Institution Statistics According to Official Figures
Public Health Report July 25, 1924.
On January 1, 1923, patients in public institutions of the United States
numbered: insane hospitals, 290,457;
psychopathic wards
of general
hospitals, 1,842; institutions for feeble minded, 46,722; institutions for
epileptics, 9,153. In addition there were confined in federal
penitentiaries, 2,010; in state prisons, reformatories, etc., 19,518; in
county and city jails, workhouses, etc., 147,489; in institutions for
juvenile delinquents, 29,385.
Rather disconcerting figures have been assembled by H. M. Pollock
(American Journal Pyschiatry, January, 1924), statistician to the
New York State Hospital Commission. From 1880 to 1920 the number of insane
patients of institutions in the whole country has increased from 40,942 to
232,680 and the ratio of patients in institutions to 100,000 of populations
from 81.6 to 220.1. This, of course, does not mean a proportionate increase
in insanity as a much larger percentage of insane patients now is confined
in institutions.
While there undoubtedly has been some general increase in insanity, this,
like the apparent increase in cancer, is mitigated by various factors. For
instance, during the 40-year period here considered, the average length of
life in the United States has increased from 41 to 56 years. This means
that hundreds of thousands of children and young people who previously
would have died from infectious diseases now live long enough to develop
insanity. One other factor which tends to increase the number of patients
is the constant increase in urban population, which was 28.6 per cent in
1880 and 51.4 per cent in 1920. The average annual rate of admissions to
insane hospitals from cities is 69.5 per hundred thousand and from rural
districts, 42.5 per cent. It is further seen that the rate of
dementia
praecox admissions is 19.1 for cities and 7.8 for country; of
general
paresis, 9.8 and 2.9 respectively; of alcoholic psychosis 3.7
and 1.6. The
number of senile psychoses from the country districts is greater,
undoubtedly because more people reach old age there.
It is gratifying to note that in the state of New York there is a marked
decrease in the proportion of alcoholic psychosis and a considerable
decrease in
general paresis. Pollock states that the movement to check the
spread of syphilis which acquired impetus during the war and has since been
continued has great significance in the field of mental health.
One important principle is that the rate of mental disease is greater among
inferior stocks than among superior stocks. This is difficult to
demonstrate by census statistics which take no account of the quality of
family stock. The general birth rate in late years has markedly declined
and it is generally believed that the decline has been greatest among
superior stocks. If this trend continues, the people of the future will
become more and more susceptible to mental disease.
Another general factor the author describes is the economic condition of
the people. Mental disease declines in times of prosperity and increases in
times of adversity, and Pollock adds that the tendency in this country
being toward general stabilized prosperity with shorter working days,
better conditions of employment, and higher standard of living, the
economic outlook for mental health is good.
The rates of
dementia praecox and manic-depressive psychosis are both
increasing, and if nothing is discovered to curb these diseases, while new
discoveries continue to be made in the realm of bodily disease, then mental
disease will supersede physical disease as the paramount social problem in
the not distant future.
Constitution and Disposition in Relation to Mental Disease.
A concise and
thoughtful discussion of this difficult subject is contributed by A. M.
Barrett. (American Journal Psychiatry, October, 1924).
We wish particularly to call attention to the following review by him of
recent work on the "cyclothymic" or "syntonic" and "schizothymic" or
"schizoid" types largely because it gives a clear account of the important
work of Kretschmer. (An explanation of these terms and of the chief
theories of
Bleuler
and
Kretschmer
was given in this Series, 1922, vol. 8,
page 293.)
Barrett states that it is in relation with the two great psychotic groups
of cyclothymia and schizothymia that the question of constitutional
dispositional relations has recently gained particular interest. In the
progressive development of conceptions of the nature of the manic-
depressive psychosis, increasing attention has been given to its underlying
constitutional aspects. Its hereditary relationships and the
characteristics that show in the cyclothymic life course in this disorder
are evidences of some fundamental specific quality that must lie in the
constitution of the individual.
The constitutional and dispositional relations of schizophrenia have been
later acquisitions to our knowledge. The study of families in which
schizophrenia occurs has shown that there are abnormalities of constitution
that seem to stand in some hereditary relation to the disorder. The
recognition of the abnormalities commonly observable in schizophrenic
individuals in pre-psychotic phases, the recent concepts of schizoid
qualities of character and temperament, and the physiological and somatic
disturbances associated with the progress of this disorder, have forced
upon us the conception that in schizophrenia, constitutional and
dispositional qualities are of fundamental importance.
The author believes that interest in this problem of constitutional
relations in both cyclothymia and schizophrenia has been stimulated by the
recent contribution of Kretschmer who in his monograph on
Körperbau und Charakter has presented data and
viewpoints that gives us a new orientation in this field. In clear
formulations of what is involved in the concept of constitutional factors
the latter author puts forward theories and points of view regarding
correlations of somatic and psychic relationships that have an application
not only in the psychoses but also in a wide range of interests dealing
with human qualities and temperament.
A study of the physical characteristics of the body in cases of cyclothymia
and schizothymia leads Kretschmer to the formulation of a theory that in
each of these groups of psychoses definite types of physical constitution
are in relation with specific psychic qualities. He finds that in
schizothymia there is a marked preponderance of body structures that are of
asthenic, athletic or dysplastic endocrinopathic types or intermixtures
among these. In cyclothymia the dominant quality of body is of a thick-set
or pyknic type. The characteristics of these contrasting types are evident
not only in the general structure of the body frame, but in the quality of
the body surfaces. It is his belief that the psychic constitution of an
individual expresses itself not only in its psychological qualities, but
also in the comprehensive manifestations of his entire personality in all
of its life phases and that the endogenous psychosis is but an episodic and
partial segment. These correlations exist also in non-psychotic individuals
and can be shown to be determining factors in their personalities and in
the quality of their creative energies.
The individual constitution as formulated by Kretschmer
"is the totality of all the individual characteristics that are based on
heredity. Constitution has its psychic correlations in character and
temperament. Character is the totality of all the reaction possibilities of
an individual that are regulated by his affective volitional functioning.
Character is a matter of the affective life. Temperament is conditioned by
the blood humoral chemistry and their physical correlate is the brain-gland
interrelations."
Qualities of temperament are essentially influenced by the endocrine
system. As evidences of this Kretschmer comments on the well-known
abnormalities of temperament that occur in states of hypo- and hyperthy-
roidism and after sex gland castration. These correlations of body habitus
and temperament suggest that the temperament types characteristic of
cyclothymia and schizothymia have similar correlations with humoral
relations. They are concerned with the entire blood chemistry of the body.
There thus exists not only a parallelism between brain and psyche but also
some and psyche. In schizothymia the facts seem to indicate that there
exists a complicated dysfunctioning of the sex glands in correlation with
the entire endocrine apparatus and brain. On the other hand, in cyclothymia
the characteristics of the individual's constitution seem to be in
correlation with the glands controlling the general nutrition of the body.
Here also there may be a humoral relation.
The temperaments according to Kretschmer, apart from their central
relations are dependent upon two great hormonal groups. One of these acts
in relation with the diathetic states or the nutritional metabolism of the
body, and the other on the psychesthetic or affective balances. In the
average individual these two groups of hormones are mixed in changing
relations, but in cyclothymia or schizothymia one or the other has gained a
dominance; the diathetic in cyclothymia and the psychesthetic in
schizothymia. This dominance may have been determined through inherited
qualities or developed through selection in family inter-relations. That
these qualities do have relations to family inheritances has been shown in
the studies on heredity by Riidin, Kahn, Hoffman and others.
In his conclusion Barrett states that it is these two contrasting
constitutional qualities that are embodied in the concepts of schizoid and
cycloid, or as discussed by Bleuler, schizoid and syntonic. With a
viewpoint that harmonizes with the conceptions of Kretschmer, Bleuler
presents the theory that every individual has in his anlage a schizoid and
syntonic component. Normally these exist in an equilibrium, but conditions
may occur that give dominance to one or the other of these in quality of
the psychic reactions. One not infrequently observes the two qualities
intermingling in a psychosis to produce such atypical clinical reactions as
"schko-mania," and "cycloid-schizophrenia." In psychoses of exogenous
origin one may sometimes recognize the temperamental characteristics of
these two conditions determining the reactions and symptoms during the
course of the disorder. Thus Binswanger has published an interesting study
on schizoid reaction in alcoholics.