Mental Abnormalities—A Factor In Industry

Mr. President and Gentlemen,--After such an introduction as this one feel relieved of the pessimism that has naturally gathered about me in my studies during the years, in connection with rather depressing subjects such as those of mental disease and mental defect. I have always felt that the man in the street did not know enough about them. Many of them said that they did not want to know about them, or that they were all-sufficient of themselves to supply the diagnosis required in the settlement of mental cases, or canes of mental defect, and that they did not want to be aided by the man of science, especially in criminal affairs. Of course that is all nonsense. The citizen of today wants to know all about these subjects in which we are engaged, and he is forming his own conclusions in regard to the proper remedies to be applied in getting over the difficulties which are ever present. I am optimistic by constitution, and though I grow

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Doctor Clarke was professor of mental diseases at Queen's University and later professor of psychiatry at the University of Toronto. He has rendered distinguished service in the asylums of Toronto, Hamilton and Rockwood, and is a widely recognized authority on mental diseases. Recently he delivered the Mandesley Lecture before the British MedicoPsychiatric Association--the only outsider thus far invited.

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pessimistic once in awhile I have become optimistic as a result of the recent developments taking place in our midst and abroad.

The trouble with our subject is that mental action is judged by the average individual too much from the point of prejudice, tradition and, very often, misplaced sympathy. Unfortunately psychology did not come into its own until within the last few years. It was engaged in all sorts of experimental work that was rather interesting to those who were carrying on the experiments, but was of -little benefit to the human race. When psychology woke up to the appreciation of the fact that it had a real place in human affairs, it began to do some good things, and to establish, for example, investigations of human behaviour among children in schools, etc. Perhaps now the pendulum has swung too far the other way, and psychology is taking itself too seriously in many directions, and attempts to accomplish by inspiration what common sense and experience alone can determine.

The Mental Hygiene Movement which I represent was the outcome of a strange occurrence. A brilliant young man named Clifford W. Beers became insane, and was subjected to treatment in institutions that caused him a great deal of pain and distress, and made him feel that he had a mission to perform when he recovered. He was clever, and told his story so well that it impressed some of the leading men in the United States, such as James of Harvard. He published a book called, "The Mind that Found Itself,"--a book that has passed through endless editions and is still just as good reading as it was on the day it was written. Perhaps it is an extreme book; possibly it is not all true; but he thought it was true, at all events. Anyway, his writing of this book led to the founding of the movement called "National Mental Hygiene," and it has had tremendous success as a result of which we adopted it in Canada. We were close followers of the movement, which has been in existence some five years in Canada, but we have departed nearly altogether from our original programme. We found that the affairs of the insane did need much adjusting in Canada, and it was not a difficult matter to do it, because all you had to undertake was to make governments realize that if they did not attend to the things pointed out the public goblins would get them. (Laughter) So very often it was not only the direct inspiration of the National Committee, but it was the indirect outcome of the desires of the practical world.

We never worked along the line of destructive criticism. We felt that was a simple thing to do, but we also realized that the public needed the guidance of an upbuilding criticism, and that has been the policy followed all through. You have not heard much of this movement in the newspapers, because it has not been our policy to advertise too freely. But we have found, too, that we have a very much greater function to perform with the public and for the public than that of looking after the insane alone. That is a definite problem, and we realize that it can be handled in a definite way. We have discovered that after all, cure and treatment are all very well, but we have a much higher function to perform, and that is, to deal with prevention; hence prevention is our slogan in every direction.

I do not know whether you all understand what the organization of any ordinary community it. I would not, of course, classify Toronto as an ordinary community; it is rather an extraordinary one in many ways, as I could point out--and if I made any comment it would be a favourable kind with a few gentle slams at some of the inevitable weaknesses. You can see, by going to any public school you wish to enter, how society is represented, and remember, too, that Toronto schools are models in their way.

After investigation of years it has been found that the public school populations represent pretty well the average public community; and there you do not find the state of affairs you might expect. You go into a public school and find it organized on the assumption that all children are exactly alike, and you have the same treatment for all, the same things prescribed for all; the children are supposed to be of average mentality. As a matter of fact it works out very differently; you find that only sixty per cent of any public school population measures up to the average.

When you realize that, you see that you have a distinctly new problem before you; that you have twenty per cent who are above the average, and twenty per cent below. I think my arithmetic will work out all right; I have gone over it very carefully and I am always anxious when dealing with figures.

Now, what of the twenty per cent above the average? They have not been considered at all in the past. School authorities have always been telling us seriously that in a democratic country such as ours of course democratic methods prevail in the management of the school populations, etc. I am not criticizing democratic methods, but I am merely pointing out that certain facts have not always been clearly understood. Now, the twenty per cent above the average are the ones in whom you are interested, because if we develop them properly you will have a valuable addition to the population. But they are not so developed. A very large proportion of those above the average drift out into society long before they are ready for it. They do their work easily but they get impatient with the educational methods employed, and they will not stay in school. They are nut educated, and you must realize that education is a great factor in the development of the good types, but they are lost to us. Gradually the school authorities are waking up to the importance of this problem, but they require the attacks of the Mental Hygiene and other movements to keep them up to the highest point of efficiency.

Subnormal children have been looked after to a certain extent, owing very largely to the inspiration of the Mental Hygiene movement. School authorities have not always accepted it gracefully, but in the Province of Ontario, for example, we were able to develop special classes in many communities long before the central school authorities had any idea of doing this work. They have followed our lead, and now, as the boys say, they have got on the bandwagon, and are helping us to do that work intelligently. They are perhaps a little too much handicapped by the psychological idea, and I may say that that idea is hampered by the fact that among these subnormal populations-only five per cent are subnormal-there are many cases of incipient mental disease.

As I pointed out in England, the study of mental disease must begin in the asylums for the insane, but if you can study the mentality of children, and especially if you can study that mentality before they are born, you can add a great deal, and when we come to the subject of heredity we know what that means. At all events, we have several definite problems which are not understood by the man on the street. He does not know that it is such a subtle question and such an important one when dealt with from the common-sense standpoint--because, after all, we do not claim to be doing anything more than trying to evolve common-sense methods in dealing with problems of great importance to the community at large.

Now, in that twenty percent below the line you have fifteen percent who are called dull normals. Those are not a hopeless crew at all, but they are interfered with school methods again. They are absolutely incapable, the majority at least, of acquiring academic education after a certain age; and yet they are kept in school during those periods without having any opportunity of acquiring vocational training or knowledge of industrial pursuits which they could acquire very easily if opportunity were afforded. In the school of the future these things will all be guarded. Those dull normals, as they are called, are really quite an asset in a community if they are properly developed; because they make good hewers of wood and drawers of water, and are good citizens who might be developed far more than they are.

This Adolescent Act that has come into force is an excellent thing in many schools, because it seeks to provide education for the older children, but it seems to ignore the dull normal, who should not be ignored, but should be removed from the school when he is about thirteen or fourteen years of age. He is useful in industry and should be so considered, just as the one above the average is an asset and should be more highly developed. This is a very intricate question, and a very large one, and I have not time to deal with it; you would not listen to me if I did, but it will be considered by the public in due course, and very thoroughly, because, after all, the mental and physical constitution of any population determines the greatness of a nation.

I suppose there is no more enthusiastic Canadian or Empire builder in our midst than myself, and yet I regard with a great deal of alarm much of the present inattention or public indifference to things that are of the most tremendous importance.

Take the question of immigration. Everybody has something to say about that now-a-days. That is the one vital question in this community today, as to whether we are going to be a replica of the United States, or whether we are going to be the great country that it is possible for us to become, if we mind ourselves. (Applause) I have never felt depressed because Canada has not gone ahead in population as the United States has, and I think my position is absolutely right. Visiting Ellis Island and getting in touch with the authorities there, I feel that we can afford to go just a little bit slowly. In the West you find the people are not so enthusiastic about immigration as some of us who do not have to handle the problem. But I do know that after visiting Ellis Island, seeing things there, talking matters over, and then observing the way immigration methods are applied in Canada, that we must scan the future with a vast deal of care if we are going to develop the great nation that is possible; for without doubt Canada has the finest chance of any country in the world to produce the greatest nation that the world has ever known. (Applause)

That opinion is not empty boast; it is founded on observation of the facts extending all over Canada, and when I see what is happening to the South of us I feel that we can afford to go slowly. I know that view does not find favour with many politicians who see only the desirability of adding to our numbers, which seems to count for everything; but those of us who have been dealing with human problems for a great many years know that you must have a care as to the stuff of which you are building your nation. It must be the best material obtainable. If you could visit, as I have done, certain districts where the immigration has been of the right kind you would see what that has accomplished-not only in Canada but in the United States. Fortunately for us, the very best types of humanity, the pioneers, are generally progressive people who are not satisfied to just sit down and work out their own salvation, but they want to do something for the benefit of humanity; and some of those studies are most interesting.

The best thinkers amongst Americans, and those who have had ample opportunity to prove the truth of what they say, recognize that they have not a nation at the present time; they do not know whether they have the making of a nation. They realize that heredity is the thing that counts, and that a melting-pot is not going to change the constitution of many races; their skulls have been of the same shape for thousands of years, and the skulls of their descendants will be the same shape for thousands of years to come. After all, there is something in the shape of the skull.

When you realize that heredity counts for sixty-five percent at least, possibly as high as eighty-five per cent of what is going to happen, you will see that you may easily dwell too much on the value of environment. Environment is not everything. You can put a great many elements into the melting-pot and they will come out unmelted. So much have the Americans taken this to heart that the thinkers and workers among them tell me that thirty years hence they will have an American type that will be totally different from the present one. They have had a specimen of the American type in the past, but they say that this type has degenerated, and a very large percentage--I think they put it at thirty percent--will become inferior in height, in physique, and intellect. They caution us not to allow the same thing to occur, not to open our doors indiscriminately to all kinds of people. They advise us that if we are wise we will limit ourselves, if possible, to those Nordic types who are said to find in Canada an environment and heredity that will be suitable for them, and that thus will we accomplish greater things than we have yet succeeded in doing.

You will find that it is difficult to deal with many of these problems, and very hard to make headway against the prejudices that exist. It is all very well for the veterinarian or agriculturist to come along and say that the improvement of the race requires the elimination of the useless members of the herd. Well, of course that would be difficult with the human race. Though it might be good sound common sense it would be difficult of application. You will find some experts who are carrying out the elimination of the culls among bulls; but the moment anybody comes along, like Dr. Forbes Godfrey, and advocates the sterilization of mental defectives, and so on, he finds himself badly handicapped in making progress. Of course his idea is repulsive to a great many, but it embodies a germ of something that we must all recognize as important. It is not going to cure the mental defective, but it is going to help to dam the stream of those defective types; because it is a fact, known by people who have studied Mendelian laws, that the feeble types under certain circumstances have a tendency to come to the top and make no end of trouble.

So all that I am advocating is the careful study of the types we are bringing into this country; to regard the politician and the steamship agent and the railway agent as necessary people, and to realize that business needs population; but for Heaven's sake let us have population of the right kind. I say that very conscientiously, because I deem myself quite as good a Canadian as anybody here; and I say this from no other motive than the wish that my country should have the highest position in the world. Now, one may talk this way and be rapped over the knuckles rather severely, yet if it is talked in a proper circle--and I take it for granted that this Club is a proper circle--it will find some commendation.

I spoke very freely on this subject in England some weeks ago, and expected to be criticized for what I said there. I will give you a resume of the statement I made at a very important meeting at, tended by a great many eminent and thoughtful people, and it brought the London Times to my rescue, though I suspected that it would take the opposite course. If you will pardon me for reading this, it will give you better knowledge than I can of the comments on my views of immigration

"Issues of great importance both to the Dominions and to the Mother Country were raised by Dr. C. K. Clarke in the Maudsley Lecture and reported yesterday in our columns. Dr. Clarke, who is Professor of Psychiatry at the University of Toronto, devoted a considerable portion of his lecture to the subject of immigration into Canada. He views immigration from the mental standpoint, and declares emphatically that the Dominion must take steps to protect itself against the entry of those who are mentally or morally unsound. To show that the danger of such immigration is real, he presented statistics of 5,800 children who were brought for examination to the National Mental Hygiene Psychiarist. Of these children no fewer than 1,386 were found to be "mentally subnormal" to such a degree that they were incapable of being educated at an ordinary school. Dr. Clarke declared that only twenty-five percent of these defective children were Canadians, while thirty-three percent were foreign born, and the remainder were children of immigrants who had recently arrived. Dr. Clarke described a personal experience which brought to his notice no fewer than 107 girls and 24 boys of the most defective and degenerate type all sent by one immigration society. Most of these girls, he said, were persistently immoral, the majority being unmarried mothers. To the objection that these girls had been resident in Canada for some time before they went astray, he replied that a careful inspection before sending them and a rigid "sorting" at the port of arrival would have weeded them out.

That this reply is well founded there can be little doubt, for the study of psychology is now so far advanced as to afford a trustworthy means of detecting weak or degenerate and further potentially immortal types. These types are, without question, the architects of slums and the perpetuators of the worst side of city life. They are also, as a rule, a heavy burden on their neighbours, and on the community in general, for their children, for various reasons, tend to reproduce their evil traits. To exclude them from a population is, therefore, to secure that population against innumerable dangers and disasters. There may be objections to the strict application of the principles which Dr. Clarke enunciates, but they are hardly likely to impress the healthy inhabitants of a country which is still in need of population. It is true that the exclusion of undesirables by one people necessarily imposes a greater strain on those countries which must continue to harbour them. The problem, in fact, like all those in which human health of mind or body is concerned, is in the last issue an international one. It can be resolved only by international effort--educative, hygienic, and medical."

You will see that is going pretty far for the London Times, and it shows that they had intense sympathy with what we felt. I afterwards met the Immigration Committee of the National Council of Women, and succeeded in stampeding them in our direction, and I feel sure that the public discussions of these questions are in the interest of the whole community, because they point out the dangers that you must appreciate.

I will give you two simple facts. I came across a case not long ago, and I was interested in the heredity of that particular case. I followed it up through four generations. I found a defective individual who had come into the country, and after a study of eighty-five of his descendants I learned the fact that no less than thirty-six of them had died in hospitals for the insane. They were all public burdens. They had cost the community anywhere from $700 to $1,000 each; that is the estimate that was made, and the end is not yet, because that danger is not eliminated, nor will it be. Another case that Dr. Hincks and I had was a woman in jail in the West. She had been there 99 times, and was just coming out for her 100th experience, due to the disease from which she was suffering.

If you knew the burdens imposed on every community through the results of imperfect inspection of immigrants-and, mind you, that is not being done very carelessly in Canada now, for the head of the Health Bureau is doing its best with a tremendous problem you would see that to have the law enforced properly is a problem that needs the backing of the whole public. It is only those who see the evil results who can estimate what it really means to the country from the industrial standpoint. Of course it is a tremendous problem, and an absolute and tremendous loss.

What are we going to do about it? Of course all sorts of suggestions are made. These public questions are most difficult to deal with when it comes down to the practical details, and I have no criticism of our authorities, because I think they have done their level best. Perhaps one might be just a little critical occasionally of political things, but after all there is a good deal to be said on that side, too. But there are progressive public men in public life in the Province of Ontario. We have such men as Dr. Forbes Godfrey coming to our rescue, and I think he will have an intelligent conception, for example, of the work in schools.

Now, the psychologist wants to assert himself, and to outdo the psychiatrist, who really is the man who is skilled, in practical things, and who should be well educated in psychology as well as psychiatry. Fortunately, the City of Toronto is under the wise guidance of Dr. Hastings (applause) and let me tell you that Dr. Hastings is an unusually wise man in this medical health question. He has adopted the method of having medical inspection of mental conditions and deficiencies under his aegis, which is a very wise provision, and will save endless trouble.

Of course you cannot convert communities to these reforms in one minute, but the condition of the whole problem is hopeful, and I do trust that the man in the street will get the help he needs in understanding these problems, because, after all, he is the hope of the whole situation.

A prominent politician told me once, "Doctor, your facts are splendid; no doubt they are all true; but you must remember that no Government will shoulder anything unless they are forced to do so." I told him he had better get his ear to the ground as fast as possible, because the public was moving. It is moving in this direction, and today there is an interest and a sympathy that is most gratifying and inspiring; and I regard this occasion as one of the inspiring things, because it shows that a body of our most important men are willing to sit and listen to as dry a discussion as we have had today. (Loud applause)

PRESIDENT WILKINSON extended the thanks of the Club for the fine address, adding that the work in which Dr. Clarke is engaged is a very definite and helpful way of building for the future of Canada.