COLUMBIA LIBRARIES OFFSITE HEALTH SCIENCES STANDARD HX64077667 RA790.A1 N212 Some phases of the RECAP Lewellys F. Barker Some phases of the mental hygiene movement and the scope of work of the National committee for mental hygiene. RA 790,4/ NZIZ- Columbia titatoergit}) mtljeCtipirfitogork College of $gtp£ician£ anb Hmrgeons Eibrarp Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/somephasesofmentOObark Columbia Uuiversit New Yor& SOME PHASES OF The Mental Hygiene Movement AND THE SCOPE OF THE WORK OF The National Committee for Mental Hygiene BY LEWELLYS F. BARKER, M. D. President of the National Committee for Mental Hygiene PUBLISHED BY The National Committee for Mental Hygiene 50 Union Square, New York 1912 .ICATION No. 4 It. tii The National Committee for Mental Hygiene 50 UNION SQUARE, NEW YORK CITY President DR. LEWELLYS F. BARKER Treasurer Vice-Presidents Secretary [R. OTTO T. BANNARD DR. WILLIAM H. WELCH MR. CLIFFORD W. BEERS DR. CHARLES P. BANCROFT DR. GEORGE BLUMER, Chairman, Executive Committee PROF. RUSSELL H. CHITTENDEN, Chairman, Finance Committee DR. WILLIAM L. RUSSELL, Chairman, Committee on Survey DR. THOMAS W. SALMON. Director of Special Studies MEMBERS Mrs. Milo M. Acker, Hornell, N. Y. Harry Pratt Judson, Chicago Jane Addams, Chicago John Koren, Boston Edwin A. Alderman, Charlottesville, Va. Julia C. Lathrop, Washington James B. Angell, Ann Arbor, Mich. Samuel McCune Lindsay, New York Dr. Pearce Bailey, New York George P. McLean, Simsbury, Conn. Dr. Charles P. Bancroft, Concord, N. H. Dr. William Mabon, New York Otto T. Bannard, New York Marcus M. Marks, New York Dr. Lewellys F. Barker. Baltimore Lee Meriwether, St. Louis Dr. Albert M. Barrett, Ann Arbor, Mich. Mrs. Philip N. Moore, St. Louis Dr. Frank Billings, Chicago Dr. J. Montgomery Mosher, Albany Surg. Gen. Rupert Blue, Washington Cyrus Northrop, Minneapolis Dr. George Blumer, New Haven Dr. Stewart Paton, Princeton Dr. G. Alder Blumer, Providence Francis G. Peabody, Cambridge Russell H. Chittenden, New Haven Dr. Frederick Peterson, New York Dr. William B. Coley, New York Henry Phipps, New York Dr. Owen Copp, Philadelphia Gifford Pinchot, Washington Dr. Charles L. Dana, New York Florence M. Rhett, New York Dr. Charles P. Emerson, Indianapolis Jacob A. Rus, New York W. H. P. Faunce, Providence Dr. Wm. L. Russell, White Plains, N. Y. Dr. Henry B. Favill, Chicago Jacob Gould Schurman, Ithaca Katherine S. Felton, San Francisco Dr. M. Allen Starr, New York Irving Fisher, New Haven Anson Phelps Stokes, Jr., New Haven Matthew C. Fleming, New York Melville E. Stone, New York Horace Fletcher, New York Sherman D. Thacher, Nordhoff, Cal. _ Homer Folks, New York Henry van Dyke, D.D., Princeton James, Cardinal Gibbons, Baltimore Dr. Henry P. Walcott, Cambridge Arthur T. Hadley, New Haven Dr. William H. Welch, Baltimore Henry L. Higginson, Boston Benjamin Ide Wheeler, Berkeley, Cal. Dr. August Hoch, New York Dr. Henry Smith Williams, New York Mrs. William James, Cambridge Robert A. Woods, Boston David Starr Jordan, Palo Alto, Cal. he Chief Objects of the National Committee for Mental Hygiene are : To work for the protection of the mental health of the public; to help raise the stan- ird of care for those threatened with mental disorder or actually ill ; to promote the study mental disorders in all their forms and relations and to disseminate knowledge concern- g their causes, treatment and prevention ; to obtain from every source reliable data regard- g conditions and methods of dealing with mental disorders ; to enlist the aid of the Fed- al Government so far as may seem desirable; to co-ordinate existing agencies and help ganize in each State in the Union an allied but independent Society for Mental Hygiene, milar to the existing Connecticut Society for Mental Hygiene. Inquiries re^ardin^ the work and requests for pamphlets •sued by the organization should be addressed to Clifford V. Beers, Secretary, The National Committee for Mental [y^iene, Room 1914, No. 50 Union Square, New York City, r to Dr. Thomas W. Salmon, Director of Special Studies. SOME PHASES OF THE MENTAL HYGIENE MOVEMENT AND THE SCOPE OF THE WORK OF THE NATIONAL COMMITTEE FOR MENTAL HYGIENE* BY LEWELLYS F. BARKER, M. D. President of the National Committee for Mental Hygiene. It is right that, in an International Congress of Hygiene and Demography, the subject of Mental Hygiene should have especial representation. Though assigned, as a sub-section, to the section on the Hygiene of Infancy and Childhood, thus emphasizing its rela- tions to inheritance on the one hand and to the early environmental period of the individual on the other, it might almost equally well, for other reasons, have been made a sub-division in any one of the main groups of the Congress. Indeed, so important is this sub- division for the welfare of individuals, of families, of communities, of nations, and of the human race in general, and so wide spread its ramifications, that committees on the organization of future Con- gresses might well consider the establishment of an additional main section, devoted entirely to Mental Hygiene. By a campaign for mental hygiene is meant a continuous effort directed toward conserving and improving the minds of the people, in other words, a systematic attempt to secure human brains, so naturally endowed and so nurtured, that people will think better, feel better, and act better, than they do now. Such a campaign was not to be expected before the rise of modern medicine. For only with this rise have we come to look upon states of mind as directly related to states of brain, to view insanity as disordered brain- function, and to recognize in imbecility, and in crime, the evidences of brain-defect. The imbecile, the hysterical, the epileptic, the insane, and the criminal, were formerly regarded sometimes as saints or prophets, sometimes as wizards or witches, often as the victims of demoniac possession, on the one hand to be revered or worshipped, or, on the other, to be burned or otherwise tortured. Now, such unfortunates are looked upon as patients with disordered or defec- tive nervous systems, proper subjects of medical care; some of them *An address delivered as Chairman of the sub-section on Mental Hygiene of the 15th International Congress on Hygiene and Demography, Washing- ton, D. C, September 26, 1912. 5 are curable ; some are incurable, but still educable to social useful- ness ; a part of them are socially so worthless, harmful or dangerous as to make their exclusion from general society necessary, or desir- able. It is but a short step from such a reformation of ideas, to the realization that less marked deviations from normal thought, feeling, or behavior, are also evidences either of brains defective from the start, or made abnormal in function by bad surroundings or by bodily disease. As examples of such marked abnormalities may be mentioned those met with in children who are difficult to educate, in young people arraigned in the Juvenile Courts, in adults, who, inadequate to the strains of life, crowd our hospitals or sanitoria on account of " nervous " or " mental " breakdown, or who, owing to anomalies of character and conduct, provide material for the news columns of the sensational press. Modern medicine has taught us to recognize that the conditions necessary for a good mind include, first, the inheritance of such germ-plasm from one's progenitors as will yield a brain capable of a high grade of development to indi- vidual and social usefulness, and, secondly, the protection of that brain from injury and the submission of it to influences favorable to the development of its powers. Now if these doctrines of modern medicine be true, the general problems of mental hygiene become obvious ; broadly conceived, they consist, first, in providing for the birth of children endowed with good brains, denying, as far as pos- sible, the privilege of parenthood to the manifestly unfit who are almost certain to transmit bad nervous systems to their offspring — that is to say, the problem of eugenics ; and second, in supplying all individuals, from the moment of fusion of the parental germ-cells onward, and whether ancestrally well-begun or not, with the environ- ment best suited for the welfare of their mentality. The natural sciences are built up by the gradual discovery of causal relationships ; and physicians and psychologists have, since the time of Pinel, gone far in the establishment of the laws under- lying normal and abnormal phenomena of mind. From the con- viction that a proper application of the facts already discovered can vastly improve the mental powers of our people, decreasing to a large extent the prevalence of mental defect and mental disease, has come the impulse to arouse public opinion in favor of a definite plan for mental hygiene. This impulse, thanks to the initiative of a layman, Cli fford W. Beers, author of "A Mind That Found Itself "* *An autobiography, published by Longmans, Green & Co., 440 Fourth Avenue, New York. 6 (now Secretary of the National Committee), whose personal suffer- ings led him, on recovery, to devote himself to the cause of mental hygiene, and who enlisted the co-operation of a group of represen- tative men and social workers, has found expression in the volun- tary formation of a National Committee for Mental Hygiene.* The policy to be pursued by the Committee has been formulated largely as a result of the deliberations of the first Chairman of the Execu- tive Committee in consultation with other distinguished psychiatrists and social workers. Among its objects may be emphasized (i) the protection of the mental health of the public at large; (2) the promotion of the study of mental disorders in all their forms and relations, and the dis- semination of knowledge concerning their causes, treatment and prevention; and (3) the amelioration of conditions among those already suffering from mental disorder. The Committee on Program has asked me to describe briefly the scope of the work of the National Committee for Mental Hygiene. As I see it, there are three great fields in which the National Committee may advantageously labor. First, there is the field of original inquiry regarding the problems of mental hygiene. A National Committee, adequately endowed could support and direct the investigation of special questions by experts, thus adding to the knowledge which can be applied in the more practical part of the campaign. This work of research is very costly; were they available, immense sums could be used for studying the influences of heredity and of external circumstances upon the structure and functions of the human nervous system; meanwhile, a National Committee, composed of leaders of thought among the men and women of the country can do much to favor such studies by university departments, by existing institutes of research, and by other agencies already organized. The second field includes the great work of educating the nation to use the knowledge which scientific investigators have already put at our disposal. In this field three powerful enemies oppose * This Committee was founded at a meeting held in New York City, Feb- ruary 19, 1909, when the following officers were appointed for the first year : President, Dr. Henry B. Favill; Vice-Presidents, Dr. Charles P. Bancroft and Dr. William H. Welch; Executive Committee, Dr. Adolf Meyer (Chair- man), Dr. C. P. Bancroft, Professor Russell H. Chittenden, Professor Wil- liam James and Miss Julia C. Lathrop. The Chairman of the Executive Committee, at present, is Dr. George Blumer, Dean of Yale Medical School. us — ignorance, apathy, and prejudice. These hostile forces, we must overcome. They will retreat, as they always do, before the attack of men and women armed with accurate knowledge of facts and energized by the emotions which accompany visions of remedi- able evil. In this campaign of education, the general public, physicians, school-teachers, the clergy, members of the legal profession, our legislators- -all must be taught the particular truths regarding mental hygiene which each group, respectively, can best apply. Only a minority of the public know and realize that the kind of mind an individual has depends upon the inborn qualities of brain he inherits and the influences which act upon it afterwards ; that not only imbecility, insanity, and epilepsy are due to disordered or defective nervous systems, but that further, in ebriety , prostitut ion^ vagrancy, pjuperism and crime have the same origin, as do also meducability, laziness, and other forms of mental disability. Not ' many know that~40 to 50% of all severer cases of mental disorder are due to known and well defined causes, preventable by means with which we are now acquainted • that 25 % of the patients admitted to institutions for the insane, and a large proportion of the criminals in confinement have brains that have been injured by the abuse of alcohol ; and that all general paresis, and much mental disorder of other sorts, has been preceded by syphilitic infection, usually insufficiently treated. Only a few are aware that there are already about 250,000 insane people in the United States to-day, and that the number is increasing at the rate of three or four per every thousand of increase of population. Not enough people realize that, if two imbeciles marry, all their children will be imbecile; or that when imbeciles marry normal persons, about half the total offspring are feeble-minded or degenerate. Nor, as yet has it been possible to impress the public with the facts that the social stigmatizing of the insane is cruel and unreasonable; that suicide, occurring as a result of a psychopathic constitution, should excite the sympathy rather than the moral judgment of those who think humanely; that early treatment of insanity in suitable institutions leads to complete recovery in at least 25% of the cases; or with a thousand other facts that ought to be known and realized. / How are the important data regarding the protection of the I mental health of the public to be made available to them ? This 8 is one of the problems to be solved. Much can doubtless be done through the dissemination of suitable books and pamphlets, through sensible articles in magazines and newspapers, through public lec- tures, through " mental hygiene exhibits " (such as the admirable one prepared under the direction of Dr. Stewart Paton, for the National Committee for Mental Hygiene to present at this Con- gress), through teaching in the schools, churches, and social clubs, most of all, however, througiLlhe advice of f^mily_physicians, who more than others have opportunity to be practically effective in 'giving wise counsel. This brings me to the education of physicians. The instruction in psychiatry in our medical schools is sadly deficient. Though in Germany, each university has for many years had its psychiatric clinic, it was not until recently that a single medical school in this country had a well equipped clinic of this sort. Now the outlook is better. At Ann Arbor, medical students of the University of Alichigan have for several years had the privileges of a small clinic conducted along the newer lines. At Boston, the new State Psy- chopathic Hospital will be available for educating students regard- ing the manifestations of mental disease. And, lately, at the cost of over one million dollars given by Henry Phipps, a model Psychi- atric Clinic has been erected in connection with the Johns Hopkins Hospital and University and its maintenance guaranteed for the coming decade. It cannot be long now before every medical school of the first class will have its own psychiatric clinic. The teaching in these clinics will undoubtedly lead to great reforms in the treat- ment, and in the prevention of mental diseases. The National Committee for Mental Hygiene may be of service in hastening the advent of such psychiatric clinics. It intends to keep on file all needed information regarding them, as well as plans of model clinics, sanitoria, hospitals, etc., which will be accessible to insti- tutions, or to community officials, who may desire to consult them. When physicians are better trained in psychiatry, they will be even more helpful than now in counselling regarding the marriage of people with psychopathic tendencies, concerning the hygiene of pregnancy, of birth, of childhood, of puberty and of the climacteric period, in relation to the education of backward or of peculiar children, and with reference to dietetic, sexual and occupational hygiene. They will also learn to recognize mental disorders earlier than now, that is, at a stage where many of them are curable, and will do much toward overcoming the prejudices of the people against referring the more serious cases to expert care in suitable institutions. The teachers in our schools and colleges should gladly join in a campaign for mental hygiene, and they, themselves, will welcome instruction which will help them in their pedagogic problems. For teachers have been among the first to notice among children great differences in degree of educability by ordinary methods. Until the reasons were made clear, some teachers unjustly blamed children slow to learn ; other teachers, discouraged, unjustly blamed themselves. Here, scientific medicine has come to the aid of pedagogy. School physicians are becoming more expert in dis- tinguishing between inborn and acquired defect, between remedi- able and irremediable difficulty. The establishment of special classes and of special schools, for " feebly endowed," " backward," and " exceptional " children is removing a great burden from the schools and the teachers. Special opportunities are being created and new methods are being devised through which such children can be favorably influenced. As to the need of education of the representatives of the law — lawyers, magistrates, judges, and legislators — anyone who has studied the psychology of criminals and who is at the same time familiar with our laws and our courts can attest. Since psychi- atrists have had the opportunity thoroughly to observe and study criminals before, during and after punishment, our notions of the relations between crime and mental disorder (or anomaly), have been greatly changed. There is a growing tendency to recognize the dependence of criminal, as well as of all other, acts upon the mental state of the agent, and of the latter, in turn, upon the functions of his bodily organs. The newer knowledge demands a revision of the old problems of responsibility, of testamentary capacity, and of the nature and purpose of punishment. Above all, the new insight into facts can be valued for opposing and prevent- ing crime. For since we no longer believe that every man, at every moment, is entirely free to act, or not, in a given way, but have come to realize that the behavior of a given moment may be a matter of necessity, we have begun to see that to prevent crimin- ality, we must bring influences to bear — social, economic, or medical — that will modify the mental factors driving individuals to anti-social acts. It will be a great step forward when all 10 offenders brought before the Juvenile Court shall, after skilled psychiatric examination, be assigned to environments that will do most to educate them to social usefulness. Criminals, young or old, incapable of education to social value, society will learn per- manently to exclude. That the scandal which has pertained to " expert " medical testimony in the Courts must quickly disappear, once a real campaign of mental hygiene has made headway, goes without saying. And, that in the revision of our law codes, particu- larly of its criminal code, specialists in psychiatry should co-operate with the best legal talent, would seem obvious. Toward the spread of these ideas, a National Committee for Mental Hygiene should be able to do much. Indispensable for accomplishment in two fields already men- tioned — those of investigation and of education — is activity in a third great field, that of organising the agencies by which the campaign is to be carried on. The bulk of the work must be done by individuals, and by local and State societies. An excellent beginning has been made by the State Societies for Mental Hygiene organized in Connecticut and in Illinois, and by the Committee on Mental Hygiene of the State Charities Aid Association of New York. To encourage the work of such societies, to stimulate the foundation of similar agencies in every state of the Union, and to co-ordinate and to give impetus to the work of the campaign throughout the whole country, will be among the principal func- tions of the National Committee. And while correlating the work of such agencies, the National Committee will make every effort to co-operate with other National and International Associations with allied philanthropic aims — eugenic, euthenic, pedagogic, sociologic, legislative. It will, of course, join in the general war- fare against poverty and all the forms of social injustice which tend to unhinge the mind. If the National Committee for Mental Hygiene is successful in makin g of itself a stron g/central agency devoted to the objcets mentioned, it will serve a function of fundamental importance to the whole American people. For if local communities remain back- ward in mental hygiene, they must sooner or later injure more advanced distant communities. By keeping all the States informed of the plans of work adopted where progress is making fastest, advances can be made more rapidly, more uniformly and more economically than would be otherwise possible. A representative II National Committee should be able to secure that nation-wide attention to the problems which is necessary for any steady advance toward those higher ideals of mental hygiene which we cherish. It is conceivable that Congress may be induced to supplement private funds in support of a movement of such national signifi- cance. It would be a good policy. Like many other forward movements in this republic, however, the larger movement for mental hygiene must be initiated and be voluntarily supported by those who see the need and the opportunity, long before the con- sciousness of the masses is aware of them. To carry out its plan, the National Committee for Mental Hygiene will require large amounts of money. It would be hard to think of any project, likely to yield larger returns, even in a material way, on money invested in it. The care of the insane of the nation together with the economic loss incurred through incapacity and death were estimated by Dr. C. L. Dana* in 1904 to be about 85 millions of dollars per year. It is said to amount now to much more than 100,000,000 dollars per year. If we add to this the expense borne by society because of the feeble or abnormal minds of crim- inals, inebriates, paupers and social parasites generally, we see what enormous sums could annually be saved by applying methods which will prevent mental anomaly and defect, or which will restore work- ing__capacity and economic independence to th^sT~?urr L eTing from mental disorders. It is hoped that the various phases of these problems will appeal to patriotic citizens who are well-to-do, and who are willing to give of their surplus to better the minds of our people. To some philan- thropists, the endowment of original investigation will most appeal ; to others, the support of educative measures ; to still others, the defraying of the expenses of the work of organization. One gentle- man, well-known for his devotion to the public welfare, has offered to give $50,000 toward an Endowment -Fund as soon as $200,000 has been given by others for the purpose mentioned, and the same philanthropist has already contributed $50,000 to the National Com- mittee for immediate use in " helping to ameliorate conditions among the insane." This gift has made possible the work of the " Special Sub-Committee on the Survey and Improvement of Conditions among the Insane," of which Dr. William L. Russell is Chairman, * See Dr. Dana's address before the Congress of Arts and Sciences, St. Louis, 1904. 12 and Dr. Thomas W. Salmon, of the U. S. Public Health Service, who has been granted leave of absence for the purpose, is the Director of the Special Studies now being made. The work of ameliorating the conditions of the insane is very important and the National Committee rejoices in a gift that per- mits a beginning in that direction. But its members hope that, before very long, large gifts may become available, also, for the very important matter of prevention. Sums of any size will be wel- comed by THe^treasureroT the National Committee for Mental Hygiene, Otto T. Bannard, President of the New York Trust Com- pany, or by the Chairman of the Finance Committee, Professor Rus- sell H. Chittenden, Director of the Sheffield Scientific School, New Haven, Connecticut. The task which the National Committee for Mental Hygiene has set itself, is an enormous one. It hopes by investigation, by educa- tion, and by organization steadily to improve the brain-power of the nation. It is striving to hasten the time when our people will be so begot, and so reared, that their minds will develop normally and harmoniously; wii£H_society will have less need than now for^sani- tajia H ^ylums J 3n^_pjis^nsj and wherTalT but anTrreducible minority of those born to membership in the nation may think, feel, and act in a way that will make them desira ble citizens of that Bet ter State which is our goal. _ Tt~is~~a~~g , reatrtask, but surely not too great for the country that produced George Washington, and John Marshall, and Abraham Lincoln, or for the parents of a people to whom belong Benjamin Franklin, and Willard Gibbes, and Ralph Waldo Emerson. 13 Publications of The National Committee for Mental Hygiene Sent upon application free, or for the price indicated below. No. 1. Origin, Objects and Plans of the National Com- mittee for Mental Hygiene. No. 2. Principles of Mental Hygiene applied to the Management of Children predisposed to Ner- vousness. — By Dr.Lewellys F. Barker, Professor of Medicine, Johns Hopkins University. (Issued March, 1912.) No. 3. Summaries of the Laws relating to the Commitment and Care of the Insane in the United States. Compiled by Mr. John Koren. Price, One Dollar, postpaid. (Issued Septem- ber, 1912.) No. 4. Some Phases of the Mental Hygiene Move- ment and the Scope of the Work of the National Committee for Mental Hygiene. — By Dr. Lew- ellys F. Barker, Professor of Medicine, Johns Hopkins University. An address delivered as Chairman of the sub-section on Mental Hygiene at the 15th International Congress on Hygiene and Demography, Washington, D. C, September 26, 1912. (Issued November, 1912.) Requests and orders for pamphlets and reports should be addressed to Clifford W. Beers, Secretary, No. 50 Union Square, New York City. The National Committee for Mental Hygiene also distributes reports and pamphlets issued by the Con- necticut Society for Mental Hygiene, the Illinois So- ciety for Mental Hygiene, and the Committee on Mental Hygiene of the State Charities Aid Associa- tion of New York. Press of The Brandow Printing Company Albany, . N. Y. COLUMBIA UNIVERSITY LIBRARIES This book is due on the date indicated below, or at the expiration of a definite period after the date of borrowing, as provided by the library rules or by special arrangement with the Librarian in charge. DATE BORROWED DATE DUE DATE BORROWED DATE DUE i~M-i- 13 ft! 1/ " LJLu Q. - — l*$f& s';--- : C28(842)MSO ^PA^ Z^flr V