ISAAC RAY AND MENTAL HYGIENE IN AMERICA Jacques M. Quen Section on the History of Psychiatry and the Behavioral Sciences Department of Psychiatry N e w York Hospital-Cornell Medical Center New York, N . Y. 10021

Isaac Ray was one of the “original thirteen” founders of the Association of Medical Superintendents of American Institutions for the Insane (AMSAII), now the American Psychiatric Association (APA). Besides founding this oldest of the American medical specialty organizations, Ray was, effectively, the founder of legal psychiatry as an area of special study. In 1952 the American Psychiatric Association established the Isaac Ray Award, t o be given annually to the person deemed “most worthy by reason of his contribution t o the improvement of the relations of law and psychiatry.” A friend and supporter of Dorothea L. Dix, Ray was, himself, a social reformer. Born in Beverly, Mass., in 1807, Isaac Ray was the first child of a widower Yankee sea-captain and his second wife. Isaac was followed by Lydia, Mary Ann, and Albert, in that order. The eight-week-old infant, Albert, died when Isaac was almost seven years old. Eight months later, Isaac Ray had a second tragedy t o cope with, the death of his father. We know little else of his early years other than that he attended Phillips Academy at Andover, Mass., where he roomed with Robert Rantoul, Jr., who later became a notable social reformer and the successor t o Daniel Webster in the U.S. Senate. Isaac Ray entered Bowdoin College in Brunswick, Maine, in 1822, at the age of fifteen. This was during Bowdoin’s remarkable decade, when it was the Yale of Maine. Its student body included Henry Wadsworth Longfellow, Nathaniel Hawthorne, William Pitt Fessenden, Franklin Pierce (our fourteenth president), and Luther V. Bell. Bell later became the Superintendent of the McLean Asylum and one of Ray’s fellow founders of the AMSAII. Ray dropped o u t of Bowdoin in 1824, perhaps due t o ill health; however, he began the study of medicine in that same year, under the guidance of Dr. Samuel Hart of Beverly. In 1827, Ray received his medical degree from the Medical School of Maine at Bowdoin College. His dissertation, “Remarks o n pathological anatomy,”’ was remarkably knowledgeable about the currents of medical researches in Europe. The dissertation can also be read as an article of faith in the scientific method and a rejection of vitalism. Isaac Ray said of his first effort t o establish himself in private practice: “At the tender age of 20, being a member of the medical profession in regular standing, 1 offered my services as practitioner of medicine and surgery t o the people of Portland, [Maine] in 1827. They manifested no vehement desire to avail themselves of this privilege, and thinking my services might be better appreciated somewhere else, I removed in 1829 t o Eastport, where I resided till 1841.”* Two years after his move t o Eastport, Isaac Ray married Abigail May Frothingham of Portland. In 1838, he published A Treatise on the Medical Jurisprudence oflnsanity. It made little stir here in America, but separate editions were published in 1839 in Edinburgh and in London. In 1843, Daniel M’Naghten’s defense attorney based

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the bulk of his case on this American physician’s book. “It is safe t o say that never since, in an English or a n American courtroom, has a scientific work b y a psychiatrist been treated with such r e ~ p e c t . ” ~ Although Benjamin Rush’s Medical Inquiries a n d Observations Upon Diseases of rhe Mind (1 81 2) was our first major psychiatric publication, it consisted of Rush’s own clinical experiences and thinking about insanity. It was, in fact, a presentation of one man’s “observations and inquiries.” Ray’s Treatise was t h e first systematic exposition of Western World medical thinking about insanity written in the United States. About a third of the book is devoted t o “such legal consequences as seem warranted by a humane and enlightened consideration of all the fact^."^ The remainder of the 25 chapters are devoted largely t o clinical discussion and speculations on etiology and pathology. It was the definitive American psychiatric text and the definitive work o n the medical jurisprudence of insanity for more than a generation. It became relied o n enough t o warrant several American editions, the fifth and last in 1871. Winfred Overholser, the late Superintendent of St. Elizabeth’s Hospital, remarked, in 1962, “We have not even yet fully caught up with the reforms h e advocated.” (Ref. 4, p vii., reprint edit.) In 184 1, Ray was appointed Superintendent of the Maine Insane Hospital in Augusta. Four years later he resigned his position to become superintendent of the yet-to-be-built Butler Hospital, which opened in 1847. He used the intervening time t o study the asylums in E u r ~ p e Shortly .~ after his return, the Rays’ 14year-old daughter, Abby, died of a consumptive disease. Their son, Benjamin Lincoln, now their only child, became a physician and worked with his father at the hospital. In 1867, Ray reluctantly retired because of ill health and moved t o Philadelphia. Isaac Ray’s retirement years were remarkably active and productive. He soon became a controversial public figure in social reform and in hospital reform. Unfortunately, in 1879, Benjamin Lincoln Ray died of an unspecified “brain disease.” The Rays were grief-stricken. One friend described Mrs. Ray as appearing crushed and resigned. “[ O ] ne feels as if in such entire surrender her life must go before too long. In Dr. Ray one sees more of a struggle . . . . his talk was as earnest and clear as ever, yet with all its naturalness, I felt the hidden agony.”6 Almost a year later, Isaac Ray wrote t o his old and good friend, Dorothea L. Dix: “My poor brain is so torpid and my ribs so full of rheumatism, that I shrink from writing, even a letter. I sleep well and eat well, but I a m good for little else. I can walk one square with much discomfort, and t w o causes distress. I have not written a line except as a letter since Lincoln died, and t h e sofa and easy-chair now furnish about all the daycomfort [sic] I have.”’ Isaac Ray died quietly in his sleep o n March 3 1, 188 1 , of tuberculosis, at the age of 74. Mrs. Ray survived him b y four years. The bulk of their estate was left t o Butler Hospital. They are buried, alongside Benjamin Lincoln Ray, in the Swan Point Cemetery, in Providence, R.I., adjacent t o the hospital. I have presented a brief summary of Isaac Ray’s life, but I have not mentioned that, in 1863, he published a book titled Mental Hygiene.8 The book was written during the latter years of Ray’s tenure as Superintendent of Butler Hospital. As such, it was the product of a mature and experienced psychiatrist, in contrast t o the Treatise, which was written b y a young general practitioner who had had no significant experience with the insane o r with t h e law. At the time he wrote Mental Hygiene, the term was a relatively new one. It had appeared for the first time in American medical literature in 1843.9 It will be helpful t o define mental hygiene. Few, probably, would hesitate to

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accept the Oxford English Dictionary definition of hygiene: “that department of knowledge or practice which relates t o the maintenance of health; a system of principles or rules for preserving or promoting health.”l0 It would seem t o be a short and equally acceptable step from the dictionary definition of hygiene t o a definition of mental hygiene by inserting the word “mental” before the word “health.” It is here, however, that difficulties become apparent. When we ask for a definition of mental hygiene, we are predicating a dualistic nature t o man, and requiring clear distinction between the mental and physical hygienes or healths. Should a well-balanced diet be part of mental hygiene? or should that more properly be considered physical hygiene? Certainly inadequate nutrition yields physical conditions that impair mental functioning (e.g. beri-beri, pellagra, and some forms of cretinism). Where shall we assign physical conditions related to emotional etiologies? Is preventive psychosomatic medicine properly part o f mental or of physical hygiene? To complicate the problem of defining mental hygiene, Albert Deutsch, in his excellent review of its history, suggests that mental hygiene in t h e twentieth century is “indelibly associated with organized [emphasis in original1 efforts t o promote mental health, more specifically, with the mental hygiene movement.”” The definition used in this paper will be implicit and not incompatible with t h e definition used by Isaac Ray, which will be presented later, nor with the previously referred-to dictionary definition of hygiene. It will be useful to note some of the antecedent “principles or rules for preserving or promoting [mentalJ health.” Since antiquity, the concept of moderation, or the Greek “Golden Mean,” has been basic to almost all systems of hygiene or medicine. In the 1769 edition of William Buchan’s Domestic Medicine, the discussions of the causes of hysteria, hypochondriasis, madness, and melancholy, implicate various excesses.12 William Falconer’s prize-winning Dissertation on the Influence of the Passions Upon Disorders of the B o d y (1788) discusses phrenitis, hypochondriasis, melancholia, hysteria, and mania, and takes essentially the same p ~ s i t i o n . ’ In ~ America, at the beginning of the nineteenth century, Benjamin Rush and David Hosack d o l i k e w i ~ e . ’ ~ ~ ~ ~ In 1832, a young Connecticut physician, Amariah Brigham, published a book that was critical of childeducation practices, with their overemphasis o n t h e early development of the intellect and their neglect of the physical aspects and physical well-being of the child.16 The book was characterized by Albert Deutsch as “the most popular of works o n psychosomatic medicine in the first half of the nineteenth century” and as “a pioneer American work in that aspect of mental hygiene known as child guidance.” (Ref. 11, p. 327) Hunter and MacAlpine describe it as “a guide t o mental hygiene with the stress on social i n f l ~ e n c e s . ” ~ ’ In 1835, Brigham extended his mental hygiene efforts in Observations o n the Influence of Religion Upon the Health and Physical Welfare o f Mankind, in which one of his major conclusions was that “numerous meetings for religious purposes, night meetings, camp meetings, protracted meetings, &c., injure the healthcause insanity, and other diseases, and ought t o be abandoned . . . .“la Brigham was a strict dualist, convinced that the mind itself could not be diseased, “for that which is capable of disease and decay may die,”19 but that mental illness was a disease solely of the brain. “The phrase derangement of mind, conveys an erroneous idea; for such derangement is only a symptom of disease in the head, and is not t h e primary affection. It is true that moral and mental causes may produce insanity, but they produce it by first occasioning either functional or organic disease of the brain.” (Ref. 19, p. 20) In 1840, Brigham became Superintendent of the Hartford Retreat, resigning

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after two years t o become the first Superintendent of the State Lunatic Asylum at Utica, N.Y. It was here that he founded and published the American Journal of Insanity (AJI) which eventually became t h e official organ of the APA and in 1922 was renamed the American Journal of Psychiatry. In 1843 Dr. William Sweetser published a book titled Mental H ~ g i e n e .In ~ his introduction, Sweetser said: “The mutual relationship and constant interchange of influence subsisting between o u r mental and corporeal natures can hardly have escaped even t h e most careless observation. The functions of either being disturbed, more o r less derangement will almost necessarily be reflected to those of the other. What frame SO hardy as t o escape the agitations and afflictions of the mind? and what mind so firm as t o remain unharmed amid the sufferings and infirmities of the body?” (Ref. 9 , pp. ix-x) Like Brigham, but witho u t mentioning him, Sweetser believed that t h e timing of formal schoolingin relation t o the development of the brain of the child was particularly important because “Premature and forced exertions of the mental faculties must always be a t the risk of the physical constitution.” (Ref. 9, p. 52) In 1859, Dr. George Cook, founder of the private asylum Brigham Hall, in Canandaigua, N.Y., published a two-article series in the AJI titled “Mental Hygiene.”20 In explicit disagreement with Amariah Brigham who believed in a faculty psychology and a phrenological organization of the brain, Cook asserts, “We believe that the mind is a unit, that it has capacities and powers far beyond our present conception. that it is through t h e brain and nervous system that it manifests itself and is developed: we d o not believe that it is made u p of isolated faculties, one or more of which may be impaired or destroyed, leaving the remainder or that it is not influenced or modified by its material associations.” (Ref. 20, p. 274 1 In agreement with Brigham and Sweetser, Cook suggests that “Any tendency t o undue nervous [system] development should attract the attention, and instead of being cherished by parental pride as a mark of precocity and promise, should give rise to a watchful anxiety; and especial care should be taken t o retard the early growth of this dangerous element.” (Ref. 20, p. 275) Cook is quite concerned with the mental hygiene of children. Allowing for the differences in vocabulary and style, many of his comments have a definite contemporary quality. “Children should be early impressed b y the routine of daily life that there is a place for them in the home-circle, ever vacant in their absence. . . . ” (Ref. 20, p. 275) He criticized parents “who, while professing t o be guided by faith in truth and goodness, resort t o deception and falsehood, too thinly veiled to deceive the quick perceptions of childhood.” (Ref. 20. p. 280) And, finally, “We would have the thoughtful reader consider well the blighting effects of parental hypocrisy, spreading out into an unconscious social hypocrisy, which pervades many homes.” (Ref. 20, p. 281) Four years after the publication of Cook‘s articles, and four years before resigning from the Superintendency of Butler Hospital, Isaac Ray published Mental Hygiene. He had been thinking about the book long before it appeared, as evidenced in a letter he wrote t o Edward Jarvis in 1855, inquiring “DO you know of anything lately published o n t h e general subject of mental dietetics, within a year or two past? I except a translation of a little German book, which I have seen. To be guilty of a pun, I think of dieting for a book of that sort.”21 The German book was probably Ernst von Feuchtersleben’s Zur Diatetik der Seele which had been translated into English as The Hygiene of the Mind.22 What delayed the writing of the book and what made Ray abandon the phrase “mental dietetics” is unknown.

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During the four years that followed the appearance of Cook’s articles, however, the materialist-spiritualist, mind-brain controversy had not diminished. Ray entered the arena and threw down the gauntlet in the opening pages of his book by stating, “The efficiency of the mental powers is determined in a high degree by the hygienic condition of the bodily organs, especially the brain . . . . the spiritual element of the mind has seemed t o place it beyond the accid.ents of health and disease . . . . If the mind may be diseased, then it may perish, and SO our hopes of immortality be utterly destroyed. This startling conclusion has been sufficient t o deter the mass of mankind from admitting very heartily the facts which physiological and pathological inquiries have contributed t o this subject . . . . Thus they completely missed the principle which is the foundation of all true mental hygiene, viz that the manifestations of the mind and the organic condition of the brain are more o r less affected by each other.” (Ref. 2 1, pp. 1-2) This is an obvious, though unacknowledge, reference to Brigham’s thesis in his Remarks o n the Influence of Mental Cultivation U p o n Health. (Ref. 19, p. 20) Ray does explicitly recognize the limitations of the knowledge of his time when he points o u t that “the conditions of this relation,-the parts respectively borne by the bodily and the spiritual element in the production of the mental manifestations,-of course, are but imperfectly understood.” (Ref. 8, p. 2 ) He proceeds t o raise a question that parallels one often raised in o u r contemporary nature-nurture controversies: “Is the development of the mind a result exclusively spiritual, o r exclusively cerebral? . . . It may be doubted if it is quite correct to consider the individual as composed of two things essentially distinct both in origin and nature, instead of considering him as a being endowed with various powers which, though each serving a special purpose, form an harmonious whole -a single, individual man.” (Ref. 8, p. 6) Ray derives from this “the general principle that whatever improves t h e physical qualities of the brain also improves, in some way or other, the qualities of the mind; and that judicious exercise of the mind is followed by the same result [in the brain] .” (Ref. 8, p. 8) This 1863 belief finds a 1974 confirmation in a review article in Science o n research in environmental enrichment and its effects o n brain chemistry and anatomy. “Many scientists have believed for some time that very early experiences are critical in intellectual and emotional development, but only within the last decade has it been demonstrated that the actual structure and chemistry of brain tissue are affected by differential rearing.”23 The conditions of rearing laboratory animals in an enriched environment includes raising them in groups with many playthings that are changed daily. “Berkeley scientists found that, compared with ‘impoverished’ rats, enriched rats had a heavier cerebral cortex, which is an area of the brain associated with intellectual functioning and information processing, and greater thickness of cortical tissue.”23 The “enrichment” is essentially psychological, and, as Isaac Ray postulated, exercise of the mind is followed by improvement in the physical qualities of the brain. Ray offered, as a definition of mental hygiene, “the art of preserving t h e health of the mind against all the incidents and influences calculated t o deteriorate its qualities, impair its energies, o r derange its movements. The management of the bodily powers in regard t o exercise, rest, food, clothing, and climate; the laws of breeding, the government of the passions, the sympathy with current emotions and opinions, the discipline of the intellect,-all come within the province of mental hygiene.” (Ref. 8, p. 1 5 ) Ray adds that the brain “being the instrument of the mind, its condition must necessarily affect the mental manifestations, and therefore, it may not be improper t o speak of mental disorders as if the brain were the only agency concerned in them.”

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Ray proposes t w o requisites for a sound and vigorous mind: first, a brain free from hereditary or congenital “tendencies t o disease or deterioration, and [second,] a healthy condition of the other bodily organs.” (Ref. 8 , p. 17) The first requirement, Ray would achieve by applying the “laws of breeding” t o humans, or what later would be called eugenics. However, Ray’s conception was not aimed toward some goal of monolithic perfection. In fact, he considered that such a goal was doomed t o failure. “The fleet Arabian cannot be considered as nearer the point of equine perfection than the immense English dray-horse; nor would anyone but a Smithfield drover contend that a Berkshire o r a Suffolk [pig] was a worthier specimen of the porcine race than the wild boar of the forest . . . . the general rule is that each special excellence is obtained at the expense of some other. So well is this now understood, that nobody attempts t o obtain in one breed the excellences of all. Now what we seek for as the proper result and aim of mental cultivation is, not a particular endowment that may be transmitted from one generation t o another, but a large range of capacity, great facility of achievment, and great power of endurance.” (Ref. 8 , pp. 13-14) Ray, in effect, was striving for the elimination o f hereditary pathology, and here too, there is an appreciation of the integrated relationship of t h e psychological and the physical. To illustrate his point about hereditary o r congenital diseases, Ray speculated that “A complete history of the inmates o f our jails and prisons, embracing all their antecedents, would show, in regard t o a large proportion of them, that the active element was not immoral training, nor extraordinary temptations, but defective cerebral endowment . . . . They enter upon life with a cerebral organization deficient in those qualities necessary for the manifestation of the higher mental functions. Many of them are bad subjects from the cradle, and their whole life is a series of aggressions o n their fellow-men. Whether they finish their career in a hospital or a prison, is a point oftener decided b y adventitious circumstances than any definite, well-settled principles. The frequency of insanity among convicts in prison is, probably, not so much owing t o t h e immediate circumstances of their position, as t o this latent element of mischief in their mental constitution, which, n o doubt, is rendered more active by confinement.” (Ref. 8, pp. 212 2 ) Compare this with a mid-twentieth century statement by Bernard Diamond, professor of law and psychiatry: “The widespread electroencephalographic testing of habitual criminal offenders, sociopaths, and those with character disorders has revealed what many of us had long suspected: That [sic] many of these unfortunate individuals are suffering from an organic, neuro-physiological disease of the brain, which completely dominates their behavior.’” Further on in Mental Hygiene, in a somewhat different approach, Ray says: “In the moral sense o r faculty, it is easy to recognize two different elements, viz the power t o discern the distinction between right and wrong, virtue and vice, the honest and the base, and the disposition t o pursue one and avoid the other. These elements, like those of the intellect, are unequally developed in different men, which inequality may be either congenital o r produced in after life, by moral or physical causes. And thus though a person may act with perfect freedom of will, unconscious of any irresistible bias, yet it is obvious that his conduct is governed more by these variable conditions of his moral nature, than by any abstract notions formed by the intellect [emphasis in the original] .” (Ref.8, pp. 6162) How much like Freud that last sentence could sound. Let us, however, contrast these words with those of Bernard Diamond, who, a century after the publication of Mental Hygiene, speaking of criminals with brain disease, says, “Their appearance of normalcy, their apparent ability t o exercise free will,

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choice, and decision (and somehow invariably choose the wrong instead of the right) is purely a facade, an artifact that conceals the extent t o which they are victims of their own brain pathology.” (Ref. 24, p. 198) As Ray’s definition indicated, he did not conceive of mental hygiene as involving simply a hereditarian approach. Mental hygiene problems required practical, multiple, and coordinated approaches. “But while we are bringing t o bear upon [the poor and the criminal] all the kindly influences of learning and religion, let us not overlook those physical agencies which determine the efficiency of the brain as the material instrument of the mind. The tract and the missionary may do good service in the dwellings of the ignorant and depraved, but active ventilation, thorough sewerage, abundance of water, will be found, eventually, no less efficient in t h e work of reform and elevation. To check the increase of crime, improve, if you please, your penal legislation and penal discipline, but, above all things, improve the dwellings of the poor. Render industry and virtue as attractive as possible, but never cease, by all practicable means, t o prevent the production of tubercle, rickets, scrofula, and all defective o r unequal developments.” (Ref. 8 , p. 23) But that was more than a century ago, and now is merely history. Like Brigham, Sweetser, and Cook, Ray had fairly definite views o n child education practices and their relation t o mental health. Like these others, Ray was critical of the social pressure t o have children learn at a very young age and t o be encouraged in intellectual o r academic precocity. “There is another kind of cerebral labor in regard t o which i t is of the utmost importance that the theory and practice of the community should be correct,-I mean that which is imposed upon the young in the process of education, under the name of study . . . . Here, as in everything else, speed is the great test of merit. Lesson is piled upon lesson, the hours of study are increased, and the active, irritable brain of tender youth is habitually forced t o the utmost power of effort.” (Ref. 8 , p. 117-1 18) “It is the law of the animal economy that the various organs do not arrive at their full maturity of vigor and power, until some time after the adult age has fairly commenced. T o suppose the youthful brain t o be capable of a n amount of task-work which is considered an ample allowance to an adult brain, is simply absurd, and the attempt t o carry this folly into effect must necessarily be dangerous t o the health and efficiency of this organ.” (Ref. 8 , p. 121-1 22) “The precise period at which school instruction should begin will vary a little, of course, in different children; but I feel quite safe in saying that it should seldom be until the sixth o r seventh year. Not that the mind should be kept in a state of inactivity until this time, for that is impossible. It will necessarily be receiving impressions from the external world, and these will begin the work of stimulating and unfolding its various faculties. Instinctively the young child seeks for knowledge of some kind, and its spontaneous efforts may be safely allowed.” (Ref. 8 , pp. 135-1 36) Ray used practically the same words in a n address he gave, in 1850, to a group of Rhode Island educators.25 It should be noted that these themes are not restricted t o nineteenth century America. George Mora, in a recent publication, compared the thinking of the seventeenth century Italian philosopher, Giambattista Vico, and Jean Piaget, and found similar themes in the works of these two men.% Incidentally, Mora also refers t o contemporary and, perhaps, characteristic American interest in acceierating infant preschool education. (Ref. 26, p. 376) Ray’s observation that the child will be “receiving impressions from the external world, and that these will begin the work of stimulating and unfolding its various faculties,” certainly calls t o mind much of the new and exciting work in

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ethology and the researches o n the remarkable influence that the presence or absence of early sensory stimulation has o n the subsequent anatomy and functional capacity of sensory and information processing areas of the brain.23927.28 The combination of nineteenth century conceptions regarding differential development of mental faculties with twentieth century laboratory findings leads me to speculate that we may soon be reading about epigenetic epistemology as a refinement and development of the current concept of genetic epistemology. But that is for some other discussion. I should like to return to Ray’s definition of mental hygiene, specifically the phrase “the sympathy with current emotions and opinions.” Ray did not use the term “sympathy” in its current sense, but rather in its older meaning, such as the sympathetic vibrations of a violin string. In Ray’s sense, sympathy refers to a compulsive, extrapersonal force t o which the individual responds passively and, frequently, unconsciously, as a function of his own structure. Ray said, “A principle more prompt and impulsive than the slow and cautious deductions of reason is required t o meet all the exigencies of the social state; and its existence, in some of its forms at least, has long been recognized under the names of sympathy and propensity t o imitate. It is in ceaseless operation wherever men are gathered together; but whether quietly and irresistibly upon scattered individuals, or with tremendous manifestations of its power upon large masses, few are aware of its nature-many not even of its existence-and fewer still apprehend the importance of rightly regulating its influence upon themselves. . . . Independent, self-originating movement is, probably, a far rarer thing than that which springs, more o r less directly, from some outward source, which is to be found in the prevailing mental movements that, like the atmosphere about us, exert an increasing, unconscious, inevitable pressure . . . . By an irresistible and inevitable law, they impart their own moral complexion t o whatever they involve in their progress.. . . W e are instinctively impelled-some more, some less, strongly-to imitate whatever others are feeling and doing around us. The passion or emotion exhibited by one excites t h e same passion o r emotion in others. . . . Whoever lives in close communion with one who is irascible, peevish, and overbearing, is liable t o become equally irascible and peevish . . . . The sad, depressed, and sorrowing spirit will inevitably impart its leaden tinge t o all who live within its shadow. . . . Over and above the appeal made by every example t o the reasoning faculties, there is an instinctive tendency t o admire what others admire, to seek distinction where it is sought by others, t o fall into the same social routine which is followed in the community around us. In this process of assimilation the intellect is entirely passive, and the result is accomplished without calculation, almost unconsciously. The individual is transformed without being aware of the change.” (Ref. 8. pp. 156-162) Space does not allow me t o expand upon the parallels and associations to contemporary psychoanalytic psychologies, including those of Freud and Sullivan; however, the idea is much broader and extends to other behavioral disciplines and other cultures. The 1911 edition of the Encyclopedia Brittanica article o n “Imitation” says: “There is among t h e majority of adults a tendency t o assimilate themselves either t o their society or t o those whom they especially admire or respect: this tendency t o shun the eccentric is deeply rooted in human psychology. Moreover, even among highly developed persons the imitative impulse frequently overrides the reason, as when a n audience, a crowd, or even practically a whole community is carried away by a panic for which n o adequate ground has been given, or when a cough or a yawn is imitated by a company of people . . . . The universality of the imitative impulse has led many psychologists to regard it as an instinct (cf. William James), and in that large class of imitative actions which have n o obvious

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ulterior purpose the impulse certainly appears t o be instinctive in its ~ h a r a c t e r . ” ~ ~ Later, during the period of the first World War, Trotter’s book on the “herd instinct” appeared, based o n the phenomena referred t o by Ray and others.w In 1945, Trotter’s work constituted a significant portion of the psychology presented in the textbook used in my college abnormal psychology course.31 And today, we find the same phenomenon being studied in ethology and sociobiology, as, for instance, the cultural transmission of potato washing in Japanese macaque monkeys.32 Contemporary studies of humans indicate that the same principle may be involved in t h e unconscious synchronization of biorhythms such as menstrual periodicity among cohabiting groups of women33 o r the synchronization of temperature cycles of men to those of the women they live with, when those women are not controlling their menstrual cycles with the Earlier, I referred t o the materialist-spiritualist controversy that still raged at the time of the publication of Ray’s Mental Hygiene and to his throwing down the gauntlet in the opening pages of his book. That gauntlet was picked u p by his colleague, John P. Gray, editor of the AJI, who said in a review, “[Ray’s] doctrine is that the mental phenomena have only one origin, the physical organization; whence it follows that there can be but one mode of treating them, which is from the side of natural laws. This is simply the doctrine of the old phrenologists, and is, we think, fairly exploded and obsolete . . . . Aside from the one fatal doctrine, so persistently urged. . . we can only speak in terms of unqualified admiration of the whole book. As it is, we confess to a feeling of impatience that so much matter of the highest importance t o the welfare of t h e community should be deprived of its practical value by the union with a false philosophy of a past age.”37 It is ironic that only thirteen years after having published his antimaterialistic review of Ray’s book, John P. Gray, in an address o n mental hygiene t o the International Medical Congress a t Philadelphia (on the occasion of our nation’s centennial celebration), said, “Indeed we must start with the proposition that what is now denominated Mental Hygiene is practically inseparable from Physical Hygiene.”3s Since much has been written of Ray’s interest in phrenology, i t may be worth while t o cite here what Ray said about phrenology in the early part of Mental Hygiene. “It was reserved for our own day, however, to see . . . a complete and systematic body of doctrine, in which every portion of the cortical substance of the brain is assigned t o some particular faculty, sentiment, or propensity, each of which is regarded as an original, innate independent power, exercised by its appropriate organ. In the localization of these organs the founders of Phrenology profess t o have been guided solely by observation; but they also endeavor, in every instance, t o show that the necessities of t h e human economy require such a power. In the latter branch of their system, they have been more fortunate, perhaps, than in the former. In a few instances, both the existence and the place of the organ have been established by abundant proof; but, with these exceptions, the evidence has not satisfied the deliberate and unbiased judgement of scientific men. As a speculative theory, it unquestionably contains much truth, recognized as such, too, by many who have little sympathy with its anatomical doctrines. Its analysis of the mental phenomena is clear and precise, indicatingwhat metaphysical inquiries seldom have-a shrewd observation of springs of action, and a profound insight of the relations of man to the sphere in which h e moves. Deficient as it is, as a theory of mind, it is nevertheless valuable as having indicated the true mode of investigation, and especially for the light i t throws on the whole process of education and development.” (Ref. 8, pp. 8-10) This review of Isaac Ray and mental hygiene in nineteenth century America

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must, o f necessity, remain incomplete. I have not t o u ch ed u p o n his views on temperance a n d a l c o h o l i ~ m ,exercise, ~~ sleep, diet, novels, the epidemic nature of suicide, an d m an y o t h e r factors falling within his co n cep t of m en t al hygiene. I hop e t h at you will m a k e the o p p o r tu n i ty to read Mental Hygiene, as well as Ray’s other publications. I should like to close with a paraphrase of a statement George Santayana made in The Life of Reason o r the Phases o f Human Progress. “Progress, far from consisting [ m e r e l y ] in change, d e p en d s [largely] on retentiveness. When change is absolute there remains no being to improve a n d no direction is set for possible improvement: a n d when experience is not r e t a i n e d . . . infancy is perpetual.”‘”’ REFERENCES 1. QUEN, J.M. 1964. Isaac Ray and his “Remarks on pathological anatomy.” Bull. Hist. Med. 38: 113-126. 2. RAY, 1. 23 March 1854, manuscript letter to Parker Cleaveland, Alumni Archives, Alumni Office, Bowdoin College, Brunswick, Maine. 3. DIAMOND, B. 1956. Isaac Ray and the trial of Daniel M’Naghten. Am. J. Psychiat. 112: 655. 4. RAY, 1. 1838. A Treatise on the Medical Jurisprudence of Insanity. Charles C. Little and James Brown. Boston, Mass. Reprint edition. 1962. Winfred Overholser, Ed.: 8. The Belknap Press of Harvard University Press. Cambridge, Mass. 5. RAY, 1. 1846. Observations on the principal hospitals for the insane in Great Britain, France, and Germany. AJI 2: 289-390. 6. KIRKBRIDE E. B. 1879. Manuscript letter to Dorothea L. Dix, Dec. 15. Dorothea L. Dix Collection. Houghton Library. Harvard University, Cambridge, Mass. 7. RAY, 1. 1880. Manuscript letter to Dorothea L. Dix, Nov. 29. Dorothea L. Dix Collection. Houghton Library. Harvard University, Cambridge, Mass. 8. RAY, I. 1863. Mental Hygiene. Ticknor and Fields. Boston, Mass. 9. SWEETSER, W. 1843. Mental Hygiene,or an Examination of the Intellect and Passions, Designed to Illustrate Their Influence on Health and the Duration of Life. J. & H. G. Langley. New York, N.Y. 10. OX FORD ENGLISH DICTIONARY, Compact Edition. 197 1.: 1358. Oxford University Press. New York, N.Y. 11. DEUTSCH, A . 1944. The history of mental hygiene. In One Hundred Years of American Psychiatry. J. K. Hall, et al., Eds.: 332. Columbia University Press. New York, N.Y. 12. BUCHAN, W. 1769. Domestic Medicine; or, the Family Physician: Being an Attempt to Render the Medical Art More Generally Useful, by Shewing People What is in Their own Power Both With Respect to the Prevention and Cure of Diseases. Chiefly Calculated to Recommend a Proper Attention to Regimen and Simple Medicines: 5 0 8 4 0 9 , 5 16. Balfour, Auld, and Smellie. Edinburgh, Scotland. 13. FALCONER, W. 1788. A Dissertation on the Influence of the Passions Upon Disorders of the Body: 4 2 4 5 , 59-61, 70-83, and passim. C. Dilly and J. Phillips. London, England. 14. RUSH, B. 1812. Medical Inquiries and Observations Upon the Diseases of the Mind. Kimber and Richardson. Philadelphia, Pa. 15. HOSACK, D. 1838. Lectures o n the Theory and Practice of Physic, Delivered in the College of Physicians and Surgeons of the University of the State of New York. Henry Ducachet, Ed. Herman Hooker. Philadelphia, Pa. 16. BRIGHAM, A. 1832. Remarks on the Influence of Mental Cultivation Upon Health. F. J. Huntington. Hartford, Conn. 17. HUNTER, R. & 1. MACALPINE. 1863. Three Hundred Years of Psychiatry: 15351860. A History Presented in Selected English Texts: 822. Oxford University Press. London, England. 18. BRIGHAM, A. 1835. Observations on the Influence of Religion Upon the Health and Physical Welfare of Mankind: 331-332. Marsh, Capen & Lyon. Boston, Mass. 19. BRIGHAM, A. 1833. Remarks on the Influence of Mental Cultivation and Mental Excitement Upon Health: 20. 2nd edit. Marsh, Capen & Lyon. Boston, Mass. 20. COOK, G. 1859. Mental hygiene. AJI 15: 272-282, 353-365. 21. RAY, I. 1855. Manuscript letter to Edward Jarvis, Nov. 3. Edward Jarvis Collection, The Francis A. Countway Library of Medicine. Harvard University. Cambridge, Mass.

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22. V O N FEUCHTERSLEBEN, E. 1838. Zur Dintetik der Seele. Armbruster. Vienna. The Hygiene of the Mind. (Trans. by Aim6 Ouvry.) 1852. Churchill. London, England. 23. WALLACE, P. 1974. Complex environments: effects on brain development. Science 185: 1035. 24. DIAMOND, B. 1962. From M’Naghten to Currens and beyond. Cal. Law Rev. 50: 198. 25. R A Y , 1. 1851. Education in its Relation to the Physical Health of the Brain. A Lecture Delivered Before the Rhode Island Institute of Instruction, Oct. 18, 1850. Ticknor, Reed, and Fields. Boston, Mass. 26. MORA, G. 1976. Vico, Piaget, and genetic epistemo1ogy.h Giambattista vico’s Science of Humanity. G. Tagliacozzo and D.P. Verene, Eds.: 365-392; 375, 376, 381, and passim. 27. V A N DER LOOS, H. & T.A. WOOLSEY. 1973. Somatosensory cortex: structural alterations following early injury to sense organs. Science 179: 395-397. 28. BLAKE, R. & H.V.B. HIRSCH. 1975. Deficits in binocular depth perception in cats after alternating monocular deprivation. Science 190: 1 1 14-1 116. 29. ENCYCLOPEDIA BRITANNICA. 1910. Eleventh edit., 14: 332. The Encyclopedia Britannica Co. New York, N.Y. 30. TROTTER, W. 1916.The lnstinctsof the Herd in Peace and War. T.F. Unwin. London, England. 31. HART, B. 1931. The Psychology of Insanity. 4th edit. The Macmillan Co. New York, N.Y. 32. WILSON, E.O. 1975. Sociobiology: The New Synthesis: 51. The Belknap Press of Harvard University Press. Cambridge, Mass. 33. MCCLINTOCK, M.K. 1971. Menstrual synchrony and suppression. Nature 229: 24445. 34. MEDICAL TRIBUNE. 1976. Men’s temperature changes equated to menstrual cycle. April 14: 9. Medical Tribune. New York, N.Y. 35. HENDERSON, M. 1975. The menstrual cycle and evidence for a male hormonal cycle. Health 25: 7 . 36. AUSTRALIAN MED. ASS. GAZETTE. April 1,1976. 37. G R A Y , J.P. 1864. Mental Hygiene by 1. Ray. AJI 20: 338-342. 38. G R A Y , J.P. 1878. Mental hygiene. AJI 34: 307. 39. Q U E N , J.M. 1967. Isaac Ray on drunkenness. Bull. Hist. Med. 41: 342-348. 40. S A N T A Y A N A , G. 1905. The Life of Reason or the Phases of Human Progress. Vol. I. Introduction and Reason in Common Sense: 284. Charles Scribners Sons. New York, N.Y.