Insanity:

By: Joseph Jacobs , Maurice Fishberg , Solomon Schechter , Julius H. Greenstone

Mental disease. Among the Jews the proportion of insane has been observed to be very large. From statistics collected by Buschan he concludes that they are four to six times more liable to mental disease than are non-Jews. Lombroso quotes Servi ("Gli Israeliti di Europa," 1872) to the effect that in Italy there is one insane among 391 Jews, nearly four times as many as among the Catholic population of that country. Verga ("Archivio di Statistico," 1880) shows that in 1870 there was one insane among 1,775 Catholics in Italy, while with the Jews it reached the alarming proportion of one insane in 384 of population. A similar phenomenon has been observed in other countries. In the various provinces of Germany and also in Denmark the percentage of Jewish insane is very large, as is seen from the figures in the appended table:

Country.	Year.	Insane to 10,000.			Authority.
		__________________________
		Christians.		Jews.
Prussia	1871	Catholics	8.84	16.79	"Preussische Statistik," QI 1883, xxx. 137.
		Protestants	8.47
"	1880	Catholics	12.37	38.9	ib. 1883, p. xlii.
		Protestants	24.2
Berlin	1880	Catholics	14.0	13.9
		Protestants	18.1
Posen	1880	Catholics	13.8	19.3
		Protestants	17.5
Silesia	1880	Catholics	19.3	32.1
		Protestants	22.1
Hanover	1880	Catholics	30.8	62.9
		Protestants	29.2
"	1863		17.1	29.7	Buschan, "Allg. Med Centralzeitung," 1897, Nos. 9 et seq .
Württemberg	1863		4.8	6.4
Bavaria	1863		10.6	19.2
"	1871		9.8	25.2
"	1881		9.0	28.6
"	1883		16.9	31.5
"	1884		17.0	37.3
"	1885		16.4	27.19
Denmark	1863		5.8	33.4
Italy	1880		5.8	39.0

In this table the proportion of Jewish, insane is in nearly all places very large, in some cases more than double that of the non-Jewish population.

Maximoff and Sikorsky have shown that similar conditions prevail in Russia. Among the troops in Kiev they found the following proportions of insane:

Russians	0.91	per cent	insane.
Poles	0.92	"	"
Mohammedans	1.06	"	"
Jews	2.19	"	"

("Proceedings of the Twelfth International Medical Congress," vol. iv., part i., p. 661.)

There are similar statistics for other parts of Russia (see M. A. Ryazanski, "Vrachebnaia Gazeta," 1902, ix. 438-442).

In Vienna.

In Vienna A. Pilcz has recently shown that the Jews have a proportionally larger number of insane than the Gentiles. The figures taken from the records of the First Psychiatric Clinic in that city show that from Jan. 1, 1898, to Aug., 1901, 1,219 patients (723 men and 496 women) were treated for insanity at that institution. Of these 134 (10.99 per cent) were Jews. As to sex, 81 (64.9 per cent) were men and53 (35.1 per cent) women. The population of Vienna, according to the census of 1900, was 1,648,335, of which 146,113 (8.86 per cent) were Jews. Among the 723 non-Jewish male insane 173 were found to be affected with alcoholic insanity; among the 496 female patients, 22. As not one Jew or Jewess was affected with alcoholism, Pilcz remarks that when the cases of alcoholism are deducted the relative percentage of Jewish insanity is perceptibly increased.

In New York city Frank G. Hyde has collected the statistics of the admission of Jewish insane to the asylums during the period extending from Dec. 13, 1871, to Nov. 30, 1900. He found that of 17,135 males, the total number of cases recorded, 1,722 (10.05 per cent) were Jews. While the percentage of Jews in Greater New York is at the present time (1903) estimated to be about 18 per cent, it must be recalled that up to 1882 there were comparatively fewer Jews there, and that this indicates a higher proportion than 10.05 per cent for the 29 years. Indeed, an analysis of the figures given by Hyde for the five years ending Nov. 30, 1900; shows that the proportion of Jewish insane in New York city is perceptibly larger. During these five years 3,710 insane were admitted to the asylums of the city; 573 (15.44 per cent) of these were Jews.

C. F. Beadles, who has investigated the subject in the Colney Hatch Asylum in London, shows that there appears to be a great preponderance of general paralysis among Jewish males, over 21 per cent of all the male Jews admitted being subjects of that disease, while the proportion of cases of general paralysis among all the males admitted to the hospitals for the insane in England and Wales is only 13 per cent. "It is evident," says Mr. Beadles "that among the Jewish males, admissions for general paralysis are 60 per cent more frequent than among the non-Jewish English and Welsh." No such disparity has been observed in the case of Jewesses.

General Paralysis.

The frequency of general paralysis in Jews observed by Beadles is confirmed by Hirschl, who found among 200 of his paretic patients 40 Jews, i.e. , 20 per cent (Hirschl, "Zur Aetiologie der Progr. Paralysis," in "Jahrbuch für Psychiatrie," xiv. 449). Pilcz also found a large proportion of pareties among the Jews in Vienna: 18.75 per cent of all cases, though this is about the same proportion as among his non-Jewish patients—18.07 per cent. He adds that the Jews' acute struggle for existence, and their peculiar occupations as merchants, speculators, stockbrokers, etc., are etiological factors.

On the other hand, Minor of Moscow has found that general paralysis has been six times more frequent among his Gentile patients than among his Jewish patients. He also cites statistics from the practise of Kajewnikoff and Korsakoff to the effect that among the 2,403 cases of nervous diseases, including 347 Jews, noted by the former he found 48 affected with general paralysis. Only three of the 347 Jewish patients were affected with this disease. He explains this by the fact that 65 per cent of the paretics gave a history of previous syphilis, while among the Jews syphilis was very rare. Among the 2,610 of Korsakoff's patients were 89 Jews. Of these patients 69 were affected with general paralysis, including one Jew. This observer also attributes the infrequency of paresis among Jews to the rarity of syphilis among them, and he shows that in 72 per cent of his paretics could be discerned syphilitic antecedents. Minor summarizes as follows:

In 4,700 Christian patients 124 cases of general paralysis = 2.6 per cent.

In 696 Jewish patients 6 cases of general paralysis = 0.8 per cent.

It thus appears that the whole question resolves itself into the relative infrequency of syphilis among Jews. "In my experience," says George II. Savage of London, "there has been very little general paralysis either among the [Jewish] men or women. Just as other races are affected, general paralytics among Jews have nearly all some history of syphilitic degeneration" ("Jour. of Mental Science," 1900, xlvi. 735).

The infrequency of syphilis among Jewish insane, as among the Jews generally, has been observed repeatedly. In the insane asylums of New York city, as Hyde reports, among the 1,722 Jewish insane only 72 (4.18 per cent) had syphilitic antecedents, which proportion is very low.

In parallel lines it may be mentioned here that alcoholic insanity is only rarely found among Jews. Among 205 patients suffering from alcoholic insanity at the insane asylum in Vienna, Pilcz did not find a single Jew. In the New York city insane asylum Hyde records only 5.51 per cent of alcoholics among the Jewish patients. A similar low proportion is reported by Minor, Korsakoff, Kajewnikoff, and others to be the case in Russia.

According to the observations of Pilcz, Jews are more liable to the acute psychoses of early age than are Gentiles, and moral insanity is rare among them. In London, Beadles observed that insanity following childbirth is more common among Jewish women than among women of other races, being found in 15 per cent of all the Jewish women admitted to the Colney Hatch Asylum, as compared with 6.18 per cent among non-Jewish patients. It was also found by Beadles that insanity appears earlier in Jews of both sexes than in non-Jews: at thirty-seven years of age in Jews as compared with forty-three years in Christians. Relapses occur twice as frequently in Jewish patients discharged from insane asylums as in other patients. Melancholia is said to occur in Jewish patients more often than mania.

Suggested Causes.

The causes of the great frequency of insanity among Jews are differently interpreted by different authorities. Some, like Buschan, see in it a racial characteristic. They show that there is evidence in the Bible that the ancient Hebrews were already great suf ferers from mental alienation. They point out that many passages in the Bible indicate that mental alienation was not unknown in Biblical times (see particularly Wilhelm Ebstein, "Die Medizin im Alten Testament," pp. 114-117; also the references to persons "possessed with devils," "lunatics," "men of unclean spirits," etc., in Matt. viii. 16, ix. 32, xii. 22, xvii. 15; Mark v. 2; Luke viii. 27,xii. 11, and in many other places in the New Testament).

As is the case with all the physical, mental, and intellectual traits of the Jews, consanguineous marriages have been considered a cause of a great part of the insanity among them. The Jews, it is well known, are very neurotic, as is manifested by the frequency of various nervous affections among them ( see Nervous Diseases ); and the marriage of relatives who are affected by a neurotic taint has been positively proved to be detrimental to the succeeding generation. In one generation the neuropathy may manifest itself as hysteria; in another, as some organic or functional nervous affection, then as insanity, etc. The chances of thus perpetuating the nervous strain in families by consanguineous marriages are therefore greater among Jews than among peoples in whom nervous diseases are less frequent.

J. M. Fi. —Legal Status:

The deaf-mute ("ḥeresh"), the insane ("shoṭeh"), and the minor ("ḳmṭan") are usually classed together in the Talmud as far as their legal standing is concerned. From the rabbinical legal standpoint, not only the confirmed maniac is regarded as insane, but also the idiot or imbecile that shows signs of derangement, as one who persists in unnecessarily exposing himself to danger, or one who destroys his garments for no reason Whatsoever. When the derangement is temporary or periodic, the person so stricken is not regarded as totally irresponsible, but is accountable for actions committed in lucid intervals (Ḥag. 3b). A person intoxicated to the degree of unconsciousness is also classed with the insane as regards legal responsibility ('Er. 65a).

Insane Not Responsible.

The insane person is not capable of "willing"; as the Rabbis express it, he "has action, but no thought" (Maksh. iii. 8), and therefore can enter into no transaction which requires consent (Yeb. 31a). He is not responsible for his actions; he can bear no testimony, and the court, can pay no attention to claims instituted by him or against him. In all civil and ritual matters he is placed in the same category as the deaf-mute ( see Deaf and Dumb in Jewish Law ). The court must act as trustee, or appoint a trustee, for the insane, as it does in the case of minors (Ket. 48a).

The marriage of insane persons is not valid, since the consent of both parties is absolutely necessary. A man who becomes insane after marriage can not give a bill of divorce to his wife, nor can he order others to do so (Yeb.112b). A woman who becomes insane after marriage can, according to the Mosaic law, be divorced, for no consent is necessary on her part ( see Divorce ). But the Rabbis forbade divorce in such a case, because, if left without a protector, she might become the victim of the lust of wicked people ( ib. 113b). Her husband, however, is permitted to marry again, even since polygamy has been prohibited. At a later period the Rabbis endeavored to put all possible obstacles in the way of his remarriage, and even demanded the signatures of one hundred rabbis of three different countries before granting him permission to marry again. Rabbis are warned to investigate very carefully before signing such a permission (Shulḥan 'Aruk, Eben ha-'Ezer, 1, 10, Isserles' gloss; "Pitḥe Teshubah," ad loc. ).

S. S. J. H. G.