Geographical Distribution of Insanity 



377 



remainder of the United States the ratio 

 of colored insane as shown by the Tenth 

 Census was i to 542, while for the whites 

 it was 1 to 520. The ratio of colored 

 insane in the United States, minus the 

 Southern States, is then almost exactly 

 the same as the ratio for the white in- 

 sane. 



It seems that all the lines of evidence 

 I have followed up lead to the same con- 

 clusion; they are mutually confirmatory 

 of the general law that the proportion 

 of insane is highest where we find the 

 greatest congestion of population, and, 

 therefore, where the stresses incident to 

 active competition are most severe. Our 

 inquiry thus far, however, has been 

 nothing if it has not been an inquiry 

 into the causes of insanity, and I think 

 I may fitly close by a general discussion 

 of causes with a view to indicating some 

 general conclusions relative to the com- 

 parative influence of these mental 

 stresses I have been discussing in the 

 actual production of insanity. 



If we will take up any annual report 

 of an institution for the insane and 

 turn to the table giving the causes of 

 insanity in the several patients under 

 treatment, we will find assigned such 

 causes as these: "business anxiety," 

 "death of mother," "disappointment 

 in love," "domestic troubles," "ex- 

 cessive study," "loss of property," 

 ' ' political excitement. ' ' How many of 

 us but have suffered at some time or 

 other from one or perhaps all of these 

 so-called causes of insanity ? Certainly 

 we have all had business worries ; cer- 

 tainly we have all lost property at some 

 time, otherwise our good fortune is 

 phenomenal ; certainly we have all 

 been subject to political excitement 

 many times, and all of us presumably 

 have lost a dear friend or relative, per- 

 haps a father or mother. Dr Carlos F. 

 MacDonald says very forcibly on this 

 subject, "* * * that substantially 

 every individual at some time during 

 his life is exposed, in many cases re- 



peatedly, to many of the so-called ex- 

 citing causes of insanity, both mental 

 and physical, and yet, despite this fact, 

 we find that sanity is the rule — insanity , 

 the exception," 



In ascribing these causes what has 

 been done is simply this : The particu- 

 lar set of conditions that happened to 

 maintain at the time the patient was 

 attacked with insanity have been tabu- 

 lated as the causes of that attack, 

 whereas the true cause was in all prob- 

 ability far removed from these which 

 were in reality only accidental contem- 

 poraries. In reality the true under- 

 lying condition in all these cases for 

 which such causes are assigned is the 

 predisposition to insanity. 



Predisposition to" insanity may be 

 either inherited or acquired. The 

 former is more generally recognized and 

 is what is referred to when insanity is 

 said to be hereditary. Of all causes of 

 insanity heredity is recognized as being 

 by far the most important and as being 

 most frequently present. The average 

 for all countries has been estimated at 

 from 60 to 70 per cent. This I believe, 

 as a matter of fact, falls below the truth. 

 But any one who is at all familiar with 

 the collecting of statistics must know 

 how impossible it is for them to fully 

 represent the facts in such a matter. 



Next to hereditary predisposition 

 comes acquired predisposition as a factor 

 in causation, and the two most im- 

 portant agents in bringing about this 

 acquired predisposition are generally 

 acknowledged to be, first, alcohol, and 

 second, sjphilis, both of which, how- 

 ever, may ■ ct as true exciting causes at 

 times. It is further conceded that both 

 of these causes are much more preva- 

 lent in civilized communities, and in 

 fact seem to be fostered by that irregu- 

 lar life which the active struggle after 

 wealth necessitates. 



The inadequacy of predisposition alone 

 to account for insanity, especially ac- 

 quired predisposition dr.e to alcohol, 



