Insanity in Ancient and Modern Life, with chapters on its prevention is a medical book written by the English physicist and practical worker in medicinal psychology Daniel Hack Tuke (1827-1895) in 1878. Tuke dedicated much of his time encouraging humanitarian treatment for the mental ill. His knowledge is summarized and clarified in many of his medical books, in which he often takes controversial and novel standpoints. The presented book discusses the causes of mental disorders in relation to the maturation of society and considers factors which can positively contribute to the prevention of psychiatric diseases.
Historical context Being part of the movement dynamic psychotherapy in the later 19th century, Tuke is acknowledged to be one of the earliest authors to coin the term "Psychotherapeutics". He combines psychological insights similar to Freud's psychodynamic therapy with a medical and somatic approach that Tuke adopted from his studies of medicine. Living in a time in which mental illness is no longer regarded as the consequence of having committed a religious sin, a more biological basis and environmental foundation of psychiatric diseases was established. An especially pronounced insight of this viewpoint is that mental illness is caused by genetical factors as well as influenced by nurture and is therefore treatable and may be even preventable.
The breakthroughs of the 19th century In the 17th and 18th centuries there was a gradually increasing focus on the brain itself and how brain injury affects behavioral displays like in the famous case of Phineas Gage. Additionally, a growing interest in reflexes facilitated the viewpoint that behavior is not necessarily self-generated but can be also environmentally caused. However, despite the huge medicinal and factual progress in the study of the brain and its influence on behavior, the new insights did not yet contribute to an improved treatment of psychiatric diseases and brain injuries. Although there was an increasing interest in mental processes and behavior, until the middle of the 19th century psychology as a scientific study and subject itself was largely disregarded and rather considered to be a branch of philosophy.
Irrevocably, this mindset turned enormously due to five scientific discoveries that enabled the development of modern neurophysiology and are still relevant for today's psychology. They were the discovery of the 1) cerebrospinal axis, 2) the growing impact of the reflex and its relation to mental functioning in studies by Marshall Hall (1790-1875), 3) the localization of brain functions such as the center of speech production (Broca's Area), 4) the discovery of the nerve cell by Camillo Golgi (1843-1926) and lastly, the 5) disentangling of the communication between neurons by Ramón y Cajal (1852-1934). All these findings consider a biological and physical basis by which behavior can be explained. This is also an opinion held by Tuke himself, as he not only waited for a proof of a physical basis for normal behavior but also as an explanation for what he terms "insanity".
The emergence of experimental psychology Although psychology as an independent scientific study was largely discredited by well-known scientists and philosophers such as Immanuel Kant (1724-1804), scientists such as Johann Friedrich Herbart (1776–1841), took the issue as a reason to invent a mathematical basis for scientific psychology. Despite his unsuccessful attempts to quantify behavior, his efforts were taken up by the scientists Ernst Heinrich Weber (1795–18 78) and Gustav Theodor Fechner (1801–1887), aiming to measure the mathematical relationships between the physical magnitudes of external stimuli and the psychological intensities of the resulting sensations. Their vast and unique insights are later coined by the term "Psychophysics". Meanwhile, the breakthroughs in neuronal structure and physiology (the five most important listed above), evidenced a physical and biological nature of human functioning that can serve as the basis for scientific experiments in studying behavior. One of the principal founders of experimental physiology, Hermann Helmholtz (1821–1894), conducted experimental studies of a wide range of topics that would later be of huge interest to psychologists. The speed of neural transmission, the physical natures of sound and color and our perception of them count as some of the most important insights. Together with the German physiologists, psychologists and philosopher Wilhelm Wundt (1832-1920) he addressed more complicated psychological questions than had not been investigated experimentally in the past. Of particular interest for both was the nature of apperception, which is defined as the point at which a perception occupies the central focus of conscious awareness. To conduct all the studies, in 1879, Wundt founded the first laboratory worldwide that was specifically dedicated to original research in experimental psychology. Tuke himself as a physicist was largely interested in the practical and experimental part of psychology and psychiatry but contributed to the development of experimental psychology mainly by providing theories and hypothesis about biological and environmental factors that influence the mind and also cause mental illnesses. His research and findings are majorly based on observational studies and analysis of existing literature and statistics.
Content The presented book discusses the causes of mental disorders in relation to the maturation of society and considers factors which can positively contribute to the prevention of psychiatric diseases. By considering the ecological and social conditions of people, starting in prehistoric times until the late nineteen hundreds, it is analyzed in twelve chapters how these factors and a steady growth in complexity of civilizations contribute to an alleged increase in prevalence of mental illnesses. He claims, that emotional and cognitive conflict is a natural human response to life's injuries, which he defines as the rapidly changing lifestyle during the British Industrial revolution from the Mid-18th century to early 19th century and the rising gap between the rich and the poor. Consequently, the majority of insane people would always be found in a civilized community.
Causes of insanity In the first chapter, Tuke gives a broad overview about the diverse set of factors that he considers to be of vital importance when answering what causes and influences the development of insanity. By doing this, he acknowledges biological, societal, environmental, cultural, as well as religious and political factors. He claims, that all these factors accumulate and increase in intensity when societies became more complex and civilized.
Intoxication and defective nourishment Throughout history, intoxication could be found in almost any community, especially the consume of alcohol but also of other stimulants. The intake of mind- and mood-altering drugs is distributed in time and space. Tuke claims, that intoxication leads to the exhaustion of the nervous system and inhibits it to function properly. This degeneration would accumulate in succeeding generations, especially when considering the increasing importance alcohol gains with the maturation of society.
With a similar mechanism he describes that malnutrition contributes to an increased chance to develop insanity, which in his opinion could be evidenced by every underfed population. This would also apply to the British society at the time. Until the late 19th century, chronic hunger and malnutrition were the norm for the majority of the population of the world, including Britain. The life expectancy in Britain suffered immensely, in large part due to malnutrition. A usual worker of a factory usually did not exceed the age of 40. Partly the shortage of food can be explained by the fact that food supply in Great Britain was adversely affected by the Corn Laws (1815-1846). The Corn Laws, which imposed tariffs on imported grain, were enacted to keep prices high in order to benefit domestic producers. As additionally population grew exponentially in these years in urban areas, among others noticed by Thomas Maltus, not enough food could be provided and money was scarce among the lower ranks of society. All these factors increased poverty and malnutrition and may explain the high prevalence of insane people among the lower working classes of British Society. Not surprisingly, Tuke names pauperism to be one of the major influential factors causing insanity.
Dissolute Life, Depraved Habits and Disappointments in Love Tuke was among the first scientists to recognize that emotional problems and general life satisfaction highly influence the mental health of a person, disregarding his societal rank. During the Industrial Revolution steadily rising standards caused changes in the mindset of society. An increased incidence of emotional conflict was the result of the competitive spirit of the modern civilization. When people compared their living standards, they often became dissatisfied with their own and luxury goods grew in importance. Tuke explains, that this kind of depression interferes with normal cognitive functioning and additionally, often leads to the consume of drugs and thus indirectly precipitates insanity.
Overwork Another consequence of the industrial revolution in the 18th century was the increased number of hours per day that people belonging to the working class had to absolve with only little payment. As increasingly more factories were built, more workers were needed in total and a worker had to work on average more under terrible working conditions. Oftentimes, even children were used as workers in the factory to ensure the survival of the family. On average, children were paid less than 10 Cent for a fourteen-hours shift. However, also members from upper classes were confronted with an increased amount of work to maintain their business. According to Tuke, both, the mental and the physical exhaustion like business or monetary worries, lead to emotional stress which has similar effects on mental health as dissatisfaction with the own living circumstances.
Intellectual Strain Intellectual strain in form of excesses of educational work, is also a potent cause Tuke introduces in his book. Similar to the physical overwork mentioned above, Tuke expects similar consequences for mental exhaustion. As with the industrial society also the external societal pressure rises, so did the urge for self-perfection and societal improvement. The pressure and overthinking in turn, is thought to cause sleeplessness which interferes with the proper formation of memories. Contrastingly, he underlines that the contrary, namely mental underload is also a dangerous factor considering the development of mental illnesses. He states that the upper classes of society are heading towards a style of living in which intellect is of minor importance as compared to luxuries and reputation. Less cognitive engagement would cause cognitive abilities to decline in the long-term and would also elevate mental tension.
Religious and political excitement Political excitement is termed as one of the major influential factors that positively contribute to insanity. As society increases in size, opinions become more diversified. The traditionally and religiously shaped views become challenged, which according to Tuke interferes with the implementation of an ideal society. This would open room for insanity to arise and spread. Additionally, political and religious excitement is hypothesized to generally lead to emotional stress and upheaval which would disturb the mental equilibrium that is required in order to ensure mental health.
Prevalence of Insanity in the course of history
Insanity in Prehistoric times