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  Eugenics as a Factor in the Prevention of Mental Disease


  By HORATIO M. POLLOCK, Ph.D.
  Statistician, New York State Hospital Commission


  THE NATIONAL COMMITTEE FOR
  MENTAL HYGIENE, Inc.
  370 Seventh Avenue
  New York City
  1921




The National Committee for Mental Hygiene

  FOUNDED 1909
  INCORPORATED 1916

  370 SEVENTH AVENUE, NEW YORK CITY

  _President_
  Dr. Walter B. James

  _Vice-Presidents_
  Charles W. Eliot
  Dr. Bernard Sachs
  Dr. William H. Welch

  _Executive Committee_
  Dr. William L. Russell, Chairman
  Dr. Owen Copp
  Stephen P. Duggan
  Dr. Walter E. Fernald
  Matthew C. Fleming
  Dr. Walter B. James
  Dr. George H. Kirby

  _Treasurer_
  Otto T. Bannard

  _Committee on Mental Deficiency_
  Dr. Walter E. Fernald, Chairman

  _Committee on Education_
  Dr. C. Macfie Campbell, Chairman

  Edith M. Furbush, Statistician

  _Executive Officers_
  Dr. Thomas W. Salmon, Medical Director
  Dr. Frankwood E. Williams, Associate Medical Director
  Dr. V. V. Anderson, Associate Medical Director
  Dr. Clarence J. D'Alton, Executive Assistant
  Clifford W. Beers, Secretary




GENERAL PURPOSES


The National Committee for Mental Hygiene and its affiliated state
societies and committees are organized to work for the conservation of
mental health; to help prevent nervous and mental disorders and mental
defect; to help raise the standards of care and treatment for those
suffering from any of these disorders or mental defect; to secure and
disseminate reliable information on these subjects and also on mental
factors involved in problems related to industry, education, delinquency,
dependency, and the like; to aid ex-service men disabled in the war, to
coöperate with federal, state, and local agencies and with officials and
with public and private agencies whose work is in any way related to that
of a society or committee for mental hygiene. Though methods vary, these
organizations seek to accomplish their purposes by means of education,
encouraging psychiatric social service, conducting surveys, promoting
legislation, and through coöperation with the many agencies whose work
touches at one point or another the field of mental hygiene.

When one considers the large groups of people who may be benefited by
organized work in mental hygiene, the importance of the movement at once
becomes apparent. Such work is not only for the mentally disordered and
those suffering from mental defect, but for all those who, through mental
causes, are unable so to adjust themselves to their environment as to live
happy and efficient lives.




[Reprinted from MENTAL HYGIENE, Vol. V, No. 4, October, 1921, pp.
807-812.]


EUGENICS AS A FACTOR IN THE PREVENTION OF MENTAL DISEASE[1]

HORATIO M. POLLOCK, PH.D

_Statistician, New York State Hospital Commission_


The burden of mental disease is each year becoming heavier. State
hospitals for mental disease throughout the country are overcrowded, and
the construction of new hospitals does not keep pace with the increase of
patients. Fairly complete censuses show that the number of patients with
mental disease under treatment in institutions increased from 74,028 in
1890 to 232,680 in 1920. The rate per 100,000 of population increased from
118.2 to 220.1. Careful estimates based on statistics of the New York
State Hospital Commission indicate that approximately 1 out of 25 persons
becomes insane at some period of life. The economic loss to the United
States on account of mental disease, including loss of earnings as well as
maintenance of patients, is now over $200,000,000 per year. Although much
of the apparent increase in the prevalence of mental disease may be due to
causes that do not involve weakened resistance to the stresses of life,
the load born by the public is clearly becoming more oppressive.

Associated burdens are those of mental defect, epilepsy, dependency, and
delinquency. These combined cause an economic loss even greater than that
caused by mental disease.

Taxpayers are groaning under excessive loads and calling in vain for
relief, but their cries are faint compared with those of the persons whose
relatives are mentally diseased or defective.

As less than one-fourth of those who develop psychoses can be cured by
present methods of treatment, we cannot hope for any permanent relief by
treating patients in hospitals. The most skillful treatment should of
course be given, but the problem must be attacked in other ways before
any adequate solution can be hoped for.

The fact of inheritance of the neuropathic constitution may be taken for
granted. Much evidence has been adduced to prove that such inheritance
occurs in accordance with Mendelian laws, but the subject is so
complicated that more comprehensive studies must be made before we may
consider the matter as settled. The application of skillfully devised
measures of intelligence has shown us that there are many grades of
intelligence between the idiot and the super-average. The so-called
normals represent many types, the extremes of which are as far apart as
the moron is from the low-grade normal. Recent studies of temperamental
abnormalities have also revealed a wide variety of types and combinations.
These abnormalities or marked peculiarities seem to be more or less
dissociated from intellectual capacity. Children with super-average
intelligence are frequently seclusive and morons often seem to be
temperamentally normal. It becomes difficult, therefore, to establish
standards of normality and to draw fixed lines between the normal and the
neuropathic. This is especially true in studying family histories, when
judgment must be based on reports of untrained observers. Mental disease
may occur in a person of almost any type of intellectual or temperamental
make-up. This fact was clearly demonstrated during the recent World War.
Men of strong intellect and of exceptional poise who had withstood the
strain of intense warfare for several months at last succumbed when
weakened by wounds and deprivation of food and drink. These were extreme
cases, but they illustrate the important principle that all men have
limitations and may develop a psychosis or expire when their limit is
reached. Psychopathic personalities give way to the common stresses of
life, while stronger personalities yield only to extraordinary mental
strain. It is evident, therefore, that the whole etiology of a case of
mental disease must be carefully studied before the related family stock
can be safely discredited.

The data we have collected in the New York State Hospital Commission
relative to the family history of patients seem to indicate that slightly
more than half of our ascertained cases have no discoverable hereditary
basis. If more thorough inquiries were made, the proportion of patients
with unfavorable family history might be increased, but the significance
of the history in relation to the family stock is open to question in many
cases.

In our hospitals for some years past, we have studied both the
intellectual and temperamental make-up of the first admissions and have
tried to apply uniform standards throughout the service. In 1920 it was
found that of the ascertained cases 61 per cent were temperamentally
normal and 88 per cent were rated as intellectually normal. Only about 7
per cent of the patients were both temperamentally and intellectually
abnormal. The proportion of patients with abnormal make-up varied
considerably in the different groups of psychoses. For example, in the
dementia-praecox group in 1920, 61 per cent were rated as temperamentally
abnormal while in the manic-depressive group only 33 per cent were so
rated.

The absence of marked abnormalities in individuals prior to the onset of
the psychosis cannot be construed as conclusive evidence that there are no
hereditary defects in the make-up, neither can the development of the
psychosis be taken as proof of a defective constitution. All the facts in
connection with the onset of the mental disorder and previous reactions
must be brought together before the constitutional make-up of the patient
can be positively determined.

Psychiatrists have recently emphasized the connection between bodily
states and behavior and the importance of the sexual and endocrine organs
in relation to the psychoses. What part of the disorders related to these
organs is due to hereditary and what part to environmental factors have
yet to be determined.

Notwithstanding these and many other complications, there is abundant
evidence that mental disorders occur much more frequently in some family
stocks than in others, and that prolonged inbreeding of degenerate stocks
is productive of most disastrous results.

With the limited knowledge at hand, what is to be done to lessen the
burdens imposed on society by the prevalence of mental disease?

Three lines of action are suggested:

1. Environmental stresses may be lessened and natural resistance
strengthened.

2. Procreation of defective stock may be checked.

3. Procreation of normal stock may be increased.

The methods now in use to prevent physical disease may be applied to a
considerable extent in preventing mental disease. They include the
dissemination of knowledge of hygiene and sanitation, prompt treatment of
incipient diseases, segregation of those suffering from contagious
diseases, and immunization of those liable to exposure to pathogenic
germs. Another line of attack consists in safeguarding the public from
injurious food and artificial beverages and from polluted air and water.
The abolition of the liquor traffic and the movement to check the spread
of syphilis are examples of effective work along these lines.

Economic and social stresses should be lightened for those unable to
withstand them. It is far easier to relieve an overburdened man by taking
part of his load than to wait until he is exhausted and then carry him
together with his burden. Physicians, parents, and teachers should be
alert to detect signs of mental disorder and apply the proper remedy
before complete breakdown occurs.

Mental clinics and social workers are of large service in giving treatment
in incipient cases. Many a case of mental disease is averted by adjusting
the environment to the individual and by giving him a clear understanding
of his mental difficulties and the best methods of meeting them. Wide
extension of mental-clinic work is clearly indicated.

The new science of mental hygiene is teaching us that individuals with
unfavorable heredity may do much to overcome their constitutional
tendencies and to preserve their mental health. It is of the highest
importance, therefore, that mental hygiene be taught and practiced in the
public schools along with physical hygiene.

A decade ago sterilization of defectives was widely advocated and laws
making provision for it were passed in several states. These measures have
availed little because they have not been supported by active public
sentiment. Judging from the present outlook, we cannot hope that
sterilization will soon be an effective means of preventing mental
disease.

Segregation of the mentally defective and epileptic is the prevailing
method of limiting procreation among these classes. Its eugenic value is
beyond question, but the enormous cost limits its application. As a rule
the mental defectives and epileptics cared for in institutions are of low
grade. These, if left at liberty, would multiply far less than those of
higher grade. Much is to be hoped from the colony plan of segregating
mental defectives, as colonies care for high-grade defectives and under
wise management become self-supporting and may be increased without limit.

A new departure has been made by the state of New York in establishing a
separate institution for defective delinquents at Napanoch. This
troublesome group has been a serious problem in the jails and prisons of
the state, and heretofore there has been no satisfactory way of dealing
with them. Their segregation should have large eugenic significance.

Segregation of the insane is fairly complete, but as only about one-fourth
of the first admissions are under thirty years of age on admission, its
value in preventing procreation in this group is not as great as would
appear when only the number of patients under treatment is considered.
Overcrowding and the expense of maintenance cause patients to be promptly
released on improvement of their mental condition, regardless of the
eugenic factors involved.

Something can be done to lessen reproduction among the unfit by
enlightened public sentiment and by better marriage laws. Marriage of
persons with marked intellectual or temperamental abnormalities should be
entirely prohibited.

To prevent the marriage of normal persons with those carrying a
neuropathic taint more knowledge of family stocks must be made available.
At the present time genealogical records of the average family are
woefully meager and comparatively few are available for public inspection.
If we are to improve the race by better marriages, genealogical or eugenic
bureaus must be established in cities and villages. Data concerning family
stocks should show the defects as well as the excellencies and
achievements of the individuals recorded and be available to interested
parties.

Love is proverbially blind, but few normal persons would be rash enough
knowingly to join fortunes with a neuropathic or degenerate family stock.
Unfortunately very little thought is now given to the eugenic significance
of marriage and few signs warn impetuous youth of the danger ahead.

Eugenic bureaus, by collecting data concerning family histories and by
emphasizing the importance of family stock, would naturally promote
marriages among persons of good stock and thereby increase procreation of
a desirable kind. The increase of good stock would raise the general level
of the race, even if there were no decrease of poor stock, but we may
safely assume that more definite knowledge would gradually lessen
reproduction among the unfit.

The elimination of mental defects and diseases is after all principally a
matter of education. We must learn by careful research what should be done
and what should not be done and then disseminate the information so that
it will be shared by every household. Action will slowly follow knowledge,
but ultimately a more perfect race will be evolved.




MENTAL HYGIENE

  QUARTERLY MAGAZINE OF THE NATIONAL COMMITTEE FOR MENTAL HYGIENE, INC.

  PUBLICATION OFFICE:
  27 COLUMBIA STREET, ALBANY. N. Y.

  EDITORIAL OFFICE:
  370 SEVENTH AVENUE, NEW YORK CITY

  EDITORIAL BOARD

  THOMAS W. SALMON, M.D., _Medical Director, The National Committee for
        Mental Hygiene_
  FRANKWOOD E. WILLIAMS, M.D., _Associate Medical Director, The National
        Committee for Mental Hygiene_
  WALTER E. FERNALD, M.D., _Superintendent, Massachusetts School for
        Feebleminded_
  C. MACFIE CAMPBELL, _Director, Boston Psychopathic Hospital_
  STEPHEN P. DUGGAN, PH.D., _Professor of Education, College of the City
        of New York_
  STEWART PATON, M.D., _Lecturer in Neuro-biology, Princeton University_


  Vol. V, No. 4      INDEX      October, 1921

  The Significance of the Conditioned Reflex in Mental Hygiene,
        _William H. Burnham_                                           673

  The Elementary School and the Individual Child
        _Esther Loring Richards_                                       707

  Extra-Medical Service in the Management of Misconduct Problems in
        Children _Marion E. Kenworthy_                                 724

  Mental Hygiene and the College Student--Twenty Years After
        _Anonymous_                                                    736

  Mental Hygiene Problems of Normal Adolescence _Jessie Taft_          741

  Suicide in Massachusetts _Albert Warren Stearns_                     752

  The Function of the Correctional Institution _Herman M. Adler_       778

  What is a "Nervous Breakdown"? _Alice E. Johnson_                    784

  Mental Hygiene and the Public Library _Mary Vida Clark_              791

  Inadequate Social Examinations in Psychopathic Clinics _Dorothy
        Q. Hale_                                                       794

  Eugenics as a Factor in the Prevention of Mental Disease
        _Horatio M. Pollock_                                           807

  Mental Hygiene Problems of Maladjusted Children As Seen in a
        Public Clinic _A. L. Jacoby_                                   813

  Speech Defects in School Children _Smiley Blanton_                   820

  Extra-Institutional Care of Mental Defectives _Earl W. Fuller_       828

  Abnormal Psychology _Barrington Gates_                               836

  Abstracts:
    The Problem of a Psychopathic Hospital Connected with a
        Reformatory Institution. By Edith R. Spaulding                 837
    A Psychological Study of Some Mental Defects in the Normal
        Dull Adolescent. By L. Pierce Clark                            840
    The Social Worker's Approach to the Family of the Syphilitic.
        By Maida H. Solomon                                            843
    Some Practical Points in the Organization of Treatment of
        Syphilis in a State Hospital. By Aaron J. Rosanoff             844
    The Mental Clinic and the Community. By Everett S. Elwood          845
    An Analysis of Suicidal Attempts. By Lawson G. Lowrey              846

  Book Reviews:
    Psychopathology. By Edward J. Kempf _Bernard Glueck_               848
    The Unconscious. By Morton Prince _William A. White_               849
    A General Introduction to Psychoanalysis. By Sigmund Freud
        _Bernard Glueck_                                               851
    Sleepwalking and Moon Walking. B. J. Sadger _C. Macfie Campbell_   851
    From the Unconscious to the Conscious. By Gustave Geley
        _William A. White_                                             855
    Suggestion and Auto-Suggestion. By Charles Baudouin _Bernard
        Glueck_                                                        856
    Psychology and Psychotherapy. By William Brown _C. Macfie
        Campbell_                                                      857
    Our Social Heritage. By Graham Wallas _Miriam C. Gould_            858
    August Strindberg: A Psychoanalytic Study with Special Reference
        to the Oedipus Complex. By Axel Johan Uppvall _Frankwood E.
        Williams_                                                      861

  Notes and Comments                                                   878

  Current Bibliography _Dorothy E. Morrison_                           891

  Directory of Committees and Societies for Mental Hygiene             894

  Members and Directors of the National Committee for Mental Hygiene   895


MENTAL HYGIENE will aim to bring dependable information to everyone whose
interest or whose work brings him into contact with mental problems.
Writers of authority will present original communications and reviews of
important books; noteworthy articles in periodicals out of convenient
reach of the general public will be republished; reports of surveys,
special investigations, and new methods of prevention or treatment in the
broad field of mental hygiene and psychopathology will be presented and
discussed in as non-technical a way as possible. It is our aim to make
MENTAL HYGIENE indispensable to all thoughtful readers. Physicians,
lawyers, educators, clergymen, public officials, and students of social
problems will find the magazine of especial interest.

The National Committee for Mental Hygiene does not necessarily endorse or
assume responsibility for opinions expressed or statements made. Articles
presented are printed upon the authority of their writers. The reviewing
of a book does not imply its recommendation by The National Committee for
Mental Hygiene. Though all articles in this magazine are copyrighted,
others may quote from them freely provided appropriate credit be given to
MENTAL HYGIENE.

Subscription: Two dollars a year; fifty cents a single copy. Publication
Office: 27 COLUMBIA ST., ALBANY, N. Y. Correspondence should be addressed
and checks made payable to "Mental Hygiene," 27 Columbia St., Albany, N.
Y., or to The National Committee for Mental Hygiene, Inc., 370 Seventh
Avenue, New York City.

Copyright, 1918, by the National Committee for Mental Hygiene, Inc.




Footnote:

[1] Read before the Section on Eugenics and the State of the Second
International Eugenics Congress, New York City, September 26, 1921.