Nervous diseases, insanity, and feeble-mindedness are a grievous burden for modern society. Every form of social ill roots itself in these mind disorders. Since this great burden seems to be increasing as a result of the conditions of present-day living, it is not strange that those most familiar with the situation are seriously alarmed. This concern is expressing itself in movements that attempt to educate the public to the need of conserving the mind in every possible way. Interest is being aroused in mental hygiene and this fact promises great social relief. It is indeed fortunate that philanthropic effort has thus become welded with science and is eager to get at one of the most serious sources of poverty, alcoholism, prostitution, crime, and physical suffering. The student of any of these great social problems knows that the roots of the difficulty usually run down into human weaknesses such as the mental hygiene movement is attempting to correct and prevent.

The mental hygiene propaganda has been up to the present time largely confined to the urban centers, but it is very important that our rural districts receive the benefits that come from attention to the problems of mental health. Not that rural people have greater need of mental hygiene than have those who live in the cities. Many alienists, on the contrary, believe the city more in need of mind-conserving activities, and, although there is no satisfactory basis for comparison, it would seem as a result of the data gathered by the last census[3] that their conclusion is reasonable in light of the evidence we have at present regarding conditions in this country. The country needs emphasis because it can be more easily neglected than the city.

People in the country are less likely to realize the needs of mental hygiene. As a rule, rural conditions that should challenge the attention of the leaders of the communities are not spectacular and appear in isolation. In urban life, on the other hand, thoughtful social workers are bound to see many individual cases that belong to the defective group as a mass, and thereby to realize the seriousness of the problem. If the rural leaders could put together the cases of social maladjustment present in many different communities, there is no doubt that the great need of mental hygiene in the country would be easily recognized.

It is also true that mental hygiene propaganda is somewhat more difficult in the country, partly because of the temper of mind of rural leadership and partly because of the lack of means for the reaching of popular attention. People are not likely to be spontaneously interested in the mental hygiene movement. They require the instruction and inspiration that come through the personality of the alienist. Fortunately our daily and weekly papers realize the seriousness of the mental hygiene propaganda and they circulate both in the country and in the city. This fact is making many of the leading people in the country nearly as familiar with the problem of mental hygiene as are city leaders.

Even though we know less than we should like concerning the amount and the significance of mental deficiency in the country, we already have information that reveals the need of mental hygiene effort among rural folk. The report of the New Hampshire Children's Commission made in 1915 contains a significant conclusion in regard to the feeble-mindedness in the rural section of that state. "One of the most significant studies that can be made in the survey of these counties is the geographic distribution of the feeble-minded and the proportion of the entire state population that falls within this defective class. Since there has been a report from every town in the state, either by questionnaire or personal canvass, this proportion may be considered fairly correct, even though many cases have not been reported. One of the most significant revelations of this table is the range of feeble-mindedness gradually ascending from the smallest percentage, in the most populous county of the state, to the largest percentages, in the two most remote and thinly populated counties. It speaks volumes for the need of improving rural conditions, of bringing the people in the remote farm and hill districts into closer touch with the currents of healthy, active life in the great centers. It shows that a campaign should begin at once—this very month—for the improvement of rural living conditions, and especially for the improvement of the rural schools, so that the children now growing up may receive the education that is their birthright." We also have two recent government reports that disclose the need of mental hygiene among rural people.[4]

The first report, based upon a survey made in Newcastle County, Delaware, contains among the conclusions these that are of special interest to the student of rural life:

"Five-tenths of 1 per cent of 3,793 rural school children examined in New Castle County are definitely feeble-minded and in need of institutional treatment.

An additional 1.3 per cent of the total number were so retarded mentally as to be considered probable mental defectives and in need of institutional care.

A number of mentally defective children were encountered who exhibited symptoms similar to those which are observed in the adult insane.

It is believed, as a result of this survey, that epilepsy is a more prevalent disease than it has heretofore been thought to be."

The other report gives the following information:

"Of the 1,087 girls and 1,098 boys examined in the rural schools, 93 of the former and 100 of the latter were below the average mentally, or 8.7 per cent of the whole number.

Of the total school population, 0.9 per cent were mental defectives.

The undue number of one-room rural schools in the county which were of faulty construction, with poor equipment, and with imperfect teaching facilities, were largely responsible for the retardation found in the county.

The average loss of grade by 193 children, as recorded by teachers, was 1.28 years for girls and 1.5 years for boys, a total of 269 school years.

No special classes for the instruction of retarded children were found in any of the rural schools of the county.

In addition to the 214 children who were retarded and exceptionally retarded, three epileptics and two constitutionally inferior children were found among the school children of the county."

These interesting investigations do not, of course, disclose the full amount of mental defectiveness in the localities studied, because they are based on a survey of the children at school and because they especially take up the matter of retardation and feeble-mindedness. It is no uncommon thing in the small rural community to find the more troublesome feeble-minded child withdrawn from the school. The reports suggest that a wider investigation would increase the number of defective children, for the method chosen could hardly be expected to discern all the seriously neurotic children. The information gathered indicates that epilepsy and the neurotic predisposition to insanity need to be investigated as well as amentia,[5] and that the epileptics and neurotics, even among rural children, are more numerous than is usually supposed. Of course an investigation of the adults would still more increase the amount of mental abnormality.

The sociologist is familiar with the social menace of the degenerate family in the country. Most of the members of the families thus far studied have lived in the country or small village. It is reasonable to suppose that on the whole such families find it easier to survive in the country than in the city. The country offers occupation for the high grades during the busy season and yet does not require steady employment all through the year. The social penalties of mental inferiority are not likely to be so oppressive; certainly there is much less danger of coming into collision with the law. Our institutions find from experience that the feeble-minded take kindly to rough, out-door work and from this it is natural to assume that a large number of the feeble-minded, free to choose their environment, prefer the country to the city. They are probably more often handicapped by the competition of city life than by the conditions of life in the rural community.

It is probably true also that the feeble-minded family is more likely to renew its vitality by the mixing in of new, normal blood in the country than in the city. Illegitimacy holds in the problem of rural feeble-mindedness the same position that prostitution occupies in urban amentia. The attractive feeble-minded girl—and of course many of these girls are physically attractive to many men—does not find it difficult in the country to have sex relations with mentally normal men. Indeed it is often not realized that the girl is mentally abnormal, and all too frequently we have a marriage in the country between a woman of unsound mind and a man who is mentally sound. Illegitimacy is, however, the larger problem in rural amentia. The same type of girl that in the country becomes the mother of several children, often by different men, in the city, unless protected, enters prostitution. The city prostitute, because of the sterilizing effects of venereal diseases, is less likely to become the mother of children, but, on the other hand, she scatters about syphilis, which has so much to do with causing mental abnormalities. It may be a matter of opinion which of the two social evils, illegitimacy in the country or prostitution in the city, has the larger influence upon the spread of mental abnormalities, but there can be no doubt that the rural difficulty deserves the attention of all interested in mental hygiene.

It is unfortunate that rural people do not realize more often the serious meaning of feeble-mindedness. The close contact between neighbors and the familiarity of community life tend in the country to develop an indifference to the variations from normal standard that the high-grade ament expresses. People, as a rule, take the social failures of the feeble-minded for granted and do not specially regard them as evidences of mental inferiority. This condition makes the limited segregation possible in the country very difficult indeed. The thoughtful parent hardly knows how to keep his child from associating with the deficient child of his neighbor when they live near together and attend the same school.

At school also the feeble-minded child is likely to have advantages over his city brother, which keep him from exhibiting to the full his inherent mental weakness. A conversation with almost any rural teacher will impress upon one the fact that the teacher is loath to declare feeble-minded a child whose records give unmistakable evidence of amentia and that she generally regards the child as merely dull. Fortunately this is likely not to be so true in the future, as a result of the recent instruction that candidates for teaching are now receiving in our normal schools.

There is, however, the greatest need of clinic work being carried on in our rural schools. The problem cannot safely be left with local authority. The demand is for some state-wide method of mental examination of school children. This service, which in most states could be given over to the superintendent of public instruction, ought to be given wider scope than merely the mental measurement of school children. The problem requires the service of the alienist. Only by this more fundamental treatment of the problem can we expect to obtain the full social relief that the preventive side of mental hygiene promises. As a matter of fact, however, it is likely that the problem will be considered first from the viewpoint of retardation in our rural schools. It will be unwise to force the mental hygiene movement into our rural school administration more rapidly than the need of it can be made clear to our rural leadership.

It is an unhappy fact that we are at present doing so little. The state certainly must try in some way to provide, for the country children who need it, the special class instruction now given backward children in the cities. This will give relief by providing a basis for the separation of the curable and the incurable defective children. At present the defective child who requires treatment and improves in the special class suffers a great handicap by being in the country rather than in the city.

Without doubt epilepsy and psychopathic cases, as well as feeble-mindedness, receive relatively less attention in the country than in the city. This situation certainly hinders rural progress and adds to the social burdens of rural communities. Any one familiar with the life of a typical rural town will know of peculiarities of conduct and strange attitudes of non-social persons which indicate mental unsoundness. These abnormalities express themselves in various forms and I happen to know of some New England communities that have been hopelessly separated into two hostile parts as a result of the influence of persons whose subsequent careers have proven that the originators of the difficulties were socially irresponsible. One such case was a church quarrel that finally had to receive a state-wide recognition because of the serious situation that finally resulted. The later suicide of the individual, who first started the dispute, a suicide that had little objective explanation, seems to have demonstrated that the whole difficulty originated because of the influence of a psychopathic character. In this case had the community known a very little about mental aberration the history of the difficulty would have been very different. Even as it was, a very few of the more thoughtful people believed the man insane.

The chief reason, however, for mental hygiene propaganda in the country is the influence it will have in preventing human suffering. The problem of mind health is a humane one and this fact removes the distinction between rural and urban need. Urban fields offer more inducements at present for the worker, but the rural need is also great. The rural districts are less conscious of their distress and perhaps respond less readily to whatever instruction is given them, but they certainly must be given the benefits of the mental hygiene movement by a patient and persistent propaganda.

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