch of my mother's finger upon 
 her arm, and a deprecating glance at the bed- 
 room of the children, brought a humble apol- 
 ogy and an immediate return of the knife to her 
 belt. 
 
 WHEN, instead of observing the life of a sin- 
 gle insane person, our duties lead us to 
 study them isolated in a community, as 
 they are found in asylums, a new and altogether 
 different impression is made upon 
 The Insane us, which not only supplants all 
 in Asylums fear or dread of contact with them, 
 but gives every phase of their lives 
 an interest of marvelous intensity. We seem to 
 be among a people so like ourselves in many re- 
 spects, and so unlike in others, that at first we 
 experience a degree of mental confusion quite 
 disturbing. 
 
 If the visitor to an asylum is an official, who 
 is required to converse with every one who de- 
 sires to speak with him, apart from officers and 
 attendants, the impression that is made upon 
 his mind becomes so pronounced that he can- 
 not possibly escape the conviction that there can 
 be no hard and fast lines drawn between large 
 numbers of the sane and insane. He discovers 
 that he is in a community of people quite as full 
 of mental activities as the one he left in the out- 
 
22 WHO IS INSANE? 
 
 side world. Here he finds the same passions, 
 emotions, conceptions and themes of conversa- 
 tion that occupy the people of the town. One 
 is loitering along the hall like a man of leisure, 
 another walks rapidly with knitted brow as if 
 intent on business, a third is reserved or even 
 morose, as if laboring under a disappointment, 
 a fourth is talkative and mirthful, and laughs 
 at every unusual event. Evidently each one 
 has a special subject of interest to him or her 
 alone, which occupies the thoughts to the ex- 
 clusion of everything else. On this one topic the 
 individual speaks freely and earnestly, and, 
 whether correctly or incorrectly, certainly with 
 entire candor. 
 
 My impression of the insane in asylums was, 
 therefore, that they form a community not very 
 unlike the ordinary village. There are in each 
 the quiet, sober, thoughtful; the active, restless, 
 excitable; the queer, peculiar, nondescript. 
 
 THE mental impression which a stranger to 
 the insane experiences, after a day spent in 
 constant conversation with the inmates of an 
 asylum as he meets them under varying condi- 
 tions, is peculiarly confusing. For my own part 
 
 I could not divest myself of 
 
 Every One the impulse to regard and 
 
 Seemed Insane treat every one whom I met 
 
 in the outside world as in- 
 sane. Whether walking along the public street. 
 
WHO IS INSANE? 23 
 
 or entering a passing car, or stopping at a hotel, 
 I could not escape the conviction that I was still 
 among the insane. Involuntarily, I endeavored 
 to determine from what form of insanity every- 
 one with whom I conversed was suffering. 
 
 The more rational they appeared to be, the 
 more closely I questioned them, in the constant 
 expectation of discovering the carefully con- 
 cealed clue to their mental delinquencies. As 
 never before, though quite unconsciously at 
 the moment, I studied the peculiarities of each 
 stranger and strove to detect in his or her feat- 
 ures, dress, manner or acts, the latent evidences 
 of an unsound mind. And it is true, I met 
 many persons in the outside world, active in its 
 affairs, who, on careful scrutiny, exhibited 
 mental aberrations quite as distinct as did many 
 of the inmates of the asylum. Especially was 
 this true of perversions of the senses, as of see- 
 ing, hearing, smelling, tasting, touching. While 
 in large numbers of cases the evidences of men- 
 tal disturbance were readily recognized, in other 
 cases the most careful and painstaking inquiry 
 elicited no positive proof of a deranged mind. 
 
 BUT though I had become so inquisitive as to 
 the insanity of others, I was altogether un- 
 prepared for the discovery that I was about 
 to have my own sanity tested by an inmate of an 
 
24 WHO IS INSANE? 
 
 asylum. "Who is insane, you or I?" was the 
 
 startHng question put to me 
 Who Is Insane, as I walked along the Hall, 
 You or I? pencil and paper in hand. I 
 
 was intently studying the pe- 
 culiarities of others to determine the special 
 features of their mental aberrations, but 
 it had not occurred to me that, from the view- 
 point of the inmates of an asylum, I might my- 
 self be a "suspect." I was not surprised at the 
 first part of the question, "Who is Insane?" for 
 that was constantly uppermost in my own mind. 
 It was the entirely unexpected application of the 
 inquiry to myself that created momentary men- 
 tal confusion. 
 
 My querist was a young lady who had been 
 a prominent teacher in a seminary for young 
 ladies. Her mobile features, quick movements, 
 excited manner and rapid speech indicated a 
 highly organized nervous system. The mincing 
 manner of her approach, the sarcastic smile and 
 the attitude of expectancy which she assumed, 
 her head being poised on the tip of her finger 
 resting on her cheek, showed that she antici- 
 pated the embarrassment which her question 
 might create. Other patients, who heard the 
 question, quickly gathered about us, all evi- 
 dently intent on hearing my answer. 
 
 At a loss for an explanation which would not 
 offend so sensitive an audience, I hesitated a 
 
WHO IS INSANE? 25 
 
 moment, and then replied: "Why you, of 
 course, are insane." She slowly and thought- 
 fully repeated my words, and added in the same 
 strain, "You, of course! Why, *of course?' Do 
 you see insanity in my features?" Taking a 
 small mirror from a stand, she moved it before 
 her face, saying: "Will you be so kind as to 
 teach me how to examine a person's face and 
 discover what may be his mental condition?" 
 She placed herself in different attitudes, hold- 
 ing the mirror in different positions, and mak- 
 ing ludricous grimances, greatly to the amuse- 
 ment of the by-standers. She continued: "If 
 you will teach me your occult art, I should be 
 delighted to be able to say to anyone I meet: 
 'Why, of course, you are insane.' If I become as 
 expert as you think you are, and had your assur- 
 ance, I might even say to you, 'Why, you, of 
 course, are insane.' " 
 
 The interview was becoming decidedly per- 
 sonal, and the patients gathered around us 
 were excited by the shrewd turn of her remarks, 
 and boisterously applauded the points which 
 she made against me. I attempted to bring the 
 colloquy to a close, but she spoke so rapidly that 
 I could not interrupt her, until I turned away, 
 when she apologized for what she said I might 
 regard as rudeness, but which she felt was the 
 proper improvement of a rare opportunity to 
 express her opinions. 
 
26 WHO IS INSANE? 
 
 "You altogether mistook the meaning of my 
 reply to your question," I said, with as much 
 composure as I could command. "I did not and 
 could not decide as to your sanity or 
 insanity by any peculiarity of your feat- 
 ures, nor for anything noticeable in your 
 personal appearance, for, in these re- 
 spects, I see no difference between you 
 and many whom I meet in the streets. It oc- 
 curred to me, at the moment, that I should make 
 no mistake in my answer if I said 'You, of 
 course, are insane,' for this reason, the law pro- 
 vides that only insane persons shall be confined 
 in asylums for the insane, while the sane are 
 rigidly excluded. Now, as between you and 
 me, you are legally confined in this asylum, and 
 I am legally excluded; therefore, when you 
 called upon me for a decision as to 'Who is in- 
 sane, you or I,' I could promptly and truthfully 
 say, 'Why you, of course, are insane.' " 
 
 "Ah, I see how you work the problem," she 
 said. "In an asylum, insane; out of an asylum, 
 sane; it's the same old story of the ins and outs, 
 with this difference, that the ins are anxious to 
 get out and the outs are anxious not to get in." 
 
 Assuming a defiant attitude, she sneeringly 
 said: "This whole business of locking people 
 in these prisons for life, because some fool of a 
 doctor says they are insane, is a contemptible 
 and transparent fraud. You admit that if you 
 
WHO IS INSANE? 27 
 
 had met me in the street, or in the cars, or in a 
 hotel, you would have declared me sane, but 
 happening to meet me in this asylum you 
 promptly and audaciously pronounce me in- 
 sane. On what a slender thread hangs our des- 
 tiny!" 
 
 With a graceful wave of her hand and a low 
 bow she withdrew to her room, leaving me to 
 my reflections. 
 
 She had propounded one of the most pro- 
 found questions known to science and had made 
 a declaration of immense social significance. 
 "Who is insane, you or I?" is a question which 
 confronts us whenever we look into the eyes of 
 our fellows. And, truly, on what a slender 
 thread hangs our destiny, when we may be com- 
 mitted to an asylum for a lifetime because we 
 differ in thought, word or action from another, 
 whose mental integrity has never been gauged 
 by any absolutely correct standard ! 
 
II. 
 
 Is There Any Sure Sign of Insanity? 
 
II 
 
 Is There Any Sure Sign of Insanity? 
 
 STUDENT of the famous alien- 
 ist, Esquirol, inquired of him, 
 "Is there any sure sign by which 
 the insane can be distin- 
 guished?" He replied, "Please 
 dine with me to-morrow at six 
 o'clock." The student complied. 
 Two other guests were present, one of whom 
 was elegantly dressed and apparently highly ed- 
 ucated, while the other 
 Apparent Insanity was rather uncouth, noisy 
 of Balzac and extremely conceited. 
 
 After dinner the pupil rose 
 to take leave, and as he shook hands with his 
 teacher he remarked: "The problem is very 
 simple after all; the quiet, well dressed gentle- 
 man is certainly distinguished in some line, 
 but the other is as certainly a lunatic and 
 ought at once to be locked up." "You are 
 wrong, my friend," replied Esquirol with a 
 smile. "That quiet, well dressed man who 
 talks so rationally has for years labored under 
 
 31 
 
32 WHO IS INSANE? 
 
 the delusion that he is God, the Father; where- 
 as the otlier man, whose exuberance and self- 
 conceit have surprised you, is M. Honore de Bal- 
 zac, the greatest French writer of the day." 
 
 A MORE remarkable misadventure, recorded 
 on the authority of the distinguished 
 writer, Aurelien Scholl, befell not a student 
 but a shining light of medical science, Le- 
 grand du Saule, one of the acknowledged au- 
 thorities on mental diseases in 
 The Case of Paris. A well-known man of let- 
 
 Renan ters, feeling uneasy about a 
 
 daughter who showed some signs 
 of eccentricity, was anxious to get the 
 opinion of this specialist without arousing 
 her suspicions. For this purpose he concluded 
 to give a dinner to which de Saule and several 
 other celebrities were invited. It was a feast of 
 reason and the flow of soul was full and free. 
 Legrand du Saule took little part in the conver- 
 sation, but listened attentively and used his 
 highly trained powers of observation. 
 
 Toward the end of the dinner he leaned to- 
 ward his host and whispered : "You may make 
 your mind easy about your daughter. She is 
 suffering from nothing more serious than a tri- 
 fling nervousness which will pass off. But I 
 think it right to tell you that there is one of your 
 guests whose mental condition is distinctly 
 
WHO IS INSANE? 33 
 
 alarming, and, I fear, hopeless." Being asked 
 who this was, the oracle said : "That stout gen- 
 tleman yonder, with the look of a canon, who is 
 laughing so heartily." The man who was thus 
 enjoying himself, all unconscious of the doom 
 pronounced upon him, was Ernest Renan. 
 
 LORD Erskine, who as Lord High Chancellor 
 of England, had supervision of the insane, 
 received several letters from an inmate of 
 an asylum, alleging false commitment. The let- 
 ters were so well written that the Chancellor 
 requested the superintendent of 
 Insane on the asylum to bring this patient 
 One Subject to him for his personal exami- 
 nation. The patient proved to 
 be a very gentlemanly person, and in conversa- 
 tion on a great variety of subjects showed unu- 
 sual intelligence. Turning to the superintend- 
 ent, the Chancellor expressed his surprise at the 
 detention of a gentleman whose mind was so 
 well balanced and so free from delusions. The 
 superintendent requested the Chancellor to ask 
 his visitor, "Who is the King of England?" On 
 putting this question, the conduct and attitude 
 of the man suddenly changed, and, rising and 
 assuming a proud air, he placed his hand over 
 his heart, saying: "I am the King of England, 
 and you are my Lord Chancellor." 
 
 I conversed with a man who spoke readily 
 
34 WHO IS INSANE? 
 
 and very intelligently on a variety of subjects. 
 I could detect no defect in his views on what- 
 ever topic we discussed. Noticing that in the 
 intervals of our conversation he looked at a 
 tree-top and smiled, I asked him if he saw any- 
 thing in the tree. "Why, certainly," he replied, 
 "don't you see the two women in the tree, one 
 above the other, and both smiling at us?" I 
 confessed my inability to see them, though at 
 his suggestion I took different positions. He 
 ceased to converse, but in sotto voce declared 
 "everybody is in the conspiracy." 
 
 A SUPERINTENDENT requested me to ex- 
 amine a certain patient and inform him 
 as to the man's sanity. I spent an hour or 
 more in conversation with him and we discussed 
 a great variety of subjects. He was very intelli- 
 gent, humorous and inquisitive. 
 The Effect and I could discover no sign of 
 of a Word mental confusion or disturbance. 
 On reporting the fact to the super- 
 intendent he suggested that while conversing 
 with him I should incidentally say, "Telephone." 
 On the following day, while passing through the 
 hall in which this patient was confined, he came 
 to me and we again entered into conversation, 
 the topic which most interested him being cur- 
 rent political events. In an interval I spoke the 
 word, "Telephone," at which he became excited 
 
WHO IS INSANE? 35 
 
 and declared that I was one of the conspirators. 
 On inquiry I learned that he never showed any 
 signs of mental disturbance except when that 
 word was spoken in his hearing. He had been 
 employed in an establishment in the constant 
 use of a telephone, then a new and novel instru- 
 ment. 
 
 On visiting a county asylum one hot summer 
 day, I found a very efficient man in charge. 
 The patients were all in the field and he was 
 alone. The little isolated asylum building for 
 the insane was in excellent condition in every 
 part and I spent some time with the attendant 
 conversing on matters relating to inmates and 
 the management of the almshouse, about which 
 he was very well informed. 
 
 On finishing my inspection he invited me to 
 his room, and on entering he locked the door 
 and put the key in his pocket. To my inquiry 
 as to his training for his present position, which 
 he seemed to fill so acceptably, he replied, with 
 marked emphasis, that God was his only in- 
 structor; that he was in immediate communi- 
 cation with Him and never took any advice 
 from man or woman, but always followed His 
 instructions. I asked if God should instruct 
 him to punish one of the inmates would he do 
 so without consulting the superintendent. "Cer- 
 tainly," he replied, and raising the cover of his 
 desk he showed me a whip, a sharp pointed 
 knife and a pistol. 
 
36 WHO IS INSANE? 
 
 Looking at my watch, I arose, expressed my 
 surprise that it was so near train-time and 
 mioved towards the door, complimenting him 
 meantime effusively on his devotion to his du- 
 ties and his reliance on God. I was immensely 
 relieved when he took the key from his pocket, 
 opened the door and gave me free access to the 
 outer world. For years this man continued to 
 do excellent work as an attendant, and it was 
 only when allusion was made to this one mat- 
 ter of his source of instruction that he showed 
 any symptom of insanity. 
 
 THE preceding illustrations seem to prove 
 that there is no sure sign by which the in- 
 sane can readily be detected. While the 
 grosser forms of insanity are easily diagnosed, 
 there are vast numbers of cases that require the 
 most careful and prolonged ob- 
 No Sure Sign servation to determine the spe- 
 of Insanity cial phase of aberration. In some 
 cases only allusion to a certain 
 thing, subject, or person will cause the insane 
 to reveal their illusions, delusions, or hallucina- 
 tions. 
 
 The explanation of the apparent anomaly, 
 that there is no sure sign of insanity, is found in 
 the following facts : — The brain being a compli- 
 cated mechanism, as will be shown in a subse- 
 quent chapter, any one of the innumerable 
 
WHO IS mSANE? 37 
 
 parts may become deranged in its action. The 
 effect of such derangement may be Hmited to 
 a change in the function of that part chiefly, or 
 it may involve a change in the action of many 
 parts closely allied in physiological activities. 
 
 It follows, as in any mechanism, that the evi- 
 dences of mental derangement will be more or 
 less obscure or pronounced according to the 
 functional relations of the part in which the dis- 
 turbance began. We may derange the striking 
 apparatus of a clock without affecting it as a 
 correct time-piece; but if we change the action 
 of the pendulum, we can no longer rely upon the 
 clock as a measurer of time. So, in the action 
 of the brain (though in a much larger sense own- 
 ing to the enormous number and intricate con- 
 nection of its parts), the speaking of a certain 
 word may be the only method of eliciting the 
 derangement. The entire mental operations 
 may be deranged by the entrance of a poison 
 into the blood, which would affect large sec- 
 tions of the brain. 
 
Ill 
 
 The Diagnosis of Insanity at Sight 
 
Ill 
 
 The Diagnosis of Insanity at Sight 
 
 REMARKABLE exception to the 
 preceding proofs of the diffi- 
 culty of diagnosis of insanity 
 occurred in my personal expe- 
 rience and is worthy of record 
 in this connection. That an in- 
 sane person may be recognized 
 at sight by an expert was demonstrated in the 
 famous trial of William Freeman, the murderer. 
 I happened to be a witness of the 
 A Dramatic incident, which was highly dra- 
 Episode matic in all of its details. In an 
 instant and without warning the 
 large gathering of excited spectators, all intent 
 on the question at issue, the insanity of the pris- 
 oner, found the issue shifted to itself by the de- 
 mand of the prosecution that the learned expert 
 witness on the stand should point out an insane 
 person in the audience. The trial was at Au- 
 burn, New York, and it happened that I at- 
 tended the court at that critical period. 
 
 "What ! Do you affirm that you can diagnose 
 insanity at sight?" 
 
 41 
 
42 WHO IS INSANE? 
 
 "I do," was the calm, dignified, but emphatic 
 response. 
 
 THIS question was put by John Van Buren, 
 Esq., at that time Attorney-General of the 
 
 State of New York, and was answered by 
 
 Dr. Amariah Brigham, Superintendent of the 
 
 Utica Asylum for the Insane. The incident was 
 
 remarkable for the intense pop- 
 
 The Freeman ular interest in the results of the 
 
 Case trial, the scientific questions in- 
 
 volved, and the eminence of the 
 now historical personages engaged in its man- 
 agement. This occasion was the trial of Wil- 
 liam Freeman, a negro, for the murder of the 
 Van Ness family in the vicinity of Auburn, Cay- 
 uga county. New York, on the night of the 12th 
 of March, 1846. The frightful tragedy was thus 
 described in a local paper: 
 
 "William Freeman, a negro, a native of Au- 
 burn, who has recently been discharged after 
 five years' confinement in the States Prison, 
 having provided himself with weapons, proceed- 
 ed to the house of John G. Van Ness, in the sub- 
 urbs of Auburn, and there, without notice and 
 without any apparent motive, slew Mr. Van 
 Ness, a wealthy and worthy citizen, Mrs. Van 
 Ness, her sleeping infant, and her aged mother, 
 and wounded mortally, it is believed, the labor- 
 ing man who dwelt with them, leaving only the 
 
WHO IS INSANE? 43 
 
 maid servant of the family, and she had only 
 been spared because he had been disabled in 
 the affray." 
 
 The murderer was arrested and confessed the 
 perpetration of the crime, but showed no signs 
 of regret; on the contrary, he freely described 
 the incidents of the murder, and laughed con- 
 tinually during the recital. The incensed and 
 excited public saw in his strange acts and unac- 
 countable conduct, together with the entire ab- 
 sence of motive for the crime, grounds for the 
 belief that he might escape punishment on the 
 plea of some wily lawyer that the prisoner was 
 insane. Crowds of excited people gathered 
 about the jail determined to seize the prisoner 
 and lynch him, but the sheriff adopted such 
 precautions that no serious effort was made at 
 a rescue. But popular feeling now took another 
 form. It was determined to resist to the last 
 any effort that might be made to secure the es- 
 cape of the criminal under cover of alleged in- 
 sanity. The greatest vigilance was maintained 
 over every movement in the legal proceedings 
 in order to prevent that issue. What made the 
 apprehension that this question would be raised 
 more decisive was the circumstance that only a 
 month previously a murderer had escaped the 
 lawful punishment of his crime through the 
 plea of insanity interposed by his counsel, Wil- 
 liam H, Seward, Esq. Tljere was, indeed, a 
 
44 WHO IS INSANE? 
 
 wide-spread belief that the criminal in the Van 
 Ness tragedy was emboldened to perpetrate 
 murder owing to the results of the recent trial. 
 The excitement of the public was in some meas- 
 ure allayed by the remark of a prominent Judge 
 that the prisoner would not escape conviction 
 by any plea or defense of Seward. 
 
 BUT the Judge and the people were destined 
 to be disappointed. Freeman was indicted 
 and in due time brought into court for ar- 
 raignment. The court-house was densely packed 
 by an eager and excited crowd of citizens. The 
 District Attorney arraigned the 
 Freeman's prisoner on the several counts of 
 Condition the indictment. Freeman's appear- 
 ance was said to be that of a man 
 "deaf, stupid, unable to talk connectedly or to 
 any sensible purpose; had an idiotic laugh upon 
 his face, and, apparently, was ignorant of, or in- 
 different to, his own situation." To the question, 
 "Have you any counsel?" the prisoner replied, 
 "I do not know." To the further question, "Who 
 are your counsel?" he replied, "I don't 
 know." These questions led up to the 
 tragic feature of these proceedings. The Judge 
 asked the usual question, "Will any one defend 
 this man?" A death-like hush fell upon the au- 
 dience. The report states that "The spectators 
 looked at each other in breathless silence, bro- 
 
WHO IS INSANE? 45 
 
 ken only when Mr. Seward, pale with emotion, 
 but with inflexible determination in every feat- 
 ure, arose and said, "May it please the Court, I 
 shall remain counsel for the prisoner until his 
 death." It is added, "A murmur of indignation 
 ran around the court-room at this continued 
 defiance, as it was regarded, both of public 
 opinion and of public justice." 
 
 At that period the anti-slavery agitation had 
 reached a degree of development which con- 
 verted the prejudices of the great mass of the 
 people against the negro into an uncontrollable 
 frenzy when he committed crimes. Scarcely 
 less bitter was the public feeling against the few 
 anti-slavery sympathizers in the community 
 who, though equally shocked by the murder, de- 
 sired to have a fair trial given the criminal. 
 But nothing could have occurred which tended 
 to arouse greater popular indignation than the 
 announcement that the negro was to have as his 
 legal adviser and protector one who, under the 
 specious plea of insanity, had recently secured 
 the disagreement of the jury in a trial for mur- 
 der. And it is certain that no man of less dis- 
 tinction than Mr. Seward would or could have 
 had the courage to assume, voluntarily, the po- 
 sition of counsel for this self-confessed negro 
 murderer. One prominent local attorney who 
 was impressed with the conviction that the pris- 
 oner was insane or an imbecile, and that he 
 
46 WHO IS INSANE? 
 
 might not receive fair treatment owing to the 
 popular excitement, and had volunteered to de- 
 fend him, publicly withdrew from the case 
 rather than face the storm of indignation which 
 awaited the counsel of the murderer. It was 
 the abandonment of the case by this lawyer that 
 led Mr. Seward, in volunteering to defend Free- 
 man, to add, "I shall remain counsel for the 
 prisoner until his death." 
 
 MR. SEWARD occupied at that time a 
 unique position in the political history of 
 the State of New York. He had already 
 been Governor of the State for two terms, and 
 took rank among those advanced leaders of the 
 Whig party who entertained and 
 Mr. Seward*s occasionally gave utterance to 
 Position strong anti-slavery sentiments. 
 No man of less note and courage 
 would have dared to appear as counsel for the 
 prisoner, and even he was denounced by the 
 press and pulpit in unmeasured terms, and the 
 most dishonorable motives were attributed to 
 him in explanation of his conduct. Even the 
 clergyman who conducted the funeral services 
 of the murdered family had inflamed the public 
 mind by appealing to instincts of self-preserva- 
 tion against any indulgence of moderation or 
 forbearance toward "adroit counsel" in the ef- 
 forts to lower the standard of accountability for 
 crime by the plea of insanity. 
 
WHO IS INSANE? 47 
 
 It appears from the record that Mr. Seward 
 did not undertake the defense of Freeman from 
 mere sentiment, but that he thoroughly studied 
 the case and became convinced that the pris- 
 oner was hopelessly demented. He personally 
 visited him in his cell and endeavored to con- 
 verse with him, but found him hardly more 
 than idiotic. He invited friends to visit the pris- 
 oner and study the case; their reports confirmed 
 his experience. He also engaged the services of 
 expert physicians, all of whom agreed that 
 Freeman was suffering from dementia due to a 
 severe injury to the head received several years 
 before, and his delusion was that he had been 
 wrongfully confined in prison, and that he 
 would seek revenge on some one. 
 
 The District Attorney of Cayuga county, im- 
 pressed with the gravity of the situation and the 
 favorable character which Mr. Seward might 
 give to the defense, summoned to his aid the 
 Attorney-General of the State, John Van Buren, 
 Esq., son of ex-President Martin Van Buren, 
 then at the height of his professional and polit- 
 ical fame. He was regarded as an excellent an- 
 tagonist of Mr. Seward. The appearance of 
 these famous men in court gave additional in- 
 terest to the trial. The court-room was con- 
 stantly crowded and the town was filled vdth 
 strangers interested in the case. 
 
 The theory of the defense was insanity, and 
 
48 WHO IS INSANE? 
 
 among the eminent alienists summoned as ex- 
 pert witnesses was Dr. Amariah Brigham. He 
 was Superintendent of the Asylum for the In- 
 sane at Utica, and was regarded as the highest 
 authority in his specialty in this country. He 
 had previously seen the prisoner and fully sus- 
 tained the theory of insanity. At the time of 
 the trial he had desired to see the prisoner 
 again and make a more thorough study of the 
 case. In order to weaken, as far as possible, 
 Doctor Brigham's testimony, the prosecution re- 
 fused to allow him to examine the prisoner dur- 
 ing the trial. He was compelled, therefore, to 
 form his opinion of the mental condition of 
 Freeman by daily observations of his appear- 
 ance and actions in court. 
 
 THE testimony of Dr. Brigham was regarded 
 as the pivot on which the case would ulti- 
 mately turn, and public excitement was at its 
 height when he was called to the witness stand. 
 I happened to be in Auburn on the day Doctor 
 
 Brigham was examined and 
 The Testimony witnessed the remarkable 
 of Dr. Bingham scene which transpired, and 
 
 which has never, to my 
 knowledge, been fully described. 
 
 Doctor Brigham was a man whose personal- 
 ity would attract attention in any audience. He 
 was very tall and spare, and his smoothly 
 
WHO IS INSANE? 49 
 
 shaven face was as impassive and expression- 
 less as marble. His eyes were piercing when 
 fixed on an object, but expressive of humor 
 when he was subjected to examination. The 
 general impression which he made upon the 
 spectators was that of a man of great intellect- 
 ual superiority, but who had the most perfect 
 self-control. On his direct examination he de- 
 scribed in great detail the signs and symptoms 
 of dementia, and gave his reasons for believing 
 that this was the special form of insanity with 
 which the prisoner was afflicted. He admitted 
 that his opinion was based on his study and ob- 
 servation of the prisoner while in court. In re- 
 ply to questions as to his ability to diagnose in- 
 sanity at sight, he expressed the most positive 
 opinion that he could do so ordinarily, and had 
 often proved his power to detect the absence of 
 insanity when insanity was feigned, by observa- 
 tion and without asking a question. 
 
 On the cross-examination, Mr. Van Buren re- 
 sorted to every known strategem and quibble to 
 destroy the effect of these firmly expressed 
 opinions. He ranged through the fields of lit- 
 erature, science, history, and philosophy to find 
 some point of attack where Doctor Brigham 
 might be vulnerable, but in vain, for he was met 
 not only with prompt answers, but frequently 
 the learned counsel was placed at a disadvan- 
 tage by the incisive repartee of the witness. 
 
50 WHO IS INSANE? 
 
 The character of much of this part of the tes- 
 timony will appear from quotations from the 
 record. 
 
 "Is suicide contagious?" asked the counsel. 
 
 "I think it was in the French army until Na- 
 poleon put a stop to it by executing two or three 
 suspects," the witness replied. It is stated that 
 a titter ran through the audience and the Attor- 
 ney-General renewed the charge. 
 
 "Is hysterics contagious?" he asked. 
 
 "It seems to be catching," the Doctor placidly 
 said. 
 
 "Suppose, Doctor," said the counsel, with a 
 sneer, "that I should go out and steal a hundred 
 dollars and then come in again and sit down 
 here, would you swear I was insane?" 
 
 "I think I should," calmly replied the Doctor. 
 
 At length the examination took a more prac- 
 tical form when the counsel inquired as to the 
 method pursued by the witness in diagnosing 
 insanity at sight. The witness replied that he 
 relied on the features of the patient, which he 
 always attentively studied. 
 
 "Which feature do you rely on in your diag- 
 nosis?" queried the counsel. 
 
 "I rely on no one feature, but study them as 
 a group," was the answer. 
 
 "Do your rely on the chin?" he was asked. 
 "No," he said. "Do you rely on the nose?" was 
 the next question. "No," he said. "Do you rely 
 
WHO IS INSANE? 51 
 
 on the ear?" the counsel persisted. "No," said 
 the witness. "Do you rely on the cheek?" was 
 the next tantalizing question. "No," was 
 the answer. "Do you rely on the mouth?" 
 the counsel continued. "Very much," said 
 the Doctor. "Do you rely on the eyes?" 
 was the next question. "Still more than 
 on the mouth," the witness answered. "If, 
 then, this prisoner were concealed all but his 
 mouth or his eyes, you affirm that you could de- 
 cide accurately whether or not he is insane?" 
 queried Mr. Van Buren. "No, I do not state 
 that; I must see all the features at once," the 
 witness urged. For a considerable time the as- 
 tute Attorney-General dwelt on the features of 
 different persons, endeavoring by his wit and 
 sarcasm to throw the utmost ridicule upon the 
 witness's method of detecting insanity at sight. 
 With passive countenance and in the most quiet, 
 self-possessed manner the witness answered all 
 the questions, exhibiting not the slightest irri- 
 tation at the gibes and jeers of the wily and 
 witty counsel as he held up to ridicule before 
 the jury Doctor Brigham's new method of diag- 
 nosing insanity. 
 
 The interest of the court, jury, counsel, and 
 the immense audience had gradually increased 
 as the examination progressed, until the ner- 
 vous tension of the entire mass of people had 
 become painful and the suppressed excitement 
 
52 WHO IS INSANE? 
 
 was intense. The crisis was reached when the 
 Attorney-General exclaimed, with startling ve- 
 hemence and emphasis on every word, "What! 
 Do you affirm that you can diagnose insanity 
 at sight?" "I do," was the calm, dignified, but 
 emphatic response. Apparently satisfied that 
 the climax in the examination had been reached, 
 and turning towards the jury and spectators, the 
 Attorney-General demanded in the most con- 
 temptuous manner and tone, "Point out to the 
 court and jury an insane person in the audi- 
 ence." This challenge was the critical test of the 
 competency of the witness on the credibility of 
 whose testimony the defense placed its chief re- 
 liance. Doctor Brigham accepted the challenge 
 without a moment's hesitation, and with an air 
 of reserved confidence which impressed every 
 one with belief, or perhaps fear, that he would 
 prove equal to the emergency. 
 
 IT is impossible to describe the scene which fol- 
 lowed. A breathless silence fell upon the 
 court-room. The venerable Judge raised his 
 glasses to his forehead and surveyed the excited 
 mass of people about to undergo the ordeal of 
 
 an examination as to their 
 
 Dr. Brigham sanity. The large number of 
 
 Put to the Test legal gentlemen within the bar 
 
 arose to their feet and gazed 
 at the crowded hall and passageways with in- 
 
WHO IS INSANE? 53 
 
 tense curiosity. The spectators were simply 
 awe-stricken when they reahzed that the cru- 
 cial test was to be applied to them, and, being 
 one of the number, I still feel the thrill of hor- 
 ror I experienced. 
 
 Dr. Brigham arose from his chair very delib- 
 erately and stood for a moment surveying the 
 people, as if to determine where to begin his 
 scrutiny. He was white and emotionless as a 
 marble statue. Turning slowly to the left or 
 first tier of seats he began a deliberate survey 
 of the spectators, scanning the features of each 
 one with the apparent confidence that he could 
 detect the faintest traces of insanity. As his 
 keen, searching eyes glanced from tier to tier of 
 seats the suspense was simply unendurable. He 
 had reached the middle aisle and yet no one 
 had been pointed out as insane. Five hundred 
 faces had been scrutinized and no group of indi- 
 vidual features had responded to the test. 
 That portion of the audience at least 
 breathed more freely. An incredulous smile 
 began to play about the mouth and light 
 up the mobile features of the Attorney- 
 General, while a greater earnestness of 
 manner and intensity of scrutiny were ap- 
 parent in the witness. Deep furrows appeared 
 on his pallid face, and his eyes assumed a pierc- 
 ing brilliancy which made every one shrink on 
 whom his gaze was momentarily fixed. I felt 
 
54 WHO IS INSANE? 
 
 myself transfixed when I realized that my face 
 was focalized on his vision, and I experienced 
 a sense of the greatest relief when I saw that I 
 had safely passed the trying ordeal. A sigh of 
 relief followed along the rows of seats as the 
 glance of the great expert swept over them. 
 The area of faces still to be examined was now 
 rapidly diminishing, and but one-fourth of the 
 audience remained to be scanned. It was ap- 
 parent that thus far either there was no insane 
 person in the crowd, or if there was, the witness 
 had failed to detect such person, and hence had 
 failed to answer the practical test to which he 
 had been challenged by the prosecution and 
 which he had accepted without protest. 
 
 SUDDENLY the wandering eyes of the expert 
 became fixed; his features relaxed and as- 
 sumed their customary impassiveness, and 
 it was evident that he had discovered the object 
 of his search. Stretching out his long arm and 
 
 pointing with his finger 
 Insanity Recognized toward a person on one 
 at Sight of the rear tiers of seats, 
 
 he quietly said, "There 
 is an insane man." At the instant a man, as if 
 struck with a bullet, sprang from his seat and, 
 wildly gesticulating and shouting a volley of 
 oaths against any one who would call him in- 
 sane, rushed down the aisle toward the bar. 
 
WHO IS INSANE? 55 
 
 The Judge rose hastily from his chair as if 
 about to escape, the lawyers were panic-strick- 
 en and mingled with the crowd; but Doctor 
 Brigham stood perfectly self-possessed, while 
 the officers struggled with the lunatic in their 
 efforts to remove him from the court-room. 
 
 The whole scene was intensely dramatic and 
 the termination was a surprising ovation for the 
 triumphant actor. Doctor Brigham. The prose- 
 cution was completely nonplussed, and the wit- 
 ness was allowed to retire without further tests 
 of his ability as an authority in the di- 
 agnosis of insanity at sight. The man 
 who was pointed out as insane proved to be 
 a harmless lunatic who had strayed into 
 court from a neighboring livery stable. To 
 break the force of Doctor Brigham's successful 
 test, however, the prosecution circulated the 
 report that Mr. Seward, in anticipation of this 
 test being made, had caused the insane man to 
 be placed in that seat, and that Doctor Brigham 
 had previously seen him. This absurd story 
 only heightened the effect of the favorable im- 
 pression which Doctor Brigham's successful an- 
 swer of the challenge of the Attorney-General 
 made upon the court, jury, and the people. 
 
 The final issue of the case was the conviction 
 of the criminal for murder in the first degree. 
 Public feeling would admit of no other verdict. 
 
56 WHO IS INSANE? 
 
 He was not executed, but died in prison, de- 
 mented to idiocy. An autopsy confirmed the 
 correctness of the defense — insanity. 
 
IV 
 What Is Insanity? 
 
IV 
 
 What Is Insanity? 
 
 ^LEASE define the term insanity," 
 said the lawyer, in an insinuat- 
 ing tone, to an expert witness 
 in a recent case where the issue 
 in court was the insanity of a 
 deceased millionaire. The 
 learned counsel had been very 
 suave and courteous in his manners, had asked 
 very simple questions, and had complimented 
 the witness on his ready and cor- 
 An Expert rect answers. Suddenly his en- 
 Challenged tire attitude toward the witness 
 changed. Straightening himself 
 to his full height and thrusting his thumbs into 
 the arm-holes of his vest, he assumed a most ag- 
 gressive appearance as he put this question, 
 meantime casting an inquisitive glance at the 
 •Jury. 
 
 Simple and proper as the question appeared 
 to be, it was evident from his pose and grimaces 
 that the astute attorney knew well the endless 
 possibilities of the field of inquiry upon which 
 
 59 
 
60 WHO IS INSANE? 
 
 he now entered. He had traversed it many 
 times before with learned experts and had 
 amused court and jury with the tangled mesh 
 which he wove about his victims in the form of 
 quotations from eminent authorities entirely 
 contradictory of the answers of the witness. He 
 appeared to have no thought or concern about 
 the definition which might be given. And the 
 sequel proved that Be really did not care what 
 reply he elicited. Like the spider in the center 
 of his web, he could attack his game on what- 
 ever line he might alight. All the advantage 
 which he asked was that the witness attempt a 
 definition. When this was obtained, the 
 learned casuist immediately proceeded to con- 
 front the witness with a variety of definitions of 
 authorities quite unlike that which he had 
 given. The result of these quibblings of the at- 
 torney proved disastrous to the reputation of 
 the alienist witness for expert knowledge of the 
 nature of insanity. 
 
 The reckless and often unscientific testimony 
 of so-called experts in cases where the plea of 
 insanity is set up, especially in the trial of crim- 
 inals, has in these latter days necessarily but un- 
 fortunately discredited such evidence in the 
 opinion of legal authorities and the courts. 
 
 Taylor, in his work "On Evidence," says: 
 "Perhaps the testimony which least deserves 
 credit with a jury is that of skilled witnesses; 
 
WHO IS INSANE? 61 
 
 these gentlemen are usually required to speak, 
 not to facts but to opinions; and when this is the 
 case, it is often quite surprising to see with what 
 facility and to what extent their views can be 
 made to correspond with the wishes or the in- 
 terests of the parties who call them. They do 
 not, indeed, wilfully misrepresent what they 
 think; but their judgments become so warped 
 by regarding the subject in one point of view, 
 that, even when conscientiously disposed, they 
 are incapable of expressing a candid opinion." 
 
 JUDGE PECKHAM, of the New York Court of 
 Appeals, said: "Expert evidence, so-called, 
 or, in other words, evidence of the mere 
 opinion of witnesses, has been used to such an 
 extent that the evidence given by them has 
 
 come to be looked upon with 
 Expert Evidence great suspicion by both 
 Under Reproach courts and juries, and the 
 
 fact has become very plain 
 that in any case where opinion evidence is ad- 
 missible, the particular kind of an opinion de- 
 sired by any party to an investigation can be 
 readily procured by paying the market price 
 therefor." 
 
 In a recent judicial opinion the court declared 
 that it had more confidence in the testimony of 
 an ordinary observer as to the insanity of a per- 
 son with whom the witness was acquainted than 
 
62 WHO IS INSANE? 
 
 in that of the alienist most expert in a knowl- 
 edge of the technicalities of the so-called sci- 
 ence of insanity. 
 
 Undoubtedly, the failure of expert testimony 
 to enlighten the court as to the existence or non- 
 existence of insanity in a given case is largely 
 due to the fact that our knowledge of the mech- 
 anism of the brain and its functions is so imper- 
 fect. The result of fhis ignorance of the ma- 
 chinery on which every mental and physical act 
 of the individual depends is an incredible 
 amount of theorizing, having no reliable basis 
 other than the observation of mere symptoms 
 which are so variable in different persons as to 
 admit of a great variety of interpretations. 
 
 This has led naturally to the multiplication of 
 new terms until the modern student of insanity 
 is confused and perplexed by definitions be- 
 yond his capacity of comprehension and even 
 memorizing. It is not surprising that under 
 such conditions the courts are inclined to attach 
 little or no importance to the testimony of alien- 
 ist experts, and that they are subjected to un- 
 sparing criticism and even ridicule. 
 
 The fault also lies in our loose and unregu- 
 lated system of selecting experts. While each 
 party in a suit is at liberty to select experts, the 
 grade of their qualifications will be measured 
 by other considerations than learning, skill and 
 experience. 
 
WHO IS INSANE? 63 
 
 The failure of alienist-experts to define insan- 
 ity, or fix any definite value to the term, is very 
 suggestive. Is not the public justified in doubt- 
 ing v^hether the commitment of persons as in- 
 sane is always scientifically correct, when even 
 our highest authorities are unable to define the' 
 term? Incredible, is it not, that at this period 
 of advance in the medical sciences, when pre- 
 cision in details is so exact, that a definition of 
 insanity cannot be formulated of universal ac- 
 ceptance? Does not this fact authorize the con- 
 clusion tliat insanity, as at present taught, has 
 not a scientific basis? Are not authorities still 
 seeking a solution of the phenomena of the 
 mind in the hazy realm of pure metaphysics, 
 rather than in an accurate knowledge of the 
 structure and functions of the brain, the center 
 and source of all mental activities? 
 
 IN view of the unsettled opinions of alienists 
 in regard to the definition of insanity, it has 
 been proposed by a high authority that an ex- 
 pert witness should decline to attempt to de- 
 fine the term. And this seems to be, at present, 
 the true position to take in courts 
 Insanity of law. Admittedly the term has 
 Undefinable no precise clinical nor practical 
 significance among physicians. 
 Its original meaning is "not-sound," "not-in- 
 health," a term applicable to any sick person. 
 
64 WHO IS INSANE? 
 
 but explains nothing, and hence has no technical 
 value. Though the word "insanity" has been 
 limited to disturbance of the mind, or, more cor- 
 rectly, to the morbid conditions of the brain, it 
 has no more importance to the modern student 
 than have the old terms "lung disease" and 
 "liver disease." It defines nothing and cannot 
 be defined; it can only be explained, like other 
 ancient scientific terms which, in the develop- 
 ment of the sciences, have entirely lost their 
 former or original value. 
 
 Do not these facts suggest that the terms 
 "insanity," "lunacy," "lunatic," "mental dis- 
 ease," and allied words, are based on false 
 premises and are now really obsolete? Should 
 they not, therefore, be abolished and an en- 
 tirely new nomenclature be substituted in iiar- 
 mony with the present advanced state of our 
 knowledge of the anatomy, physiology and 
 pathology of the brain? 
 
 THESE terms are also very disturbing to the 
 insane and excite the same resentment when 
 applied to them as when applied to the 
 sane. They take pleasantly to the terms, "ner- 
 vousness," "nervous prostration," and especially 
 to the new and popular word 
 A New Term "neurasthenia," which is believed 
 Needed to be a disease of the wealthy. 
 The public also attach a meaning 
 to the word "insanity" altogether out of proper- 
 
WHO IS INSANE? 65 
 
 tion to its significance even when properly em- 
 ployed. "Once insane always insane," is a su- 
 perstition so deeply and firmly fixed in the 
 popular mind that the mere fact of having been 
 adjudged insane is utterly destructive of the 
 future character, not only of the individual 
 himself or herself, but of their children and 
 children's children to the remotest generations. 
 
 What is insanity? has been the unanswered 
 question of the ages. The ancients referred it 
 to the mysteries of demonianism, and sought 
 many and various methods of exorcising the 
 evil spirit. Harsh and cruel measures were re- 
 sorted to with the result that the victim of in- 
 sanity became an outcast for life. 
 
 The moderns have sought an answer in the 
 realm of metaphysics, and have mistaken the 
 shadow for the substance, the symptom for the 
 disease. Consequently, treatment has been em- 
 pirical and without scientific precision. Minis- 
 tering to the vagaries of that unknown quantity, 
 the mind, has effected few recoveries. 
 
 The result has been most disastrous to the in- 
 sane, for custody and not cure of the insane has 
 long been the chief concern of both physicians 
 and managers of asylums. This is seen in the 
 rapidly increasing number of citizens, for the 
 most part able-bodied, living in idleness in pala- 
 tial structures built and maintained at enormous 
 cost, by the people. If the present rate of in- 
 
66 WHO IS mSANE? 
 
 crease of the insane in public care continues, 
 and no more successful methods of treatment 
 are discovered, the burden upon the public for 
 their custody and support will ere long prove 
 a crushing weight. 
 
 The failure of alienists to formulate an ac- 
 ceptable definition of insanity for the profes- 
 sion and for the courts, suggests that, after all 
 these years of progress, Shakespeare, with mar- 
 velous intuition, included and concluded the 
 whole matter in two lines: 
 
 "To define true madness, 
 What is it but to be nothing else but mad?" 
 
 But there is, in these latter days, a more hope- 
 ful outlook for the insane. Rational methods of 
 research are supplanting those of the past. In- 
 stead of merely observing a few ill-defined 
 symptoms and attributing them to some dis- 
 turbance of the brain not explained, hence not 
 understood, thus reaching a vague and indefi- 
 nite conclusion, skilled and expert anatomists 
 and physiologists, inspired by the scientific 
 spirit of the age, are gradually unveiling the 
 mysteries of the nervous system, which has 
 hitherto remained a sealed book. These con- 
 structive students are thus laying the founda- 
 tions of a true science of psychology in the im- 
 mutable facts of the structure and functions of 
 
WHO IS INSANE? 67 
 
 the ultimate elements of the brain, the center 
 and source of all mental activities. 
 
 Though the mechanism to be analyzed and 
 synthesized is constituted of the most subtile 
 and elusive elements of the body, and their ar- 
 rangement for the co-ordination of function is 
 the most complex mechanism known to science, 
 such progress has been made in determining 
 the nature of these units of the nervous system 
 that it is now possible to understand the archi- 
 tecture of the brain and to correctly interpret 
 its operations. 
 
How We Become Insane 
 
How We Become Insane 
 
 OW did you become insane?" I 
 asked an Irishman who was 
 amusing a group of inmates of 
 an asylum. Touching his fore- 
 head with his finger he said, 
 with a grimace, "We are all 
 built that way." In those six 
 words he embodied all of the knowledge that 
 science has discovered in regard to insanity in 
 
 the centuries past. That 
 
 We are All short and crisp answer was 
 
 Built that Way a more luminous statement 
 
 of the essential fact of insan- 
 ity than is contained in all the books on 
 that, and the kindred subject of psy- 
 chology, which cumber the shelves of our 
 public Hbraries. The most famous cell-physiol- 
 ogist required a volume to elaborate the same 
 answer. 
 
 Both the man adjudged insane and doomed 
 to the helpless and hopeless life of an asylum, 
 and the learned medical philosopher, expressed 
 
 71 
 
72 WHO IS INSANE? 
 
 the same truths, viz., that in the constitution of 
 every human brain there are conditions tending 
 powerfully to induce mental states known as in- 
 sanity. The former stated this truth in direct, 
 concrete form, while the latter answered in sci- 
 entific terms with exact formulas and abundant 
 technicalities which only the most learned 
 could read understandingly. 
 
 THE story of the brain, as scientists have grad- 
 ually unfolded its intimate structure and 
 architectural peculiarities, is of marvelous 
 interest. It is no longer to be regarded and 
 treated as a pulpy, homogeneous mass of unor- 
 ganized matter, but as the most 
 The Marvelous highly vitalized and special- 
 Brain ized organ of the body. Though 
 
 our knowledge of its ultimate 
 structure is limited, it is now possible to explain 
 in a familiar way the anatomical elements of 
 the brain, — their structure, relations and func- 
 tions, — and in that explanation we discover the 
 peculiar architectural features of the entire ner- 
 vous system, and how pertinent was the answer 
 of the Irishman to the question as to how he be- 
 came insane, "We are all built that way." 
 
 Anatomy teaches that the ultimate organ- 
 ized element of every tissue of the body — bone, 
 muscle, nerve, skin, hair, nails — is a cell. The 
 vast importance of the cell in the structure and 
 
WHO IS INSANE? ?3 
 
 functions of the animal economy may be 
 learned from the following opinions of eminent 
 physiologists : 
 
 "The cell is a unified organism, a self-con- 
 tained living being." 
 
 "The sole active principle in every vital func- 
 tion." 
 
 "The medium of sensation, will, and even 
 thought, the highest of psychic functions." 
 
 "The cell is not only like — it actually is — an 
 engine, machine, or mechanism, but it is also a 
 living mechanism." 
 
 "Our own body is a very elaborate social sys- 
 tem of countless microscopic organisms; a col- 
 ony or commonwealth made up of innumerable 
 independent units." 
 
 ERNEST Haeckel, the German scientist, says, 
 "We have now ascertained in the clearest, 
 most indisputable manner, that all which 
 we term the 'soul' is in a scientific sense 
 nothing more than the total effect or func- 
 tion of the 'soul cells' of the numerous neu- 
 rones in the brain." What has 
 The Brain a hitherto been known in the 
 Cell Structure anatomy of the brain as a cell, 
 nerve, branch (dendrite), com- 
 missure, associate fiber, has been found to be a 
 single anatomical unit, having as its base or ori- 
 gin the cell proper. This cell, with its projec- 
 tions or prolongations, is now described as a 
 single organ under the name, "Neurone." 
 
74 WHO IS INSANE? 
 
 The following histological facts in regard to 
 the nerve-cell are essential to an understanding 
 of the anatomy and physiology of the nervous 
 system. 
 
 The cell has its origin in foetal life and at 
 birth is in a rudimentary state, but is endowed 
 with a capacity of large development for the 
 performance of its special function. It is es- 
 timated that there are between one and two 
 thousand million cells in the brain alone. The 
 physical constitution of the cell consists of two 
 distinct portions, viz., the nucleus, and a mass of 
 protoplasmic matter which incloses the nu- 
 cleus — the cytoplasm. The intimate structure 
 of these bodies has not been accurately deter- 
 mined, nor have their physiological relations 
 been completely established, though great prog- 
 ress has been made latterly to that end by the 
 science of Biology and Physiology. 
 
 This protoplasmic matter is so extremely sen- 
 sitive that the passing of a cloud over the sun 
 will effect changes in it which can be detected 
 by instruments made for that purpose. Cells 
 vary in size from 1/250 to 1/3500 of an inch in 
 diameter and may or may not be surrounded by 
 a capsule. 
 
 The anatomist teaches that the brain-cells are 
 grouped into centers according to their particu- 
 lar functions. We have long been familiar with 
 the so-called special senses, which consist of 
 
WHO IS INSANE? 75 
 
 collections of nerve cells and are known as 
 nerve-centers with special functions, viz., see- 
 ing, hearing, smelling, tasting, feeling. These 
 centers are designed to bring the individual into 
 conscious relations with five distinct objective 
 features of the external world in which he lives, 
 moves and has his being. 
 
 IT IS probable that comparatively few of these 
 centers have as yet been accurately deter- 
 mined, but enough is known to prove that 
 every function, every act, and possibly every 
 thought has its origin in special cells in the cen- 
 ter of the cerebro-spi- 
 The Brain Coordinates nal axis. For the co- 
 Sense-Impressions ordination of the op- 
 erations of these innu- 
 merable centers, the interior of the brain is a 
 mass of connective nerve fibers, through which 
 the intimate relations of the nerve-centers are 
 maintained, thus securing the most perfect har- 
 mony in the functions of all the organs of the 
 body. These fibers are "commissural," connect- 
 ing the two hemispheres; "projection," which 
 project "upon the cortex of the brain the re- 
 sults of sensory stimuli upon the body;" and 
 "association," which "connect different convo- 
 lutions in the same hemisphere." 
 
 It is stated that "Were it not for the existence 
 of these fibers, perception, memory, and 
 
76 WHO IS INSANE? 
 
 thoughts would be impossible." Our perception 
 of a pear is incomplete until "we have fused 
 into one mental whole the sensations from tast- 
 ing, smelling, seeing, touching and hearing the 
 fruit fall from the tree." 
 
 Another important anatomical feature of the 
 nerve-centers is their arrangement. First, there 
 are the centers of the special senses through 
 which the individual communicates with the 
 external world. This group is sometimes called 
 the "lower brain." The functions of these cen- 
 ters are to receive the impressions and transmit 
 them to another higher series of centers, called 
 the "mid-brain." The function of the latter cen- 
 ters is to take cognizance of the special charac- 
 ter of each impression, and transmit it to the 
 proper center in a still higher grade. This last 
 is called the "higher-brain," which it is both in 
 location, being in the frontal part of the cere- 
 brum, and in function, being devoted to idea- 
 tion, or thinking. 
 
 Without going farther into what would be- 
 come tedious anatomical details, let us con- 
 sider what the physiologist teaches in regard to 
 the nerve-cells, or neurones, and the nerve-cen- 
 ters. First, we learn that the cells are implant- 
 ed at birth in a rudimentary form and undergo 
 an evolution from the cell of the lowest of animal 
 life to the complex cell of the human brain. 
 Though at birth the cell has been perfected, so 
 
WHO IS INSANE? 77 
 
 far as regards its structural adaptation to its 
 special future function, yet it will remain in an 
 inert state and undergo no further change or 
 development until excited to activity by its spe- 
 cial stimulant. For example, if a person is born 
 blind, the cells of the center of sight will remain 
 in a rudimentary state and undergo no further 
 development until excited by their proper and 
 only stimulus — light. The same is true of a 
 large number of nerve-centers which are in im- 
 mediate functional relation with the center of 
 sight. 
 
 If now an operation is performed upon the 
 eye, the light reaches the cells of the center of 
 vision, an immediate change takes place; the 
 cells begin to enlarge; the blood supply is in- 
 creased, which results in active nutrition, and 
 all of the related nerve-centers undergo similar 
 changes as to activity and development. 
 
 The physiological facts in regard to the cells 
 of the center of seeing are the same in the cen- 
 ters of all the special senses — hearing, feeling, 
 tasting, smelling — through which the brain as a 
 whole is stimulated to functional activity. It 
 follows that in proportion to the integrity of the 
 special senses is a human brain perfect, or, on 
 the other hand, defective. It is also asserted 
 as a physiological fact that if the apparatus by 
 which each of the nerve-centers of the five spe- 
 cial senses receives impressions from the exter- 
 
78 WHO IS INSANE? 
 
 nal world were destroyed at birth, the thou- 
 sands of millions of nerve-cells of the brain 
 would remain inert and undeveloped during 
 the lifetime of the individual. 
 
 THIS fact leads the physiologist to believe that 
 in the human brain there are large numbers 
 of nerve-cells that remain undeveloped, be- 
 cause never excited to functional activity, and 
 also that at any period of life, cells hitherto 
 inert may receive their proper 
 Undeveloped stimulus and take on functional 
 Brain Cells activity. Their susceptibility may 
 be considerably increased or di- 
 minished by nutrition. In other words, we may 
 withhold from the nerve-cells the elements of 
 nutrition on which their normal integrity de- 
 pends, and thus diminish their power and sus- 
 ceptibility, or we may supply them with nutri- 
 tive materials equal to the natural demands of 
 the cells and greatly increase their force and 
 susceptibility. 
 
 If to the born-blind there is no world of light, 
 and to the born-deaf there is no world of sound, 
 may it not be a fact that around us exist other 
 worlds than those revealed by the five special 
 senses, which we do not recognize because the 
 special nerve-centers for that purpose have not 
 as yet been stimulated to activity? St. Paul 
 hints at this opinion when he declares that cer- 
 
WHO IS INSANE? 79 
 
 tain religious truths can be discerned by those 
 in whom the spiritual sense cell has been 
 awakened. May not the strange mental phe- 
 nomena of dreams, telepathy, hypnotism, and 
 kindred experiences of individuals be traced to 
 the stimulation of nerve-centers aroused to ac- 
 tivity only under special conditions? 
 
 Summarizing these anatomical and physiolog- 
 ical facts we may formulate the following con- 
 clusions : 
 
 1. The neurone — the nerve-cell and its 
 branches of communication — is the unit of the 
 nervous system; there are thousands of millions 
 of them and their specialized functions are the 
 control of every organ, and act, of the body — 
 "sensation, will, and even thought." 
 
 2. The intimate texture of the cell, on which 
 its susceptibility and capacity to perform its 
 functions depends, is inherited, but may be mod- 
 ified at will by proper exercise, nutrition, and 
 conditions of environment. 
 
 3. The germ-cell is implanted at birth, and 
 its subsequent development depends upon its 
 stimulation to functional activity by its appropri- 
 ate stimulus; that is, if it is not stimulated it will 
 remain inert and undeveloped, thus making it 
 possible, by applying the appropriate stimulus, 
 to bring into healthy activity cells long dormant. 
 
 4. When an active cell ceases to be stimu- 
 lated it begins to diminish in size — atrophy — 
 
80 WHO IS INSANE? 
 
 and will become inert as regards its function, 
 and will remain inactive until excited to activity 
 by its special stimulant, showing that any class 
 of cells may be reduced to an inert state and 
 again restored to activity by withholding or sup- 
 plying their appropriate stimulus. 
 
 5. Every cell has inherent in its constitution 
 the power of selecting from the blood substances 
 for its nutrition and stimulation, and for which 
 it has a "selective affinity." This feature in the 
 constitution of the cell enables us, by means of 
 the appropriate remedies, to increase, diminish, 
 or pervert its action. 
 
 6. In the structural arrangement of the neu- 
 rones they are grouped into "centers" according 
 to their special functions; in these centers the 
 cells communicate with each other by means 
 of innumerable branches — dendrites — while the 
 centers communicate with each other through 
 nerve-fibers known as commissures. In the 
 grouping of these centers there is a perfectly 
 logical and orderly series of sequences by which 
 impressions are made, received, and responded 
 to on the part of the centers, so as to secure the 
 most perfect harmony in all of the acts, func- 
 tions, and even thoughts, of the individual. 
 
 7. The fundamental grouping of the nerve 
 centers was designed to bring the individual 
 into proper relation with the external world — 
 the source of all power — and hence we have. 
 
WHO IS INSANE? 81 
 
 first, the centers of the five special senses, see- 
 ing, hearing, smelling, tasting, and feeling; from 
 these the impressions are conveyed to other cen- 
 ters closely allied in function, until they finally 
 reach their destination in the cerebral centers, 
 the seat of the "highest psychic function," and 
 where the inhibitory centers control all volun- 
 tary acts. 
 
 8. Every nerve-cell has its own special func- 
 tion, and these functions are as numerous as the 
 acts and even the thoughts of the individual, 
 but each depends ultimately for its activity and 
 development upon the stimulation which it re- 
 ceives from one of the five special senses, 
 through the medium of association fibers. 
 
 From the preceding summary of anatomical 
 and physiological facts we may conclude that 
 every vital function, as well as every mental 
 operation, thought, word and act has its ori- 
 gin and expression in one or many of these en- 
 tities or units of the nervous system. Their com- 
 bined physiological functions, in health, consti- 
 tute the normal individuality of the person, 
 mentally and physically. 
 
 If we now consider the extreme susceptibility 
 of these bodies to the innumerable variety of im- 
 pressions to which they are exposed, external 
 and internal to the body, we can form some 
 conception of how unstable their functions may 
 be. Their own structure is constantly undergo- 
 
82 WHO IS INSANE? 
 
 ing change in the act of nutrition. Their integ- 
 rity thus depends upon the absorption and re- 
 moval of dead tissue and its replacement with 
 suitable nourishment. If the dead matter is not 
 promptly removed, or if the food of the individ- 
 ual is not suitable, the neuron is no longer in 
 health and must perform its function less per- 
 fectly. 
 
 They are also extremely susceptible to, and 
 receptive of, impressions derived from the ex- 
 ternal world. Thus they are affected by the 
 food we eat and the fluid we drink; by diseases 
 of every kind which afflict the body; by every- 
 thing recognized by the senses. 
 
 IT follows that any change in the constitution 
 or structure of the cell or neuron must be at- 
 tended by a derangement of its function 
 which would find expression in the mental acts 
 of the individual. If a group of cells should 
 from any cause cease to act, the 
 The Cause of mental attributes which they 
 Derangement manifest, when acting normally, 
 must cease. Equally, if the 
 same cells are over-stimulated, their functional 
 activities are correspondingly increased. Or, 
 again, if the structural properties of the cells are 
 changed, as by alcoholic intoxication or by any 
 other toxic agent which finds access to the brain 
 and for which any cells have an affinity, the 
 
WHO IS INSANE? 83 
 
 mental functional expression would be changed 
 to the extent, and in the particular feature, that 
 the affected bodies contribute to the mentality 
 and personality of the individual. 
 
 Thus, if certain intoxicants are administered, 
 the change effected in the constitution of the 
 bodies devoted to the function of seeing are 
 such that external objects assume new forms, 
 technically causing an illusion of sight. The 
 experimental physiologist can, at will, with cer- 
 tain toxins, change the action of groups of cells 
 so that the individual will exhibit certain men- 
 tal traits entirely foreign to his usual habit of 
 thought and expression. 
 
 In various forms of sickness the temper and 
 conduct of the patient undergo marked changes; 
 he often becomes delirious, due to the changed 
 conditions of nutrition caused by toxins in the 
 blood or by the various forms of disease. Auto- 
 intoxication, on which modern therapeutists 
 place so much stress, finds its most frequent ex- 
 pression in the vagaries of character which the 
 toxins generated in that great culture bed, the 
 colon, produce on the nerve-cells. 
 
 The old-time remedy for persons of gross 
 habits of overfeeding — blue pill at night and a 
 seidlitz powder in the morning — has changed a 
 sour to a sweet temper. An English clergyman 
 who had many wealthy parishioners was accus- 
 tomed, when summoned to minister to the spir- 
 
84 WHO IS INSANE? 
 
 itual wants of a certain class, to send the appli- 
 cant several pills with the request that they be 
 taken at bed-time and the promise that he 
 would call on the following day. The famous 
 philosopher, Dr. Samuel Johnson, declared in 
 his vehement manner that every sick man is a 
 rascal. 
 
 IN health the individual exhibits ever-varying 
 "moods of mind," owing to the constant 
 changes in cell structures or neurons, due to 
 nutrition and the infinite number and kind of 
 impressions acting upon them from within and 
 
 from without the body. We 
 Our Ever-Varying are not the same in every 
 Moods respect this year that we 
 
 were last year, this month 
 that we were last month, this evening that we 
 were this morning. The wise Diotima said to 
 Socrates (The Symposium of Plato) : "In the 
 same individual there is succession and not ab- 
 solute unity; a man is called the same; but yet 
 in the short interval which elapses between 
 youth and age . . . he is undergoing 
 a perpetual process of loss and reparation. 
 And this is true not only of the body but also of 
 the soul, whose habits, tempers, opinions, de- 
 sires, pleasures, pains, fears, never remain the 
 same in any one of us, but are always coming 
 and going." 
 
WHO IS INSANE? 85 
 
 In the ultimate elements of the brain, then, 
 science is seeking the true explanation of the 
 mental phenomena which characterize the va- 
 rious phases of insanity. A learned authority 
 has thus tersely stated the conclusions of sci- 
 ence : "As his neurones are, so the man is." 
 
 THE nerves, or axones of the cells, are classi- 
 fied, in general, according to their func- 
 tions as follows: First, sensory, or those 
 conveying impressions or sensations to the cen- 
 ters (afferent) ; second, motion, or those convey- 
 ing impulses from the centers to 
 The Nerves the muscles (efferent) ; third, in- 
 Classified hibitory, or those which control 
 the functions of the two former. 
 The practical action of these groups of neurones 
 may be illustrated in such familiar acts as the 
 following : We touch a pin-point with the finger 
 in the dark; the impression or sensation is in- 
 stantly conveyed to a nerve-center through the 
 sensory, or afferent nerve, which has been con- 
 tinued at its terminal extremity in the skin at the 
 tip of the finger; this sensation stimulates the cell 
 which generates the nerve force, to send out an 
 impulse through the motor or efferent nerve to 
 the muscles of the arm, and the hand is as in- 
 stantly withdrawn from contact with the pin. 
 Such would be the natural or physiological ac- 
 
86 WHO IS INSANE? 
 
 tion of this group of nerves, or neurones. But if 
 we add to the illustration the further fact that 
 we are searching for that pin and would be lia- 
 ble to lose it if the finger was removed from 
 contact with its point, there comes to our aid 
 another nerve-center, which has been aroused 
 to activity, which inhibits the removal of the 
 hand by controlling the action of the muscles 
 of the arm and compels us to maintain contact 
 with the pin until it is secured. This simple il- 
 lustration explains the differences which we 
 daily witness in the conduct of persons under 
 similar conditions; one is quiet and apparently 
 indifferent whatever the cause of excitement, 
 while another weeps and screams; in the former 
 the inhibitbry centers completely control the 
 acts of the person, while in the latter they have 
 lost temporary influence over the disturbed 
 centers. With the insane the inhibitory centers 
 exercise little or no control generally over those 
 disturbed and hence their thoughts, words and 
 acts betray their mental derangement. 
 
 A familiar illustration of this regulating 
 power of a class of nerve-centers over the opera- 
 tions of another class is seen in the "governor" 
 of the machine whose impelling force is steam. 
 Without this regulator, which always pre- 
 serves an equilibrium in the constantly varying 
 force of the steam, the machine would soon be 
 destroyed. 
 
WHO IS INSANE? 87 
 
 It follows from this review of the structure 
 of the brain, and the physiological processes in 
 the performance of its functions, that sanity, or 
 a sound mind, depends upon the harmonious 
 relations, at all times and under all conditions, 
 of the individual vital units — the cells, thou- 
 sands of millions in number — which constitute 
 the human brain. And these cells are so sensi- 
 tive and impressionable, as noted, that they are 
 affected by the passage of a cloud over the sun. 
 
 THAT any kind of harmony of action in such 
 a vast colony of independent living bodies, 
 performing an immense variety of differ- 
 ent functions, can be maintained, even for 
 a moment, amid the distracting excitements and 
 discordant influences of modern life, is amaz- 
 ing. That the average man 
 The Wonder That should be able for a lifetime 
 Any Are Sane to preserve such a degree of 
 
 sanity as will save him from 
 commitment to a lunatic asylum can be ex- 
 plained only by a marvelous conservation of 
 nervous energy and inhibitory power in the 
 coordination of functions of the nerve-centres 
 inherent in the constitution of the nerve-cells. 
 Truly did the pious hymnist, Dr. Isaac Watts, 
 sing: 
 
 "Strange that a harp of a thousand strings. 
 Should keep in tune so long." 
 
88 WHO IS mSANE? 
 
 Disturbances of the harmony of the brain 
 cells are more frequently transient in their ef- 
 fect. They quickly recover their normal condi- 
 tion when the exciting cause is removed, or 
 ceases to act. These functional disturbances of 
 the action of the cells cannot be classed as any 
 form of disease, for the structure of the cell re- 
 mains unchanged. If, however, the tissue of the 
 cell becomes changed in its intimate nature, so 
 that the function of the cell is not restored, a 
 condition of disease exists. In a recent decision 
 of a United States Court of Appeals it was held 
 that "the term 'disease' was not intended to 
 cover and did not apply to a temporary de- 
 rangement of the functions of some organ, as, 
 for example, of the stomach." 
 
 The most familiar illustration of the nervous 
 system is the telegraph. The resemblance is so 
 striking that it has been alleged that the latter 
 was modeled after the former. 
 
 THERE is the central station communicaang 
 with the external world by its cables to for- 
 eign countries which corresponds with our 
 brain-centres and nerves of special sense; the 
 central station has its cells generating the elec- 
 trical force as the brain- 
 The Nerve-System centre's nerve-cells gener- 
 Telegraph ate the nervous force ; from 
 
 the electric cells proceed 
 wires to other telegraph centres as do the nerves 
 
WHO IS INSANE? 89 
 
 from the nerve-cells to the other nerve 
 centres; and from the terminal telegraph 
 station the message is delivered as from the ter- 
 minal ends of the nerves the messages of the 
 brain-cells of ideation are delivered to the mus- 
 cles and organs v^hose functions are the protec- 
 tion and preservation of the life of the body. 
 
 It is not difficult to understand how 
 easily the telegraph system may become so de- 
 ranged as to give wrong or imperfect messages. 
 If the operator who receives the cable messages 
 from the outside world — Europe, Asia, Africa, 
 Islands of the Sea — wrongly interprets the signs 
 through some defect in his electrical apparatus, 
 however slight, the messages which he transmits 
 to other centers in this country will be wrong 
 and the final news given to the people will be 
 false. The same is true of every telegraph cen- 
 tre in the entire system. 
 
 Comparing this illustration with the action of 
 the nervous system, we note that if the cells of a 
 nerve-centre of special sense — seeing, hearing, 
 touching, tasting, smelling — through and by 
 which we have some knowledge of the external 
 world, fail to perform their functions, wrong 
 impressions will be conveyed to other nerve- 
 centres, and while this condition lasts the per- 
 son is of unsound mind, or insane. 
 
PART TWO 
 
 CRITICAL PERIODS OF LIFE PREDISPOS- 
 ING TO INSANITY 
 
VI 
 
 Childhood 
 
VI 
 
 Childhood 
 
 HE pertinency of the reply, "We 
 are all built that way," becomes 
 more apparent when we review 
 the normal and physiological 
 changes which the human sys- 
 tem undergoes at different pe- 
 riods of life. Childhood, the 
 period from birth to adolescence, is full of possi- 
 bilities for good and for evil to the infantile 
 
 brain. The nerve-centres are 
 peculiarly sensitive and are 
 especially retentive of the 
 first impressions made upon 
 them. "Just as the twig is bent the tree's in- 
 clined" is an old and extremely useful axiom 
 to those responsible for the care and training of 
 children. Immature as the child seems during 
 its first decade, impressions may be made upon 
 the sensitive elements of its brain which will 
 finally control the whole mental life of the indi- 
 vidual. 
 
 St. James's description of the power of the 
 
 95 
 
 Possibilities for 
 Good or Evil 
 
96 WHO IS INSANE? 
 
 tongue for mischief is an apt illustration of the 
 final result of a single disturbed nerve centre. 
 He declares that though the tongue is a "little 
 member," it is "a world of iniquity;" it "defileth 
 the whole body;" it "setteth on fire the course 
 of nature;" it "is set on fire of hell." He com- 
 pares it to a spark which kindles a forest fire. 
 
 THIS is a graphic illustration of the power of 
 a few over-stimulated nerve-cells to extend 
 their influence gradually until they finally 
 dominate the entire life of the individual. If 
 this excessive stimulation is not promptly cor- 
 rected, and these few infinitesi- 
 Domination mal organisms are not brought 
 By a Few Cells into harmonious relations with 
 their fellows, they may prove to 
 have been set on fire of hell; to contain a world 
 of iniquity; to have the power to defile the 
 whole brain; to set on fire the whole course of 
 nature. In the light of these facts, consider the 
 following illustrative cases : — 
 
 A bright, nervous schoolboy began to practice 
 personal cleanliness. He was so infatuated with 
 this impression that it gradually became the ab- 
 sorbing purpose of his existence. He brushed 
 his clothes many times daily; wiped his shoes 
 frequently with a pocket handkerchief; never 
 crossed the street except on a clean cross-walk; 
 always brushed the seat before sitting down. 
 
WHO IS INSANE? 97 
 
 At twenty years of age the habit had in- 
 creased so that he examined his Hnen for specks 
 of dirt with a magnifying glass, before he would 
 use it; placed a chair beside his bed on retiring, 
 on which he would stand while undressing and 
 from which he might step into his bed, and thus 
 not soil his feet by stepping on the floor; wore 
 gloves constantly while at business that he 
 might not touch the bare hand of another in 
 shaking hands; carried a handkerchief in his 
 hand much of the time with which he frequent- 
 ly brushed his coat collar. He became a suc- 
 cessful merchant in New York, married and 
 reared a family of children, and was greatly re- 
 spected by business men and by a large circle of 
 social and church associates. He showed no dis- 
 position to enforce his own habits of thought 
 and action upon others, nor did his peculiar 
 personal neatness and cleanliness attract other 
 attention than that of admiration. 
 
 AT FIFTY, having acquired a competence, he 
 retired from the more active duties of his 
 business and built a very costly house in a 
 suburban village. Relieved by his co-partners 
 of constant attention to the details of a diversi- 
 fied business, and thus de- 
 A Mania prived of the hourly contact 
 
 for Cleanliness with a great variety of men, 
 
 he concentrated his thoughts 
 more and more upon his new residence, 
 
98 WHO IS INSANE? 
 
 especially as it approached completion. As 
 room after room was finished he would daily 
 clean it and lock the door that no one should 
 soil the floors in his absence. On the comple- 
 tion of his palatial residence he spent hours in 
 dusting and cleaning, and became very irritable 
 when he was advised to give more attention to 
 business and less to cleaning his house. 
 
 It required but a twelve month of isolation 
 from business, which had formerly maintained 
 a fair degree of harmony among the brain-cells 
 by healthful devotion to their normal functions, 
 for those cells, so long since set on fire of hell, 
 to defile the whole body of cells, and set on fire 
 the whole course of nature. He became more 
 and more morose, and could not be diverted 
 from his favorite employment of cleaning. 
 
 The result of this life-long aberration, begin- 
 ning with the deranged function of a few nerve- 
 cells, or neurones, was the defilement of the 
 whole brain, commitment to an asylum, and 
 finally death, while in the act of dusting his bed- 
 clothes. His brain was all aflame with the fire 
 which a spark had kindled. 
 
 A medical student, by the name of Jones, lin- 
 gered after the class was dismissed, and, after 
 some hesitation, stated that he had long been 
 disgusted with the name Jones. I replied that 
 it was a very convenient name, one which no 
 person could easily forget, and hence useful for 
 
WHO IS INSANE? 99 
 
 a professional man. He expressed a strong dis- 
 like of the name and said he was determined to 
 change it. He was a good scholar, very precise 
 in all his acts, a perfect gentleman in his de- 
 portment, but very sensitive to criticism of ev- 
 ery kind. In due time he graduated among the 
 best students of the class. The Civil War began 
 soon after his graduation and he entered the 
 service of the Medical Department. He made an 
 excellent record and at the close of the war took 
 rank with the best officers in the army. 
 
 After the war he was assigned to a Military 
 Department in the West, where he led a very 
 quiet life. About fifteen years after his gradua- 
 tion I received a newspaper from him with a 
 mark at the official records of a court, which 
 made public the fact that on application to a 
 court he had legally changed his name by in- 
 corporating his first name, Harvey, with the 
 second, making it Harvey- Jones, and assuming 
 as his first name. Tames. I acknowledged the 
 receipt of the paper, and, without men- 
 tioning the fact that 1 had noticed the 
 change in his name, directed my letter to 
 Dr. Harvey Jones, as formerly. He replied 
 promptly and called my attention to our con- 
 versation a score of years before, when he de- 
 clared his intention to rid himself of the name, 
 Jones, and directed me, if I ever addressed an- 
 other letter to him, to remember his present 
 name. 
 
100 WHO IS INSANE? 
 
 Several years elapsed, during which I occa- 
 sionally heard from my student at different 
 posts. An army officer who had been at the 
 same station with him for a time informed me 
 that the Doctor was generally regarded as a 
 "crank" in many matters and on several occa- 
 sions had appeared quite "luny," especially 
 when anyone accidentally called him Jones. 
 
 LATER in life, when he had reached the age of 
 fifty-five, an army officer wrote me request- 
 ing my good otfices in endeavoring to in- 
 duce my former student to write his name in 
 full on the Government pay-roll. I learned that 
 latterly the Doctor had begun to 
 Mania drop the letter "o" from the 
 
 Over a Name "Jones" part of his name, and 
 that the Secretary of the Treas- 
 ury, having been informed that there was no 
 person of that name in the army service, had re- 
 fused to pay his salary any longer; that all ef- 
 forts to induce him to spell his name correctly 
 were violently resented; that he had declared 
 that he would never write his full name under 
 any circumstances, and would prosecute the 
 Secretary if he persisted in refusing payment. 
 Accordingly, I wTote a very conciliatory letter to 
 him, being careful to direct it in accordance with 
 his known wishes. It brought me a letter in re- 
 ply in which he refused, under any circum- 
 
WHO IS INSANE? 101 
 
 stances, to comply with the Secretary's request. 
 The result was a suit against the Secretary to 
 compel payment, a verdict sustaining the Secre- 
 tary, and the dismissal of the surgeon from the 
 army service. He retired to private life. Free 
 from all duties, oppressed with the dread of im- 
 pending poverty, goaded by a feeling of wrong 
 treatment by the Secretary and army officers 
 who had urged him to sign his name in full, his 
 whole brain rapidly became involved and his 
 life was soon cut short by an acute disease. 
 
 WHAT intensely interesting lessons these 
 cases teach, and yet how differently 
 will they be interpreted! One class of 
 alienists, who know the brain only as a mass of 
 homogeneous matter, will regard them as strik- 
 ing illustrations of the incurable 
 The Lesson nature of insanity, confirming 
 of Such Cases the theorj^ "once insane always 
 insane." The younger student 
 will recognize them as stupidly neglected cases 
 of mere functional derangement of a few nerve- 
 cells, that might either have been restored to 
 their normal condition by early and proper 
 treatment, or have been reduced to a state of 
 "innocuous desuetude" in later life. 
 
 To the public the lesson of these cases is full 
 of significance. How rare the family of many 
 children in which the parents fail to detect in 
 
102 WHO IS INSANE? 
 
 some one, or several of the group, a trend of 
 thought or action not in harmony with right de- 
 velopment of character! But no other notice is 
 taken of it than a passing remark that the child 
 is peculiar, and the spark that is destined to en- 
 velope the w^hole brain in conflagration is al- 
 lowed to smoulder, with occasional marked in- 
 terruptions, until in later life it flames forth 
 in every thought and act of the individual, now 
 a fit subject for a custodial institution, whose 
 hospitable doors always open inwards for the 
 reception of such disturbers of the peace and 
 rarely open outwards for their discharge. 
 
 Not less suggestive are these cases to the 
 teacher of youths. In his daily intercourse with 
 his pupils he constantly meets with such in- 
 stances of tendencies to vicious development of 
 the brain, which could be changed either by re- 
 moving all sources of stimulation of the nerve- 
 centres involved, or by counteracting their nu- 
 trition through the diversion of blood to other 
 parts of the brain. Infinite are the possibilities 
 of developing one section of the brain at the ex- 
 pense of another. Bandage a child's eyes and 
 he will depend upon the ear for knowledge of 
 events occurring around him, and, meantime, 
 the nerve-cells of sight will waste, while those 
 of hearing will correspondingly increase. 
 
 And, finally, the lesson comes home to every 
 individual. We recognize tendencies to thought 
 
WHO IS INSANE? 103 
 
 and action that we know will end, if al- 
 lowed to develop without restraint, in the 
 formation of habits which may entirely change 
 character. These personal peculiarities, of 
 which we are conscious, are quite under our 
 control for long periods, and even late in life. 
 
VII 
 
 Adolescence 
 
YLl 
 
 Adolescence 
 
 jDOLESCENCE is defined to be 
 the period of life between pu- 
 berty and the full development 
 of the frame, extending in man 
 from about the age of fourteen 
 years to twenty-five, and in 
 woman from twelve to twen- 
 ty-one. It is truly the beginning 
 of the enlarged and perfected life of the individ- 
 ual, or, rather, it is having life more abundantly. 
 What is its real nature and im- 
 Life More port? It marks the development 
 'Abundantly of a new element in the constitu- 
 tion of the nervous sj^stem. Even 
 at birth nature had made provision for the per- 
 petuation of the species by implanting in the 
 nervous centres certain cells specifically devoted 
 to that function. They remain dormant 
 until adolescence, when they begin to de- 
 velop and take on functional activity. Hitherto 
 youths, both male and female, associated 
 freely together as boon companions, but on 
 
 107 
 
108 WHO IS INSANE? 
 
 reaching the above ages, respectively, a new ele- 
 ment in their conscious relations arises, a sen- 
 timental distinction, which, though "probably 
 the most profound and most nearly universal 
 attribute of organized beings," is so subtle in its 
 development and expression that its origin and 
 purport are not recognized. 
 
 THE simple truth is that a new and trans- 
 forming force has appeared in the nervous 
 constitution of both, which is destined to 
 dominate every faculty and determine largely the 
 mental and moral character of the adult indi- 
 vidual. If the strong pas- 
 Dormant Nerve- sions which have been 
 Centres Awakened aroused find full and 
 
 healthful play, the high- 
 est type of manhood and womanhood is devel- 
 oped, but if they are diverted from their normal 
 functional activities and affinities the integrity 
 of the mental, moral and physical constitution 
 of the individual is threatened with disaster. 
 
 With the awakening of these long dormant 
 nerve-centres to functional activity, the affect- 
 tive faculties receive a rich endowment of per- 
 ception. Every sense-nerve-centre becomes 
 more developed and active, and sights, sounds, 
 odors, tastes and feelings, hitherto unknown, are 
 recognized. So profound are the effects 
 wrought by this new and impelling force, that 
 
WHO IS INSANE? 109 
 
 the personality of the individual often appears 
 to undergo a complete change. But that change 
 is markedly different in the two sexes. 
 
 The form of the female expands and becomes 
 more symmetrical; her features assume a firm, 
 inquisitive expression; she is no longer the 
 romping, rollicking, daring leader in the sports 
 of her playmates, but is shy, sensitive, emotion- 
 al; she becomes so impressionable that a word 
 may cause an ecstacy of joy, or excite an out- 
 burst of passionate grief. Suddenly, without 
 preparation or premeditation, a smile, a tear, a 
 word, a touch, transforms her boy-companion 
 from a simple playmate to a sensuous, ideal- 
 ized being, whose presence hereafter will have 
 a strange, irresistible fascination which charms 
 every sense. Quite unconsciously she seeks by 
 various arts to increase her personal attrac- 
 tions; she studies grace in attitude and manners, 
 style in dress, precision in speech. Her entire 
 personality has undergone such a marvelous 
 change that her former self can scarcely be rec- 
 ognized. 
 
 Not less apparent, but radically different, are 
 the influences of adolescence upon her boy-com- 
 panion when he reaches the age of fourteen 
 years. The implanted hair-bulbs of his face, 
 dormant until adolescence, become active and 
 soon change his features; his voice assumes a 
 grave, commanding tone; his bones lengthen, 
 
110 WHO IS INSANE? 
 
 his muscles strengthen, his chest broadens; he 
 moves with dehberation; he speaks hke one 
 born to command, and his attitude toward oth- 
 ers is that of a master. 
 
 Ambition stimulates every energy to intense 
 activity; he becomes aggressive, contentious, de- 
 fiant; he is imperious, and when opposed or 
 baffled in his efforts, resorts to extreme phys- 
 ical measures to accomplish his purposes. His 
 girl-companion, by her modesty and shyness, 
 appeals for protection to his sense of superiority, 
 and he proudly assumes her care and makes her 
 an idealized vassal in the realm of his affections. 
 Adolescence has wrought in his personality a 
 change not less striking, but entirely opposite in 
 all of its manifestations, from that of his boy- 
 hood playmate. 
 
 THE normal physiological significance of 
 these peculiar changes of character and 
 conduct of adolescents is efflorescence of the 
 affective faculties, due to the awakening of their 
 nerve-centres to functional activity. The ex- 
 pression of these faculties is 
 The Meaning known and described as 
 of the Changes "love." An eminent writer on 
 
 metaphysics says: "The first 
 awakening of love in true and gentle natures is 
 a psychological moment of the utmost impor- 
 tance; the spiritual life has not unfrequently 
 
WHO IS INSANE? Ill 
 
 started from this point." But so various are the 
 forms of this expression that six contemporary 
 experts of insanity give the following defini- 
 tions of love, as described in current works of 
 fiction, viz., "emotive delusion," "fixed idea," 
 "rudimentary paranoia," "psychic emotive ob- 
 session," psychic neurasthenia," "episodic symp- 
 toms of hereditary degeneracy." 
 
 Such an array of diverse opinions of learned 
 observers proves the controlling influence of the 
 new elements which enter into the nervous con- 
 stitution during adolescence. A high authority 
 says: "From whatever side or symptom we 
 start, we trace the mental peculiarities of ado- 
 lescents to the aroused and active affective 
 nerve-centres." How true was the remark of the 
 unlearned victim of insanity, "We are all built 
 that way !" 
 
 It is not surprising that adolescents are often 
 not only popularly believed to be insane, so com- 
 plete is the change of character and conduct, but 
 that thousands are committed to asylums in 
 whom the first impulses of love are misinter- 
 preted as acts resulting from delusions, illu- 
 sions and hallucinations. Shakespeare gives ex- 
 pression in emphatic language to the popular 
 opinion, "Love is merely a madness, and, I tell 
 you, deserves as well a dark house and whip as 
 madmen do." Carlyle writes more philosophic- 
 ally, "Love is not altogether a delirium, yet it 
 
112 WHO IS INSANE? 
 
 has many points in common therewith." Plau- 
 tus says, "It is good to be moderately sane in 
 love." Browning, Coleridge, Tennyson and oth- 
 er writers might be quoted to the same effect, 
 and it is very natural that they should regard 
 love as a species of insanity from the standpoint 
 of its vagaries. 
 
 THIS is the story of "one who never told her 
 love." Among her adolescent boy compan- 
 ions was one for whom she suddenly con- 
 ceived a peculiar attachment, but she carefully 
 concealed her feelings. She believed that he 
 entertained the same feelings 
 Derangement toward her, but did not make 
 from Love his love known. One day he 
 
 and a companion went out on 
 the sea in a small sailing craft and never re- 
 turned. She at once fell into a melancholy 
 mood, and in her morbid mental state gradually 
 came to the conclusion that her friend was not 
 lost at sea, but had gone to some remote coun- 
 try and in time would return and acknowledge 
 his love for her. 
 
 She continued to pursue her course of study 
 of art and finally attained considerable repute 
 as an artist. The belief that her long absent lover 
 would return became more and more a fixed 
 opinion and she began to scrutinize men whom 
 she met in the street in the hope that she would 
 
WHO IS INSANE? 113 
 
 discover him. At length she saw a young man 
 approaching, who, before meeting her, passed 
 to the other side of the street, which im- 
 pressed her with the behef that he was her 
 friend, considerably changed by time. She fol- 
 lowed him and succeeded in learning his name. 
 It was not the name of her friend, but she con- 
 cluded that he had assumed another name to 
 escape detection, and accordingly wrote him a 
 letter full of endearing terms, urging him to re- 
 turn to her and professing her undiminished 
 love for him, notwithstanding his wandering 
 life and efforts to conceal his identity. 
 
 With a detective the gentleman thus ad- 
 dressed visited the writer of the letter, who 
 frankly told them of her long-lost lover and 
 her belief that he was the man, changed both 
 in appearance and name. She was promptly 
 committed to an asylum, and her useful life 
 brought to an abrupt close. 
 
 Sad beyond expression is the mental pertur- 
 bation of adolescents who are the victims of 
 concealed, disappointed, rejected, or despised 
 love. 
 
 "Of all pains, the greatest pain. 
 It is to love, but love in vain." 
 
 The daily papers are constantly recording 
 the most revolting crimes, suicidal and homi- 
 cidal, committed by persons distracted by dis- 
 
114 WHO IS INSANE? 
 
 appointed love, or frenzied by jealousy. It is 
 not surprising that, in the present state of hu- 
 man society and popular ignorance of the brain, 
 its anatomy and physiology, on which all men- 
 tal operations depend, so many adolescents 
 are wrecked at this most impressionable period 
 of their lives. By the community they are ac- 
 counted weak-minded, frivolous, and are made 
 the subjects of ridicule and even contemptuous 
 remarks, though they are passing through a nat- 
 ural physiological process which is preparing 
 them for the higher and more responsible du- 
 ties of life. 
 
 THE lesson which these facts impress is this. 
 During the period of adolescence, when the 
 integrity of the nervous system trembles in 
 the balance, every proper effort should be made 
 to create such associations and affiliations of 
 
 young men and women as 
 Care Required will lead to congenial affini- 
 in Adolescence ties. The ridicule and con- 
 tempt with which "love-mak- 
 ing" is usually treated is exceedingly unwise, 
 harmful and against divine appointment and a 
 wise public policy. The judicious and discreet 
 "match-maker" is a most useful person as is 
 witnessed in every Jewish community. 
 
 "Are you married, and if not, why not?" was 
 the pertinent inquiry by the great Chinese 
 
WHO IS INSANE? 115 
 
 statesman of many gentlemen and ladies to 
 whom he was introduced on his visit to this 
 country. Though regarded as a facetious ques- 
 tion and indicative of ignorance of the proprie- 
 ties of our social customs, it had a profound 
 significance when interpreted in the light of so- 
 ciology. As a suitable marriage is the true pre- 
 ventive, or remedial measure, of a vast number 
 of physical, mental and moral ills to which ado- 
 lescents are extremely liable, the principles un- 
 derlying this institution, sanctioned by the State 
 and solemnized by the Church, should be so in- 
 culcated by education, encouraged by society, 
 and sanctified by religion that marriage would 
 become obligatory on every adolescent, except 
 under conditions unfavorable to the individual 
 concerned, or against public policy. 
 
 The clear indication of treatment of this, as 
 of all similar intensive actions of a group of 
 nerve-cells, is the effort to divert the affections 
 from the unattainable object, which originally 
 interested them, and to concentrate them upon 
 other objects of as absorbing interest. Physio- 
 logically, this treatment involves the diversion 
 of nutrition from the over-stimulated nerve-cen- 
 tres to other inactive nerve-centres. The result 
 would be the gradual shrinking and diminution 
 of the function of the excited nerve-centres and 
 a compensatory activity of newly-aroused 
 nerve-centres. 
 
116 WHO IS INSANE? 
 
 How can this be accomplished? First, by 
 removal of, or from, the object on which the 
 affections have been concentrated, and every 
 thing or condition which suggests such object. 
 Second, by concentration of the thoughts upon 
 objects of interest entirely foreign to those 
 which originally created mental disturbance. 
 The methods of meeting these indications must 
 be adapted to the peculiarities of the individual 
 and the conditions in each case, but they are 
 innumerable both in quantity and variety. Ex- 
 cept in the case of a suicidal or homicidal per- 
 son, requiring custodial care and isolation from 
 the activities of life, the world abounds with 
 remedies, preventive and remedial, for "ado- 
 lescent insanity." 
 
VIII 
 Mm-LiFE 
 
yiii 
 
 Mid-Life 
 
 HE period in the life of woman be 
 tween the years of twenty and 
 forty-five and in the life of man 
 from twenty-five to fifty, may 
 well be called the "Mid-Life" of 
 each sex. With woman it is the 
 period of the creation of the 
 family, and with man it is the period of build- 
 ing and sustaining the home. With both it is a 
 period of physical and mental 
 The Time of stress and strain; of testing the 
 Testing inherited tone and temper of ev- 
 
 ery fibre of the constitution; of 
 patient endurance of manifold ills; of meas- 
 uring the amount and kind of vital forces — 
 "Stock in Trade" — ^with which they have been 
 endowed, and which they have conserved dur- 
 ing the treacherous period of adolescence. 
 
 Mid-life of a woman is beset with far more 
 incidents and accidents, which tend to impair 
 the integrity of her nervous system, than is the 
 case with her companion — man. The wonderful 
 
 119 
 
120 WHO IS INSANE? 
 
 mechanism that creates a living soul is her in- 
 heritance. On her alone fell the heavy penalty, 
 "in sorrow thou shalt bring forth children." She 
 alone endures the pains and perils of maternity, 
 and she alone — highly favored — experiences 
 its anticipations and its ecstacies. But at every 
 stage in its progress her nervous system is in a 
 state of tension requiring continued care and ef- 
 fort to maintain its normal equilibrium. 
 
 Occasionally, alas, when the crisis seems to 
 have been safely passed, the affective faculties 
 yield to the long-continued strain and the old 
 demoniacal possession recurs. The child, the 
 object of so much anticipated joy, is rudely 
 thrust from the breast that is giving it nourish- 
 ment, and all of the maternal instincts of affec- 
 tion are turned to hate and violence against the 
 innocent and helpless creation of her own blood 
 and body. 
 
 Fortunately, from this maniacal state the 
 mother usually rallies as the nerve centers of 
 the affections recover their energy and cast out 
 the demon of insanity. But frequently we meet 
 the wrecks of maternity in the wards of the asy- 
 lums, and sometimes in the pitiable condition 
 of dementia in which the sufferer gratifies the 
 still strong maternal instinct by carefully nurs- 
 ing a "rag-baby." 
 
 Another feature of Mid-Life in woman, tend- 
 ing in many temperaments to mental depres- 
 
WHO IS INSANE? 121 
 
 sion and melancholia, is the necessary isolation 
 which her duties in her home create. Man is a 
 "social, gregarious animal," says the philoso- 
 pher, and universal experience proves the truth 
 of the proposition. No man can live to himself 
 and develop all that is possible in his physiolog- 
 ical constitution. The recluse, the ascetic, the 
 man retired from business, suffers from atrophy 
 of large, unused sections of the brain, which 
 tends to mental feebleness and imbecility. 
 
 WE conclude that the decision of the Council 
 of Creation, "It is not good that the man 
 should be alone," applies with equal force to the 
 woman, who was made "an helpmeet for him." 
 
 It is painful to see so many 
 
 Woman's Need wives of farmers in the asy- 
 
 of Companionship lums and hospitals, most of 
 
 whom are suffering from 
 forms of mental depression. Their insanity is 
 usually traceable to some apparently unimpor- 
 tant event, but which was sufficient to unbal- 
 ance a nervous system already weakened by 
 long isolation from the tonic stimulant of social 
 intercourse. 
 
 The measures preventive of insanity in the 
 "Mid-Life" of woman, as suggested by our pre- 
 vious studies, are simply to treat the human 
 mother with the same care with which we treat 
 the brute mother, viz., protect her from worry. 
 
122 WHO IS INSANE? 
 
 fatigue, and undue excitement and disturbance, 
 supply the housewife with adequate means for 
 social enjoyments, as the telephone, magazines, 
 a library, neighborhood gatherings for enter- 
 tainment or cooperative labor, frequent holi- 
 days for sight-seeing and travel. It will, of 
 course, be alleged that the ordinary farmer, me- 
 chanic, tradesman, and laborer, cannot afford 
 the time nor the expense for indulgence in such 
 luxuries; but there is no force in such an ex- 
 cuse when we contrast the benefits, which cer- 
 tainly follow the adoption of some or all of the 
 above measures, with the consequences which 
 attend their omission. 
 
 The Mid-life of the man, who builds and sus- 
 tains a home amid the uncertainties of modern 
 competition in business, is constantly subjected 
 to a mental and physical strain that ought, ap- 
 parently, to terminate in a nervous break-down 
 of a large percentage. Does not the fact that so 
 few of the most active men in every department 
 of business become insane, prove that the integ- 
 rity of the brain-cells depends, like other tissues 
 of the body, largely on their functional activity? 
 We have amply demonstrated that the cell which 
 ceases to perform its accustomed function must 
 atrophy, or return to its rudimentary state. With 
 the modern business man there is no cessation 
 in the activity of the brain-cells devoted to his 
 business during his Mid-Life period, and hence 
 
WHO IS INSANE? 123 
 
 there is no lapse in their functions, no derange- 
 ment, no unsoundness, no insanity. It is 
 when conditions interrupt their functioning or 
 arouse other nerve-centers to an activity which 
 dominates all others, that the normal course of 
 thought and action indicates mental aberration. 
 How can the business man prevent insanity? 
 Certainly not by retiring from business, but by 
 so regulating its details as to cause the least 
 worry or anxiety. The business man who has 
 eight hours of uninterrupted dreamless sleep in 
 the twenty-four hours will maintain and sustain 
 — "other things being equal" — a sound mind in 
 a sound body. While, therefore, there are perils 
 in the liabilities to great disasters in business of 
 every kind, there is compensation in the power 
 of resistance which the nerve elements acquire 
 by constant stimulation to activity through con- 
 fact with opposing and contending forces. 
 
IX 
 
 Climacter 
 
IX 
 
 Climacter 
 
 LIMACTER is a technical word 
 which means a dangerous or 
 critical period of life, a period 
 in which some great change is 
 supposed to take place in the 
 human constitution. The older 
 writers attached much impor- 
 tance to these periods, but without having any 
 rational basis for their opinions other than im- 
 perfect observations. They re- 
 The Time duced these periods to a system of 
 of Crisis seven years each. They regarded 
 the years ending the third, fifth, 
 seventh, and ninth periods as climacteric — dan- 
 gerous, critical — because a great change takes 
 place in the constitution. The year ending the 
 ninth period of seven years — the sixty-third year 
 — was called the grand climacteric. Though 
 there is a physiological basis for some of these 
 periods, the changes in the constitution which 
 they are supposed to indicate occur so variably 
 as regards individuals that they have only a gen- 
 eral significance. 
 
 127 
 
128 WHO IS INSANE? 
 
 The true import of the "grand climacter," in 
 every person who reaches that period, is the be- 
 ginning of the atrophy or wasting, and return to 
 their dormant condition, of the nerve-centres on 
 which depends the perpetuation of the species. 
 Great as was the change in the nervous consti- 
 tution of the individual when these centres were 
 aroused to activity in adolescence, not less great 
 and disturbing is the change in the elements of 
 the brain structure and functions, and hence in 
 the mental and physical conditions of the same 
 person when their activity begins to decline. 
 
 THE rich currents of nutritive blood, now 
 diverted to other sensitive and susceptible, 
 but formerly passive centres. 
 New Centers may so change the mental char- 
 of Activity acteristics and conduct of the in- 
 dividual as to justify the verdict 
 of insanity. Or, again, if this diversion of blood 
 is to centres long active, they may be so over- 
 stimulated that the equilibrium is unbalanced 
 and traits of conduct and character, hitherto 
 normal, become so exaggerated as to change the 
 mental operations in a very marked degree. 
 
 The immediate effects of these changes is 
 most noticeable in the mental states of women. 
 An alienist author writes: "The affectiveness 
 changes in its object and greatest intensity 
 from the mate to the progeny, losing its imag- 
 
WHO IS INSANE? , 129 
 
 inative force, its fire, and its impulsiveness; po- 
 etry and love tales cease to have the power to 
 set the brain on fire; action of all kinds ceases 
 to be so pleasurable for its own sake; much of 
 the go is out of the person; the instinctive feel- 
 ing of difference of sex and all that it implies, 
 which has been all-pervading before, now les- 
 sens visibly; the subtile interest of the society of 
 the other sex is less electric and overmastering; 
 the form alters and the expression of the face 
 changes; the blood-forming and blood-using 
 processes slacken in speed; life becomes slower, 
 mentally and physically." 
 
 The same writer traces the development of 
 insane ideas during this period along these 
 lines: There is a loss of energizing power, bod- 
 ily and mentally; failure of courage; groundless 
 fears, which are at first known to be groundless; 
 annoyance from trivial things; dreamy, broken 
 sleep; dread of appearing in company, or in 
 public, no restful feeling, no contentment or 
 happiness. 
 
 These conditions may pass to more real and 
 continuous depression; the morbid fears assume 
 a more intense character, though they are often 
 still indefinite; the person is sure some evil 
 thing is going to happen but cannot tell what 
 it is to be; self-control is often lost, but more 
 frequently there is fear that it will be lost. There 
 are vague impulses towards suicide, sometimes 
 
130 WHO IS INSANE? 
 
 towards hurting children and friends, which 
 add to the terror and intensify the depression; 
 a conscious loss of affection, or, rather, a loss 
 of the pleasurable feeling, that conscious affec- 
 tion for the members of the family gives, is a 
 cause of the greatest distress. 
 
 In extreme cases suicidal feelings are strong 
 and attempts frequent, but the very loss of 
 courage and vigor of will operates against any 
 effectual attempts at suicide; hallucinations of 
 hearing are frequent. Finally, this condition 
 may pass into acute excited melancholia and 
 exhaustion, or it may become a chronic, shy use- 
 lessness or paralysis of power. 
 
 A lady forty-five years of age, mother of sev- 
 eral children, began to be depressed, then very 
 irritable and fault-finding. A feature of her 
 irritability was developed towards her hus- 
 band; she could neither endure his presence, 
 nor his absence; she drove him from her room 
 with violence and insulting language, and then 
 charged him with neglect while he was absent 
 and begged him to return, only to renew her 
 violence on the touch of his lips, though insist- 
 ing on kissing him. She was committed to an 
 asylum, but promptly threw herself from a win- 
 dow, receiving a profound shock and a broken 
 leg, followed by a severe hemorrhage. Prompt 
 recovery from her insanity resulted. 
 
 The remedy in this case was severe, but it was 
 
,WHO IS INSANE? 131 
 
 a repetition of the method of treatment followed 
 by the old-time practitioners, who believed that 
 nature indicated repeated blood-letting as the 
 proper treatment during the climacteric period. 
 It was also held by the ancients that a severe 
 shock to the nervous system was the kind of di- 
 version the patient required to restore mental 
 equilibrium — two remedies which this lady re- 
 ceived. 
 
 In a rude and general sense these indications 
 of treatment have a physiological basis 
 and are correct, and, when properly met, give 
 a measure of success, as in the case given in il- 
 lustration. The course of blood-lettings, so gen- 
 erally practiced but a score or two years ago, 
 are rarely required, as far more simple and 
 equally effective measures may be employed. 
 
 A CULTIVATED lady, the mother of a fam- 
 ily, had been devoted to the care of her 
 house from her marriage at twenty. Housekeep- 
 ng was with her a matter of absorbing interest, 
 even to the minutest detail. She 
 The Effect of was of an excitable temperament 
 Inactivity and any disturbance of her 
 household arrangements was the 
 source of great annoyance. At the age of forty- 
 five a change in her physical and mental condi- 
 tion was noticed by her friends. In family con- 
 sultation it was decided that she was suffering 
 from too much care of household affairs, and it 
 
132 WHO IS INSANE? 
 
 was proposed that the eldest daughter assume 
 the charge of the home and that the mother 
 should be completely relieved of her former du- 
 ties. 
 
 Accordingly the daughter began to assume the 
 position of mistress and the mother was required 
 to spend her days quietly and unoccupied in her 
 room, to retire early and rise late, and avoid ev- 
 ery form of household duty. At first the mother 
 accepted the situation and seemed pleased with 
 the change, but soon began to exhibit a train of 
 new symptoms. She became more wakeful than 
 usual, conplained of flashes of heat, headaches, 
 bad dreams; her complexion became sallow, 
 her appetite fickle. Her mental condition 
 changed; she was more easily annoyed, refused 
 to see friends, conversed with herself, feared 
 burglars and examined every door and window 
 at night. As time passed her feebleness and de- 
 pression increased, suspicions of persecution ap- 
 peared, and, later, she developed delusions of 
 hearing w^hich took the form of suggestions of 
 suicide and homicide. She was duly examined 
 by expert physicians, adjudged insane, and 
 committed as a dangerous lunatic. 
 
 The sequel of her case was very happy and in- 
 structive. The superintendent of the asylum to 
 which she was taken was a learned and expe- 
 rienced man in his specialty, and, withal, had 
 sound judgment and a large measure of good 
 
WHO IS INSANE? 133 
 
 sense. After a thorough examination of all the 
 facts in her history, and a careful study by prop- 
 er tests of her bodily condition, he advised that 
 she return home and be allowed to resume her 
 former household duties. He gave specific di- 
 rections to her attending physician to the effect 
 that the first and most essential feature of the 
 treatment was occupation of her thoughts with 
 her life-long duties; second, improvement of her 
 digestion; third, bathing, with well regulated 
 massage; fourth, excursions which should give 
 the greatest amount of diversion. 
 
 She did not enter the asylum, but returned 
 home, and the treatment recommended was 
 faithfully followed. The result was most fa- 
 vorable; the patient readily resumed her house- 
 hold duties and at once ceased to complain; the 
 physician corrected errors in her diet so that her 
 nutrition rapidly improved; the bathing and 
 massage were enjoyed after a brief trial, and the 
 out-door exercise diverted her thoughts to nat- 
 ural objects, which tend powerfully to quiet a 
 mind disturbed by insane ideas. 
 
 The lessons which we learn from a study of 
 the physiological changes of the nervous system, 
 and the consequent mental disturbances at the 
 climacteric periods, are so closely related to the 
 final decadence of all of the tissues of the body 
 that the peculiarities of what is familiarly 
 known as "old age," or the post-climacteric pe- 
 riod, requires our study in this connection. 
 
X 
 
 Old Age 
 
Old Age 
 
 LD age, the period of decadence, 
 physiologically begins with the 
 passing of the climacter. What 
 is its significance? In the av- 
 erage person it means the de- 
 cline of all of the physical 
 forces and functional activities. 
 For two-score years the nervous system has 
 been aflame with passion, fervor and ambition; 
 the bodily temperature has been at 
 The Time fever heat; the heart has throbbed 
 of Decline with tremendous energy; every mus- 
 cle has been keyed up to its utmost 
 tension; every sense-organ has been keenly 
 alive to impressions. Now the fires begin to 
 slacken, the fever declines, the heart slows 
 down, the muscles relax, the senses become dull. 
 Sadness, like a malarial chill, creeps along the 
 nerves. The long-active nerve-centres, now un- 
 used, shrink and undergo loss of vitality; the ar- 
 teries become brittle by changing to bone, or 
 soft and weak by deposits of fat; the joints stif- 
 
 137 
 
138 WHO IS INSANE? 
 
 fen from want of the lubrication that comes of 
 constant use; the senses — sight, hearing, smell, 
 taste, touch — decline in proportion as they cease 
 to be actively employed. 
 
 The rush of business, the clash of rivalry, the 
 heat of contention no longer stimulate to activ- 
 ity, but rather increase the desire for quietude, 
 repose, retirement. The arm-chair in the cozy 
 corner, the smoking cap, the dressing gown and 
 easy slippers, meet every want. Eating, drink- 
 ing, smoking, sleeping are the favorite pastimes. 
 The body becomes over-laid and over-weighted 
 with fat, and every organ — heart, liver, kidneys 
 — is clogged with waste. 
 
 All of these conditions tend inevitably to that 
 degeneration of brain tissues which terminates 
 in dementia, or paralysis. The approaches of 
 the former, says an author, will begin in slight 
 failure of mind, slight change of character, and 
 slight loss of muscular strength and accuracy of 
 muscular adjustment, proceeding, sometimes 
 faster and sometimes slower, with occasional 
 temporary improvement, to complete demen- 
 tia, and helplessness. Paralysis, due to effusion 
 of blood from a ruptured artery of the brain, 
 will, on its first occurrence, be slight, as the ar- 
 tery is small; the second stroke will be more se- 
 vere, as the artery is larger; and the third will 
 probably be fatal for the same cause. Truly 
 "we are all built that way." 
 
WHO IS INSANE? 139 
 
 BUT is there no obverse side of this picture? 
 Have we no power of retarding, if not pre- 
 venting, the degeneracies and consequent insani- 
 ties of old age? A very pertinent answer was 
 
 given by a nonagenarian phy- 
 Can We sician to one who inquired by 
 
 Remain Young? what mode of living he main- 
 tained a high degree of health 
 at such a great age: "I have always kept my 
 brain and stomach in good repair and very 
 busy." This answer was characterized by good 
 sense and it embodied two physiological truths 
 very compactly stated. The brain, the source of 
 vital energy, and the stomach, the source of nu- 
 trition, maintained in a state of functional ac- 
 tivity, are capable of retarding the decadence 
 of old age. 
 
 An ingenious physiologist explains the phe- 
 nomena of old age in terms that give point to 
 the nonagenarian's rule of living, as follows: 
 "A healthy, well nourished human body is main- 
 tained in that condition only when each cell- 
 structure is performing its normal or physio- 
 logical function. In proportion as that func- 
 tion diminishes, the cell shrinks and wastes. 
 The powerful arm of the blacksmith soon with- 
 ers to helplessness when placed in a sling, ow- 
 ing to the diminution of the blood-supply to its 
 nerve and muscle cells, but if the normal use of 
 the arm is restored these cells soon resume their 
 activity by the increased nutrition." 
 
140 WHO IS INSANE? 
 
 Bandage the eyes, and the nerve and nerve- 
 centre of sight will waste until blindness en- 
 sues. Restore the light, the natural stimulus 
 of the nerve-centre of sight, and its cells at once 
 begin to resume their activity, and through the 
 increased flow of blood which results, they 
 enlarge to their natural size and their functions 
 are fully restored. 
 
 A surgeon of great eminence determined to 
 retire to the country at the age of sixty and en- 
 joy the remainder of his life in the quiet and 
 leisure of rural scenery. He had been very suc- 
 cessful in his profession, to which he had de- 
 voted every energy of body and mind for a gen- 
 eration. He was a popular teacher in the med- 
 ical college, an author of great repute, and took 
 rank in society among the first citizens. He pur- 
 chased a large and well appointed estate and 
 with much ceremony and publicity retired 
 from business and entered upon his new mode 
 of living. 
 
 All the conditions of his daily life were 
 changed. The very stillness of the country pre- 
 vented sound and refreshing sleep. He arose 
 in the morning, depressed by the thought that 
 no patients would call and at a loss how he 
 could employ his time. Walking soon became 
 irksome, riding tedious and very tiresome, the 
 affairs of his estate were uninteresting because 
 the details were unfamiliar. He became irrita- 
 
WHO IS INSANE? 141 
 
 ble, morose and melancholic; delusions of con- 
 spiracies against his person and property fol- 
 lowed, and scarcely a year elapsed before he 
 was pronounced of unsound mind, and unable 
 to manage his estate. 
 
 His son-in-law, also a surgeon of repute, be- 
 came his guardian. Believing that the break- 
 down of the father-in-law was due to an ab- 
 rupt change of occupation, the young surgeon 
 restored him to his former office. His old pa- 
 tients returned, and scarcely a week passed be- 
 fore the senior surgeon was himself again. 
 
 THE plain, practical lesson, which this, and 
 thousands of similar cases, teach, empha- 
 sizes the physiological truth that those who 
 reach the border-land of old age and begin to 
 suffer the sadness incident to 
 Remain Active the depression of the vital 
 in Old Age forces should strive to keep ev- 
 ery organ of the body attuned 
 to its normal functional activity. Retirement 
 from business at this period, to enjoy the fruits 
 of a life of toil, is to turn one's face towards the 
 cemetery to which he will hasten with ever 
 quickening step. 
 
 The asylums number among their insane in- 
 mates aged, helpless dements and imbeciles, by 
 the score, who could have enjoyed a vigorous 
 old age had they not passively yielded to the de- 
 
142 WHO IS INSANE? 
 
 pressive influences which attend the abatement 
 of the vital forces at sixty. The brain, the 
 source of vitality, and the stomach, the source 
 of nutrition, maintained in good repair and 
 healthy activity at oinety, are rational philoso- 
 phy and sound physiology. No one can grow 
 old or be old while these two organs are in good 
 condition. 
 
 Victor Hugo stated that when he reached the 
 age of sixty years he was seized with a sadness 
 which made him very miserable, but he pressed 
 forward with his daily tasks with unabated 
 vigor. At seventy he recovered all of his for- 
 mer buoyancy of spirits and life, and was as full 
 of brightness and happiness as in his boyhood. 
 Reflecting upon this peculiar change of feeling 
 and outlook upon life, he came to the conclu- 
 sion that at sixty he entered upon the old age 
 of youth, but at seventy he entered upon the 
 youth of old age. 
 
 The experience of the great French writer, 
 who continued activity at his life-work far be- 
 yond the allotted period of life, should impress 
 the lesson that the best protection against the 
 dementias and imbecilities of old age is the 
 maintenance of the healthy functions of the 
 brain and stomach. We often hear of per- 
 sons who grow old gracefully. They are the 
 energetic class, who never retire from the activ- 
 ities of life in one form or another. With them 
 
WHO IS INSANE? 143 
 
 there is no climacter, or change of life, but the 
 current runs smoothly on, ever widening, ever 
 deepening, until it is lost in the ocean of eter- 
 nity. 
 
 Whittier was several years the senior of 
 Holmes, and when the former reached the age 
 of eighty, the latter, in a witty poem, inquired 
 as to the outlook from that dizzy height. Whit- 
 tier replied in the same strain, giving a glowing 
 account of the scenery from that view-point 
 and urged Holmes to hasten up the steep as- 
 cent and enjoy with him the glorious prospect, 
 assuring his friend that there would be no more 
 climbing as the path, radiant with the dawn of 
 the life beyond, had a gentle descent to the river. 
 
 We conclude, therefore, that, although "we 
 are built that way," we may escape the insani- 
 ties of childhood, adolescence, climacter, and 
 old age, if we strictly comply with the physio- 
 logical laws governing the evolution of the body 
 during these periods. 
 
 By taking heed to our ways we may peace- 
 fully and happily pass through the sixties; at 
 three score and ten, realize the joys of a re- 
 newal of life with Victor Hugo; at four score 
 view the future with the serenity of Whittier; 
 and if we keep the brain and stomach busy, we 
 may pass, with the nonagenarian physician, 
 into the nineties; and thence, by Grace, with the 
 last words of Sir Henry Irving on our lips : "Into 
 Thy Hands, Lord." 
 
XI 
 
 The Prevention of Insanity 
 
XI 
 
 The Prevention of Insanity 
 
 E conclude, therefore, that "we 
 are built that way," and but 
 for certain conservative or 
 inhibitory forces, inherent in 
 the constitution of the brain- 
 cells, we should be liable 
 at any moment to become so 
 "deranged," "strange," "peculiar," as to be ad- 
 judged insane. It is only necessary, indeed, that 
 a group of cells should become 
 The Liability so disturbed in their operations 
 to Insanity that they control the person's 
 mentality, to raise the question 
 of sanity. This may happen on the instant, 
 when some exciting cause, to which the cells are 
 intensely susceptible, overwhelms the brain 
 with its disturbing force. Generally, however, 
 the change is slow and often very insidious, and 
 may not be detected for a considerable period. 
 To discover the first departure from the path 
 of normality, and the inducing cause, may be 
 a very simple or a very difficult act. In either 
 
 147 
 
148 WHO IS INSANE? 
 
 case the first aberrations are frequently lim- 
 ited to a single, and, perhaps, obscure function 
 of the brain. Gradually other affiliated nerve- 
 cells become involved, and, finally, the mental 
 expressions show that large sections of the 
 brain have become tainted with the original in- 
 fection. Shakespeare traces the progress of the 
 insane ideas thus ; 
 
 "And he repulsed (a short tale to make). 
 Fell into a sadness, then into a fast; 
 Thence to a watch; thence into a weakness; 
 Thence into a lightness ; and, by this declension, 
 Into the madness whereon he now raves." 
 
 HOW the harmony of functions of the brain- 
 cells may thus be disturbed by natural con- 
 ditions in the life of every one, what are the 
 causes of such disturbance, and by what signs 
 
 and symptoms they may be 
 
 The Prevention recognized at the earliest pos- 
 
 of Insanity sible moment, are questions of 
 
 immense and pressing impor- 
 tance to parents, teachers and individuals. If 
 these questions were affirmatively answered, so 
 as to be thoroughly understood by the general 
 public, such preventive measures could be 
 adopted in the home-training of children, in the 
 education of youths, and in the personal living 
 and conduct of the masses of the people, that 
 
WHO IS INSANE? 149 
 
 our asylums would be depopulated by depriving 
 them of fresh recruits. 
 
 The parent would detect in the evolution of 
 the physical constitution of the child the first 
 evidences of an abnormal development of any 
 given class of nerve-cells, and would quietly, but 
 promptly, adopt proper measures to secure their 
 repression. The instructor could not fail to dis- 
 cover and appreciate the most subtle mental pe- 
 culiarities of his pupils, and, with the abundant 
 means at his command, he could effectually 
 counteract their incipient tendencies. And, 
 finally, each person could intelligently interpret 
 the true significance of any and every passion, 
 propensity, habit, thought, emotion which in- 
 fluenced or controlled his acts. 
 
XII 
 
 The Susceptibility of the Insane to Curative 
 
 Measures 
 
XII 
 
 The Susceptibility of the Insane to Curative 
 
 Measures 
 
 HILE the extreme sensitiveness 
 of the brain-cell to impressions, 
 both from external objects 
 through the medium of the five 
 sense-centres, and from dele- 
 terious substances circulating 
 in the blood (auto-intoxica- 
 tion), tend powerfully to cause deranged men- 
 tal action, the same condition is fortunately 
 
 very favorable to its 
 
 Brain-cell Sensitiveness 
 Favorable to Cure 
 
 recovery. We are 
 often surprised at the 
 slight and unimpor- 
 tant circumstance or occurrence that so dis- 
 turbed the equilibrium of the brain as to 
 require the commitment of a person to an 
 asylum, and, quite as frequently, we are not less 
 surprised at the simple and unimportant inci- 
 dents which often change the mental operations 
 of the insane and restore their sanity, or so far 
 relieve them of any disturbing or dangerous 
 
 153 
 
154 WHO IS INSANE? 
 
 tendencies that they may no longer require cus- 
 todial care. The following cases came under 
 observation : 
 
 THIS incident occurred in the life of a dis- 
 tinguished public man and famous orator, 
 who became melancholy owing to an incident 
 reflecting upon his character. He finally refused 
 food, was wakeful and restless, and began to 
 wander from home. Commitment to an asylum 
 followed. On entering he was greatly emaciated, 
 
 talked incoherently about 
 Cured by a Bowl the conspiracy formed to 
 
 of Hot Soup ruin him, slept little, re- 
 
 sented every effort to con- 
 trol his movements, and finally became violent 
 at times. Worry and consequent insomnia and 
 inanition had exhausted his brain-cells, and 
 without proper care dementia would have re- 
 sulted from the inevitable atrophy of these cells, 
 from which he would never have recovered un- 
 der the ordinary routine treatment of the asy- 
 lum. 
 
 "I protest!" said the patient as he arose in bed 
 and with much deliberation drank the bowl of 
 hot, rich soup. The asylum physician had care- 
 fully examined him on admission and con- 
 cluded that he was suffering from exhaustion 
 due to want of proper nourishment. Accord- 
 ingly, he had a bowl of nourishing soup pre- 
 
WHO IS INSANE? 155 
 
 pared and brought to the bedside and the pa- 
 tient was directed to take it. He promptly and 
 with great emphasis declared he would not 
 under any circumstances. On the failure of re- 
 peated efforts to persuade him to drink the 
 soup, the physician assumed an appearance of 
 determination to compel him to obey. 
 
 He ordered an attendant to bring a stomach 
 pump and an assistant. On their arrival the 
 superintendent, holding his watch in his hand, 
 looked sternly into the face of the patient, and 
 said: "I will give you just five minutes to 
 drink the soup, and if you do not I shall pass 
 this tube into your stomach and pump the soup 
 into it." The physician then called, "One min- 
 ute! two minutes! three minutes! four min- 
 utes!" when the patient arose, and, taking the 
 bowl in both hands, said in a dramatic manner, 
 "I protest!" then drank the liquid. 
 
 The effect was as anticipated. After some 
 excitement sleep ensued. This was the firsf 
 nourishing food and refreshing sleep that he 
 had had in many months. He awoke after sev- 
 eral hours and realized his condition. His re- 
 covery was rapid and complete, and he contin- 
 ued of sound mind until his death many years 
 later, of an acute disease. 
 
 B 
 
 ELIEF that he was immune against arsenic 
 led to the discharge of a paranoiac as recov- 
 
156 WHO IS mSANE? 
 
 ered. He was an old man very much emaciated 
 and feeble, who begged piteously to be dis- 
 charged from the asylum. His 
 Cured by a chief complaint was that arsenic 
 Suggestion was put in his food and that he 
 was suffering for the want of 
 proper nourishment, which was evident from 
 his appearance. As he said he could show me 
 the arsenic in his food, I visited his table at the 
 dinner hour and he pointed with great excite- 
 ment to a greenish tint on the fried eggs, and 
 declared that it was arsenic. After dinner I had 
 an interview with him. "What would you do if 
 you had such food regularly given you?" he in- 
 quired. "Eat it," was my reply. "What! allow 
 yourself to be killed by these conspirators? Not 
 much!" he said. I assured him that arsenic was 
 not poisonous in small doses, such as appeared 
 on his food; that a great many ladies took it to 
 improve their complexion; that some persons 
 are immune against the effects of poisons; that 
 he appeared to be one of that kind; that it was 
 well worth the risk of a trial, for if he proved to 
 be immune, and ate his meals regularly, never 
 alluding to poisons again, he would soon be dis- 
 charged; but that if he persisted in refusing his 
 food, because it was poisoned, he would never 
 leave the asylum alive. 
 He was greatly impressed with the statement 
 
WHO IS INSANE? 157 
 
 that a person could be immune against such a 
 poison as arsenic. He hesitated some time to 
 make the trial but at length he yielded, on my 
 assurance that he was undoubtedly immune 
 and that he would secure his discharge if he ate 
 regularly and never again mentioned the word 
 poison. 
 
 On visiting this asylum several months later 
 I found this patient at work in the "Cook 
 House." He was bright and cheerful and his 
 face shone with fatness. He had found that he 
 was immune against arsenic, ate all his food 
 with a relish and was enjoying excellent health. 
 
 On parting with him he cautioned me not to 
 mention the word "poison" to the Superintend- 
 ent, as the latter had promised him his dis- 
 charge on the following Monday and he never 
 wished that word used again for fear it would 
 lead to his detention. Approaching me cau- 
 tiously and whispering in my ear he said, 
 "Since I came to the Cook House I have learned 
 just how they do it, for I see them put the ar- 
 senic in the food." Nevertheless his belief that 
 he was immune against arsenic led to the dis- 
 charge of this paranoiac as recovered. 
 
 ANIGHT spent with the insane effectually 
 cured an incipient case. The patient was a 
 young man who gradually exhibited symptoms 
 
158 WHO IS INSANE? 
 
 of derangement, and finally became so dis- 
 turbed that his family were 
 Cured by a alarmed. By the advice of the f am- 
 
 Shock ily physician he was taken to the 
 "Insane Pavilion" at Bellevue Hos- 
 pital, New York. He passed a sleepless night ow- 
 ing to the disturbance of his companions. In the 
 morning he begged to be taken home and prom- 
 ised never to repeat his previous conduct. He 
 declared that he was so shocked at what he saw 
 that he began to think, "Is this what I am com- 
 ing to? I will change my life here and now." 
 He was able to control himself thereafter, under 
 the influence of that night's experience, and re- 
 mained sane during his lifetime. 
 
 "Can a paretic — a person suffering from 
 'general paralysis' — recover?" was an inquiry 
 made of a superintendent distinguished as an 
 accurate diagnostician. He replied: " I was 
 formerly of the opinion that paresis was an ab- 
 solutely fatal disease, but a case under my ob- 
 servation unsettled my belief in its incura- 
 bility. He then related in substance the follow- 
 ing particulars: 
 
 A man was admitted to this asylum whose 
 history gave a complete clinical record of pare- 
 sis. His disease progressed as a typical case of 
 that trouble until it seemed to have reached its 
 final stage, and a fatal convulsion was antici- 
 pated at any time. The patient's wife was then 
 
WHO IS INSANE? 159 
 
 notified of his condition and she visited him for 
 the purpose of removing him to his home in ful- 
 filment of a promise she had made him, when 
 he consented to enter the asylum, that she 
 would never allow him to die elsewhere than in 
 his own home. 
 
 She was informed that it would be very un- 
 wise to remove him, as he could not possibly en- 
 dure the journey of twenty miles. She insisted, 
 however, even if he should die on the way. Con- 
 sent was finally given on her assuming all re- 
 sponsibility, and every effort was made to ren- 
 der his transportation comfortable and to pro- 
 vide her with the means of meeting any and 
 every emergency. 
 
 DURING the long journey he remained in a 
 semi-conscious condition, occasionally tak- 
 ing such food and stimulants as she gave him. 
 On approaching his home, his house suddenly 
 
 came into view from a hill-top. 
 
 Cured by a when he became excited and 
 
 View of Home attempted to speak and rise 
 
 from his seat. On her inquiry 
 as to the cause of his excitement he muttered, 
 with, great effort, "Is not that my house?" From 
 that moment he began to recover. The superin- 
 tendent, one of the most distinguished in the 
 country, added: "To-day he ranks as the best 
 farmer in his county, as he takes the largest 
 number of prizes at the annual fairs." 
 
160 WHO IS INSANE? 
 
 This case is not related to illustrate the possi- 
 ble curability of paresis at an extreme stage of 
 its progress, but rather to show the effect of 
 arousing to activity nerve-centres, long dor- 
 mant, by change of environment. Though there 
 may have been an error of diagnosis, the fact 
 remains that this man was believed to be in the 
 last stage of a fatal disease and that his recov- 
 ery dated from a new stimulus to his brain by a 
 view of his house. The lesson which we learn 
 is that the cases of insanity apparently most 
 hopeless should not be abandoned. ^ 
 
 THIS is a Lunatic Asylum and not a Sanita- 
 rium, which they said I was to come to. I 
 want to go home. Do you know how to get out of 
 this place?" This was the greeting which the 
 visitor received on entering the 
 Cured by disturbed ward of an Asylum. 
 Good Advice The patient, who had just been 
 admitted, was a young man, in- 
 tensely excited, much emaciated, with hair dis- 
 heveled, eyes protruding, arms thrown wildly 
 about, voice hoarse from screaming. He was 
 the picture of one suffering from acute mania, 
 for which he was admitted. 
 
 As he rushed up to the visitor and asked the 
 above question the latter was seized with an 
 impulse to attempt to quiet him, and placing 
 his hand on his shoulder in a familiar manner 
 
WHO IS mSANE? 161 
 
 whispered in his ear, "Yes, I know how to get 
 out of here, but I should not dare tell you as 
 you speak so loud that the attendant might learn 
 what I had done and would have me locked up." 
 He immediately became quiet and begged my 
 pardon in a whisper, declaring that he would 
 keep the secret if I would help him escape. 
 
 Taking him into a private room I expressed 
 my doubts as to his being a proper person to 
 whom I should reveal the secret; that he must 
 first give me an accurate account of his life and 
 all of the circumstances which led to his being 
 committed. He related a series of business 
 transactions which had greatly disturbed him, 
 culminating in an incident which led him to be- 
 lieve that his wife was unfaithful to him through 
 the influence of the Catholic priest. This event 
 was the climax of his efforts to control his acts 
 and for a fortnight, or until brought to the Asy- 
 lum, he said. "I painted the village black as 
 h — 1." The last shock to his nerve-centres, ex- 
 hausted from want of sleep and nutrition, was 
 to find that he had been deceived by his friends 
 by being placed in a Lunatic Asylum instead of 
 a Sanitarium. 
 
 A few words of comment on his nervous con- 
 dition, an explanation of the events which so 
 disturbed him, and an emphatic denial of the 
 construction which he put upon his wife's con- 
 duct, and the added charge that he had evi- 
 
162 WHO IS insane' 
 
 dently treated her shamefully and cruelly, broke 
 him completely down. With tears and sobs he 
 acknowledged his mistakes and asserted with 
 great earnestness, "I see that I have been a d — d 
 fool from the start." 
 
 Promising to strictly follow advice, he was 
 directed in detail how to conduct himself, viz., 
 be very quiet, very clean and well dressed; keep 
 his room in perfect order; constantly assist the 
 attendant in all of his ward work; endeavor to 
 preserve order among the patients by his exam- 
 ple and kindly attention to their wants, 
 show no irritation or resentment in his 
 treatment by patients. He was assured that he 
 would be discharged within a week if he fol- 
 lowed strictly the rules of conduct prescribed. 
 
 On visiting the Asylum two months after this 
 interview it was found that he was discharged, 
 "not insane," on the fourth day after admission. 
 On calling the attention of the Superintendent 
 to his case he remarked that the physician who 
 committed him made a very grave mistake, for 
 though much disturbed on entering the Asylum 
 he soon quieted down and proved to be the best 
 worker and most useful man about the place. 
 Frequent inquiries in regard to him after his re- 
 turn home showed that he had continued per- 
 fectly well. 
 
 What saved this man from becoming a per- 
 manent resident of the Asylum? He entered a 
 
WHO IS INSANE? 163 
 
 complete "nervous wreck" and was in a frenzy 
 on finding that he was in a "Lunatic Asylum" 
 instead of a Sanitarium; he was assigned to the 
 "disturbed ward" where fifty or more inmates 
 similarly affected terrified him with their rav- 
 ings; no officer ir?id inquired into the peculiari- 
 ties of his case and kindly advised and encour- 
 aged him, nor in the ordinary course of treat- 
 ment was he likely to receive such attentions at 
 any time. Undoubtedly the quiet, friendly in- 
 quiry into the events which led to his commit- 
 ment, an explanation of their significance with 
 impressive firmness, and advice as to his con- 
 duct to secure prompt release, led to his imme- 
 diate discharge, saved the State from the ex- 
 pense of his support for fifteen years, the aver- 
 age life-time of inmates of Asylums; and, final- 
 ly, returned to his home in sound mind its sup- 
 porter and protector. 
 
 INSANE Women Go Shopping," is the start- 
 ling headline of a daily paper. It appears 
 that the Superintendent of an Insane Asylum 
 was impressed with the belief that diver- 
 sion would aid in curing the insane, and put his 
 theory to the test by allowing sixty women pa- 
 tients suffering with milder forms of mental 
 disturbance to visit a department store. The 
 first party consisted of twenty patients and is 
 thus described. 
 
 "Two attendants were in charge of the shop- 
 pers. Their uniforms were left behind and they 
 
164 WHO IS INSANE? 
 
 abandoned as far as possible all tokens of au- 
 thority. 
 
 "Mingling in the crowds down town and in 
 the big stores, the patients and attendants were 
 swallowed among thousands of other women 
 bent on the same mission. The patients pur- 
 chased with a keen regard to appearance and 
 value, just as their normal sisters were buying 
 all about them. Apparently the saleswomen 
 noted nothing unusual in their demeanor. 
 
 "Laughing, chatting, haggling with the sales- 
 women, they spent their time and money all too 
 soon. They were loath to return when dark- 
 ness found them still at the counters buying 
 what they could and admiring the much greater 
 treasure of what they could not purchase. 
 Above all, they were impressed with the novelty 
 of a moving stairway in a big department store. 
 Some, timid at first, became frequent passen- 
 gers on this stairway and left the store grudg- 
 ingly." 
 
 The Superintendent says of the experiment: 
 "Such recreation as that afforded by a day in the 
 stores is a valuable part of the treatment for the 
 insane. Just as normal persons are better merry 
 than moody, so are my charges improved by 
 anything that pleasantly occupies their minds 
 while at the same time not exciting their 
 nerves." 
 
WHO IS INSANE? 165 
 
 The most impressive lesson which my expe- 
 riences among the insane taught was the 
 vast importance of a thorough examination of 
 the patient by a competent person at the earUest 
 
 possible period. Thou- 
 Importance of sands are admitted to 
 
 an Early Examination the institution, classi- 
 fied and assigned to 
 wards, merely on the statement of the certifying 
 physician in the commitment papers which ac- 
 company the patient. In the wards they are 
 subject only to the general observation of the at- 
 tendant, in connection with fifty or more who 
 constantly require his care. 
 
 Long periods often elapse before a case at- 
 tracts the special attention of the medical offi- 
 cer, if, indeed, at any time his interest is suffi- 
 ciently excited to induce him to deliberately 
 study the case exhaustively. And yet untold 
 numbers of insane might be immediately placed 
 under conditions which would result in quick 
 recovery if their physical condition was under- 
 stood and all of the circumstances of their ner- 
 vous break-down were exactly determined. 
 
PART THREE 
 
 THE CARE AND TREATMENT OF THE 
 
 INSANE 
 
XIII 
 Mechanical Restraint 
 
XIII 
 
 Mechanical Restraent 
 
 HE treatment of the insane 
 forms one of the saddest chap- 
 ters in the history of the ev- 
 olution of human society. It 
 is one continued record of 
 savagery down to our own 
 times. Indeed, we have scarce- 
 ly passed from under the shadows of the 
 pernicious influence of the belief in the demo- 
 niacal possession of the insane, to 
 A Sad which we may trace most of the cru- 
 Chapter elties practiced upon them. That su- 
 perstition was discarded long ago, but 
 its results, in the barbarous treatment of the in- 
 sane, have been an inheritance which clings to 
 us with a tenacity that often controls public pol- 
 icy. But we are making manifest progress in 
 our better care of the insane, and, fortunately, 
 under the safe and sane guidance of science and 
 the humanitarian spirit of the age. 
 
 Reviewing the dominating forces in the care 
 and treatment of the insane in the past, and at 
 
 171 
 
172 WHO IS INSANE? 
 
 present, and forecasting them for the future, 
 we should give for the past, Mechanical Re- 
 straint, for the present. Custodial Care, and for 
 the future. Curative Treatment, 
 
 It is along the lines of such a characteriza- 
 tion that The question of care and treatment of 
 the insane can be most intelligently considered. 
 
 Mechanical restraint, as a recognized method 
 of treatment of the insane, ceased during the 
 years 1882-1888. When I performed the duties 
 of State Commissioner in Lunacy every form 
 of appliance for the restraint of the disturbed 
 insane was to be seen in constant use. They 
 were found in manacles, in "stocks," in dun- 
 geons, chained to posts, strapped in bed, etc. 
 
 IN one alms-house a man was daily brought out 
 of a stall in an out-building, where he had 
 been confined twelve years, arms pinioned and 
 led by his keeper precisely as a dangerous ani- 
 mal is treated. Meantime, an- 
 Treated Like other man cleaned the stall and 
 Animals supplied fresh straw for his bed. 
 In another alms-house seven 
 women were found in separate stalls in a bar- 
 rack in a state of indescribable filthiness. Their 
 attendant, or keeper, as he was called, was a de- 
 mented man, who could scarcely answer a ques- 
 tion. 
 
 In the State and private asylums the methods 
 
WHO IS INSANE? 173 
 
 of restraint were comparatively mild, as con- 
 finement in isolation rooms, the restraining 
 sheet, the straight-jacket. The exceptional 
 method of restraint was the famous "Utica 
 Crib," which, owing to the heated discussion for 
 and against mechanical restraint, obtained a 
 world-wide reputation. 
 
 It consisted of a box-bed with a movable 
 slat-cover which prevented the patient from 
 rising and was designed for meeting the neces- 
 sity of maintaining in a recumbent position fee- 
 ble inmates who persisted in walking about the 
 halls. This device took the place of confine- 
 ment in bed by means of straps, or other means. 
 It was a harmelss affair in that it could do the 
 patient no physical injury; and when used for 
 the purposes for which it was originally made, 
 was very beneficial. On a visitor who saw the 
 patient through the slatted cover the impression 
 was liable to be that the inmate was being tor- 
 tured, and this opinion was likely to be con- 
 firmed by the patient's complaints and urgent 
 request to be relieved. 
 
 The era of Mechanical Restraint was neces- 
 sarily characterized by the violence of the in- 
 mates of asylums, the rudeness of attendants, 
 and absence of the close supervision of the 
 officers. A disturbed patient safely restrained 
 by whatever means was angry and resentful, 
 the attendant who had struggled to place him 
 
174 WHO IS INSANE? 
 
 in restraint was elated at his success, however 
 rudely he may have handled him, and the phy- 
 sician in charge no longer feared an outbreak, 
 and therefore his anxiety ceased. 
 
XIV 
 
 Custodial Care 
 
XIV 
 
 Custodial Care 
 
 HE records of many institutions 
 for the insane show that by 
 present methods of treatment 
 one-fourth in general, and one- 
 third at best, are discharged 
 from the asylums cured. And 
 those reported cured seldom 
 recover because of any special treatment 
 adapted to their individual cases. "They just 
 get well," said a Superintend- 
 Inadequacy of ent. And it is little less 
 Present Method than a miracle that even one 
 recovers his normal mental 
 equilibrium amid the distractions of the ordi- 
 nary asylum. 
 
 But in considering the question of the cura- 
 bility of the insane it is a most encouraging fact 
 that one-fourth of those committed as insane 
 actually recovered under conditions which tend 
 powerfully to unbalance a sound mind. It is a 
 striking proof of the inherent capacity in the 
 cell to revert, after being disturbed, to its nor- 
 
 177 
 
178 WHO IS INSANE? 
 
 mal state. This power and disposition of the 
 cell to resume its original function, when the 
 disturbing cause is removed, has been shown to 
 be one of its most important features in con- 
 serving and maintaining its integrity. 
 
 Another peculiarity of the cell must be con- 
 sidered, viz., that when a cell is functionally de- 
 ranged it tends to derange other cells in imme- 
 diate relation with it, as occurs in anv mechan- 
 ism. Hence, the importance of the earliest pos- 
 sible cure. 
 
 The practical question which the preceding 
 facts suggest is. How can the policy of the State 
 in the management of its institutions for the in- 
 sane be changed so as to enable them to increase 
 largely the ratio of cured, or, in other words, 
 to render them curative as well as custodial? 
 
 In all the conditions which pertain to the 
 physical health and comfort of the inmates 
 these institutions are amply equipped, but for 
 custodial rather than curative purposes. And 
 in all of the details of management as custodial 
 institutions there is, only exceptionally, any just 
 ground of criticism. The governing commis- 
 sion and the local managers are usually ap- 
 pointed with due discrimination as to qualifica- 
 tions. The Medical Staffs take high rank in 
 the profession and perform their official duties 
 with skill. 
 
 Nor can these institutions be condemned for 
 
WHO IS INSANE? 179 
 
 failure to treat the inmates humanely. The most 
 constant complaint of the insane is cruel treat- 
 ment. The forms of cruelty alleged are of ev- 
 ery variety, from merely refusing the discharge 
 of inmates to gross kinds of corporal pun- 
 ishment. The investigation of these ever-re- 
 curring complaints of ill-treatment by patients 
 and their friends established the fact that the 
 insane are peculiarly liable to construe every 
 act of restraint or discipline as a form of per- 
 sonal abuse. Nor is it difficult to explain this 
 tendency. As a class the insane are intolerant 
 of restraint of any and every kind. They resent 
 all interference with their personal liberty. The 
 supervision and discipline required and en- 
 forced in institutions are rarely submitted to 
 without mental disturbance, taking the form 
 often of physical struggle. If the attendant re- 
 sorts to any force, however mild and harmless, 
 the patient is thrown into a paroxysm of rage 
 which requires force on the part of the attend- 
 ant to control. This necessary effort of the at- 
 tendant is always construed as an assault. 
 
 Although it is a fact that the insane in 
 asylums are sometimes too rudely treated, and 
 occasionally unjustly assaulted, yet a careful in- 
 quiry as to the truth of a large number of com- 
 plaints satisfactorily proved that such occur- 
 rences are infrequent, and usually result from 
 attacks of patients upon attendants, who lose 
 
180 WHO IS INSANE? 
 
 self-control, or from the violent resistance of 
 patients to the rules and regulations of the asy- 
 lums. Indeed, the comparatively small number 
 of cases of abusive treatment which were proved 
 to be cruel and unprovoked by the conduct of the 
 patients was a most gratifying surprise. 
 
 KNOWING from long experience how diffi- 
 cult is the task of securing a class of attend- 
 ants upon the sick in general hospitals, who will 
 always be patient, cheerful, attentive, and con- 
 siderate to the persons in 
 Cruel Treatment their charge, I had antici- 
 Exceptional pated that in institutions for 
 the insane there would be 
 found far greater abuses in the treatment of 
 the inmates, by the attendants, than in hospital 
 practice. Certainly, it requires a higher order 
 of mental and moral character, greater self-con- 
 trol, and a more impressive personality to win 
 the confidence and respect of the insane than of 
 the patients of the ordinary hospital ward. And 
 it was creditable to the management of the State 
 Asylums that the attendants were generally found 
 to be of a higher grade than in public hospitals, 
 and that they exercise a degree of patience and 
 forbearance under most trying and anno^dng 
 circumstances worthy of the highest commenda- 
 tion. 
 
XV 
 
 Curative Treatment 
 
XV 
 
 Curative Treatment 
 
 N States with a well organized 
 system of lunacy administra- 
 tion, the question is, How can a 
 research and curative depart- 
 ment, thoroughly adapted to 
 meet the requirements of mod- 
 ern science, be engrafted upon 
 the custodial Asylums? Fortunately, these State 
 Asylums are generally located on large arable 
 tracts of land which permit the 
 The New extension of the present arrange- 
 Department ment of buildings to any desirable 
 extent, or in any necessary form. 
 An ideal arrangement of the ordinary State 
 Asylum, admitting the incorporation of the 
 curative branch of the service, would be to cre- 
 ate the following divisions of administration, 
 viz., the Research, the Curative, the Industrial, 
 the Custodial, and the Hospital. The object of 
 this division of the service is a graded classifi- 
 cation of the inmates in the order of develop- 
 
 183 
 
184 WHO IS INSANE? 
 
 ment of their several forms of mental derange- 
 ment. This separation into specific classes in- 
 sures far greater precision in the details of care 
 and treatment of individual inmates. 
 
 Every patient, on admission, would be as- 
 signed to the Research Department, where an 
 exhaustive investigation would be made of his 
 or her life-history and present physical condi- 
 tion. The result of this study would be an ac- 
 curate diagnosis of every essential feature of 
 the case and consequent precision in determin- 
 ing the course of treatment to be pursued. 
 When the diagnosis is satisfactorily made the 
 patient is transferred to that one of the other 
 departments adapted to the conditions found, 
 viz., the Curative, the Industrial, the Custodial 
 or the Hospital. In the organization of these 
 departments there should be such a separation 
 of the Curative from the others that to common 
 observation there is no connection. 
 
 THE Curative Department should be under 
 the exclusive control of a Research Staff, 
 and located on isolated, picturesque grounds, 
 laid out and cultivated as a park. The buildings 
 should consist of such a number of 
 Cottages cottages, arranged on the plan of a 
 In a Park village, as would accommodate in 
 small family groups all of the pa- 
 tients admitted for a period of six months. 
 
WHO IS INSANE? 185 
 
 There should he cottages for the resident med- 
 ical staff, an isolation building for immediate 
 care of the disturbed, a gymnasium and a li- 
 brary. This department should be equipped 
 with every device necessary to accuracy of diag- 
 nosis and precision in the use of remedial 
 measures. 
 
 The purpose of the isolated, picturesque 
 grounds and cultivated park-garden is to have 
 the entrance of the patient to the institution as 
 free as possible from the disagreeable and often 
 extremely exciting or depressing effect which 
 the insane experience on finding themselves in 
 a "Lunatic Asylum." 
 
 THE Research and Curative Departments, be- 
 ing closely allied in their objects, should 
 be practically one in organization and manage- 
 ment. The official head should be a board con- 
 sisting of an Alienist, a 
 Departments Physiologist, a Pathologist 
 Under Specialists and a Psychologist, each be- 
 ing of the highest grade of 
 qualification in his branch. The Physiologist, 
 Pathologist and Psychologist should be devoted 
 to the Research service, which should be 
 equipped with laboratories and every other nec- 
 essary device for the most accurate work. Sub- 
 ordinate officers as field-workers, should be 
 supplied in such kind and manner as to reach 
 every requirement. 
 
186 WHO IS INSANE? 
 
 The Alienist should have the supervision of 
 the Curative branch, in which the remedial 
 measures directed by the Research service are 
 practically applied. The equipment of this de- 
 partment should embrace every recognized 
 means or appliance for curing the insane not 
 otherwise available. 
 
 The residential buildings of these depart- 
 ments should be cottages adapted to family life, 
 so located and constructed that there is the 
 least possible contact of the inmates with each 
 other, and their closest possible oversight by 
 attendants. The object of this arrangement is 
 to have the insane, in the beginning of their 
 treatment, under the immediate influence of a 
 sound rather than an unsound mind. 
 
 The resident head of a family in the cottage 
 should, as far as possible, be of the same na- 
 tionality or occupation as the patient, in order 
 that the former may be able more readily to 
 obtain the confidence of the latter, and thus un- 
 consciously exert a controlling power over him. 
 
 The plan of a Research and Curative depart- 
 ment, above sketched, to be added as an inte- 
 gral part of the great State Asylums is, of 
 course, susceptible of important modifications, 
 but the outline given will serve to illustrate 
 their peculiar features. 
 
 In practical operation in an Asylum, a patient 
 would enter the institution and might be under 
 
WHO IS INSANE? 187 
 
 observation and treatment for a considerable pe- 
 riod without being aware that he was in a 
 "Lunatic Asylum." When the record of his life 
 is completed, his physical condition understood, 
 and the precise origin, progress and trend of his 
 mental derangement ascertained he would be 
 transferred from the Research Department to 
 his proper place in the greater institution. He 
 might be discharged as not insane, or be as- 
 signed to a specific form of treatment in the 
 Curative branch, or to a trade, to the farm, the 
 Industries, or to the Custodial division, or to 
 the Hospital. Whatever was the decision as to 
 his destination, there would be the absolute 
 certainty that the State had exhausted its re- 
 sources in its efforts to relieve him of his disa- 
 bility and restore him to his family as promptly 
 as his condition would permit. 
 
 WE can but conclude that, in the light of the 
 modern physiological and psychological 
 sciences, we are not making proper progress in 
 curing the insane in public care. Custody has 
 
 been the policy of the 
 No Real Attempt State, and as a result the 
 to Cure the Insane asylums are always over- 
 crowded and there is a 
 constant demand upon Legislatures for large 
 appropriations to increase the capacity of ex- 
 isting institutions and to establish others. 
 
188 WHO IS ENSANE? 
 
 The conclusion which my observations forci- 
 bly impressed was that thousands of persons 
 languish in Asylums for the insane, suffering 
 from curable forms of neuroses involving dis- 
 turbance, or, more accurately, derangement of 
 the functions of some brain-cells. They have 
 never been subjected to the exhaustive study 
 by scientific experts now proposed, and, conse- 
 quently, have never received adequate treat- 
 ment. 
 
 It is a pertinent question for the most serious 
 consideration of those who control the policy 
 of the State: Might not the per cent, of "dis- 
 charged as cured" from our Asylums be raised 
 from twenty-five or thirty-three per cent, to 
 eighty or ninety per cent., if all the resources of 
 science, art, and humanity were brought into 
 requisition immediately on admission of each 
 person legally committed as insane? 
 
 It may be alleged that the installation of Re- 
 search and Curative departments in our great 
 State Asylums would be so expensive as to be 
 prohibitive. That objection raises another 
 question, viz., WouLi it not be more economical 
 to cure, by the proposed organization, even fif- 
 ty per cent, of the admitted patients, than to 
 maintain them fifteen years, the allotted life- 
 time of the insane in Asylums? 
 
 But while we are satisfied of the economy of 
 the reform proposed, there is a question of far 
 
WHO IS INSANE? 189 
 
 higher import than that of economy involved 
 in the proposed change of pohcy in the treat- 
 ment of the insane by the State. It is the obli- 
 gation of the State to restore to health and ac- 
 tivity, in the briefest possible time, citizens who 
 become its wards by the accidents of disease, 
 which unfit them for life in the family and 
 communit}''. 
 
 Dr. Hering, Secretary of the Commission in 
 Lunacy of Maryland, already referred to, 
 makes the following statement as the result of 
 his experience in visiting institutions for the in- 
 sane: 
 
 "There are approximately one hundred and 
 fifty thousand insane people in the United 
 States, a large proportion of whom might be 
 cured and become useful citizens, if the State 
 Legislatures would appropriate sufficient 
 money." 
 
XVI 
 
 Cure the Curable 
 
XVI 
 
 Cure the Curable 
 
 HE curable insane are those; 
 whose brain-cells are not de- 
 stroyed by injury or disease, 
 but are only temporarily dis- 
 turbed in their function. Thus, 
 the cells may absorb from the 
 blood a substance which while 
 it remains within them changes their action as 
 in alcoholic intoxication, but when the poison is 
 removed the cells resume their normal func- 
 tions. 
 
 Considering the extreme susceptibility of the 
 brain-cells to impressions from without the 
 body, through the special senses, and 
 Curable from within by the absorption of dele- 
 Cases terious waste matters (auto-intoxica- 
 tion), it is apparent that the number 
 of persons suffering from temporary mental 
 derangement, requiring custodial care, must be 
 very large, and greatly in excess of those suf- 
 fering from destruction of the same cells by or- 
 ganic diseases. This conclusion is sustained by 
 
 193 
 
194 WHO IS INSANE? 
 
 a comparison of the functional and organic dis- 
 eases of other organs, in which the former al- 
 ways largely predominate. 
 
 We may, therefore, justly estimate the curable 
 insane, or those who at the outset of their men- 
 tal aberrations suffer only from simple disturb- 
 ances of brain-cell functions, as much more nu- 
 merous than those suffering from destructive 
 organic diseases. Even in the long-established 
 State institutions for the insane it has been es- 
 timated that half of the inmates have no organic 
 disease of the brain. 
 
 IN the Psychopathic Hospitals, where persons 
 are admitted for observation, their conduct 
 leading to the suspicion that they are insane, 
 the number found to be suffering from tem- 
 porary mental derangement. 
 Why Are Not which may be relieved by sim- 
 More Cured? pie measures, is so large, com- 
 pared with those whose delu- 
 sions, illusions or hallucinations are permanent, 
 as to confirm the belief that the curable insane 
 are greatly in excess of the incurable, on first 
 admission to asylums. 
 
 If, then, a large proportion of the insane suf- 
 fer only from functional disturbances of brain- 
 cells in the incipient stage of their special forms 
 of mental aberration, the question acutely 
 
WHO IS INSANE? 195 
 
 arises, Why is not the rate of cure greatly in ex- 
 cess of the twenty-five to thirty-three per cent, 
 which is the standard of success in pubHc institu- 
 tions devoted to their care and treatment? 
 
 The science and art of healing during the last 
 half-century has made great advances in reduc- 
 ing the mortality of diseases in all of the de- 
 partments of practice — medicine, surgery, ob- 
 stetrics, gynecology, therapeutics; but in the cure 
 of the insane psychiatry has made no corre- 
 sponding advance during that period. 
 
 Dr. Pliny Earle made an elaborate study of 
 the statistics of asylums and from them drew 
 the conclusion that the final results of the ef- 
 forts to cure the insane were unfavorable, owing 
 chiefly to the relapses which occur in those dis- 
 charged as cured. The result of his researches 
 was to revive in the minds of many the old be- 
 lief, "Once insane always insane." How far that 
 author's opinion has influenced the treatment 
 of the insane in public institutions cannot be 
 determined, but as his statistics were the results 
 of treatment in a comparatively primitive pe- 
 riod, they do not illustrate the resources of mod- 
 ern medical science and art. 
 
 Assuming, therefore, that the insane, suffer- 
 ing only from functional derangement of brain- 
 cells, may be cured, as are the functional 
 derangements of other organs, by removing the 
 disturbing cause and reducing their functional 
 
196 WHO IS INSANE? 
 
 activity to a minimum until their integrity is re- 
 stored, it will be interesting and instructive to 
 inquire as to the susceptibility of the insane to 
 curative measures. 
 
 It is noticeable that in every case the relief 
 was due primarily to satisfying a desire or to 
 divertion therefrom. 
 
XVII 
 
 Use the Usable 
 
XVII 
 
 Use the Usable 
 
 FEATURE of the Asylum life 
 of the insane, which has a de- 
 pressing effect upon their phys- 
 ical health and injuriously con- 
 centrates their thoughts upon 
 the special objects of their men- 
 tal disturbance, is idleness. A 
 most painful impression is made upon the vis- 
 itor as he passes from ward to ward, to witness 
 the restlessness and irritability 
 Evil Effects of vast numbers of stalwart 
 of Idleness men and women, due largely to 
 the absence of vigorous labor in 
 the open air — labor to which they may have 
 long been accustomed. The cause of this idle- 
 ness is due chiefly to the unwillingness of the 
 insane to labor, owing to their grievance at be- 
 ing adjudged insane and confined. 
 
 Refusal to labor can be overcome only by 
 compulsion or a promise of reward. The re- 
 ward may be money or favors in the form of 
 privileges. The value of work as a curative 
 
 199 
 
200 WHO IS INSANE? 
 
 measure is greatly enhanced when the laborer 
 is rewarded and he performs his task volun- 
 tarily. On this account the Superintendents of 
 English Asylums are allowed a reserved fund 
 with which to pay patients who labor. 
 
 On the part of the management the excuse 
 for not securing more work from the insane is, 
 first, and generally, that it requires so much 
 time and effort to care for the laborers, while 
 employed, their labor is too expensive; and sec- 
 ond, that the task itself is too often of such lit- 
 tle money value as to discourage efforts to make 
 large numbers of the more demented class 
 work. 
 
 While these objections to "wasting the time" 
 of attendants in efforts to make the insane work 
 have apparently much weight, as an economic 
 feature of the management, we must not lose 
 sight of the fact that a well-planned system 
 of toil is the most successful curative measure 
 for the physically able insane yet devised. For- 
 tunately the State Asylums and Hospitals, with 
 their ample farm and garden lands, furnish the 
 necessary opportunity for developing indus- 
 tries adapted to the physical and mental pecu- 
 liarities of every inmate capable of doing any 
 kind of work. 
 
 The following cases illustrate interesting feat- 
 ures of the usefulness of the insane: 
 A Superintendent was impressed with the in- 
 
WHO IS mSANE? 201 
 
 fluence which an inmate of a ward devoted to 
 a very disturbed class exercised over his asso- 
 ciates. Though he was an incorrigible patient 
 as regards obeying attendants, being always 
 the leader of outbreaks of the more violent, the 
 Superintendent determined to place him in 
 charge of the ward and thus utilize his peculiar 
 power over the disturbed patients. On making 
 this proposal to him he refused to assume the 
 care of such an unruly "lot of insane devils," 
 as he called them, unless he was paid one mil- 
 lion dollars a day. The Superintendent ac- 
 cepted his offer and he entered upon his duties, 
 and from that time this ward was the most or- 
 derly in the Asylum. The new attendant went 
 regularly to the office daily and received a 
 check for the stipulated amount. If for any rea- 
 son he did not receive it he notified the Super- 
 intendent that he should "knock off work" until 
 he was paid. 
 
 One of the best laborers on an asylum farm, 
 especially in the cultivation of corn and pota- 
 toes, was an elderly farmer who was so de- 
 mented that when he reached the end of a row 
 he would continue on in a straight line search- 
 ing for the plants, even climbing over neighbor- 
 ing fences for that purpose. He always had a 
 companion at his work who would turn him 
 about at the end of each row. 
 
202 WHO IS INSANE? 
 
 A feature of a County Asylum was a stalwart 
 farmer working a well-groomed mule. On in- 
 quiry I learned that he had been a most un- 
 governable inmate of a State Asylum and was 
 returned to the County as an incorrigible. He 
 seldom spoke without using the word "mule." 
 The Keeper, a shrewd, practical man, was im- 
 pressed with the extreme restlessness of the 
 man and his frequent use of the word "mule," 
 which seemed to be the suggestion of his sub- 
 conscious mind. Adopting quite unconsicously 
 the method of psycho-analysis he determined to 
 learn the occasion of his using that word as a 
 possible clew to the cause of his mental disturb- 
 ance. On visiting the home of the farmer the 
 Keeper learned that he had gradually developed 
 a fondness for an old mule and finally would do 
 no other work than drive this animal about the 
 farm and neighborhood; whatever work could 
 be done by the mule and the farmer together — 
 ploughing, carting — was always well and thor- 
 oughly done. His devotion to the mule finally 
 became such a nuisance that he was committed 
 to an asylum as a hopeless dement. 
 
 The Keeper had the mule transferred to the 
 County Farm and placed in charge of the 
 farmer. The effect was immediate; he spoke to 
 the mule in affectionate terms and from that 
 time was as docile as a child. He became one 
 of the most useful men in the colony and never 
 manifested any irritability, but was continually 
 planning work which he and the mule could do. 
 
WHO IS INSANE? 203 
 
 These cases suggest Freud's "Psycho-analy- 
 sis," which Max Eastman says means analysis 
 of the soul, or mind. The theory is that count- 
 less numbers of diseases that we call nervous, 
 or mental, and countless others that we do not 
 name, are caused by desires which dwell in our 
 minds without our knowing they are there. His 
 contention is that if the patient is made clearly 
 aware of these desires their morbid effects will 
 disappear, and it is equally true that if these 
 desires are satisfied they will cease to disturb 
 the mind. Freud thinks a large part of the 
 sickness and trouble in the world is caused by 
 desires which we have refused to think about, 
 but which live their life of imagination below 
 the surface of our minds and act through it 
 whether we will or no. Most of these trouble- 
 making desires are related to the sex life — first, 
 because sex desires are so strong, and, second, 
 because they are so urgently repressed by cul- 
 ture, conscience and convention. 
 
 CONVERSING with a physician in a large 
 practice, he stated that he had long labored 
 under this disadvantage in his treatment of his 
 patients, that if he touched the medicine which 
 
 he prescribed it had the effect 
 The Delusion of on the sick of morphine. 
 a Physician When I expressed a doubt as 
 to the power of his touch to 
 change the therapeutical effect of a drug, he be- 
 came excited and declared with an oath that 
 
204 WHO IS INSANE? 
 
 ever since he was poisoned by morphine his 
 touch transmuted drugs into morphine. On di- 
 verting his attention to other professional sub- 
 jects he proved to be a most instructive conver- 
 sationahst, and I learned that he ranked with 
 the first members of his profession as a prac- 
 titioner, but he had to administer medicines by 
 prescription. 
 
 The failure of asylum officers to secure pro- 
 ductive labor from the insane is due largely to 
 the State's policy of regarding and managing 
 these institutions as custodial rather than cura- 
 tive institutions. The custodial policy, which 
 tends to treat the inmates en masse, is antago- 
 nistic to the curative, which individualizes the 
 patients and applies its remedies to the special 
 peculiarities of each. Success in the manage- 
 ment of the former is estimated by the number 
 in care and the creature comforts supplied, 
 while the latter estimates its success by the num- 
 ber discharged cured and improved, and the 
 economies effected by the productive labor of 
 the inmates. 
 
 It is impossible to estimate the gain to the 
 State, not only of productive labor in its insti- 
 tutions for the insane, but in the recovery and 
 discharge of self-supporting inmates cured by 
 labor, if a branch of the service of each were 
 thoroughly equippecl for, and devoted to, the 
 cure of the insane by some form of mental di- 
 version and physical labor. 
 
WHO IS ESrSANE? 205 
 
 Dr. Hering, Secretary of the Commission in 
 Lunacy of the State of Maryland, says : 
 
 "I contend that nine hundred and ninety-nine 
 out of every one thousand patients can be so im- 
 proved in condition by proper treatment and 
 proper environment as to make them in every 
 case partially self-supporting and in a great 
 many cases entirely self-supporting. Not only 
 can they be made self-supporting, but self-care- 
 ing." 
 
XVIII 
 Voices from the Asylums 
 
XVIII 
 
 Voices From the Asylums 
 
 iT is not often that we listen or 
 give credence to a voice from 
 the asylum wards. But in the 
 following statement a lady of 
 great intelligence gave her ex- 
 perience in an asylum when 
 Mechanical Restraint was the 
 prevailing method of controlling the disturbed 
 or violent patients : 
 
 "The whole system of treating 
 Views of the insane in asylums is wrong and 
 an Inmate makes more cases chronic than it 
 cures. I am a school teacher by 
 profession, trained from childhood in self-care, 
 especially in personal cleanliness, dress and 
 manners. I was brought here under pretense 
 that I was going to a sanitarium to convalesce 
 after a long spell of sickness. On arriving I was 
 escorted to the door by my nurse, a refined 
 young woman, who, I understood, was to be my 
 companion while I remained in the sanitarium. 
 At the door we were met by a man who took me 
 
 209 
 
210 WHO IS INSANE? 
 
 alone to an office where a clerk made a record 
 of some facts of my life. Then a nurse was 
 called, a coarse Irish woman, who led the way 
 to a hall where there were forty insane women. 
 I inquired for the nurse who came with me 
 and was to attend me in the sanitarium. "Sani- 
 tarium!' said my guide. 'Eh! So they deceived 
 you by calling a lunatic asylum a sanitarium! 
 Your friend skipped at the door, as do many 
 who bring lunas here.' 
 
 "I was ushered into a room where there was a 
 a large number of women, who terrified me by 
 their insane acts, and was assigned to a small 
 room whose only furniture was a low bed with 
 dingy, soiled clothing. I was ordered to undress 
 and prepare for a bath. I told the nurse that I 
 had had a bath that morning, but she said, 'That 
 makes no difference,' and I went with her to the 
 bath-room, which was a common receptacle 
 with a repulsive looking tub from which I 
 shrank. 
 
 "Under a threat that I would be forcibly put 
 in the tub if I resisted, I complied, but begged 
 that I be allowed to use my own toilet articles, 
 which I had brought. This request was refused, 
 and I was forcibly held while towels were used 
 which sickened me at the very sight. When the 
 nurse approached me with a filthy hair-brush 
 and comb, I again begged to be allowed to use 
 my own, which were in my bag, but the nurse 
 
WHO IS INSANE? 211 
 
 made no reply and attempted to comb my hair, 
 which I resisted by placing my hands on my 
 head. She called an assistant, a very strong 
 Irish woman, who pinioned my arms in her 
 grasp, while the nurse appHed the comb and 
 brush with such harshness that I cried with 
 pain. 
 
 "This part of my toilet over, the nurse brought 
 a ward dress and directed me to put it on. 
 Again I remonstrated and asked the privilege of 
 wearing my own dress, but it was refused, and 
 I was forcibly assisted in putting on the old and 
 ill-fitting garments. 
 
 I WAS finally taken to my room perfectly ex- 
 hausted by my excitement, excessively un- 
 comfortable in my shabby dress, terrified by the 
 screams of patients, and deeply resentful be- 
 cause of the deceitful method 
 The Effect of a which my friends had pursued 
 Rude Reception in securing my admission to 
 the asylum. I passed a horri- 
 ble night, sometimes screaming to relieve the 
 nervous tension which I suffered. For this act 
 the night watch threatened to put me in the 
 'Seclusion Room,' which so alarmed me that I 
 did not dare to speak, but sought relief by walk- 
 ing the floor and wringing my hands. 
 
 "When the 'rising-belF rang I was so ex- 
 hausted that I did not feel able to stand, and sat 
 
212 WHO IS INSANE? 
 
 on the side of the cot, but the attendant ordered 
 me to dress and go out on the hall. I finally 
 succeeded in getting into the filthy, striped 
 ward dress, and the feeling crept over me that 
 I was a prisoner for life. In the hall I was con- 
 fronted by a dozen insane women, who gath- 
 ered about and stared at me as if I were a wild 
 beast. With these poor creatures I had to take 
 my breakfast, for which I had but little relish 
 in their presence. 
 
 "When the physician made his morning visit 
 I attempted to speak with him, but the attendant 
 explained my case to him, placing great stress 
 on my resistance in the bath and my disturb- 
 ance of the ward at night. On my attempting 
 to explain he listened for a moment with a 
 bored look, then waved me away and passed 
 on without a word of advice. I made several 
 efforts to speak with him afterwards, but with 
 no better success, and now it is more than a year 
 since my admission, and no one has examined 
 me to determine my condition or to give me ad- 
 vice." 
 
 She continued her narrative at much greater 
 length, and then gave her views as to the proper 
 treatment of the insane, which were, in sub- 
 stance, as follows : 
 
 "If I had met at the door of the asylum an in- 
 telligent lady, who would have taken me to a 
 private room, and there in a sympathetic man- 
 
WHO IS INSANE? 21 
 
 Q 
 
 ner explained that this institution was a sani- 
 tarium for nervous people; that I would proba- 
 bly soon recover my health; that it was neces- 
 sary to have very strict rules, where there were 
 so many nervous persons; that she wished me to 
 take a bath before retiring, as that was re- 
 quired; and if she had given me my toilet arti- 
 cles, and then had given me a quiet, decently 
 furnished room, I should have had all my fears 
 removed and should have passed a comforta- 
 ble night. 
 
 "In the morning the same lady, or one equally 
 intelligent and sympathetic, should have taken 
 me to a private table, then for a walk or drive, 
 meanw^hile inquiring into the peculiarities of 
 my case and encouraging me with the hope of 
 early recovery. On the same morning the physi- 
 cian should have thoroughly but sympathet- 
 ically examined me in private, determined my 
 course of treatment, and assured me of my early 
 recovery, or, at least, have said some kind and 
 encouraging word. But from the day I entered 
 until the present I have not had five minutes' 
 continuous conversation with him. Though a 
 Seminary graduate, second in my class, a teach- 
 er for ten years, and an author, my only com- 
 panionship for a year has been that of these 
 poor women, and we have nothing in common 
 but our miseries." 
 
 Perhaps these statements are exaggerated. 
 
214 WHO IS ESrSANE? 
 
 but there is sufficient truth to make them worthy 
 of record. The method of having ordinary em- 
 ployees receive patients who are always in- 
 tensely sensitive and usually greatly excited on 
 being taken to an asylum for the insane, is liable 
 to aggravate their mental disturbance unneces- 
 sarily. The cold and repulsive treatment which 
 they receive from attendants on admission cre- 
 ates a prejudice from which the patient never 
 recovers. The first introduction to a hall filled 
 with the insane; the want of genial companion- 
 ship; the neglect of the physician, as described 
 by this lady, are incidents in the life of the in- 
 sane in public care which ought to be remedied. 
 
 TREAT me like a man and I will treat you 
 like a man; treat me like a brute and I 
 will treat you like a brute.*' This was the chal- 
 lenge of an old man who had been admitted to 
 an asylum as insane. No atten- 
 "TreatMe tion was given to what was re- 
 LikeaMan** garded as the conceit of a dis- 
 eased brain and he was assigned 
 to a hall with inmates of the disturbed class. It 
 naturally happened that the old man soon took 
 offense at his treatment by the attendant and he 
 resented it by destroying everything possible in 
 his room. For these acts he was subjected to 
 various forms of restrictive treatment, which he 
 as persistently resented. His violence became so 
 
WHO IS INSANE? 215 
 
 uncontrollable and his destructive habit so dan- 
 gerous that he was "the terror" of two asylums 
 which successively had the care of him. 
 
 One of the younger members of the resident 
 staff of physicians was passing the window of 
 the room where the old man had long been con- 
 fined and heard the familiar challenge, "Treat 
 me like a man and I will treat you like a man; 
 treat me like a brute and I will treat you like a 
 brute." The young physician was struck as 
 never before with the propriety of this pathetic 
 appeal and the necessity of accepting the chal- 
 lenge. He sought the Superintendent and pro- 
 posed to take the patient under his personal 
 charge and give him the benefit of a trial of 
 his pledge. The Superintendent at first refused, 
 but consented when the physician promised to 
 be personally responsible for the damage which 
 the patient might commit. 
 
 Going to the patient's room the physician ac- 
 costed him with a slap on the shoulder and the 
 hearty greeting, "See here, my friend, come with 
 me to my rooms, for I intend to have you take 
 charge of them and assist me." With a sob the 
 patient grasped the physician's hand and said, 
 "That is the first kind word that has been spo- 
 ken to me in five years." He proved true to his 
 word and so faithfully performed all the duties 
 assigned to him that he was finally placed in 
 charge of gangs of working patients. In one 
 
216 WHO IS INSANE? 
 
 instance he superintended the pruning of a 
 large orchard by inmates, each armed with 
 an axe. 
 
 He was finally discharged and supported him- 
 self comfortably for several years, always main- 
 taining that he would at all times have faith- 
 fully fulfilled his promise to treat any officer* 
 or attendant of the asylum as a man if he had 
 been treated as a man. 
 
 How different would have been the history 
 of this man if he had been properly examined, 
 on his admission to the asylum, and if an ef- 
 fort had been made to test his demand at once, 
 instead of waiting five years! 
 
XIX 
 
 State Care of the Insane 
 
XIX 
 
 State Care of the Insane 
 
 HE deplorable condition of the 
 insane in county care, re- 
 vealed on my first inspection 
 in 1882, and the excellent 
 care which the same class was 
 receiving in State Asylums, 
 convinced me that I could do 
 no service more immediately useful and 
 of more lasting benefit to the insane than 
 
 to secure their removal to 
 State Instead of the State institutions and 
 County Care close the alms-houses for- 
 ever to their admission. I 
 had no conception of the opposition which a 
 proposition so manifestly just and feasible 
 would meet, nor of the sources of that opposi- 
 tion. 
 
 Accordingly, in 1883, I drew a bill providing 
 for the gradual transfer of the insane from the 
 alms-houses to the State Asylums, the object 
 being to remove at first, and immediately, the 
 more disturbed inmates who were treated by 
 
 219 
 
220 WHO IS INSANE? 
 
 means of the most severe forms of mechanical 
 restraint. The measure was first submitted to 
 the county officials by whom it was received 
 wdth general opposition as a method, concocted 
 by the State Asylum Managers, of depriving the 
 counties of their rightful privileges. The preju- 
 dice against the State asylums for the inroads 
 they already had made upon the insane popula- 
 tion formerly in county "poor-houses," was in- 
 tense, and it was soon evident that only opposi- 
 tion from that source could be expected. 
 
 The proposed reform was discussed with the 
 Managers of the State Asylums as opportunity 
 offered, but was not generally well received on 
 account of the opposition which it was believed 
 the counties would make to any further en- 
 croachments upon the poor-house population, 
 and the undesirability of adding chronic dis- 
 turbed insane to their number. 
 
 The subject was also discussed with the mem- 
 bers of the State Board of Charities, which then 
 had visitatorial supervision of all of the insane 
 in custody. The older members opposed any 
 such change and advocated the adoption of 
 measures which would improve the care of the 
 insane by the counties, the principal change 
 being the creation of County Insane Asylums. 
 That plan was adopted by some counties, and 
 under the closer supervision of the State Board of 
 Charities considerable improvement was ef- 
 
WHO IS INSANE? 221 
 
 fected. But at the best their management was 
 far below the standard established by the State 
 institutions and emphasized the necessity of fi- 
 nally placing all of the insane in the care of 
 the State. 
 
 IMPRESSED with the urgency of this reform I 
 prepared another bill which would more im- 
 mediately and totally remove the insane from 
 the alms-houses. Having failed to secure 
 the co-operation of any ade- 
 Bow State Care quale number of persons, or 
 
 Was Secured organizations capable of secur- 
 ing the passage by the Legisla- 
 ture of a measure destined to meet with the 
 most powerful opposition, I decided to appeal 
 to the State Charities Aid Association, a vol- 
 untary organization devoted to the improve- 
 ment of the State Charities. On submitting the 
 measure to Miss Louisa Lee Schuyler, the 
 founder of the Association, and an uncompro- 
 mising advocate of reform of these institutions, 
 she declined at first to have the Association un- 
 dertake a work of such magnitude, but several 
 months later she informed me that if the bill 
 was approved by the President of the Associa- 
 tion, Prof. Theodore W. Dwight, she would ad- 
 vise undertaking its passage by the Legislature. 
 The bill was submitted to Prof. Dwight, who 
 proposed some changes in the phraseology, but 
 
222 WHO IS INSANE? 
 
 decidedly approved the effort to secure the re- 
 form which the measure would effect. 
 
 Preparatory to the introduction of the bill 
 into the Legislature, I deemed it very impor- 
 tant to secure the cooperation of the Presi- 
 dent of the State Board of Charities, Hon. Os- 
 car Craig, of Rochester, a lawyer of a thor- 
 oughly judicial mind, of profound convictions 
 of justice and righteousness and of a pleasing but 
 impressive personality. As he was unfamiliar 
 with the condition of the insane in the County 
 Asylums, having visited with me in committee 
 only the insane in the State institutions, a reso- 
 lution was passed by the State Board of Chari- 
 ties, on my suggestion, requesting the President 
 to visit the County Asylums and report on their 
 condition. Accordingly Mr. Craig visited these 
 Asylums in the summer of 1888 and as a result 
 earnestly approved a measure which would ef- 
 fect the transfer of the insane from County to 
 State care. 
 
 The amended bill was introduced into the 
 Legislature of 1889 and its passage urged with 
 the powerful forces at the command of the State 
 Charities Aid Association. Conspicuous among 
 its advocates was President Craig, representing 
 the State Board of Charities, who was actuated 
 by personal knowledge of the conditions of the 
 insane in county care. The opposition was 
 chiefly from the adherents of the alms-houses, 
 
WHO IS INSANE? 223 
 
 represented by local political organizations. The 
 bill became a law in 1889, thus closing forever 
 the "Poor-Houses" of the State against the ad- 
 mission of the insane poor. 
 
 Estimating the importance of the change in 
 the care of the insane effected by this measure 
 in the light of nearly a quarter of a century's 
 experience, the "State-Care Act" of New York 
 takes its place with the most advanced and sal- 
 utary reforms of that period. Other States have 
 followed the example of New York, and the 
 "Poor-House" as a residence of the insane is 
 destined to be only a recorded fact in history. 
 
 AT the close of my term of service as State 
 Commissioner in Lunacy, in 1888, the total 
 number of insane in the various institutions was 
 about 20,000. The system of lunacy administra- 
 tion had as yet no 
 A Proper Commission properly organized 
 in Lunacy method, but had been 
 
 the accidental growth 
 of years, from the old-time custody in the jail or 
 alms-house to the care and treatment of the 
 State Asylum. Each stage of progress was, how- 
 ever, marked by a popular agitation favorable 
 to the more humane treatment of the insane. It 
 was apparent from my experience that the pop- 
 ulation of insane had reached a limit that ren- 
 dered it necessary for adequate supervision by 
 
224 WHO IS INSANE? 
 
 the State, and that there should be a properly 
 constituted Commission, created with adequate 
 visitatorial and supervisory powers. 
 
 Accordingly, in 1888, I prepared a bill creat- 
 ing a State Commission in Lunacy. The per- 
 sonnel of the Commission consisted of a Medical 
 member, a Legal member and a Business mem- 
 ber. These three members represented the 
 three important interests of the institu- 
 tions for the insane. While the Commission had 
 not the power of direct administration of the 
 affairs of the asylums, which was continued in 
 local boards, it had such advisory powers and 
 supervision of details as would enable it to ex- 
 ercise a controlling influence upon the manage- 
 ment. The bill passed the Legislature some- 
 what in advance of the State-Care Act, as was 
 intended, in order that when the latter went 
 into effect, there would be a competent author- 
 ity prepared to organize and direct the changed 
 policy of the State. 
 
 The Commission in Lunacy has fully met the 
 purposes of its establishment. The personnel 
 of the Commission has been judiciously selected 
 by the State Executives for nearly a quarter of 
 a century, and during that period there has 
 been scarcely a criticism of its acts. Upon the 
 members of the Commission first appointed the 
 greatest responsibility rested, and it proved 
 fortunate for the State that its President was 
 
WHO IS INSANE? 225 
 
 Dr. Carlos F. Macdonald, a man eminent in his 
 profession and of an exceptionally large and 
 varied experience in the management of the 
 State Asylums. Under the fostering care of the 
 Commission, the insane of the State of New 
 York are receiving the highest grade of humane 
 care. In all that pertains to creature comforts 
 — food, clothing, housing, freedom from cruel 
 forms of restraint — the equipment and manage- 
 ment of the State Hospitals excel. 
 
 THERE was a feature in the practical appli- 
 cation of these two Legislative acts that 
 might have accomplished more desirable results 
 had it been adopted and enforced on the en- 
 trance of the former occu- 
 Another Reform pants of the alms-houses into 
 Much Needed the State Hospitals. One of the 
 objections of the managers of 
 these Hospitals to the transfer of the insane of 
 the alms-houses was that they were a chronic 
 class of low order and had never had any dis- 
 cipline. Hence they would tend to disturb the 
 management by their violence and degrade the 
 service by their physical and mental inferiority. 
 The objection was well taken and raised an im- 
 portant question as to the best method of avoid- 
 ing such an undesirable result. 
 
 It was suggested that as these Hospitals had 
 under their control large acreages of farm- 
 
226 WHO IS INSANE? 
 
 lands it would be practicable to segregate them, 
 with the chronic insane already in the Hospital, 
 in colonies, supplied with simple and inexpen- 
 sive cottages where the inmates would live in 
 families and be trained to useful labor. This 
 arrangement would have relieved the existing 
 buildings of a considerable population and ad- 
 mitted of larger opportunities and greater facil- 
 ities for the treatment of recently admitted 
 cases. Unfortunately the managers, with few 
 exceptions, proceeded to build new structures 
 in immediate contact with the existing build- 
 ings, thus reducing the entire population to the 
 common level of a custodial institution and im- 
 pairing its more important function of curing 
 the insane. 
 
 HAVING, in 1872, assisted in establishing the 
 first "Training School for Nurses," in Belle- 
 vue Hospital, New York, and having experi- 
 enced the remarkable reform which they made 
 
 in the care of the sick in my 
 Training Schools own wards, the first impres- 
 f or Nurses sions I received on visiting 
 
 the wards of the asylums for 
 the insane were unfavorable, owing to the ab- 
 sence of the uniformed attendant or nurse. My 
 proposition to organize Training Schools for the 
 education of attendants in asylums was not well 
 received by either medical officers or attend* 
 ants. 
 
WHO IS INSANE? 227 
 
 At length, however, it was discovered that 
 one of the medical staff of the Buffalo Asylum, 
 Dr. William D. Granger, was giving to the at- 
 tendants of that institution instruction in the art 
 of nursing and had prepared a manual on that 
 subject. His interest in the organization of a 
 school for the training of attendants was so 
 great that it was not difficult to obtain the con- 
 sent of the Superintendent, Dr. Judson B. An- 
 drews, and through him the approval of the 
 Managers, to organize a course of instruction 
 for the attendants. The plan of organization 
 was that of the Training Schools of the general 
 hospitals, with a term of two years, and gradua- 
 tion with a certificate or diploma. The scheme 
 was carried out in all of its details, and thus 
 the Training School for Attendants in institu- 
 tions for the insane, now found in every asylum 
 throughout the country, was initiated in the 
 Buffalo Asylum for the Insane. 
 
PART FOUR 
 
 THE LESSON APPLIED TO THE IDIOT, 
 FEEBLE-MINDED AND CRIMINAL 
 
XX 
 
 Extend Curative Methods to All the Depend- 
 ent Classes 
 
XX 
 
 Extend Curative Methods to All the Depend- 
 ent Classes 
 
 HE lessons which the preceding 
 illustrations of the anatomy 
 and physiology of the nervous 
 system teach have a wide appli- 
 cation to our treatment of the 
 dependent classes. We learn 
 that the mental attributes of 
 every person depend ultimately upon the phys- 
 ical state of the nerve-cell, over which we have 
 almost absolute control, both in 
 The Lesson its individual and collective ca- 
 Repeated pacity. If its texture is feeble 
 from heredity or disease, we may 
 make it strong by nutrition, exercise, pure air, 
 and medication; if it is undeveloped, we can de- 
 velop it by applying its appropriate stimulus 
 and suitable nourishment; if it is unduly devel- 
 oped and hence over-active, we can reduce it to 
 a rudimentary and inactive state by removing 
 every form of stimulant and reducing its nutri- 
 tion; where neither the regulation of the stimu- 
 
 233 
 
234 WHO IS INSANE? 
 
 lant nor nutrition accomplishes our purpose, we 
 can rel}^ upon specific remedies. 
 
 The logical and inevitable conclusion to be 
 drawn is that, if we thoroughly understood the 
 exact function and the functional relations of 
 all the cells of the nervous system, we could, 
 beginning with the child, control in a large 
 measure the development of character, and in 
 the adult modify existing attributes by stimula- 
 tion of one class of nerve-cells and the repres- 
 sion of another to any extent that we desired. 
 There is no doubt that the marked changes 
 which we often witness in the mental attributes 
 of the sane and the insane, temporary and per- 
 manent, are due to temporary conditions af- 
 fecting the functional activity of nerve-centres. 
 Nothing can be more thoroughly practical than 
 the application of the proper remedial meas- 
 ures by which the equilibrium of these centres is 
 secured. 
 
 The superficial and mere surface knowledge 
 of the inmates of institutions, on the part of the 
 officers, not only results in ignorance of the 
 possibilities of improvement of large numbers 
 of patients, but begets incredulity as to the ca- 
 pacity of an entire class to be improved by any 
 method of treatment. It is equally true that the 
 medical officers, attendants and managers of 
 our charitable and correctional institutions 
 have little, and too often, no faith in the capac- 
 
WHO IS INSANE? 235 
 
 ity of the vast majority of the mentally defect- 
 ive class to be taught, the mentally diseased 
 class to be cured, or the criminal class to be re- 
 formed. And this want of faith is due to ig- 
 norance of the capacities of the human brain to 
 be infinitely modified by expert care. 
 
 THE result is that no State institution, devoted 
 to the care and treatment of these classes, is 
 so organized and conducted as to be thoroughly 
 curative in its methods. They are, in fact, cus- 
 todial. In their an- 
 State Institutions nual reports they 
 
 Not Thoroughly Curative never call special 
 
 attention to the in- 
 creasingly large percentage successfully taught, 
 cured, reformed, and discharged. They do not 
 appear before the Legislatures asking appropri- 
 ations for better facilities for teaching the idiot, 
 curing the insane, and reforming the criminal, 
 using as an argument the seventy-five per cent, 
 taught, cured, and reformed the past year, and 
 promising, with improved facilities, to raise the 
 p ^rcentage tb ninety-five per cent. On the con- 
 trary, the constant demand upon the State is for 
 more buildings to accommodate the ever-in- 
 creasing number to be added to the fixed popu- 
 lation of these institutions. 
 
XXI 
 
 Teach the Idiot and Feeble-Minded Self-Care 
 
 AND SeLF-SuPPORT 
 
XXI 
 
 Teach the Idiot and Feeble-Minded Self-Care 
 AND Self- Support 
 
 IHAT shall we do "with the idiot 
 and the feeble-minded? Teach 
 them self -care and self-support. 
 But can they be taught? The 
 following incident is an answer 
 to that question. On a bright 
 summer day in the early sixties 
 I took advantage of a leisure hour or two in 
 Syracuse to visit that anomaly among the char- 
 itable institutions of the State of 
 Educating New York, viz., a school for the in- 
 Idiots struction of idiots. The very pur- 
 pose of the institution — the educa- 
 tion of idiots — seemed then to be an unanswer- 
 able argument against its existence. Its found- 
 er. Dr. Hervey B. Wilbur, had encountered great 
 opposition on this very ground. No one believed 
 it possible to teach idiots sufficiently to make 
 the creation of an institution for that purpose 
 justifiable by the Legislature. The institution 
 finally took the apparently more appropriate 
 
 239 
 
240 WHO IS INSANE? 
 
 title, "The Custodial Asylum for Feeble- 
 Minded." 
 
 While crossing the lawn, in my approach to 
 the asylum, I casually noticed a group of young 
 men engaged in "making hay." Some were 
 mowing, others were spreading the cut grass, 
 but all were actively and intelligently at work. 
 On entering the administrative building I 
 found Dr. Wilbur employed with his daily du- 
 ties. I introduced myself and explained that I 
 was desirous of obtaining, by personal observa- 
 tion, information as to the success of the insti- 
 tution in teaching idiots. The doctor's inter- 
 est in my visit was marked and he became very 
 communicative in regard to his work. We ex- 
 amined every part of the asylum and saw all 
 of the inmates in their several departments and 
 classes. It would be impossible to conceive 
 of an apparently more hopeless and repulsive 
 task than teaching many of those mere vegetat- 
 ing objects. Incidentally I suggested the im- 
 possibility of educating these children to be- 
 come active and intelligent workers like the 
 you'ng men making hay on the lawn. 
 
 "Why, my dear sir," he replied, "those young 
 men are all idiots, but the attendant, whom I 
 presume you did not recognize from the oth- 
 ers; some of them were as hopeless as the worst 
 you have seen in the Asylum." 
 
 I could not conceal my skepticism, and re- 
 
WHO IS INSANE? 241 
 
 marked that I regarded it as impossible to make 
 a first impression on many of the inmates. 
 
 "That has been the mistake of the world in 
 its treatment of idiots," he replied, "but in these 
 later years we have learned how to teach the 
 first lesson, and on that first lesson the whole 
 system of educating the idiot depends. Come 
 into the class room and I will give you a 
 demonstration of the first lesson and its effects 
 and results." 
 
 WE went accordingly into the room of the 
 lowest class of inmates, some of whom had 
 been admitted so recently that the doctor knew 
 nothing of their physical or mental condition. 
 He requested me to choose one of 
 The First the latter class, who was unknown 
 Lesson to him, for a first lesson. I selected 
 a boy who sat on the floor, drooling 
 from his open mouth and swaying his body, but 
 who seemed insensible to anything about him, 
 and, as the attendant assured me, had to have 
 the food placed in his mouth at his meals. 
 
 The doctor took a dumb-bell, and placing it 
 on the floor by the side of the boy, fixed his 
 hand on the shaft with the fingers closely 
 around it. Then, taking another dumb-bell, 
 and standing in front of the boy, the doctor 
 raised his instrument high in the air and delib- 
 erately struck the dumb-bell on which the boy's 
 
242 WHO IS INSANE? 
 
 hand was placed. The boy was startled by the 
 concussion, but made no other sign of recogni- 
 tion of the blow. The doctor repeated the act 
 twice more with the same result. 
 
 "This is the first lesson," the doctor re- 
 marked, "and he is a very promising student, 
 with great possibilities. Now let me show you 
 a boy of the same grade who has been under in- 
 struction for several months with two such les- 
 sons daily." 
 
 The second boy was of the type of the first, 
 and on the trial he removed his hand from the 
 dumb-bell, when it was struck, and raised his 
 eyes from the floor, as if to see from whence 
 the blow came. A third boy had been under 
 treatment for a still longer period; he watched 
 the doctor's movements, and when he saw the 
 blow descending, raised his hand and laughed. 
 A fourth boy was tested, who was now in one of 
 the graded classes. When the doctor took the 
 dumb-bell, and handed the boy another, the 
 boy rushed at the doctor and for several min- 
 utes there was a clash of weapons, the boy 
 shov/ing dexterity and immense enjoyment of 
 the contest. 
 
 In the discussion of his method of teaching 
 the feeble-minded Dr. Wilbur laid great stress 
 upon the significance of "That first lesson." 
 His explanation was to the effect that the idiot 
 had a dormant nervous system, and the first 
 
WHO IS INSANE? 243 
 
 step in the process of educating him must 
 necessarily be to arouse the brain to activit}^; 
 that the best method of making a first impres- 
 sion was through the sense of feehng; and that 
 the shock communicated by a metalhc sub- 
 stance through the sensitive surface of the 
 hand was the most effective method. His ar- 
 gument was this : If one special sense of the ner- 
 vous system can be aroused to activity, other 
 special senses will be excited secondarily, and, 
 finally, the ^hole brain will become receptive 
 of external impressions and the higher mental 
 functions will be gradually developed. 
 
 IN the light of our present knowledge of the 
 minute anatomy of the nervous system and 
 the physiological functions of its constituent 
 parts. Dr. Wilbur's method of teaching the idiot 
 
 was founded on strictly 
 
 Interpretation of scientific principles. Un- 
 
 Dr. Wilbur's Method doubtedly he did not 
 
 understand the full sig- 
 nificance of his own reasoning, for our knowl- 
 edge of the structure or minute anatomy of the 
 nervous system at that period was little more 
 than its gross appearances. We had learned 
 that its elements consisted of gray and white 
 matter; that the gray matter was composed of 
 cells and the white matter of fibres. The physi- 
 ology of that period taught us little more than 
 
244 WHO IS INSANE? 
 
 that the cells generated the nervous force, or 
 energy, and that the fibres, or nerves, conveyed 
 impressions, or impulses, to and from the cells. 
 It quite naturally occurred to a thoughtful 
 mind like Wilbur's that the brain of the idiot 
 was in an inert, or dormant state, owing to the 
 absence of a stimulus sufficiently powerful to 
 arouse it to activity. If that stimulus could be 
 properly applied through one of the special 
 senses — seeing, hearing, feeling, smelling, tast- 
 ing — the idiot could be taught like any other 
 child. He chose the sense of feeling with the 
 remarkable results that followed. Had he 
 known the full significance of that first lesson, 
 in the light of modern scientific discoveries of 
 the intimate structure and functions of the cells 
 of the brain, its immense number of so-called 
 centres, and their relations, his work would 
 have been invested with a new interest, and 
 there would have been far greater precision in 
 its execution. 
 
 ALONG this line of inquiry as to available 
 methods of stimulating to functional activ- 
 ity is the proposed "Electrified Schoolroom to 
 Brighten Dull Pupils," of Nikola Tesla. It is 
 well known that eminent ex- 
 Stimulation perimental psychologists be- 
 hy Electricity lieve that the high-frequency 
 current intensifies cerebration; 
 that it is a mental stimulant like alcohol, but in- 
 
WHO IS INSANE? 245 
 
 stead of being harmful to the brain-cells as is 
 alcohol, electricity is harmless and confers last- 
 ing benefits. It is stated that Mr. Testa's atten- 
 tion was attracted to this subject by noticing the 
 effect of electricity on one of his assistants in 
 making certain high-frequency tests. This as- 
 sistant was very stupid in carrying out instruc- 
 tions concerning laboratory adjustments. The 
 laboratory was equipped with a coil generating 
 high voltage currents, and after a time Mr. Tesla 
 noticed that the man became brighter and did 
 his work better, but supposed the change was 
 due to the assistant's learning his duties more 
 thoroughly. This did not prove to be the proper 
 explanation. On observing the actions of the 
 man more closely he concluded that his assist- 
 ant's increased aptness and alertness were due 
 to a much deeper cause than mere experience; 
 that the elements of "mental life" — the brain 
 cells — had been stimulated to greater functional 
 activity. 
 
 This new, novel, and practical method of 
 awakening to activity dormant brain cells has 
 been subjected to trial on a large scale in 
 Stockholm, Sweden. Two sets of fifty children 
 each, averaging the same age and physical con- 
 dition, were placed in separate classrooms 
 exactly alike except for the concealed 
 wires in one of the rooms. The regu- 
 lar school work was pursued and the test 
 
246 WHO IS INSANE? 
 
 lasted for six months. The result recorded was 
 as follows: The children in the magnetized 
 room increased in stature two and a half inches; 
 those in the unmagnetized room increased one 
 and one-fourth inches; the former also showed 
 an increase in weight and physical develop- 
 ment greater than the latter. More remarkable 
 was the difference between the mental devel- 
 opment of the two classes, viz. : Those exposed 
 to the electric waves averaged ninety-two per 
 cent, in their school work, compared with an 
 average of seventy-two per cent, of the children 
 in the other room; fifteen pupils in the elec- 
 trified room were marked 100, and nine in the 
 other class. It is stated in the report that the 
 electrified children appeared generally more 
 active and less subject to fatigue than those not 
 electrified, and that the teachers experienced 
 a quickening of the faculties and an increase 
 of endurance. 
 
 The method of applying the electricity was 
 thus stated: Carefully insulated wires were in- 
 serted in the walls of the experimenting class- 
 room and the test was carried on without the 
 knowledge of either the teacher or the pupils; 
 the air of the room was completely saturated 
 with incalculable millions of infinitesimal elec- 
 tric waves vibrating at a frequency so great as 
 to be unimaginable and capable of measure- 
 ment only by a most delicate voltmeter. 
 
XXII 
 
 The Treatment of the Criminal 
 
XXII 
 
 The Treatment of the Crimenal 
 
 HAT shall we do with the crim- 
 inal? Reform himt — form him 
 anew — ^is the answer of modern 
 physiology. The problem is the 
 same as that of curing the in- 
 sane, viz., the reforming or re- 
 adjusting of a deranged mech- 
 anism. Certain nerve-centres have been over- 
 stimulated and thus enlarged until their func- 
 tional activity has controlled the 
 Reform the thoughts, purposes and acts of 
 Criminal the individual precisely as in the 
 case of the insane. The cure of 
 the insane and the reform of the criminal are, 
 therefore, closely allied problems, the solution 
 of which depends upon our ability, in either 
 case, to repress the abnormal activity of nerve- 
 centres, which incite to criminal acts, and 
 arouse to activity dormant nerve-centres which 
 counteract or inhibit the action of the former. 
 The reform of the criminal, the cure of the in- 
 sane and idiot are purely physiological ques- 
 
 249 
 
250 WHO IS INSANE? 
 
 tions, and the policy of the State in its care and 
 treatment of these classes should be in strict 
 conformity therewith. 
 
 The International Prison Congress, at its 
 session at Washington, D. C, in 1910, placed on 
 record the following resolution, which embodies 
 the opinions of the most advanced students of 
 penology, the experience of practical workers 
 in prisons, and a fundamental principle of 
 physiology: "No prisoner, no matter what his 
 age or past record, should be assumed to be in- 
 capable of improvement." 
 
 From a physiological view-point what are the 
 best methods of re-forming the criminal? Cen- 
 turies of experience have proven that the puni- 
 tive method, embodying the Mosaic "eye-for- 
 an-eye" idea of justice, and which must have 
 originated in our animal ancestry, has not an 
 element of reform in its practical details. 
 
 PHYSICAL torture by various methods may 
 compel compliance with prison rules, but it 
 only arouses to greater activity the brain-cen- 
 tres which incited to crime. Solitary confine- 
 ment in a dark cell, and a diet 
 The Effect of of bread and water enforced 
 the Old Method upon a person trained from 
 
 infancy in vice and crime, 
 combined with the cold, harsh, repellant treat- 
 ment which he daily receives from officers and 
 
WHO IS INSANE? 251 
 
 attendants, excite to intense activity every vi- 
 cious nerve-centre. When his term of impris- 
 onment expires he leaves the prison, not a re- 
 formed, a made-anew man, but a confirmed 
 criminal, prepared by long reflection for a more 
 enlarged field of crime. The punitive method 
 of reforming the criminal is not the physiolog- 
 ical method, for instead of repressing the activ- 
 ity of the vicious nerve-centres, and awakening 
 to activity the virtuous nerve-centres, it has a 
 contrary effect, and makes the criminal ten-fold 
 more undesirable as a citizen than before the 
 State attempted his reform. 
 
 Socrates was asked how a vicious boy could 
 be reformed, and he replied: "Remove every 
 possible incitement to vice, and substitute every 
 possible incitement to virtue" The Athenian 
 philosopher formulated his maxim on a sound, 
 physiological basis. The aim of the physiolog- 
 ical treatment of the criminal is, first, to secure 
 him sound physical health; and, second, to di- 
 vert his thoughts from his former evil associates 
 and associations, and to concentrate them 
 upon objects which promote virtuous acts and 
 tend to create a desire and an impulse to lead 
 a better life in the future. 
 
 The physiological effect of this treatment is 
 that long active nerve-centres, which incited to 
 vice and crime and dominated the mental op- 
 erations of the individual, fall into a state of 
 
252 WHO IS INSANE? 
 
 desuetude, and the long dormant nerve-centres, 
 which incite to virtuous acts, are aroused to 
 activity and assume complete control of the 
 thoughts and acts. The criminal is thus re- 
 formed — made anew. 
 
 Practically, the prison becomes a school and 
 the term of service depends upon the progress 
 which the inmate has made in the course of 
 training to which he was assigned on entering 
 the institution. The final test would be a pa- 
 role. Discharge, or graduation, would depend 
 upon the evidence of reform, or, in the language 
 of the schools, upon his having "satisfactorily 
 passed a final examination." 
 
 THIS view of the treatment of the criminal, as 
 the proper State policy, is no longer a theory 
 but a practical fact, demonstrated in the most 
 luminous manner both in Europe and in the 
 
 United States. No argu- 
 The New Method ment for the policy of yq,- 
 in Demonstration forming the criminal by 
 
 physiological process can 
 be adduced that has the convincing power of the 
 narrated experience and opinion of those who 
 have instituted the new method. 
 
 "I do not wish to know anything about your 
 past life. When you entered the gate of this in- 
 stitution you left your past life behind you; my 
 interest in you is as to your future life." Such 
 
WHO IS INSANE? 253 
 
 was the answer of Mrs. Johnson, of the Prison 
 for Women, Massachusetts, to the threat of a 
 young woman convict whom the trial Judge at 
 Boston declared to have the most desperate 
 criminal record ever known to that court. When 
 Mrs. Johnson, as Superintendent, made her first 
 visit, as usual alone, to the cell of the recently- 
 admitted convict, she was accosted with this re- 
 mark : "You would not dare to visit me alone if 
 you knew my history; I have been in all the pris- 
 ons of Ireland and in most in this country, even 
 in Joliet; I have killed my man, too, and you had 
 better take warning." 
 
 Mrs. Johnson's reply, "When you entered the 
 gate of this institution you left your past life 
 behind you," was the key-note to her remarka- 
 ble success in reforming criminal women. Ev- 
 ery possible effort was made to effectually close 
 the past life of crime and begin a life of virtue, 
 — that is, to repress and reduce to their rudi- 
 mentary state the vicious nerve-centres and 
 awaken to the most intense activity possible the 
 virtuous nerve-centres. To this end the institu- 
 tion, with its farm, was supplied with every 
 needed facility for in- and out-door occupa- 
 tion and diversion. No inmate was allowed to 
 be idle, and each was stimulated to the per- 
 formance of some form of active duty by the 
 agreeable nature of that duty or by the desire to 
 win a higher position in the established grades. 
 
254 WHO IS INSANE? 
 
 "Truth and Trust" was the symbol of the 
 highest grade, and those who attained to it were 
 privileged to wear a white jacket with the let- 
 ters "T & T" on the lapel. The desperate crim- 
 inal, the young Irish woman to whom we have 
 referred, not only attained to the highest grade 
 but returned to her home in Ireland, and seven 
 years after her discharge the priest of the par- 
 ish wrote Mrs. Johnson: "Sarah is my main 
 reliance in the efforts of our church to redeem 
 the wayward and vicious young people of the 
 parish." 
 
 Mrs. Johnson had the most absolute confi- 
 dence in her ability to reform the most incorri- 
 gible criminal woman by the simple method of 
 obliterating the past life of vice and crime by 
 occupation, diversion, truth and trust. To an 
 officer of the State Government, who cautioned 
 her not to be alone with a woman criminal who 
 was homicidal and hopeless as to reform, she 
 replied : "This prison is intended for that very 
 class of convict women; visit it in one year, and 
 if that woman is not in your opinion reformed, 
 I will abandon the institution." He had no con- 
 fidence in her work and did not visit the prison, 
 but the woman was reformed, was married to 
 a prominent Justice, and became the mother of 
 a family which holds a high social position in 
 a western community. 
 
 In passing through the institution, objects for 
 
WHO IS INSANE? 255 
 
 study and diversion were met on every hand. 
 In one inclosure was a pet horse, in another 
 several sheep and lambs, in a third chickens, in 
 a fourth geese, in a fifth pigs. Each animal had 
 a pet name, given by the inmates, and all were 
 tame, owing to the constant fondling by the 
 patients. 
 
 CONTRAST two reformatory institutions, in 
 one of which the discipline was by punitive, 
 and in the other by physiological methods. In 
 the first Reformatory three methods of punish- 
 ment were adopted, according 
 The Old and New to the grade of offense, viz., 
 in Contrast confinement in a dark cell 
 with bread and water as a 
 diet; standing at the door of the cell with the 
 hands raised to the full length of the arms and 
 chained in that position during the ordinary 
 working hours; spanking with a large and heavy 
 leather strap. 
 
 An examination of a large number of the in- 
 mates who had suffered these forms of pun- 
 ishment gave the following results. Those who 
 had been subjected to solitary confinement and 
 a diet of bread and water were generally so well 
 satisfied with their treatment that the Superin- 
 tendent complained of their unwillingness to re- 
 turn to work even after sixty days' confinement. 
 An examination of these offenders readily ex- 
 
256 WHO IS INSANE? 
 
 plained, physiologically, what the Superintend- 
 ent regarded as evidence of their incorrigibility. 
 First, darkness and quiet induced sleep and they 
 enjoyed the undisturbed repose. Second, bread 
 and water as a diet, with complete physical rest, 
 soon destroyed all demand and appetite for 
 food, which resulted in a general deterioration 
 of brain, muscle, heart, and, indeed, of all the 
 organs and tissues. The punished inmate was 
 in the condition of a hibernating animal. When 
 he finally returned to his work he was feeble in 
 health, morose in temper, and far more incorri- 
 gible than before his punishment. 
 
 The offenders who had to submit to spanking 
 and being chained by the hands raised over the 
 head were hostile towards the officers, threat- 
 ening and unmanageable. The atmosphere of 
 the entire Reformatory was charged with the 
 hatred and antagonism which existed between 
 the officers and the prisoners. Scarcely a word 
 was spoken to the latter by the former, except in 
 tones of command. Not a smile was seen on the 
 faces of the inmates, but many a contemptuous 
 glance was noticed as an officer passed. 
 
 Now let us study the obverse side of this pic- 
 ture, in a Reformatory where the discipline is 
 based on strictly physiological and psycholog- 
 ical principles. The Superintendent was asked: 
 "What is your method of disciplining an inmate 
 who throws down his tools and declares he will 
 not work?" The reply was, in substance: 
 
WHO IS INSANE? 257 
 
 "We regard such an inmate ias a mere crank 
 who wishes to make the other men of the class 
 feel his importance. He is at once advised that 
 he may leave his class and go to a certain room 
 — one of a number made purposely for the dis- 
 cipline of offenders — and have a rest. These 
 rooms are one story, of small size, and the roof 
 is made of glass. The furniture is a cot and 
 stool. The room is intensely lighted, owing to 
 the glass ceiling. The rebellious prisoner with- 
 draws from the gang with a defiant air and en- 
 ters his rest-room. His first impulse is to throw 
 himself on his cot and sleep, but the glare of 
 light is so great that he cannot sleep. He sits 
 upon the stool, but it soon becomes uncomforta- 
 ble and he takes to walking. He soon tires of 
 that and repeats his efforts to sleep, but again 
 fails owing to the light, and thus the day passes 
 with alternate efforts to secure rest by lying on 
 the cot, sitting on the stool, and walking. 
 
 "His meals are regularly served, and they are 
 composed of the richest and most stimulating 
 foods. Such a diet greatly aggravates his rest- 
 lessness and increases his discomfort. Within 
 three days, as a rule, the most obstinate offender 
 intimates that he would be willing to resume 
 his work, but the Superintendent, who visits him 
 daily, very kindly suggests that as he was so ex- 
 hausted with his work he had better take a good 
 rest, and adds the humiliating statement that 
 
258 WHO IS msANE? 
 
 the fellows in his class had requested that he be 
 not associated with them again as they did not 
 like him." 
 
 It is a fact of record in this Reformatory that 
 incorrigible prisoners rarely remained in seclu- 
 sion more than five days, and, when they re- 
 turned to work were strong and vigorous, hum- 
 bled, because they did not prove to be heroes in 
 the opinions of their fellows, and grateful to the 
 officers who had treated them so humanely. 
 The visitor to that Reformatory is surprised at 
 the familiarity between the officers and the 
 prisoners, and at the smiling faces of the latter 
 as the former pass through the different depart- 
 ments, speaking freely with them, calling them 
 by name, and often giving them friendly taps on 
 the shoulders. 
 
 Can there be any doubt which of these Re- 
 formatories discharged the greater number of 
 permanently reformed criminals? Of a large 
 number interviewed, who had been treated by 
 the punitive method, all condemned it, and none 
 admitted that he^was induced to change his vi- 
 cious habits by his punishments; while those dis- 
 charged from the Reformatory where rational, 
 humane and physiological methods were prac- 
 ticed, referred to their treatment in terms of 
 gratitude for its effect in changing their vicious 
 tendencies and giving them new and better 
 views of life. 
 
WHO IS INSANE? 259 
 
 It is gratifying to have on record practical 
 proofs that the humane treatment of criminals 
 should now become the policy of States, not only 
 because of its reformatory tendencies, but also 
 because of its economical results. 
 
 "The State of Vermont," says a recent writer, 
 "contains a prison where the inmates are 
 treated upon a novel plan. They are trusted 
 and treated like other human beings; they come 
 and go almost as freely as the members of the 
 jailor's own family; so far as possible, whatever 
 suggests punishment or disgrace is banished; 
 and they are made to feel that their imprison- 
 ment is designed to improve them as men, and 
 to restore them to social life not only with full 
 self-respect but with the cordial respect of the 
 community." 
 
 THIS is the physiological idea of re-forming 
 — creating anew, — the brain of a criminal, 
 tersely and accurately stated. The conditions 
 under which he is placed when he enters upon 
 
 his prison career all tend to 
 The New Method repress the vicious nerve- 
 in Vermont centres and to arouse to 
 
 healthy activity the virtuous 
 nerve-centres. The success of this treatment has 
 happily had a secondary effect upon the preju- 
 dices of the people. The writer adds : "In Mont- 
 pelier, where this prison stands, the inveterate 
 
260 WHO IS INSANE? 
 
 prejudice against prisoners has been swept 
 away. So great is the significance of this 
 achievement, denoting as it does a reversal of 
 popular sentiment toward the criminal, that 
 only something approaching a revolution in the 
 prison system itself could have produced it." 
 
 It is an interesting fact that in establishing the 
 new or physiological system of treating crimi- 
 nals, the Sheriff of the county in which Mont- 
 pelier is located was not actuated by the results 
 of scientific study but merely followed the sug- 
 gestions of his own common sense. There was a 
 State law that provided : "A male prisoner im- 
 prisoned in a county jail for being found intoxi- 
 cated, for a breach of the peace, or for being a 
 tramp, may be required to perform not more 
 than ten hours of manual labor within or with- 
 out the walls of such county jail each day of 
 such imprisonment, except on Sundays or on 
 legal holidays." The object of this law was to 
 utilize the labor of the prisoners in the interests 
 of the State for economic rather than reforma- 
 tory purposes. 
 
 When the Sheriff was questioned as to his mo- 
 tives in making this larger application of the law 
 to the regeneration of the prisoner, he replied: 
 "I thought of each prisoner as having a parent 
 with the feelings and hopes for him that mine 
 had for me, and reflected that if the prisoners 
 had grown up in the absence of such an influ- 
 
WHO IS mSANE? 261 
 
 ence, they had been defrauded, and deserved 
 only compassion, not blame, for sinking into 
 jail." This is the new spirit which is to govern 
 in the enforcement of our penal laws. 
 
 When the Sheriff began his new method he 
 had no other plan than that of treating the pris- 
 oners humanely and awakening in their minds 
 a feeling of trust and hence of respectability. 
 But his first efforts, those of finding employ- 
 ment for them among business men, proved a 
 failure. "No one would have them; the sane 
 and safe business men were not to be taken in 
 like that; they comforted him with assurances 
 that he must fail — the same business men who 
 now send regularly to him for workers when 
 they want help, in preference to picking men up 
 on the street." 
 
 THE secret of success was revealed when the 
 Sheriff attempted to employ the prisoners 
 on his own farm. He allowed the State fifty 
 cents a day for each, but paid the men nothing. 
 
 The experiment was a failure, as 
 The Secret the prisoners did little and poor 
 of Success work. It is reported that, "One 
 
 day, much discouraged, the Sher- 
 iff called one of the group into his office for a 
 heart-to-heart talk, asking him to say frankly 
 why he did not do more. 'I'm doing just as lit- 
 tle as I can and not be punished, and I'm going 
 
262 WHO IS INSANE? 
 
 to keep on. You would do the same,' answered 
 the man." The Sheriff was impressed with the 
 reply, and, imagining himself in the prisoner's 
 place, recognized the truth of the remark, "You 
 would do the same." A day's work and nothing 
 for it! What incentive had he to labor? 
 
 "If you could have seventy-five cents for 
 yourself from your work each day, what would 
 you do ?" inquired the Sheriff of a prisoner who 
 failed to do his allotted work. "Try me," was 
 the answer. The next day this "incorrigibly ob- 
 stinate idler, while there was no incentive," 
 worked as well as any free man in the gang. 
 
 The Montpelier jail was a success from the 
 moment the Sheriff received the pertinent an- 
 swer, "You would do the same," and the prompt 
 challenge, "Try me." This suggested the plan 
 of organization of the jail as follows: "One 
 dollar a day is set aside from the wages of each 
 for the State, while all in excess of that belongs 
 to the earner. As it works out in figures, every 
 man in ordinary health earns the full laborer's 
 pay of $1.75 a day, of which seventy-five cents 
 is his, the Sheriff acting as his banker and keep- 
 ing the acumulation until he leaves the prison, 
 when it is given to him in a lump sum." 
 
 The financial results of the humane method 
 of treating criminals are thus stated: "The prof- 
 its accruing to the State have steadily increased. 
 At the end of the first year they were $200; of 
 
WHO IS INSANE? 263 
 
 the second, $500; of the third, $1,000; after hav- 
 ing paid for all clothing, tools and supervision 
 in the form of keeping the books and other cler- 
 ical work. At the close of the fourth year . 
 the gross earnings for the State were over $1,800. 
 Since an amount equal to three-fourths of this 
 was retained by the men, their share was more 
 than $1,350. . . . During the whole period 
 their labor earned above $6,000, of which a total 
 exceeding $2,600 was kept by themselves. As a 
 rule the men have carefully saved their money, 
 limiting permitted purchases for themselves to 
 send it home to those dependent on them." 
 
 THE writer says that, brilliant as has been the 
 financial success of the new system, this "is 
 but a small part of the good it accomplishes; its 
 real value is to be measured by its effect upon 
 the characters and lives of the 
 The Effect prisoners. They leave the jail 
 on Character rugged and healthy from the 
 sane and vigorous existence they 
 have led while there. Their habits have been 
 regular, they have been daily in the open air 
 when work could be had, their food has been 
 substantial, the atmosphere in which they lived 
 salutary." 
 
 Speaking of his visit to the Montpelier jail the 
 writer says : "I spent the greater part of a day 
 talking with the prisoners, first in company with 
 
264 WHO IS INSANE? 
 
 the deputy sheriff, and then alone, with full per- 
 mission to discover opposition to the manage- 
 ment if I could. In this way I made the personal 
 acquaintance of the men. Later, on the main 
 street of the city, whom should I meet but five 
 or six of these very prisoners, walking along 
 with smiling faces and a happy air, no more re- 
 sembling the conventional criminal than did the 
 merchants, workingmen, and lawyers with 
 whom they mingled. 
 
 "Here was one of the keys to the mystery. No 
 officer was about, keeping an eye on them; no 
 peculiarity of clothing indicated who they were; 
 they were free to walk off if they pleased, and 
 no one at the jail was worrying about them; and, 
 best of all, the citizens of Montpelier, who knew 
 perfectly well that inmates of the county prison 
 were at all times of the day and evening at large 
 in their midst, were worrying no more about it 
 than were the sheriff and his assistants them- 
 selves. 
 
 "And yet, four years ago, when the system was 
 first put into operation, a very decided tremor 
 convulsed these very citizens. They were ani- 
 mated by all the righteous dread and abhor- 
 rence of the inhabitants of jails common to or- 
 dinary mankind. They believed that the men 
 were dangerous, that they would run away, that 
 it was treating them on wrong principles to give 
 them such freedom, and that it was a disgrace 
 
WHO IS INSANE? 265 
 
 to good people to have criminals going about 
 unguarded on the same streets. But if you sug- 
 gest these ancient and wholesome ideas to a 
 Montpelier man now, he laughs at you; he is 
 ashamed that four years ago he entertained 
 such superstitions. 
 
 "It appears that the Sheriff who inaugurated 
 the new plan of treating prisoners was himself 
 so much in doubt as to its practicability that for 
 a time, when the men did not return promptly 
 to the jail at the appointed time, he became ner- 
 vous and walked the streets in search of them. 
 But that is all past now, not only because of the 
 unsuspected traits of human nature that expe- 
 rience has unfolded, but because of the marvel- 
 ous practical success of the system. During the 
 four years, out of eight hundred prisoners treat- 
 ed upon the new plan only two attempted to 
 escape, both of whom were recaptured and sen- 
 tenced to long terms in the House of Correction 
 for betraying the trust reposed in them. With 
 such a record as this the Sheriff no longer feels 
 perturbed if his entire corps of prisoners is scat- 
 tered in every direction during the day; and he 
 is perfectly assured that at night they will reap- 
 pear at the jail." 
 
 An instance is given of the trust reposed in 
 the prisoners. The Sheriff purchased tickets to 
 a circus for as many as desired to go, and sent 
 them unattended. Eleven went, others refusing 
 
266 WHO IS INSANE? 
 
 because they were working for farmers and pre- 
 ferred the money which they were earning. The 
 opportunity to escape was excellent, as the per- 
 formance continued until after dark; yet every 
 one of them was at the jail fifteen minutes after 
 the tent closed, though some of the men had 
 long-term sentences. 
 
PART FIVE 
 
 A NEW INSTITUTION— THE DAWN OF A 
 BETTER DAY 
 
XXIII 
 A New Institution 
 
XXIII 
 
 A New Institution 
 
 T is gratifying to notice the trend 
 of thought and effort of the 
 more advanced students of so- 
 cial science to practically apply 
 the teachings of physiology to 
 the curative treatment of the in- 
 sane, the idiot and the criminal. 
 We must recognize in the Psychopathic Hos- 
 pitals, the Schools for the Education of the Fee- 
 
 ble-Minded Children, the 
 
 Enlightened Training Schools for Girls and 
 
 Public Policy Boys, and similar institutions, 
 
 the beginning of a far more 
 enlightened public policy in the care of these 
 classes. 
 
 An institution that will more nearly realize 
 the ideal standard of treatment on admission to 
 State care, which physiological and psycholog- 
 ical science demands, is the organization at the 
 New York State Reformatory for Women, Bed- 
 ford Hills, Westchester County, under the title 
 of the Bureau of Social Science. 
 
 271 
 
272 WHO IS msANE? 
 
 This Bureau had its origin in a discussion 
 between a Committee on Criminal Courts in 
 New York City, the City Magistrates of that city, 
 and the Managers and officers of the Bedford 
 Reformatory. The Magistrates stated that it 
 was often difficult to determine what to do with 
 specific cases which came before them; the mere 
 appearance of a young woman in court did not 
 furnish sufficient opportunity to form a correct 
 judgment of her mental characteristics; even in 
 cases where the probation officer investigates 
 the facts in the life of individuals, she cannot in 
 the short time allotted her obtain the informa- 
 tion necessary to enable the committing magis- 
 trate to decide unerringly to what institution 
 each prisoner should be sent. How can this de- 
 fective system of administering justice be rem- 
 edied? 
 
 What possible reply to the appeal of the Mag- 
 istrates could be more rational, in the light of 
 our preceding studies, than that of the Managers 
 which was, in substance, "After conviction and 
 before sentence have the entire life-history 
 of the convict — heredity, diseases, education, en- 
 vironment, habits, social relations, mental pe- 
 culiarities, present health, predisposing and ex- 
 citing cause of the crime — investigated and then 
 you can determine with scientific precision what 
 course must be pursued to effect her reform." 
 Here, in a single paragraph, the basic principle 
 
WHO IS INSANE? 273 
 
 of a correct public policy in the treatment of the 
 dependent classes is stated. In medical terms 
 the statement would have been thus, "Make a 
 correct diagnosis of the case before you decide 
 the course of treatment adapted to effect a 
 cure." 
 
 The germ in the question put by the Magis- 
 trates fell in good ground. The management of 
 the Bedford Reformatory had already instituted 
 a course of investigation of the life-history of 
 some of its inmates by a skilled psychopathist 
 for the purpose of being able to determine more 
 intelligently the course of treatment best adapted 
 in each case to effect reform. In this ques- 
 tion came the opportunity of enlarging and per- 
 fecting their scheme of reform in their work. 
 
 THE managers formulated a plan that 
 would give effect practically td their ideas, 
 which was submitted to the Committee on Crim- 
 inal Courts. The Committee gave the plan wide 
 circulation among the magistrates 
 A New Plan and philanthropic citizens, many 
 Formulated of whom approved it but re- 
 garded it impracticable as a pub- 
 lic measure owing to the expense attending its 
 installation, and its revolutionary character. 
 Fortunately the plan came to the notice of sev- 
 eral interested persons able and willing to fi- 
 nance the undertaking, and its success was as- 
 
274 WHO IS INSANE? 
 
 sured. An organization was formed and incor- 
 porated under the above title — The Bureau of 
 Social Science. 
 
 The details of the plan of organization finally 
 adopted are worthy of record, for they may be 
 suggestive to those who undertake the establish- 
 ment of similar institutions. The object sought 
 was to create, in immediate connection with the 
 Bedford Reformatory, a Bureau or Department 
 devoted to the thorough study of every woman 
 convicted of crime and sent to the Reformatory 
 by the magistrates of New York City in order to 
 determine, before she is admitted to the Reform- 
 atory, the kind of treatment she should receive 
 to effect her reform. While the Bureau is to be 
 under the jurisdiction and immediate control of 
 the Managers of the Reformatory, it is not lo- 
 cated within the grounds of that institution but 
 on a separate tract of land, equipped by build- 
 ings, industries and means for occupation and 
 diversion adapted to the application of every 
 test necessary to determine the physical, mental 
 and moral peculiarities of the individual. 
 
 The relation of the promoters of the Bureau 
 and the Managers of the Reformatory to the new 
 institution is as follows : "As the Bureau is re- 
 garded as an experiment, the expense of which 
 the State would not assume, the promoters un- 
 dertake to finance this feature of the operations 
 of the Bureau, and the Managers assume only 
 
WHO IS INSANE? 275 
 
 the expense ordinarily incurred in the care of 
 the same inmates in the Reformatory. Thus the 
 promoters purchase the land, build the build- 
 ings, equip the laboratories, and pay the salaries 
 of the Research Staff, while the Managers fur- 
 nish the ordinary supplies, attendants and 
 workers." 
 
 THERE are to be three Departments of inves- 
 tigation, viz.. Medical, Physiological and So- 
 ciological. Each Department is to be in charge 
 of skilled and experienced experts and to be 
 
 equipped with every device neces- 
 Three Lines sary to obtain accurate results. 
 of Research There will be several trained field 
 
 workers connected with this staff 
 who will visit the homes and haunts of the con- 
 vict in search of facts throwing light on her 
 heredity, home and scholastic training, environ- 
 ments, and social affinities. 
 
 To this Research Department every convict 
 committed to the Reformatory is first admitted 
 and subjected to such an exhaustive study that 
 there may be no mistake made in determining 
 the kind of care and treatment required to ef- 
 fect her reform. When the diagnosis of her case 
 is satisfactorily made out she is assigned to that 
 Department of the Reformatory adapted to 
 apply the prescribed remedial measures, or, if 
 necessary, she may be committed to another 
 
276 WHO IS INSANE? 
 
 State institution better equipped for her special 
 treatment. Or, what is of vastly greater im- 
 portance, the study may bring to light some 
 easily remedied defect in the home-life of the 
 unfortunate victim of circumstances which im- 
 pelled her to a criminal act. With its removal 
 she can return safely to her home and resume 
 her normal position in the household. 
 
 It is apparent that in this plan of operating a 
 Reformatory for Women the curative methods 
 of treatment dictated by physiology, psychology 
 and sociology — the sciences which teach the art 
 of healthy living and correct conduct — will be 
 the dominant forces directing and controlling 
 the care and treatment of the inmates. Every 
 woman admitted will present to the skilled and 
 expert Research staff a new scientific problem, 
 which must be immediately solved, that the suf- 
 ferer may be returned to her family and to the 
 community at the earliest possible moment. No 
 step will be taken in her treatment until every 
 important feature of her life-history — heredity, 
 diseases, education, habits, social relations, men- 
 tal peculiarities, and present physical health — 
 have been thoroughly studied and recorded. 
 From this vantage-ground will begin a course of 
 treatment having that exactness in detail and 
 precision in application which accuracy in diag- 
 nosis always secures. 
 
 It has already been demonstrated by the psy- 
 
WHO IS INSANE? 277 
 
 copathic hospitals, where the suspected insane 
 are first placed in observation buildings and 
 subjected to expert examination before admis- 
 sion to an asylum, that large numbers are found 
 suffering from temporary ills which do not re- 
 quire for their relief hospital treatment nor cus- 
 todial care. From a medical view-point there 
 can be no doubt that if the number of Bureaux 
 of Social Science organized like that at Bed- 
 ford Hills, was so multiplied that every person 
 committed to public care was subjected to an 
 exhaustive examination by experts in physi- 
 olog3% psychology, and sociology, immediately 
 on admission to an institution, and the course of 
 treatment indicated by the results of such inves- 
 tigation were rigidly and intelligently enforced, 
 our asylums, prisons, reformatories, and other 
 charitable and eleemos^^nary institutions would 
 in no distant future be largely depopulated, and 
 become in a most commendable degree self-sup- 
 porting. Such a reform would strike at the root 
 of a vast number of our social evils, restore to 
 communities a class of hitherto worthless or 
 dangerous persons, and relieve the State of a 
 source of ever-increasing taxation which is now 
 an intolerable burden. 
 
 IT is painfully evident to an intelligent visitor 
 to institutions for the care, treatment, or ed- 
 ucation of those suffering from idiocy, insanity. 
 
278 WHO IS INSANE? 
 
 epilepsy, or other affections of the nervous sys- 
 tem, that there is too often want- 
 Enthusiasm ing, on the part of physicians and 
 Is Needed care-takers ahke, that genuine 
 enthusiasm in their work which 
 insures the highest degree of success. The vast 
 variety of symptoms which these diseases pre- 
 sent for study attract but little attention, be- 
 cause the brain is a sealed book. All of the in- 
 mates are placed on a dead level, and the treat- 
 ment, instead of being individual, is en masse. 
 
 We can only feebly conjecture what vast num- 
 bers of feeble-minded would be taught self- 
 care, what an enormous percentage of insane 
 would be cured, and what universal reformation 
 of criminals would result, if every one of these 
 classes now in public care were subjected, indi- 
 vidually, to the skilled, patient, and persistent 
 treatment of experts in the physiological and 
 psychological sciences. 
 
 As a conclusion we are profoundly impressed 
 with the evidence that the policy of the State in 
 its care of those persons who become a public 
 charge — insane, criminals, idiots, feeble-minded, 
 crippled — should be curative, in the sense of 
 enabling them to live in a community as moral, 
 industrious, and self-supporting citizens. Abun- 
 dant proof has been given that untold numbers 
 of these life-pensioners upon the taxable re- 
 sources of the State, if thoroughly treated ac- 
 
WHO IS INSANE? 279 
 
 cording to the methods — physiological, psycho- 
 logical, and sociological — to be employed by the 
 "Bureau of Social Science," can be rescued from 
 the asylums, prisons, refuges and reformatories 
 of the State. The installation of that Bureau, 
 as an experimental institution designed to ap- 
 pl}^ practically the resources of science, art, 
 and humanity to rescuing young convict women 
 from lives of crime and to demonstrate thereby 
 the power of the same method to cure the de- 
 pendent classes of their innumerable crippling 
 ailments, is the dawn of a new era in the history 
 of Christian civilization. For this important ad- 
 vance in practical philanthropy too much credit 
 cannot be given to Mr. John D. Rockefeller, Jr., 
 and his associates, who agreed to finance the un- 
 dertaking, and to the Managers of the Bedford 
 Reformatory, who through the good offices of 
 the Superintendent, Dr. Katherine B. Davis, one 
 of the most advanced students of sociology, fur- 
 nished the detailed scheme of research and gen- 
 eral administration. 
 
 We must add that in this action of the Bed- 
 ford Reformatory we recognize the inspiration 
 of the spirit of aggressive reform, the indom- 
 itable will in combating social evils, the untir- 
 ing zeal in efforts to uplift the fallen, which 
 characterized the long and eventful life of its il- 
 lustrious founder, Abby Hopper Gibbons. At 
 the age of ninety-two she visited the Committee 
 of the Legislature which had the bill creating 
 
280 WHO IS INSANE? 
 
 the Reformatory under discussion and the sub- 
 stance of her remarks was as follows: "A Re- 
 formatory pure and simple is my aim. The 
 word Prison may keep in the background. 
 Criminals are made what they are by associa- 
 tion and treatment. Let us turn over a new leaf 
 and remember that they are human; and that, 
 with tact and experience, it is possible to 'tem- 
 per the wind to the shorn lamb' and soften the 
 heart of the hardest." 
 
XXIV 
 
 Eugenics 
 
I 
 
XXIV 
 
 Eugenics 
 
 lUGENICS opens a field in altru- 
 ism of infinite possibilities in 
 the prevention of public de- 
 pendency. Galton says: "Its 
 first object is to check the birth 
 rate of the unfit, instead of al- 
 lowing them to come into being, 
 though doomed in large numbers to perish pre- 
 maturely; the second object is the improvement 
 of the race by furthering the pro- 
 Objects of ductivity of the fit by early mar- 
 Eugenics riages and healthful rearing of 
 their children." It aims "to re- 
 place natural selection by other processes that 
 are more merciful and not less effective. Nat- 
 ural selection rests upon excessive production 
 and wholesale destruction ; eugenics on bringing 
 no more individuals into the world than can be 
 properly cared for and those only of the best 
 stock." 
 
 But Eugenics is in its experimental stage. Its 
 method of preventing the increase of the unfit, 
 
 283 
 
284 WHO IS INSANE? 
 
 by sterilizing or unsexing those who might be- 
 get them, would certainly effect its object if 
 rigorously enforced by the State. But the pro- 
 cedure is naturally shocking to the moral sense, 
 and must be attended with serious difficulties. 
 It is a matter of common observation that idiots 
 and feeble-minded are sometimes found in the 
 homes of the more intelligent members of a 
 community and the best scholars in the public 
 schools often come from the homes of the illit- 
 erate, who are popularly classed as feeble-mind- 
 ed. As idiocy and feeble-mindedness have not 
 been standardized, by what rule is the public 
 officer appointed to sterilize the sexes to de- 
 termine with absolute certainty that the subjects 
 of his operations would beget idiots or feeble- 
 miinded? Again, what would be the effect on 
 the morals of a community in which lived un- 
 sexed feeble-minded? 
 
 So far as the method has been practiced un- 
 der rules and regulations established by the 
 State, the reported results are not conclusive as 
 to the propriety of its general adoption and 
 rigid enforcement. It is certain that whenever 
 the method is legalized it should be protected 
 with such safeguards as will effectually prevent 
 abuses. 
 
 It may well be questioned, whether the more 
 rational methods of improving the race should 
 not now be in accord with the second object of 
 
WHO IS INSANE? 285 
 
 Eugenics, as stated by Galton, viz., "by further- 
 ing the productivity of the fit by early mar- 
 riages and healthy rearing of children." To this 
 should be added restriction of marriage of the 
 unfit, segregation of the sexes most exposed and 
 unprotected, and such education as will enable 
 them to practice self-care and self-support. 
 
T 
 
 HE following pages contain advertisements of 
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