CHAPTER V THE PREVENTION OF MENTAL DISEASE For many, many years the chief duty and ambition of the physicians was to relieve suffering, to cure the sick, to restore the maimed and mend the mutilated. They practised "the healing art." When scientists discovered and demonstrated the causes of many diseases and the means and methods by which some could be eliminated and others controlled, medicine entered upon the second and more important epoch of prevention. In no branch of medicine are preventive measures more insistently needed than in that of mental diseases, where the crippling of unnumbered minds with the resultant loss to society, waste in industry, expenditure of vast sums of money for care and treatment, and the weakening of the race by the transmission of defective nervous systems, make this a social problem of exceeding importance. More obvious does this appear when it is known that much of mental illness could be averted or checked if prophylaxis had been begun in early years, or been applied when symptoms first appeared. In some of the organic brain diseases, especially those due to senility and cerebral arteriosclerosis, measures of prevention are of slight value; in others like tumor and abscess, trauma and hemorrhage, while little can be done in the way of prevention except to increase and make more efficient the safeguards against physical violence, early diagnosis is very important for much may be effected by surgical treatment, and the removal of pressure very often means a restoration to health. The foremost cause of organic brain disease, the chronic infection of syphilis, a disease which for years could not be named because of its too often shameful origin, is directly preventable. To stop the spread of syphilis the Society of Social Hygiene and the Mental Hygiene Society broke the conspiracy of silence," and began a forward movement to dispel ignorance and disseminate knowledge of the nature of this disease, the means by which it is contracted, the inescapable dangers of reckless and voluntary exposure, and the sureness of its blighting and destructive force both upon the individual who contracts the disease and the innocent women and children to whom it may be communicated, for syphilis is a disease which may be transmitted directly from parent to child. These Societies further sought by means of an educational program to teach the physiology and hygiene of sex, to create a belief in and a practise of the single standard of morality,—a pure life for men as well as for women,—to make the disease reportable by name as in the cases of small-pox, scarlet fever and other contagious diseases, as well as to provide remedial measures and make treatment compulsory, and to arouse public sentiment not only to demand legal measures for the suppression of prostitution and adequate punishment for the purveyors and patrons of this evil, but also to demand measures which would prevent young women from becoming prostitutes, by throwing additional safeguards around the young women of the working class and the large numbers of homeless and friendless girls from whom the ranks of prostitution are chiefly recruited. The records of the probation officers show that more than 50 per cent. of the girls who are placed on probation in the state of New York have been brought to court in the first place on account of inadequate and improper guardianship. This work has been greatly advanced by the passage of a law in Congress, July, 1918, which provided for the appropriation of funds for combating the social diseases, and creating a Division of Venereal Diseases in the United States Public Health Service. Large sums of money have been and are being expended for treatment and for public education which is being carried on by means of lectures, exhibits, photoplays and personal instruction. Alcohol, which has been more potent than any other single factor in the causation of unhappiness, poverty, misery, accident, crime and disease, is, it is fervently to be hoped, eliminated from general use forever, since the "Prohibitory" Amendment to the Constitution became effective January 16, 1920. The importation, manufacture, distribution and sale of the dangerous habit-forming drugs have also been brought under Federal and State control. These measures, supported by a public sentiment which demands and coöperates in their enforcement, should result in the eradication of the alcoholic and drug psychoses. The infectious diseases are more and more being brought under control by laboratory research, scientific investigations, sanitary science and the application of serumtherapy. There are now available various sera and vaccines which will cure some and prevent others of the more serious infectious diseases. The increasing number of clinics and dispensaries where the best medical advice may be obtained free or at small cost, better housing and living conditions, improved working conditions, shorter hours of labor, more opportunities for recreation and the adaptation of work to those who are handicapped by physical weakness are among the measures of prevention already in force. As the infectious and somatic diseases are controlled and prevented, the psychoses which are produced by them will incidentally be prevented. In the prevention of the functional mental disorders prophylaxis should begin early in life, for it is during the period of habit formation, in childhood and early adolescence that defects may be most easily remedied and efforts directed at prevention offer most promise of success. More attention should be given to the cultivation of mental health and the formation and development of correct mental habits which are of equal importance with the physical. Nourish ing food, pure water, fresh air, sleep, cleanliness and exercise are recognized as factors which are essential to the development of a strong body, while the factors which are essential to protect and strengthen the nervous system are many times neglected or misapplied, for children are exposed to unhappy, irritating and disquieting influences in their environment which are easily absorbed and frequently imitated. Children who are carefully guarded against the infectious diseases are far too often in no way protected from the "psychic infections" of their environment. Gloominess, peevishness, irritability, irascibility, anger, ill will and uncharitableness are, it sometimes seems, more contagious and surely more damaging than cheerfulness, patience, kindness, courtesy and unselfishness. Children with neuropathic tendencies require special measures of training and education, and much more supervision than is necessary with children whose reactions are normal and healthy. They should not be too much shielded from and spared the small discomforts, physical hurts and disappointments which are common to childhood, but taught how to ignore or to endure them, and without too much complaining make the necessary readjustments which each sensation or experience demands. Too much sympathy and coddling should be avoided, for it is far better to help a child to use his own powers and learn to rely upon himself and so build up his mental and moral fibre. Especially should sympathy be judiciously given when it is inordinately craved and demanded. Too ready concession to the likes and dislikes and too free indulgence of whims, fancies and notions which very often are an indication of hypersensitiveness should be avoided, for these tendencies if not overcome in early life may in later years become a source of anxiety and mental distress. The attitude and example of parents, nurse, teachers and playmates are of the greatest value in correcting and conquering these inclinations and aversions, for in the early years of life the child imitates and reflects largely the attitude and behavior of those about him. Tendencies to vacillation, indecision and doubt should be early combated, and the habit of making decision after due deliberation should be inculcated, together with the habit of not questioning whether the decision is right or wrong or the best or wisest, but accepting it and abiding by it. Frankness, openness and straightforwardness in meeting difficulties and solving them should be fostered and encouraged, and tendencies to sulk, to hold a grudge or bitter feelings should be eradicated. -- Tendencies to violent outbursts of anger should be controlled by avoiding direct issues which precipitate such attacks whenever possible, and by meeting the situation in some other way, by diverting the attention, or by explaining without threats or show of irritation or annoyance, why a definite course of action is necessary or best. By forethought and skilful management these undesirable tendencies may be greatly weakened and many times eradicated. When they cannot be prevented, fits of temper should be cut short in the beginning and the consequences of such episodes should be made unpleasant and unsatisfactory by such measures as being put to bed, deprived of play or banishment from the presence of others. Isolation for a period is a most effective measure when wisely employed. "In older children the habit of giving way to temper may sometimes be broken by inculcating the conviction that one who loses his temper makes a fool of himself, loses his dignity and excites the disdain and contempt of his fellows; the horror of looking ridiculous, of making a donkey of one's self, may be a most powerful lever in conquering a tendency to attacks of fury." "1 Most unwise and noxious is the practice of some thoughtless and negligent elders of discussing before children terrible events and harrowing experiences, for in early life imagination is so active that morbid impressions are received and permanently retained. Even more pernicious is the practice of 1 Address: "Mental Hygiene for Nervous Children," L. F. Barker, M. D. |