Statistics of madness.

— The Moniteur of April 16, 1866 contained the five-yearly report, addressed to the Emperor by the Minister of Agriculture, Commerce, and Public Works, on the state of mental alienation in France. Very extensive, learnedly and conscientiously prepared, this report is a proof of the solicitude with which the Government treats this grave humanitarian question. The precious documents it contains attest to an attentive observation. They interest us greatly, because they are a formal and authentic refutation of the accusations leveled by the adversaries of Spiritism, who designate it as the preponderant cause of madness. From it we extract the most salient passages. In truth these documents establish a considerable increase in the number of the insane; but it will be seen that in this Spiritism is entirely a stranger. This number, which in the special asylums was, in 1835, 10,539, stood, in 1861, at 30,229; this is an increase of 19,700 in 26 years, that is, an average of 750 per year, as results from the following table (as of January 1):

— 10539

— 11091

— 11429

— 11982

— 12577

— 13283

— 13887

— 15280

— 15786

— 16255

— 17089

— 18013

— 19023

— 19570

— 20231

— 20061

— 21353

— 22495

— 23795

— 24524

— 24896

— 25485

— 26305

— 27028

— 27878

— 28761

— 30239 — — In addition, the report establishes this capital fact: the increase was progressive from year to year, from 1835 to 1846 and, since then, it has been decreasing, as the table below indicates: From 1836 to 1841, annual increase of 5.04% From 1841 to 1846, annual increase of 5.94% From 1846 to 1861, annual increase of 3.71% From 1851 to 1856, annual increase of 3.87% From 1856 to 1861, annual increase of 3.14% “The Minister says that, in view of this deceleration, also verified in admissions, as I shall establish further on, it is probable that the truly exceptional growth of our asylums will soon be halted. “The number of patients that our asylums could suitably accommodate was, at the end of 1860, 31,550. The actual number of patients maintained at the same period rose to 30,239. Consequently, the number of available places was only 1,231.

— “From the point of view of the nature of their infirmity, the patients under treatment on January 1 of each of the years 1856-1861 (the only years for which the distinction was made) are classified as follows: Years

Mad

Idiots

Cretins

“The notable fact of this table is the considerable increase, in relation to the mad, of the number of idiots treated in the asylums. In five years it was 32%, whereas, in the same interval, the number of the mad rose only 14%. This difference is the consequence of the admission into our asylums of a great number of idiots who previously remained within the bosom of their families.

— “Divided by sex, the total population of the asylums offers, each year, a numerical excess of the female sex over the male. Here are the figures established for the patients present at the end of each of the years 1854-1860: Year

Male sex

Female sex

“The annual average, calculated for this period of six years, is, per 100 patients, 51.99 women and 48.10 men. This disproportion between the two sexes, which is repeated annually, since 1842, with slight differences, is very notable in the presence of the numerical superiority, well established, of the male sex in admissions, where 52.91 men are counted per 100 patients admitted. It is due, as was explained in the preceding publication, to the greater mortality of the latter and, moreover, because their stay in the asylum is notably less long than that of the women.

— “Starting in 1856 the patients under treatment in the asylums were classified according to the chances of cure that their condition seemed to offer. The figures that follow summarize the facts established for the category of the mad under treatment on January 1 of each year: Year

Presumed curable

Presumed incurable

Total

“Thus, more than four-fifths of the mad maintained in our asylums offer no chance of cure. This sad result is the consequence of the negligence or the blind tenderness of the majority of families, who part with their alienated ones only as late as possible, that is, when their inveterate ill leaves no hope of cure.

— “It is known with what care the physicians of our asylums for the alienated, at the moment of a patient's admission, seek to determine the cause of his madness, in order to be able to attack the ill at its principle and there apply the remedy appropriate to its nature. However scrupulous, however conscientious these medical investigations may be, one must not forget that their results are far from equivalent to facts sufficiently established. Indeed, they rest only on appraisals whose exactness may suffer in different circumstances. In the first place, the extreme difficulty of discovering, among the various influences undergone by the patient's reason, the decisive cause, the one from which the alienation issued. Let us mention next the repugnance of families to make complete confidences to the physician. Perhaps one must also take into account the present tendency of the majority of physicians to consider moral causes as entirely secondary and accidental, in order, by preference, to attribute the ill to purely physical causes. “It is on the basis of these observations that I am going to approach the examination of the tables relating to the presumable causes of alienation of the 38,988 patients admitted from 1856 to 1860. “Is madness produced more frequently under the influence of physical causes than of moral causes? Here are the facts gathered on this point, abstraction made of heredity, for the mad admitted in each of the five years of the period from 1856 to 1860: Year

Totals Physical causes

-------

Moral causes

-------

“According to these figures, in 1,000 cases of madness, 607 were attributed to physical causes and 393 to moral causes. Madness, therefore, would be produced much more frequently under physical influences. This observation is common to both sexes, with the difference, however, that for women the number of cases whose origin is attributed to moral causes is relatively higher than for men.

— “The 15,866 cases in which madness appeared provoked by a physical cause are broken down as follows:

Effect of age (senile dementia)

Nakedness and misery Onanism and venereal abuses Alcoholic excesses Congenital defect Diseases proper to women Epilepsy Other diseases of the nervous system Blows, falls, lesions, etc.

Diverse diseases Other physical causes Total

n

— “As for the phenomena of the moral order, those that seem to produce madness most frequently are: first, domestic sorrows and the exaltation of religious sentiments; then come reverses of fortune and unrealized ambition. As for the rest, here is the detailed enumeration of the 10,357 cases of madness, marked as the immediate consequence of the various incidents of moral life: Excess of intellectual work Domestic sorrows Distress resulting from the loss of fortune Grief resulting from the loss of a loved one Sorrows resulting from unsatisfied ambition Remorse Anger Joy Wounded modesty Love Jealousy Pride Political events Sudden passage from active life to inactive and vice versa Isolation and solitude Simple imprisonment Imprisonment in solitary confinement Nostalgia Religious sentiments carried to excess Other moral causes Total

“In sum, abstraction made of heredity, it results from the observations gathered on the patients admitted into our asylums for the alienated, during the period from 1856 to 1860, that, of all the causes that concur to provoke madness, the most common is drunkenness. Next come domestic sorrows, age, diseases of various organs, epilepsy, religious exaltation, onanism, and privations of every sort.

— “The following table gives the number of paralytics, epileptics, deaf-mutes, scrofulous persons, and those afflicted with goiter, among the patients admitted for the first time from 1856 to 1860: __ Paralytics Epileptics Deaf-mutes Scrofulous Afflicted with goiter Mad 3,775 1,763

Idiots / cretins

“Madness is complicated by paralysis much more in women. Among the epileptics there are more men than women, but in a less strong proportion.

— “If one now investigates, distinguishing the sexes, in what proportions cures are produced annually, in relation to the number of patients treated, one obtains the following results: Years

Men 8.93% 8.92”

8.00”

8.11”

8.02”

7.69”

7.05”

Women 8.65% 8.81”

7.69”

7.45”

6.74”

6.71”

6.95”

Both sexes 8.79% 8.86”

7.83”

7.62”

7.37”

7.19”

7.00”

“It is seen that, if madness is curable, the proportional number of cures is still very restricted, despite the improvements of every nature brought to the treatment of the patients and the accommodations of the asylums. From 1856 to 1860 the average proportion of cures was, for the mad of both sexes, together, 8.24%. It is barely a twelfth. This proportion would be much higher if families did not commit the grave error of parting with their alienated ones only when the disease has already made disquieting progress. “A fact worthy of note is that the proportional number of cured men exceeds, annually, that of women. In 100 mad persons treated, from 1856 to 1860, there were counted on average 8.69 cures for men and only 7.81 for women, that is, about a ninth more for the alienated of the male sex.

— “Among the 13,687 mad persons discharged after cure, from 1856 to 1860, there are only 9,789 for whom it was possible to determine the various influences that had occasioned their mental affection. Here is the summary of the indications gathered from this point of view: Physical causes Moral causes Total:

5,253 4,536 ______ 9,789 cured “ “Representing this total number by a thousand, it is found that, in 536 cured patients, madness had supervened in consequence of physical causes, and in 464 in consequence of moral influences. These numerical proportions differ very perceptibly from those previously established, concerning the admissions of 1856 to 1860, where there were counted, in 1,000 admitted, only 393 patients whose madness had a moral cause. From which it results that, in this category of patients, the cures obtained would have been relatively more numerous than among those whose madness had a physical cause. “About half of the cured cases, for which the cause of the ill was gathered, were due to the following circumstances: drunkenness, 1,738; domestic sorrows, 1,171; diverse diseases, 761; diseases proper to women, 723; exaltation of religious sentiments, 460. “In 1,522 cured patients, a hereditary predisposition was established. It is a proportion of 15% in relation to the figure of the mad who were cured.”

— From the outset it results from these documents that the increase of madness, established starting in 1835, is nearly twenty years prior to the appearance of Spiritism in France, where people did not occupy themselves with the turning tables, and more as entertainment than as a serious matter, until after 1852, and with the philosophical part only after 1857. In the second place, this increase followed, year by year, an ascending march, from 1835 to 1846; from 1847 to 1861 it went on diminishing from year to year; and the diminution was strongest from 1856 to 1861, precisely in the period in which Spiritism was taking its development. Now, it was precisely at that time that pamphlets were published and the newspapers hastened to repeat that the houses for the alienated were crammed with Spiritist madmen, to such a point that several had been obliged to enlarge their buildings [See: Spiritist madness]; that there were counted, in all, more than forty thousand. How could there be more than 40,000, when the report establishes a maximum figure of 30,339? From what source more reliable than that of the authority did those gentlemen gather their data? They called for an inquiry: here it is, made as minutely as possible, and one sees whether it proves them right. What likewise stands out from the report is the number of idiots and of cretins, which enters with a considerable share into the general count, and the annual increase of this number, which, evidently, cannot be attributed to Spiritism. As for the predominant causes of madness, they were, as is seen, minutely studied, and yet Spiritism does not figure there either by name or by allusion. Would it have gone unnoticed if, as some claim, it had, by itself alone, filled the houses for the alienated? We do not think that one would attribute to the minister the thought of having wished to spare the Spiritists, abstaining from mentioning them, if there had been occasion to do so. In any case, certain figures would refuse any preponderant share of Spiritism in the state of things. Were it otherwise, moral causes would predominate in number over physical causes, whereas it is the contrary that occurs. The figure of the alienated considered incurable would not be four to five times stronger than that of patients presumably curable, and the report would not say that four-fifths of the mad maintained in the hospices offer no chance of cure. Finally, in view of the development that Spiritism takes each day, the minister would not say that, by reason of the deceleration that has occurred, it is probable that the truly exceptional increase in the population of the asylums will soon be halted. In sum, this report is the most peremptory response that can be given to those who accuse Spiritism of being a preponderant cause of madness. Here there are neither hypotheses nor reasonings, but authentic figures, opposed to fantastic figures, material facts set against the mendacious allegations of its detractors, interested in discrediting it in public opinion. [1]

[The figure 15,866 that appears at the beginning of item

and in the total of the cases described is not correct, for they add up to 16,715, and not 15,866.]