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Fashion, which is another word for the world—and religion has always pointed out that the three great enemies of the development of the spirit of man are the world, the flesh, and the devil—has always set itself in opposition to religion in the approval of sensual gratification. That conflict is unending. A great many people declare that they would rather be out of the world than out of fashion, and it is surprising what insensate things fashion leads people to. The present fashion for the slow dance with the partners closely wrapped in one another's arms, for that is of course the essence of all the modern dances, no matter what their varying names may be, is only another development of the unending opposition between fashion and religion. Here once more, as with regard to the theater, religion presents the only serious protest. Dame Fashion insists that she sees no harm in it, but that is of course only a fashion of speech. It is quite impossible for a physician to watch the dancing without becoming convinced that human passions must be aroused by such close contact of human bodies of opposite sexes.

In this, however, as in so many other phases of life, only religion can interfere or protest with any hope of success. Her protest remains often unheard; fashion may be almost all powerful even against the higher calls of duty as well as against common sense. Certainly religious influence has had more to do with keeping a great many women from following the dictates of fashion in emphasizing their sex and therefore exciting the men with whom they come in contact than any other single factor. It has not been entirely successful, it never will be; the conflict will go on and worldliness will constantly come to the surface in some form or other, often to the detriment of health; and religion when properly vital will continue to be the most important factor in keeping evil from gaining such ascendancy as would be seriously detrimental to the healthy mind in a healthy body.

Religion is the only agency in the modern time that tries to regulate the reading of young folks and indeed of others in this dangerous matter of sex excitation. A great many books seem to be written at the present time for no other purpose than to excite sex feeling,—and thereby to make money. They depend for their sale entirely on the fact that for a great many people there is a distinct physical pleasure in reading about sex subjects. This is particularly true of women. A great many of them, and especially those who have not very much else to do and who therefore have no proper outlet for animal spirits and for the energies that tend to accumulate in them because they feed well and sleep long, are prone to indulge in this sort of luxury. Most of them would resent the suggestion that it was wrong for them to indulge their feelings in this way, but religion has always taken a decided stand and insisted that the fomenting of desire and the toying with alluring thoughts and the inviting of temptation are of themselves actually sinful. As John Boyle O'Reilly said,

 
"Temptation waits for all, and ills will come;
But some go out and ask the devil home."
 

Physicians have always insisted that the sexual erethism which is excited by the reading of books on sex subjects, the attending of sex problem plays and of shows of various kinds is the worst possible background for healthy living. Such frequent titillation of delicate nervous mechanisms plays sad havoc with general nervous control. Unfortunately just those who are indoors a great deal, who take very little exercise, and who live on dainties are most likely to indulge in these habits of life with regard to reading and the theater and dancing and the like which are most harmful for them. They are irritable in the nervous sense and excitable, and this erethism increases their nervous instability which responds by craving further excitement. A vicious circle is formed which very often leads to nervous breakdown. Just now we are hearing much about sexual repression as the cause of nervous disorders, but sexual repression is as almost nothing in its tendency to produce neurotic or psycho-neurotic affections compared to the partial tantalizing, sexual indulgence which comes from sensual reading or lascivious shows. The plays that are seen, the jokes that are heard, the sex problems that are dwelt on, the stories that are read must get more and more spicy and contain more and more sex "pep" to afford any satisfaction, and the consequence is a disturbance of delicate parts of the nervous system which react more or less seriously to lessen the control over the whole nervous mechanism of the body.

When Doctor S. Weir Mitchell pointed out two generations ago that not only headache, but rather serious nervous disturbance involving often the gastro-intestinal tract and sometimes other large organs like the brain itself, as well as even mental operations, might come from so small a cause as disturbance of accommodation in the eye, most physicians refused to believe that such far-reaching symptoms could come from what was apparently so trivial a factor. The accommodation mechanism of the eye is extremely delicate, however, and requires such nice adjustment that any interference with it causes a waste of nervous energy that is likely to make itself felt at almost any part of the nervous system. In our day disturbances of the eye are confessed by all to be extremely important. In something of the same way disturbances of the sexual system of the body are reflected throughout the whole nervous system.

Religion has counseled, commanded and thundered against any practices, however simple they might seem in themselves, that would serve as excitants for the sex feelings. Without her influence even more harm would have been done than has been. It is the waning of religious power over public morality and public opinion that has led to the orgy of indulgence in sexual excitation, which has had such bad effects and which unfortunately so often leads to sexual acts which are fraught with the hideous dangers of venereal disease, because passion excited will find its satisfaction. Society heedlessly arouses passion but apparently cares not what happens afterwards.

CHAPTER XI
INSANITY

There is a very prevalent impression that religion is a common, even rather frequent cause of insanity. This is founded on popular experience. It has often been noted that not a few of the people who go insane have delusions on religious subjects. It is also a very common observation that those who are on the road to insanity and have finally to be placed in an asylum have for some time been making themselves conspicuous by their excessive practice of religious observances of one kind or another. It is not surprising then that the familiar fallacy post hoc ergo propter hoc, "after this therefore the result of this", should have come to be applied in these cases, and that religion should be set down as a prominent factor of mental disease and perhaps one of the commonest causes of the condition.

Those who have given most study to the subject, however, know very well that this conclusion is quite as unjustified by the facts of the case as the corresponding one with regard to religion being a frequent source of nervous diseases. We will discuss that in the chapter on Nervous Diseases, and almost necessarily the closely related subject of mental disturbances is touched on somewhat there. Of course it is well understood that a great many of those who are on the road to such mental alienation as will eventually require their internment in an asylum will give many external manifestations of religious feelings, some of them exaggerated beyond reason, as perhaps the very earliest striking symptom of their mental alienation. Religion, as we said in the Introduction, is one of the most universal interests of men. When people go insane, some interest will receive exaggerated attention. The delusions of their insanity are dependent on what the deepest interest of the individual was. If he was interested in money, he will believe himself the richest or perhaps the poorest of men. If he is interested in science, his delusions will be associated with that subject. Delusions concerning some phase of science are probably even more common in our day than those based on religion. Electricity is the source of more delusions than anything else, though hypnotism and telepathy and other sensationally exploited modes of so-called psychology are a close second in this respect. If the patient has recently suffered a severe loss by the death of a friend, sorrow will be the central idea of his mental disturbance; if there has been a disappointment in love, that will be the focus of his mental troubles; if there has been a money loss, that disappointment will be the core of the depression. Almost any human interest may thus become the root of excitement or discouragement leading to mania or melancholia.

The Great War gave us some very interesting material as to mental as well as nervous disease. In nothing was that more interesting than as to the causes from which insanity develops. It might very well have been expected that a great many people would break down under the awful conditions in which they were placed during the war. For instance Poland was fought over some six times, and portions of Austria overrun three times, and Servia was, between war and the ravages of famine and disease, a veritable shambles of its people for three or four years. It is easy to understand the awful states of anxiety and solicitude and almost continuous terror to which the inhabitants of Belgium, occupied by the Germans, were subjected, particularly in the smaller places where they were utterly at the mercy of the German officials whose one idea, fostered by their military teaching, was that the end of the war would be brought about or at least greatly hastened by a policy of frightfulness.

Literally many millions of people were subjected to conditions which would seem to be impossible for human nature to stand for any length of time, and yet they had to bear them continuously for four years or more.

The records of the development of insanity among these people have been rather carefully gathered, and they reveal the astounding fact that the insanity rate was very little higher among all these intense sufferers from the war than it would have been under the ordinary conditions of civil life. Manifestly a certain number of persons had the insanities which would have developed in them in later years anticipated by the trials and the hardships of wartime conditions, but only those suffered from insanity as a rule who might have been expected to do so because their family or personal history revealed tendencies in that direction which would almost surely have made themselves manifest sooner or later even under the inevitable vicissitudes of peace time.

What modern medicine has revealed to us is that apart from certain infectious diseases which produce degeneration of the physical basis of mind and the absorption of certain poisons—alcohol is a typical example—which cause a corresponding degeneration to the infections, the supreme factor in insanity is the inheritance of a predisposition to the affection. Two things have become perfectly clear in the course of modern medical investigation, that insanity and longevity run in families, and that there is almost no other basis on which the two conditions may develop. Infections or intoxications in the broad sense of the word may produce conditions to foster or impair respectively either of them, but even they are of minor significance compared to the original inheritance in either case.

Clouston, the well-known English authority on mental diseases, whose opinion is founded on many years of personal observation, in his book on "Unsoundness of Mind"⁶ has put the relationship between religion and mental disease very clearly. He said: "It is true that religion, touching as it does, in the most intense way the emotional nature and the spiritual instincts of mankind, sometimes appears to cause and is often mixed up with insanity. But in nearly all such cases the brain of the individual was originally unstable, specially emotional, oversensitive, hyperconscientious and often somewhat weak in the intellectual and inhibitory faculties and, if looked for, other causes will usually be found." He had said just before, "To talk of 'religious insanity' as if it were a definite and definable form is in my judgment a mistake."

So far from prayer—the principal exercise of religion, that is the raising up of the mind to God, either in petition or in resignation—unsettling people's minds, it has exactly the opposite effect. Professor William James, whom most people are not inclined to think of as likely to be an overstrenuous advocate of religion, in his well-known essay on "The Energies of Men" has a paragraph in which he quotes from a physician who had had long experience in the care of a great many insane and who did not hesitate to say that prayer was a benefit and not in any sense of the word a detriment to his patients.

"Doctor Thomas Hyslop, of the great West Riding Asylum in England, said last year to the British Medical Association that the best sleep-producing agent which his practice had revealed to him was prayer. I say this, he added (I am sorry here that I must quote from memory) purely as a medical man. The exercise of prayer, in those who habitually exert it, must be regarded by us doctors as the most adequate and normal of all the pacifiers of the mind and calmers of the nerves."

It is recognized as a general rule in asylum practice that when patients begin really to pray, a turn for the better has come in their condition, and they are on the high road to recovery. This does not mean, of course, noisy, wordy praying, but quiet raising of the mind to God and acts of resignation to their condition so long as they may be affected.

There is a very general impression among those who have had most to do with the insane as well as among psychologists in general that religion, instead of favoring the development of insanity, rather inhibits it. Professor Münsterberg, in his "Psychotherapy" dwells particularly on this. Almost needless to say Professor Münsterberg did not wear the special favor of religion in the lists and was in no sense her champion. He is proclaiming simply what he knows and feels to be true.

A very curious reflection on the relations of religion and insanity is to be found in the fact that the marked increase in the insane among the population of all the great modern civilized countries and most striking among our own has come since the decay of religion and the decrease of religious belief. The statistics of that increase in the number of the insane are very startling to those who are not familiar with the subject. During a single generation the number of the insane in our institutions has increased to five times what it was before in proportion to the population. There is no doubt that this is due to some extent to the fact that people are much less ready to care for their insane relatives outside of institutions than they were a generation and especially two or three generations ago. We are much less ready to make the personal sacrifices needed to keep our friends at home, which is probably also due to the lowering of our religious sense of obligation in the matter. Fortunately our insane asylums are much better conducted than they were, and this has made people more willing to confide their relatives to them. Giving all due allowance for this, however, there has been an enormous increase in the number of the insane. Such commonwealths as California and Massachusetts, in which there are very large proportions of educated people, present the highest increase in the number of the insane. There are certain critical spirits who would say that it is our education without God and without religion that has fostered this state of affairs, and that it is particularly people of a certain limited intelligence who, when overeducated, lose their faith, who are most prone to lose their minds.

The most important single factor in insanity, not dependent on constitution or heredity but on conduct, is that degeneration of the brain which brings on paresis or general paralysis of the insane. Taken by and large throughout the world generally, nearly one in five of all those who die in insane asylums die from this affection. It is the result of an infection usually consequent upon sexual immorality. The disease is inevitably fatal and once it begins it is steadily progressive from the delusions of grandeur so common at the beginning through various delusional states up to absolute dementia and death, which usually takes place in a little more than three years from the beginning of the disease; five years is a long time for a patient to survive. Nothing has done so much to limit the occurrence of this disease as religious influences, and it has increased to become the modern scourge that it is just in proportion as religion has lost its hold upon the mind of the rising generation. The disease is particularly infrequent among clergymen, and while lues from which the disease develops may be contracted innocently, it is very evident that a regular moral life such as is led under the sway of religious principles is the best possible safeguard against the spread of the disease.

After paresis the most serious form of acquired insanity in modern life is that known as alcoholic insanity, due to excess in the taking of spirituous liquors. It is not necessarily inevitable that a man who frequently indulges to excess in alcoholic liquors will become insane any more than that he will suffer from alcoholic neuritis, but a large number of individuals prove susceptible to the toxic effects of alcohol in these ways. There is an inherent liability in their brain and nervous system to degenerate under the influence of alcohol acting as a poison. This is an extremely common form of insanity, but almost needless to say it occurs much less frequently in those who have any religious principles than in those who are without them, because religion protects from the excesses that predispose to these conditions. Clergymen very rarely suffer from them and though occasionally clerical patients have developed alcoholic insanity or alcoholic neuritis, these cases on careful investigation oftener proved to be due to certain patent medicines which contained alcohol in large percentage than to any direct consumption of spirituous liquor.

Religion by its calming influence keeps a good many people who have hereditary tendencies to insanity from developing outspoken symptoms of the disease. Religious conviction has a definite efficacy in making people humble instead of conceited, and this is an excellent factor for preventing the tendency to insanity. Nearly always the preliminary sign of insanity is an exaggeration of the ego and a hint at least of delusions of grandeur. People who overrate their importance are often on the road to the asylum. Religion, by inculcating humility, at least lessens this tendency and puts off developments that are inevitable so that many more years of reasonable sanity are enjoyed than would otherwise be the case.

Probably the worst thing in the world for those who have any inherited tendency to disequilibration of mind is to have an occupation in life which involves strains and stresses of emotion. The gambler, the speculator, the man who risks his all on some attempt to make a great deal of money, are much more prone to develop insanity than those who have occupations in life at which they work from day to day for a moderate wage, and who get their joy in life out of the fulfillment of domestic duties. Almost needless to say religion has always discouraged gambling and such speculation as resembles it very closely, and the whole tendency of religious influence is to make people so satisfied with their lot in life that they will not take the risks which involve the vehement mental emotions so likely to disturb those with inherited predispositions toward irrationality. Undoubtedly religion has in this way saved a great many men from serious developments in mental alienation which might have come had they felt themselves free to take up the riskier avocations in life from which they were deterred by the feeling of religious disapproval.

After the tendency to exaggeration of the ego and delusions of grandeur, the most common symptom of incipient insanity is delusion of persecution. As regards this, once more, the religious feeling of trust in Providence and the conviction that God will somehow take care of them keeps many people from allowing their delusions of persecution to manifest themselves so soon or so violently as would otherwise be the case. Only comparatively rarely do religious minded people in the midst of their delusions of persecution commit crimes, being deterred therefrom by the underlying consciousness of the wrongness of their acts in taking judgment on their persecutors into their own hands, even though they may have yielded to a belief in their delusions. It is true that a certain number of religious-minded people do commit crime under the influence of delusions, but these are rarer than the cases which occur in people who have never had any sense of religious morality.

In a word religion has meant a very great deal for the limitation of insanity and the tendency to it, for putting off its development and giving patients years of sanity they might not otherwise have enjoyed, and it has had a very definite effect in limiting the crimes consequent upon insanity. It has a very marked tendency to create the atmosphere of placid trust and confidence which means so much for the preservation of sanity. Far from being a provocative of irrational tendencies it soothes patients' minds, prevents them from running into such excesses of emotion as are dangerous for mental balance, and it predisposes those who allow themselves to be deeply influenced by it to live such quiet satisfied lives without inordinate ambition and disordered desires as make for health of mind and body during prolonged life.

It has often been said that religion unfortunately proved harmful to insanity and the insane in the old medieval days, because ecclesiastics, sometimes for the sake of the fees that they might secure for exorcisms, taught very generally the doctrine that the insane were possessed of the devil, and that the one thing to do for them, besides exorcising the evil spirit, was to chain them up and keep them in manacles in dungeons until there was assurance that they had been released from the devil that had gained possession of them.

In spite of the fact that this is a rather common teaching in medical books and is frequently asserted even by physicians and sometimes indeed by specialists in nervous and mental diseases who are supposed to know the subject on which they discourse, there is very little foundation for this prevalent impression. Undoubtedly there was the belief in the possibility of possession by the devil and some such modern scientific minds as Alfred Russel Wallace and Professor Barrett of Trinity College, Dublin, have reverted to that belief because of their studies in spiritism and some of the curious results that follow from overdevotion to the cult of spirits. There was, however, a very definite recognition of the fact during the later Middle Ages that the insane were just ailing persons who had to be taken care of, properly treated, kept from hurting themselves or others, just as delirious individuals would have to be guarded, but who must be looked upon as sick in mind, just as a number of people were sick in body and with more than a hint that the bodily condition had more to do with the insanity than anything else. I have discussed the subject at some length in my volume on "Medieval Medicine" recently published in London.⁷ Paul of Aegina wrote in the seventh century of melancholy as a primary affection of the brain to be treated with frequent baths and a wholesome and humid diet, together with suitable exhilaration of mind and without any other remedy unless when from its long continuance the offending humor is difficult to evacuate, in which case we must have recourse to more complicated and powerful plans of treatment. Paul was a very popular author much read in the Middle Ages.

The Church's view of the subject of insanity is very well expressed in Bartholomew's Encyclopedia. This was a work written particularly for the information of the clergymen of the time, in order to explain to them all references in Scripture and to give them such details of knowledge as were necessary for preaching and for the teaching of their flocks. Bartholomew was very widely read and went through many editions before printing, was put into print very early, and some of the editions are among the greatest of bibliophilic treasures. Bartholomew, usually called the Englishman—his Latin name of Bartholomaeus Anglicus is well known—boiled down all the knowledge of insanity into a single paragraph. He has nothing at all to say of possession by the devil, and his discussion of the whole subject of madness is as modern as can be.

The causes of insanity which this clergyman writer of the middle of the thirteenth century enumerates are those which psychiatrists of the present day are insisting on. The symptoms of infection, considering the brevity of the passage, are very well and clearly described, and the treatment suggested is the very latest in modern practice and consists of improvement of nutrition and the diversion of the insane. With all our supposed advance in knowledge no physician, even of the twentieth century, could have expressed the whole subject of insanity any better than Bartholomew did. This paragraph is a complete refutation of the objections that the Church by its insistence on diabolical possession as the principal cause of insanity did a great deal of harm. Bartholomew said:

"Madness cometh sometime of passions of the soul, as of business and of great thoughts, of sorrow and of too great study, and of dread: sometimes of the biting of a wood (mad) hound, or some other venomous beast; sometimes of melancholy meats, and sometimes of drink of strong wine. And as the causes be diverse, the tokens and signs be diverse. For some cry and leap and hurt and wound themselves and other men, and darken and hide themselves in privy and secret places. The medicine of them is, that they be bound, that they hurt not themselves and other men. And namely, such shall be refreshed, and comforted, and withdrawn from cause and matter of dread and busy thoughts. And they must be gladded with instruments of music, and some deal be occupied."