Bu lle tin o f Th e Un ive r s ity o f G e o rgia

V OLUME xxxvm FEBRUAR",1 9 3 8 NUMBER 2a

PHELP S- STO"E SFELLOWSH IP STUD IES

NUMBER 14

A Comparative Study of the

Incidence of In san i ty Among

N egroes and W h ites

JOSE PH SIM EON JACOB, A.R. Ed.

Phelps-Stokes Fellow in The University ofGeorgia, 1 9 3 6- 1 9 3 7

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A Comparative S tudy of the

Inc idence of In san i ty Among

N egroes and W h ites

By

JO SEPH S IMBON JACOBA.B. Ed The University of Georgia

A Thesis Submitted in Partial Fu lfillment

of the

Req u irements for the Degree

of

MASTER OF ARTS

AT THE UNIVERSIT"OF GEORGIA

Athens, Georgia

1 9 3 8

CONTENTS

P RES IDENT ’

s FOREWORD

FOREWORD

INTRODUCT ION

F IRS T ADM ISS IONS

I I . READMISS IONS , DIS CH ARGES AND FURLOUGH S

I I I . E NV IRONMENT (URBAN AND RURAL ) OF F IRS T ADMISS IONS

IV . MAR ITAL STATUS OF F IRST ADM ISS IONS

CHRONOLOGICAL AGE OF FIRST ADM ISS IONS

V I . E CONOM IC STATUS OF F IRST ADM ISS IONS

V II. E DUCAT IONAL STATUS OF F IRS T ADM ISS IONS

V I I I . SUMMAR"OF THE DATA

I". INTERPRETAT ION OF F INDINGS

SOURCES OF DATA

PRE S IDENT’S FOREWORD

Upon the recommendation of the P helps-Stokes Committeeof The University of Georgia , Mr . Joseph Simeon Jacob wasappointed as the P helps-Stokes Fellow for the year 193 6-3 7 Thestudy was made under the direction of P rofessor James E .

Greene of the P eabody College of Education .

PHELPS-STO"E S FE LLOWSHIPThis fellowship h as been endowed under th e following resolutions

of the Trus tees of th e Phelps -S tok es Fund

Whereas , Mis s Caroline Phelps-S tok es in establishing th e Phelps»S tok es Fund was espe c ially soli c itous to as s is t in improving th e con

dition of th e Negro, andWhereas , It is th e conviction of th e Trus tees that one of th e bes t

methods of forward ing this purpose is to provide means to enables outhern youth of broad sympath ies to mak e a s c ient ific s tudy of th e

Negro and h is adjus tment to Amer i can civilization :“Resolved, That twelve thousand five hundred dollars be

g iven to The Univers i ty of Georg ia for th e permanent endowment ofa research fellowship , on th e following cond i tions

1 . Th e Univers i ty shall appo int annually"a Fellow in S ociology ,for the s tudy of th e Negro . He shall pursue advanced s tudies under

th e d ire c tion of th e Depar tments of S ociology , E conomics , E du cat ion ,

or H is tory, as may b e determined in each case by the Pres ident . The

Fellowship shall yield $5 00, and shall , after four years , be res tr ictedto graduate s tudents .

“2. E ach Fellow shall prepar e a paper or thes is embodying th e

result of h is inves tigat ion, which shall b e published by th e Univers itywith ass is tance from th e income of th e

‘ fund, any s urplus r ema in ingbe ing appli cable to other Objects incident to th e ma in purpose of th e

Fellowship . A copy of these resolutions shall b e incorpora ted in everypubl i cat ion is sued under this foundat ion .

“Th e r ight to mak e all neces sary regulations , not incons is tent with

th e spir i t and letter of these resolu tions , Shall b e g iven to the Pres ident and Fa culty , but no changes in th e condit ions of th e foundat ioncan b e made wi thou t th e mutual cons ent of both th e Regents of th e

Un iver s i ty and th e Trus tees of th e Phelps-S tok es Fund .

”

HARMON W. CALDWELL ,

President.

By th e mutual consent of th e Trustees of the Phelps -S tok es Fund and th e

Regents of th e Univer sity , th e Fel low in Sociology may be appo inted biennially ,

two fellows every th ree year s , or annua lly , a s th e President and th e Facu ltymay see fit. The Fel lows hip wil l then pay $ 7 5 0 or $ 5 00 , depending upon th efreq uency with wh ich it is awarded .

FOREWORD

The writer wishes to express his appreciation to all who havehelped make this study possible . The director of this study, Dr .

J . E . Greene,has contributed valuable suggestions and criticisms,

and my associations with him have been a constant source ofinspiration . Dr . A. S . Edwards, Chairman of the P helps-StokesCommittee

,and Dr. Wal ter Coutu

, as a member of the P helpsStokes Committee, have each made invaluable criticisms andpainstaking corrections . The writer wishes to expres s his sincere thanks to Miss Mattie Weaver

,and to theN"A students

as signed to the College of Education,for their kind as sistan ce

in tabulating data and typing the manuscript .J . S . J.

INTRODUCTION

A survey of the available literature in the field of menta lhygiene

,which has been forcefully brought to the attention

of the public in recent years , has shown that very little hasbeen written concerning the incidence of insanity among Negroesas compared with the whites . There is practically no information concerning socio-economic or other factors contributing tothe rate of Negro hospitalization . The present study is too limited in scope to permi t comip rehens ive analyses of these bas iccauses

,but it does suggest fertile fields for further research

and intens ive study.

The complexi ty and extent of the various data, which havebeen collected

,tabul ated

,and sub-analyzed according to several

socio-economic factors,psychoses

,and the l ike

,have made it

impossible to publish complete results . Hence only those statistical analyses which seem more pertinent in terms of ourpurpose are reproduced here .

The states selected for comparison with Georgia seem suitablefor the following reasons : Al abama is similar to Georgia withrespect to urban-rural groups , Negro popul ation , etc .

,and is

subj ect to very simi lari socio-economi c factors ; Illinois presentsa marked contras t to Georgia

,and hence comparisons between

the two states are valuable in suggesting differences traceableto variations in cul tural patterns . The materials from theUnited States Census Reports are included primarily to act asa control

,and also for fur ther comparisons .

SCOPE OF TH E STUD": The scope of the study is two-fold .

One problem is to discover the relative incidence of insanityamong Negroes, as shown by reports of the state hospitals inGeorgia, Al abama, Illinois, and the United States census summaries, compared with the incidence among whites within thesame areas ; the second problem is to present data indicatingthe influence of the socio-economic factors of 1 . environment

( place of residence ) ; 2. marital status ; 3 . chronological age ;4. economic status , and 5 . educational status of patients . To

facilitate comparisons, the two races are divided by sex . Al so,

all the master tables, of which only condensed summaries are

included in this report,present data subdivided by ( a ) race,

(b ) psychoses, ( 0 ) sex, ( d ) years , ( e ) state or area, and ( f )some one factor, from those mentioned above

,selected for spe

5

cific study ( for example, Environment of F irst Admissions ,classified as “ Urban

,

” “Rural

,

” and “Not Given ”) Theinstitutional reports on which the data are based cover thedecade 1923 -1932, the years having been determined by theavailability of the data . Where comparable census data areavailable

,these various factors are arranged on the basis of

the number of insane per of the general popul ationof the same clas sification the same race , sex, area, andsome sp ecific factor studied, such as environment or chronolog

ical age ) .

AS SUMP T IONS : ( 1 ) It is assumed that admissions to state hosp itals constitute a valid criterion of the incidence of insan ity .

Among the factors casting doubt on this assumption are the following : F irst

,it is known that variations in the amount of ap

p rop riations for hosp ital facilities occur from year to year andfrom one state or area to another

,and that increases in such

appropriations tend to be paralleled by increas ed commitments .Second

,the change in attitudes on the p art of the general popu

lation and of physicians has resul ted in a greater recognitionof mental disorders . Third

,there are many institutions , other

than state hospitals,dealing with patients suffering from mental

disorders . Fourth , there is probably a large and variable number of mentally ill persons who never come to the attention ofhospital authorities . Disp ite these factors , first admissions tostate hospitals constitute the best Single criterion of insanityavailable . The state institutions care for over 70 per cent Of

admissions to mental hospitals in the United States ( 1923 ,per cent ; 193 3 , per cent ) . It is felt tha t the state hosp italsoffer a sampling large enough to indicate reliably the difierencespointed out between the races

,sexes

,and areas studied .

(2) A further assump tion is that the state institutions selected for comp arison with Georgia furnish adequate samplingof all the United States . This assump tion is open to criticismbecause of the limited number of states selected for study .

However, as was pointed out in the introduction , Alabama

p resents charac teristics similar to those of Georgia,and Illinois

p resents marked contrast , valuable in suggesting differencestraceable to variations in cultural patterns .

STATIST ICAL TREATMENT : The data are treated by elementarystatistical methods . Where comparable census data were Oh

tainable, the subdivisions of the data are comp ared on the basis

of the number p er general p opulation of the same clas

6

sification . ( See Table I I . ) These population figur es were com

puted by averaging the figures tak en from the 14th ( 1920) and15th ( 193 0) Census Reports of the Uni ted States . While thisdecade does not coincide exactly with the decade studi ed ( 1923

the errors introduced are constant and the procedureus ed is not incompatible with current statistical practices . Thereare several tables computed on the basis of per generalpopulation over age 1 5 for the following reasons : ( 1 ) on theassumption that such inter-racial comparisons woul d be morevalid than those based on the total population due to the highermortali ty rate among Negro childr en, as well as to a noticeablevariance in rates between places of residence ;

1

(2) in View ofthe fact that only a very small fraction of first admissions areunder age 1 5 ( in 193 3 , the percentage of first admissions underage 15 are as follows : Georgia, Alabama

,Illinois

, .1 ;

United States,

.7 ) ( 3 ) in view of the fact that any err ors re

sul ting from such comparisons would probably be constant forall groups

,and hence not likely to vitiate the resul ts from a

statistical standpoint. Expressed in another way,this statistical

procedure makes possible a comparison of the number of insane with the general popul ation capable of becoming insane .

Many statisticians might object to the practice of l eavingaverages concerning human beings in decimal form

,but it is

thought advisable in this study because the shifting of thedecimal point one place to the right gives the exact numberof patients deal t with during the decade for the ins titutionsin Georgia, Alabama, and Illinois, the totals having been

“

oh

tained by adding the figures for each of the ten years . TheUnited States figures were obtained from two reports only

,

1923 and 193 3, and the resulting averages are slightly less

reliable for the purposes of acting as a control .2 In the Illinoisdata, 193 3 was substituted for 1932, because of lack of data onthe year 1932.

In addi tion to the above , several tables have been computedon a percentage basis

,to facilitate intercomparisons of various

factors . Also , several tables making use of the index numbers

1 Th e mortality rates among infants under one year ( per birth s ) in 1924,

by race and p lace of res idence , are as follows : wh ites— c ities , 69 , rural d istr icts , 6 5 ; NegroeH ities , 127 , rura l dis tricts , 10 5 . (Tak en from S orok in,

Zimmerman, Ga lp in , S y s tematic S our ce Book in Rural S ociology , V ol . III, p .”There i s a sligh t error due to th e inclusion of institutions other tha s tathospital s in th e 1 923 report. n e

is th at cer tain instituti ons are over -cr owded, a fac tor pr ob avleading to th e p r acti ce on th e part. of su ch h osp ital s. of ac~

cep tzing only th e more . sever e cas es for tr eatmen t, and of dis

been effected. It. must al so b e. nored th at p arts of the. Illinois

The firs t two limi ta ti ons ci ted do not decrea se th e accuracy

Th e third limitati on r elat es to a small p or ti on of th e study .

“ Pr es s sub jective judgment is p r ob ab ly neces sary in cl ass ifying p ati ents as illiterate th e amount. of sch ooling is a matterof fact as is th e age, marital status . and place of res idence.

The economi c statu s of p atients seems to b e the least rel iablyascer tained. Th e four th limi tation . a sou rce of er ror, is one

which cann ot. b e avoided under curren t conditi ons . However.

and sexes . an d it i s felt th at. the samp ling ob tained is l arge

sen t data indi cating th e influence of cer tain socio—economi cfactors

Cost of

p r inting p roh ibits publi cati on of all the tab les inwhi ch th e data are tabulated by p sy ch oses , etc. Many of th e

tables p res ented ar e merely summary tab l es in which diagnosric cl assifi cation by psych oses are omi tted. Anyone interested in p ar ticul ar p hases of th e data on th e var ious psychosesis r eferr ed to the. Gener al Libr ar y , The University of Georgia,for more detai led tab les P oin ts of esp eci al inte rest. selectedfr om the unp ublish ed mater ial are in cluded in the study from

to time.

technique“ of intercomparisons were prepared . In separatingthe races

,the “ whites”cons ist of all classes of the insane with

the exception of the “Negroes .

”If the foreign-born were ex

cluded,the Negro group would show a still higher ratio of

admissions as compared with the whites , due to the unusuallyhigh rate of institutionalization among the foreign-born .

SOURCES OF DATA : The original data are entirely from primary sources, being derived from statistical reports securedfrom the state hosp itals of the areas covered, from abstractsfrom the Census of the United States , and from the 14th and15 th Census Reports of the Department of Commerce , Bureauof Census . A detailed list of these primary sources of data isapp ended.

Helpful suggestions for arrangement of data were gleanedfrom the above-mentioned sources

,and from two articles by

Dr . Neil A. Dayton, Director of Statistics and Research ,“A

New Statistical System for the Study of Mental Diseases andSome of the Attained Results

,repr inted from the "line

Memorial Bulletin, Massachusetts State Department of MentalDiseases

,April

,1934

,and “ The F irst"ear of the New Stan

dard Nomenclature of Diseases in Massachusetts Mental Hos

p itals , reprinted from the American Journal of P sychiatry .

November,193 5 .

LIMITATION S OF TH E DATA : The data. are limited in the following ways : In the first place

,the bulletins from which the

figures were derived are limited in scope,and subject to minor

inaccuracies,which appeared from time to time . In the sec

ond place , i t is not possible to intercorrelate the several factors,such as environment, economic status, marital status , etc . ,

without access to the origina l record of each individual patient

,and

the use of some card-sorting machine,a practical limitation

which has been attacked recently by Dr . Dayton . In the thirdplace

,the data on the various factors such as economic status ,

illiteracy, etc .,are liable to errors due to the subjective nature

of the ratings given each entering p atient, and due to the

2' An e xample of the construction and use of index ta b les is as follows : Tab leII p re sents th e number of fi rst admis s ions to hosp ita ls in th e a reas s tudied , on

the ba si s of p er g eneral population over age 1 5 , of th e same race , sex.

a nd a rea . Th e incidence of fi rst admis s ions in th e United S tates a s a who leis ta k en a s a cont ro l , and these figures a re divided into th e figures for Geo rg ia ,

Ala bama . and Illinois (Ta b le V ) , thus showing th e re lation of incidence inthe s e th ree s tates to th e incidence of fi rst admis s ions in a ll s tate h os p ita ls inthe United S tate s : i . e . , th e index table shows to what extent th e incidence ofadmis sions in ea ch s ta te stud ied app roach es or exceed s th e incidence in th eUnited S tate s . E xmes s cd in anothe r way , th e United S tate s rates eq ual 1 00 .

o r th e no rma l expectancy , and e ach index numbe r u sed may be exp res sed as ape rcentage o f th e United S tates incidence .

mental condition of the patient himself . A fourth limitationis that certain institutions are over-crowded

,a factor probably

leading to the practice , on the part of such hospitals, of ac

cepting only the more severe cases for treatment , and of discharging or furloughing patients before complete cures havebeen efi ected. It mus t also be noted that parts of the Illinoisdata are not divided by race .

The first two l imitations cited do not decrease the accuracyof the data : they tend merely to limit the scope of the study .

The third limitation relates to -a small portion of the study .

Whereas subjective judgment is probably necessary in classifying patients as illiterate , the amount of schooling is a matterof fact

,as is the age

,marital status , and place of residence .

The economic status of patients seems to be the least reliablyascertained. The four th limitation , a source of error, is onewhich cannot be avoided under current condi tions . However

,

relative comparisons and contrasts can be made of the racesand sexes

,and it is felt that the sampling obtained is large

enough to serve the second problem of the study ; i . e . ,to pre

sent data indicating the influence of certain socio-economi cfactors .

Cost of printing prohibits publication of all the tables inwhich the data are tabulated by psychoses

,etc . Many of the

tables presented are merely summary tables in which diagnostic clas sification by psychoses are omitted. Anyone interested in particular phases of the data on the various psychosesis referred to the General Librar y

,The University of Georgia,

for more detailed tables . P oints of especial interest selectedfrom the unpublished material are included in the study fromtime to time .

technique3 of intercomp arisos were prepared . In separatingthe races

,the “ whites”cons t of all classes of the insane with

the exception of the “ Negres .

” If the foreign-born were ex

cluded,the Negro group wuld show a still higher ratio of

admissions as compared wit'

the whites, due to the unusuallyhigh rate of institutionalizaion among the foreign-born .

SOURCES OF DATA : The oiginal data are entirely from pri

mary sources, being derive from statistical reports securedfrom the state hospitals ofthe areas covered, from abstractsfrom the Census of the Unied States , and from the 14th and15 th Census Reports of theDep artment of Commerce, Bureauof Census . A detailed list 6 these primary sources of data isapp ended.

Helpful suggestions for rrangement of data were gleanedfrom the above-mentioned Jurces

,and from two articles by

Dr . Neil A. Dayton , Directr of Statistics and Research,

“A

New Statistical System for ;he Study of Mental Dlseases andSome of the Attained Realts , reprinted from the "lineMemorial Bulletin , Massach setts State Dep artment of MentalDiseases , April , 1934, and

“The F i rst"ear of the New Standard Nomenclature of Diseses in Massachusetts Mental Hos

p itals , reprinted from theAmer ican Journal of P sychiatry ,

November,193 5 .

LIMITATION S OF TH E DAT : The data. are limited in the following ways : In the first lace , the bulletins from which thefigures were derived are lirrted in scope

,and subject to minor

inaccuracies , which app eard from time to time . In the sec~

ond place , it is not possible 0 intercorrelate the several factors,such as environment, econonc status, marital status , etc .

,with

out access to the origina l reord of each individual patient, and

the us e of some card-sortig machine , a practical limitationwhich has been attacked reently by Dr. Dayton . In the thirdp lace , the data on the varius factors such as economic status ,illiteracy

,etc .

,

of the ratings

3 An e xample of

mental condition of the patient h imself A fourth 11111118 0 0 0

is that certain institutions are over-eroded, a factor prot

rbb '

leading to the practice, on the part otsuch hosp itals: 1cepting only the more severe cases for reatmen

t, and o I?

charging or furloughing patients befox complete cum he"been effected. It mus t also be noted tit parts of the lllmoa

data are not divided by race .

The first two limitations cited do notdecrease the accum.

’

of the data : they tend merely to limit i e scope of the study

The third limitation relates to a smallportion of.

the and,"Whereas subjective judgment is probabl necessary

.

ln cla r i fy

ing patients as il literate,the amount 0 schooling L8 a matter

of fact,as is the age

,mari tal status , 1d place of res idence

The economic status of patients seems be the least reliablyascertained. The fourth limi tation ,

a mrce of error. is not

which cannot be avoided under cur rentconditions . ll m

relative comparisons and contrasts canbe made of the run

and sexes,and it is felt that the samling obtained is l me

enough to serve the second problem of te study ; i. e . 1 pH

sent data indicating the influence ofcertain sw im na

factors .

Cost of printing prohibits publicatio of all the tefl a a

which the data are tabulated by psychce s . etc. Many th e

tables presented are merely summary ables in c h

nostic classification by psychoses are ojtted Ann a-e men

ested in particul ar phases of the data 0 the vari mmis referred to the General Library , ThdJnivemitv of Gu yfor more detailed tables . P oints of esacial interestfrom the unpublished material are inclted in the Intime to time .

https://www.forgottenbooks.com/join

mental hospitals . Alabama,with per cent of the Negro

general population, accounts for per cent of the first ad

missions .

FIRST ADMISS ION S P ER GENERAL P OPULATION

Comp aris on of Areas Disregarding Race : Table II presentsthe number of first admissions to the state hospital s of Geor

gia,Alabama

,Ill inois

,and the United States

,on the basis of

per general popul ation over ag e 15 , of the same race ,sex

,and area. Georgia has the lowest incidence of first ad

missions,with first admissions per general popul a

tion ; Alabama is next, with and Illinois is the highestof the group studied with first admissions . In theUnited States there are first admissions to state‘ hospitalsper general population over age 15 . Thus it can beseen that Georg ia and Alabama, as contrasted to Illinois and tothe United States

,have a relatively low incidence of insanity

as measured by first admissions to the state hospitals for mentaldiseases .

The males show a consistently higher incidence p ergeneral population than the females . Detailed comparison ofthe sexes, in this respect, follows : Georgia— males , fe

males,

Alabama— males,

females,

Illinois— males

,females

,United States— males

,

females,

Inter-racial Comp arisons : The relative incidence of Negro admissions is higher than that of the whites in the areas studied

,

and there is markedly less race difference in Georgia and Alabama than in Illinois . On the bas is of per general

p opulation over age 15 , the incidence is as follows : Georgiawhites , Negroes, Alabama— whites

,Negroes

,

Illinois -whites , Negroes,

United Stateswhites

,Negroes, In the United S tates , which of

course represents the largest sampling,the rate of incidence of

the two races is very nearly the same . In Illinois,however

,the

Negro incidence is well over twice that of the white incidence .

The rates of incidence for Negro males as contrasted to whitemales , and for Negro females as contrasted to white females ,present the same general picture in that the Negro incidence ,with one excep tion , exceeds the white incidence . In Alabama

,

the incidence for Negro females is less than that for white females (Negro females , white females

,The in

12

cidence for white and Negro males is very near ly the same inthe United States as a whole (Negro males, white males,

Comparable data on the femal es of the two races

(Negro females, white females,

show a slightlylower incidence for white females .

Intra-racial Comp arisons : The incidence of insanity (pergeneral population ) for Georgia Negro males is

females,

This is the onl y area studi ed in which the females have a higher incidence than that of the males . Com

par isons of the sexes among Negroes in other areas followAlabama— males

,females

,Illinois— males

,

females,

United States— males,

females ,The difference between the mal e incidence and the female incidence is higher in Ill inois and in the United States than inGeorgia and Alabama.

Similar comparisons of the male-female incidence amongwhites show that there is less difi erence between the incidenceof the sexes for Georgia and Alabama whites than for Illinoisand United States whites . The incidence for white males andfemales per general popul ation is as follows : Georgiamales

,females

,Alabama— males

,females ,

Il linois— males,

females,

United Statesmales, females

,It is thus seen that among whites ,

as among Negroes,the male incidence is much higher than the

female incidence in Illinois and the United States . In Georgia and Al abama

,the male incidence is only slightly higher

than that of the females .

P ERCENTAGE DISTRIBUTION OF FIRST ADMISSIONS , B"RACEInter-racial Comp arisons : Table III presents the distribution

of the races by percentages . Georgia and Alabama have amuch higher percentag e of Negroes in mental hospitals thanhas Illinois or the United States . The distribution of first admissions is as follows : Georgia— whites

,Negroes.

Alabama— whites, Negroes,

Ill inois —whites,

Negroes , United States— whites,

Negroes ,In Georgia, Illinois , and the United S tates

,the Negro fe

males cons titute a slightly higher percentage of total femaleadmissions than do the Negro males of the total male admissions . Thus , Georgia Negro females are per cent of thetotal female admissions , and Negro males are p er cent ofthe total male admiss ions . Simi lar comparisons for the other

13

areas follow : Illinois— Negro females , per cent,males

,

per cent ; United States— females , per cent , males ,per cent . In Alabama

,however

,the above trend is re

versed,the Negro males constituting per cent of the total

male admissions ;“

and Negro females,

per cent .

P ERCENTAGE DISTRIBUTION OF FIRST ADMISS IONS , B"SExComparison by S ex : Table IV presents the percentage dis

tribution,by sex

,of first admissions to the state hospitals of

Georgia,Alabama

,Illinois

,and the United S tates . Considered

by the total of both races, the males constitute a higher percentage of first admissions than do females . The percentage offirst admissions for each sex for the several areas follow : Geor

gia— males, females,

Al abama— males , fe

males, Il linois— males, females

,United

States— males,

females,

In Illinois,the ratio of

incidence of males to femal es is much higher than in Georgiaor Alabama

,and it is somewhat hi gher than for the United

States as a whole. In other words,Illinois has a male incidence

that is unusual ly high as compared with the United S tates ,Georgia

,and Alabama .

IN CIDENCE OF FIRST ADMISS IONS IN GEORGIA, ALABAMA, ANDILLIN OIS As

' COMPARED WITH THE UNITED STATES

Compar ison of Areas , Disregan Race : Table V is an

index table prepared to show the relative incidence of firstadmissions per general popul ation over age 15 , in threestates (Georgia, Al abama , and Illinois ) as compared with theincidence in the United S tates, in which the United States incidence equals 100

, or the “ normal expectancy.

” This means,for example, that Georgia males ( all classes ) have an incidenceonly .48 5 times ( or per cent as hi gh as ) that of the UnitedStates males, while Illinois mal es have an incidence times

( or per cent as high as ) that of the United States males .

Thus it can be seen that for both sexes and both races theGeorgia incidence is per cent of the United States incidence ; Alabama, per cent ; and Illinois, per cent .This shows that

,considering the United States rates as the

normal expectancy, the incidence of insanity in Georgia and

Alabama is very low,while the incidence in Illinois is high .

The females in Georgia and Alabama are nearer the normalexpectancy than the males (Georgia females , per cent

,

15

TABLE V .

RELATIVE INCIDENCE OF FIRST ADMI S S ION S , P ER GENERAL P OPULA

TION OVER AGE 1 5 , To TH E STATE HOS P ITALS IN GEORGIA, ALABAMAILLINOIS , AND THE UN ITED STATE S , B"RACE AND S E"(UNITED STATES

E"UALS 1923 -1932.

GEORGIA ALABAMA ILLINOI S

-s

o n

-n -g —n n c o —n u u

- o

—p l

males,

per cent ; Al abama females, per cent , males ,per cent ) . In Illinois the male incidence is above that of

the United States per cent ) , while the femal e incidenceis below that of the United States per cent ) .

Inter-racial Comparisons : The Negro admissions in Georgiaand Al abama are nearer the normal expectancy than the whiteadmissions (Georgia— whites, per cent

,Negroes, per

cent ; Alabama— whites, per cent,Negroes

,per cent ) .

In Illinois , the incidence for Negro admi ssions is times

( or 228 per cent of ) the United States incidence , whereas thewhite incidence is only times ( or 101 per cent of ) theUnited States incidence . Considered from another angle , therelative incidence between the two races

,Illinois Negroes have

twice the incidence of the whites .

Intra racial Comparisons : In Georgia and Al abama, the Negro females are nearer the normal expectancy than the Negromales . When considered from this viewp oint, the Georgia incidence for males is per cent

,females

,per cent

,of the

United States incidence ; in Al abama , the incidence is percent and per cent for males and females

,respectively. In

Illinois,the male ratio exceeds the female ratio (males ,

per cent ; femal es, per cent ) .The same phenomenon app ears when studying the white

16

ratios : i . e . , the females are nearer normal expectancy than themales in Georgia and Al abama , whereas in Illinois the maleratio is higher than that of the United States average . InGeorgia the ratio is per cent of the incidence for whitemales

,per cent of that for white females . Comparable

data on whites for Alabama and Illinois are as follows : Alabama— mal es

,per cent

,females, per cent ; Il linois

males,

per cent,females, p er cent.

SUMMARY OF DATA ON FIRST ADMIS SIONS

Alabama has approximately 10 per cent more first admissionsthan Georgia

,and Illinois has over four times as many first

admissions as either state . Of the United States total of firstadmi ssions

,Georgia has per cent

,Alabama per cent

,and

Illinois per cent . The number of Negro admissions in IIlinois exceeds the number in Georgia or Alabama . The several areas as percentag es of the United States total of firs tadmissions

,by race

,foll ow : Georgia— whites , .8 , Negroes ,

Alabama— whites , Negroes,

Illinois— whites,

Ne

groes, The Ill inois percentages for whites and Negroes arealmost the same

,but in Georgia and Al abama the percentage of

Negro admissions is much higher than the percentage of whiteadmi ss ions . Illinois , with per cent of the Negro generalpopulation of the United S tates, accounts for per cent of

the Negro first admissions,whereas Georgia, with per cent

of the Negro general population,accounts for only per cent

of the first admissions to mental hospitals in the Uni ted States .

Alabama, with per cent of the Negr o population,accounts

for per cent of first admissions to mental hospitals .

Georgia has the lowest incidence of firs t admissions pergeneral population , with Al abama is next , withand Illinois is highest wi th In the United States as a.

whole there are first admissions to state mental hospitalsper general population

,over age 15 . The males show

a consistently higher incidence per population than thefemales . The difference between the incidence of males andfemal es in Illinois is much greater than between the sexes inGeorgia or Alabama .

The relative incidence of Negro first admissions is higherthan that of the whites in the areas studied

,and there is

markedly less race difference in Georgia and Alabama than inIll inois, Illinois Negroes having over twice the incidence of

17

Illinois whites . On the basis of the general population , Georgia and Alabama have a much higher percentage of Negroes thanIllinois or the United States .

In Georgia,Il linois

,and the United States, the Negro females

constitute a slightly higher percentage of total female admissions than do the Negro males of the total male admissions .Considering the incidence of first admissions in the United

States as the normal exp ectancy, the incidence of insani ty inGeorgia and Al abama is very low

,and in Illinois the incidence

is high . The femal es in Georgia and Alabama are nearer thenormal expectancy than the males ,

and in Ill inois the males areabove

,whereas the females are slightly below

,normal expec

taney . Negro admissions in Georgia and Alabama are nearerthe United States average than are the whites . In Illinois

,

the Negro admissions have an incidence times the normalexpectancy, whereas the whites are normal . Thus , relatively,the Illinois Negroes have twice the incidence of the Ill inoiswhites .

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II

READMISSIONS,DISCHARGES AND FURLOUGHS

Readmiss ions are patients who have been previ ously undertreatment in hosp itals for mental disease , who have been discharged from the hospitals and have later returned for furthertreatment . Hence they represent relapses or recurrences ofthat particular type of mental diseas e with which they are af

flicted. The terms used in defining the condition of patientson discharge are, as follows : Recovered indicates the conditionof a patient who has regained his normal mental heal th , so thathe may be considered as having practically the same mentalstatus as he had previous to the onset of his psychosis . Im

proved denotes any degree of mental gain less than recovered .

Uni/mpr oved, as the term imp lies, denotes no mental gain atall . Without P sychosis ( or Not Insane) is a term applicableto persons discharged who had be en admi tted to a hospital without having had a psychosis .

A comparison of the recovery rates reported by the institutions in the several states and the Uni ted State s indicates thatthe terms denoting condition on discharge were not uniformlyapplied, and it is obvious that the rates of recovery var y insome institutions from year to year

,and among the several

institutions within a given year.

AVERAGE "EARLY NUMBER OF READMISS IONS

Comparison by Areas , Disregarding Race and S ea : TableVI pres ents the average yearly number of readmissions to thestate hOSp itals of Georgia , Alabama, Illinois , and the UnitedStates

,by race and sex

,for the decade 1923 -1932. Georgia and

Alabama have approximately the same average number of re

admissions - Georgia,

Alabama,

Illinois,

Of the total number of readmissions in all state hospitals inthe United States

,Georgia has per cent

,and Illinois

per cent. Thus it can be seen that Illinois has a much higherproportion of all readmissions than of all first admissions .Stated differently,

“ readmissions per first admissions”are muchmore common in Illinois than in the other areas studied

.

‘Unééed S tates bulletin,

“Patients In Hospita ls for Mental Diseases ." 19 3 3 ,page20

The averag e yearly number of readmissions, by sex, for theseveral ar eas are as follows : Georgia— male , female ,Al abama— male, female

,Illinois —male ,

female,

United States— male , female , Itshoul d be noted that in Georgia and Al abama the number offemale readmiss ions exceeds that of the males, whereas in IIlinois and the United States the number of male readmissionsexceeds the number of female readmissions .

Inter-racial Comparisons : The average number of readmis

sions for the decade are as follows : Georgia— whites ,Negroes

,Al abama— whites

,Negroes

,United

States— whites,

Negroes , Illinois data are notdivided by race

,hence comparisons on this point are impossible .

Al abama has a larger number of white readmissions than Georgia

,and Georgia has a larger number of Negro readmissions than

Alabama . Compared with total readmissions in the UnitedStates, the percentages for the several areas, by race , are as

follows : Georgia— whites , Negroes, Alabama— whites

,

Negroes,

Intro-racial Comp arisons : If the data are divided by race , itis ag ain seen that in Georgia and Al abama the female incidenceof readmissions is greater than the male incidence

,whereas

for the United States data the male incidence is greater thanthat of the females .

PERCENTAGE DISTRIBUTION or READMISSIONS , B"RACEInter-racia l Comp arisons : Table VII presents the percentage

di stribution of readmissions for the vari ous areas,by races ,

as follows : Georgia— whites,

Negroes,

Alabamawhites, Negroes

,United States— Whites

,

Negroes, It is obvious that the proportion of Negro re

admissions is much higher in Georgia and Alabama than in theUnited States . These racial variations are to be expected dueto variations in the racial distribution of the general pOpulation in the several areas .

Negro females constitute a higher percentage of the totalfemale readmissions than do the Negro males of the total malereadmissions . The proportion which Negro males constituteof the total male readmissions is as follows : Georgia

,per

cent ; Alabama , per cent ; United States , per cent .Corresponding data on Negro females for the several areas follow : Georgia, per cent ; Alabama

,per cent ; United

States,

per cent .

21

P ERCENTAGE DISTRIBUTION OF READMISSIONS , B"SExTable VIII presents data on the percentage of readmissions,

by sex.The percentage of readmiss ions for each sex in the

areas studied is as follows : Georgia— males , females,Alabama— males, females , Il l inois— males, fe

males,

United States— males, females, In Geor

gia and Alabama the females constitute a higher percentage ofreadmissions than do the males, whereas in Illinois and theUnited States, the males have a higher percentage of readmis

sions .Negro females constitute a higher percentag e of all Negro

readmissions than do the white females of all the white readmissions . The percentages which the females constitute of thetotal readmissions for their respective areas are as followsGeorgia— whites

,Negroes

,Alabama— whites,

Negroes,

United States— whites, Negroes ,

READMIS SION S As P ERCENTAGE OF TOTAL ADMISS IONS

Comp arisons by Areas, Disregarding Race and S ex : TableIX presents readmi ssions as percentages of total admissions

(first admissions plus readmi ssions ) to the state hospitals ofGeorgia

,Alabama, Illinois, and the United States, by race and

sex,for the decade . The percentage which readmissions con

stitute of total admissions in the several areas is as followsGeorgia , Al abama

,Illinois

,United States

,

It is seen that in Illinois this percentage rate is higherthan in the other three areas . In general, it might be saidthat readmissions constitute one-fifth of the total admissions inthe areas studi ed .

Inter -racial Comp arisons : Wh ite readmissions constitute amuch higher percentage of the total white admissions than dothe Negro readmissions of the total Negro admissions . Readmissions stated in percentages of total admissions for each ofthe areas

,by race

,are as follows : Georgia— whites, Ne

groes , Alabama— whites,

Negroes,

UnitedStates— whites , Negroes

,The same excess of white

readmi ssions , as compared with the Negro readmiss ions,shows

up when the races are studied by sexes .

Intro-racial Comp arisons, by S ex : For both races , female re

admissions constitute a higher percentag e of total female ad

missions than do male readmissions of the total male admis

23

sions. Negro readmi ss ions, express ed in percentages of totaladmiss ions for Negroes , by sex

,are as follows : Georgia— males,

females,

Al abama— males, females,

United States —males, females , White readmis

s ions, expressed in percentages of total admissions for whites,in the same areas , are as follows : Georgia— males

,fe

males, Alabama— males,

females,

UnitedStates— males , femal es

,

AVERAGE"EARLY NUMBER OF DIS CHARGES ANL FURLOUGHSTable"presents the average yearly number of discharges

and furloughs from the state hospitals of Georgia, Al abama,Illinois

,and the United States, by race and sex, and condition

at the time of discharge,for the decade 1923 -1932. The average

yearly number of discharges and furloughs in the several areasis as follows : Georgia, Al abama

,Ill inois

,

United States , The data as sub-divided are too com

plex to make further analysis feas ible within the limitations ofthe present study.

CONDITION OF DIS CHARGES AND FURLOUGHS , ExP RES SED B"P ERCENTAGES

Table XI presents the discharges and furloughs from thestate hospitals of Georgia, Al abama

,and the United States,

by race and sex,and condition at the time of discharge

,by per

centages,for th e decade . The percentage of patients in the

several areas released as restored is as follows : Georgia,

Alabama,

Illinois,

United States , Comparabledata on improved patients are as follows : Georgia, Al a

bama,

Illinois,

United States,

The percentagesof patients unimproved are as foll ows : Georgia, Alabama ,

Illinois, United States , Those released as saneare as follows : Georgia , Al abama , none ; Illinois,United States

,none . Racial comparisons by percentages in

terms of the diagnostic classifications at the time of furloughor discharge show such inconsistency in the various areas thatno logical analysis seems poss ible . Illinois discharges and furloughs have a much hi gher percentage of patients released as

sane, and a much lower percentage released as unimproved,

than the other areas studied . With the exception of Al abamawhites . the diagnostic classification of improved (Georgia , Illinois

,and the United States ) accounts for the highest per

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centage of all discharges and furlough s . The group dischargedas restored is second lar gest, followed respectively by the groupslisted as unimproved and sane .

P ERCENTAGE DISTRIBUTION OF DIS CHARGES AND FURLOUGHS , B"RACE

Table XII Shows the percentage distribution of discharges andfurloughs

,by race . In Georgia the Negro discharges classified

as restored p er cent ) and as sane per cent ) con

stitute a relatively low percentage of the total discharges inthe two classifications . In Georgia and the United States, theNegro females constitute a higher percentage of all femaledischar ges and furloughs than do Negro males of all male discharges and furloughs . These percentages are as followsGeorgia— males

,females

,United States— males,

females,

DISCHARGES AND FURLOUGHS E xp RESSED As P ERCENTAGES OFTOTAL ADMISS ION S”

Comp arison by Areas, Disregarding Race and S ex : Table XIIIpres ents the discharges and furloughs as percentage of totaladmissions to the state hospital s in the areas studied . Georgiaand Alabama releas e a much higher percentage of the totaladmissions than do Illinois and the United States . Dischargesand furloughs expressed as percentages of total admissions areas follows : Georgia, Al abama

,Illinois,

United States,

Inter -racial Comparsions : A higher percentage of the totalwhite admissions ar e released than of the total Negro admissions . Discharges and furloughs expressed as percentages of

tota l admissions,by races

,are as follows : Georgia— whites,

Negroes,

Alabama— whites , Negroes,

United States— whites,

Negroes, The same relativeproportions appear when the races are fur ther subdivided bysex.

aAmblgultle s in these data are dis cus sed later .

29

READMISS ION S ExP RES SED As P ERCENTAGES or DISCHARGES AND

FURLOUGHS

Comp ari son by Areas : Table XIV presents data on the re

admissions expressed as percentages of discharges and furloughsfrom the state hospitals of Georgia , Al abama , Illinois, and theUnited States

,by race and sex . Readmi ssions as percentages

of discharges and furloughs for the several areas are as follows : Georgia, Al abama

,Illinois

,United States ,

In Georgia and Al abama the proportion of released p atients returning to the state hospitals is much lower than theproportion for the United States, and in Illinois the proportionof released p atients returning to the state hospitals is muchhigher than the proportion for the United States . Taking theUnited States rates as representative , approximately two-fifthsof the patients released from mental hospitals are readmitted.

Female discharges and furloughs resul t in a higher percentageof readmissions than do the male di scharges and furloughs .

Readmissions as percentages of di scharges in the several areas ,are as follows : Georgia— males, females

,Alabama

males,

females,

Illinois - males,

females,

United States— males,

females,

SUMMARY OF DATA ON READMISS IONS , AND DIS CHARGES ANDFURLOUGHS

Georgia and Al abama have approximately the same averagenumber of readmi ss ions, and Illinois has over six times as manyas Georgia or Alabama . Readmissions to the hospitals of Georgia and Alabama

,expressed as percentages of readmissions in

the United States, are approximately the same as the correspond

ing data on first admissions . Il l inois,however

,accounts for

a higher percentag e of all readmissions in the United Statesthan it does of all first admissions . Stated differently, Illinoishas a much higher rate of readmissions than expected, as compared with first admissions . Alabama has a larger number ofwhite readmissions than Georgia

,and Georgia has a larger num

ber of Negro readmissions than Al abama . In Georgia and Alabama the number of female readmissions for the decade exceedsthe number of male readmissions

,whereas in Illinois and the

United States as a whole the number of male readmissions exceeds the number of female readmissions .

Negroes in Georgia and Alabama furnish a much higher percentage of readmissions than Negroes in the United States

,due

3 1

mainly to the presence of a relatively larger percentage of Negro population in these two states. Negro females in Georgiaand Alabama constitute a higher percentage of readmissionsthan do the mal es, whereas in Illinois and the Uni ted States,the males have the higher percentage of readmissions . Negrofemales constitute a higher percentage of al l Negro readmis

sions than white females constitute of all white readmissions .

In Ill inois,the percentage which readmissions constitute of

total admi ssions (first admissions plus readmissions ) is higherthan is found in the other three areas . In general, it mightbe said that readmissions cons titute one-fifth of the total ad

missions . Wh ite readmissions constitute a much higher percentage of the total white admissions than do the Negro readmiss ions of the total Negro admissions . Female readmissionsconstitute a higher percentage of total female admissions thando the male readmissions of the total male admissions .

Illinois discharges and furloughs have a much higher percentage of patients released as sane

,and a much lower per

centage of patients released as unimproved,than the other

areas studied . The classification of discharged patients rankedin order of relative frequency is as follows : improved, restored,unimp roved, and sane . In Georgia and the United States, theNegro females constitute a higher percentage of the total femal edischarges and furloughs than do the Negro males of the totalmale discharges and furloughs.

Georgia and Al abama releas e a much higher percentage ofthe total admissions than do Illinois and the United States . A

higher percentage of the total white admissions are releasedthan of the total Negro admissions .

In Georgia and Al abama,the proportion of the dischar ged

and furloughed patients return ing to the state hospitals is muchlower than the proportion for the United States

,and in Illinois

the proportion of released p atients returning to the state hos

p itals is much higher than the proportion for the United States .Tak ing the United States rates as representative

,approximately

two-fi fths of the patients releas ed from mental hospitals are readmitted . Female discharges and furloughs have a higher percentage of readmissions than do the males . Negro patients released from state hOSp itals have a much lower rate of readmissions than do white patients .

In studying discharges and furloughs expressed as p ercentagesof total admissions , by race, it was seen that discharges and

3 2

furloughs in the case of Georgia whites exceed 100 . On theother hand

,discharges and furloughs among Al abama whites

were 95 per cent of total admissions of Alabama whites . Theobvious fallacy involved in having more discharges and furloughs than admi ssions is treated in the discus sion of data onreadmissions

,and discharges and furloughs .

3 3

III

ENV IRONMENT (URBAN OR RURAL ) OF FIRSTADMISSIONS

In tabulating the data with respect to environment , or residence prior to admission

,incorporated places having a pOpula

tion of or over are considered as urban, and all otherplaces as rural . (United States bul letin , Table XV

p resents the environment of first admissions to the state hos

p itals of Georgia , Alabama, Illinois, and the United States, byrace and sex

,for the decade 1923 -1932. Ge orgia and Alabama

have a larger number of rural than urban admissions , and Illinois and the United S tates as a whole have a larger numberof urban than rural admissions . The average yearly numberof first admissions by place of residence is as foll ows : Georgiaurban

,ru ral, Al abama— urban

,rur al,

Illinois— urban,

rural,

United States— urban,

rural,

ENVIRONMENT OF FIRST ADMISSION S,B"P ERCENTAGE S

Table XVI presents the environment of first admissions inthe several areas

,by percentages . The majority of admissions

in Georgia and Al abama are from rural districts . The percentage of first admissions from each environment in the several areas is as follows : Georgia— urban

,rural

,Ala

bama— urban,

rural,

Illinois— urban,

rural,

United States — urban,

rural,

The distributionof the general population in the urban districts of the severalareas is as follows ( 193 0 Census ) : Georgia, Alabama

,

Il linois,

United States,

ENVIRONMENT OF F IRST ADMIS SION S P ER GENERALP OPULATION OVER AGE 15

Table XVII presents the environment of first admissions pergeneral population over age 15

,of the same race

,sex

,

and area . The incidence of first admissions per general

p opulation over age 15 , for Georgia, Illinois, and the UnitedStates

,is as follows : Georgia— urban , ru ral

,Il

linoiS —urban,

rural,

United States — urban ,rural

,

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IN CIDEN CE IN URBAN DISTRICTS RELATIVE To IN CIDENCE IN

RURAL DIS TRICTS

Table XVIII is an index (based on Table XVII ) of therelative incidence of first admi ssions by environment . In com

p uting the figures in this table, the ru ral incidence was dividedinto the ur ban incidence ; i . e .

,ru ral incidence equals 100, and

the results are expressed as percentages .

Comparisons by Areas : The ratio of urban-rural incidence offirst admissions, expressed as percentages , is as follows : Georgia

,Illinois

,United States

,This shows

that in Illinois,the urban di stricts have an incidence almost

twice as high as the incidence in r ural districts ; i . e . , there is agreater difference in the urban-rural incidence in Illinois thanthere is in the urban-rural incidence in Georgia .

SUMMARY OF DATA ON ENVIRONMENT (URBAN OR RURAL ) OF

FIRST ADMISS IONS

Georgia and Alabama have a lar ger number of rural than of

urban admissions, and Illinois and the United S tates have a.

larger number of urban than of rural admissions .

Urban districts have a higher incidence of first admissions

(per general popul ation over age 15 ) than do ruraldistricts . In Illinois

, the urban incidence is almost double therur al incidence . There is a greater difference between the urbanrural incidence of first admiss ions in Illinois than in Georgia .

The female incidence in the urban districts ( relative to thefemale incidence in the ru ral districts ) is higher than the maleincidence for the urban districts in Georgia and the UnitedStates . The urban-rural ratio of incidence is about the samefor the sexes in Illinois . The urban incidence expressed as apercentage of the rur al incidence is hi gher for Negroes than forwhites .

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IV

MARITAL STATUS OF FIRST ADMISSIONS

The study of the marital status of first admissions is indicative of one phase of social disorganization in its relations hipto mental disorders . Table XIX presents the average y earlynumber of first admiss ions by mari tal status

,by race and sex,

for the decade . Subsequent tables used for interp retations are

based on the data in Table XIX .

MARITAL STATUS , B"P ERCENTAGEComp arison by Areas : In all the areas studied, the married

group has the highest percentage of first admissions,and the

single group comes next with less than 10 per cent difierence .

(Table XX ) . The percentage of first admiss ions in the twogroups is as follows : Georgia— married, single

,Ala

bama— married, S ingle

,Illinois— married

,single,

United States— married,

single,

Thus thetwo classifications account for approximately 7 5 per cent of thefirst admissions to state hospitals for mental di sease , in eacharea studied . The groups classified as separated and divorcedvary more widely in the different areas than do the other classifications ; the widowed group has the third highest percentageof first admissions

,as follows : Georgia, Al abama.

Ill inois,

United States,

Inter-racial comparisonsShow no consistent race patterns .

In the areas studied, the males have a higher percentage ofadmissions classified as single and the females have a higherpercentag e classified as married . Data on the group clas sifiedas single

,by sex

,are as follows : Georgia— males , females ,

Alabama— males,

females,

Illinois— males,

females,

United States— males,

females,

The

group classified as married, by sex, is as follows : Georgiamales

,females

,Alabama— males

,femal es

,

Ill inois— males,

females,

United States— males,

females,

MARITAL STATUS P ER GENERAL P OPULATIONComp arison by Areas : The relative incidence of first admis

sions per general p opulation over age 15 , subdividedby mari ta l status, is p resented in Table XXI . The marital

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groups ranked from lowest to highest by the incidence of firstadmissions per general population are as follows : married

,single

,widowed, divorced . The incidence of first admis

sions in the several ar eas,by marital status

,is as follows : Geor

gia— s ingle,

married,

widowed,

divorced,

Alabama—S ingle,

married,

widowed,

divorced,

Illinois— single,

married,

widowed,

divorced,

United State s—S ingle , married,

widowed,

divorced,

Inter-racial Comparisons : The incidence of Negro admissionsper general popul ation classified as single is higherthan that of whites in Georgia

,Alabama

,and the United States .

( Illinois data are not divided by race . ) The incidence of singleadmiss ions per general population of the same maritalstatus is as follows : Georgia— whites, Negroes, Ala

bama— whites, Negroes,

United States— whi tes,Negroes

,The incidence of Negro first admi ssions clas

sified as married is lower than that of married whites in theUnited States . The incidence of the marr ied admissions is as

follows : Georgia— whites,

Negroes,

Al abama— whites ,Negroes

,United States— whites

,Negroes

,

The incidence of first admissions classified as widowed anddivorced ar e higher for the whites than for the Negroes . Theincidence of widowed admissions is as foll ows : Georgia— whites ,

Negroes , Alabama— whites,

Negroes,

United States— whites,

Negroes,

The incidenceof divorced admissions (per general population ) is asfollows : Georgia— whites , Negroes

,Al abama— whites ,

Negroes,

Uni ted States— whites,

Negroes,

INDE"on THE RELATIVE IN CIDENCE OF FIRST ADMISS IONS , B"MARITAL STATUS

Table XXII makes use of index numbers showing the relativeincidence of first admissions

,per general population

over age 15,to the state hospitals of Georgia

,Al abama

,Illinois ,

and the United States . This index table was prepared by dividing the incidence of first admissions classified as married intothe incidence of the other classifications of marital status . Theincidence of first admissions in the various classifications hasbeen di scussed above in connection with Table XXI . TableXXII p resents the relative weight of each classification in

44

terms of percentage of the group classified as mar ried . Therelative incidence of first admi ssions classified as single expressed as a percentage of the incidence of first admissionsclassified as married

,for the several areas

,is as follows : Geor

gia,170 ; Al abama, 164 ; Illinois , 15 5 ; United States, 15 5 . The

incidence of widowed first admissions expressed as a percentageof married first admissions is as follows : Ge orgia, 191 ; Alabama,13 7 ; Illinois , 268 ; United States, 216 . The incidence of divorcedfirst admissions expressed as a percentage of the incidence ofmarried first admissions is as follows : Georgia, 206 ; Alabama ,3 32; Ill inois , 5 5 8 ; United States , 418 . It should be noted thatthe widowed and divorced groups have a very high incidenceof first admissions as compared with the incidence of the mar

ried group .

SUMMARY OF DATA ON MARITAL STATUS OF FIRST ADMISS ION SThe group classified as married has the highest percentage

of first admissions,the single group comes next

,followed resp ec

tively by the widowed group and the divorced group . The twogroups clas sified as married and single together account forapproximately 7 5 per cent of all first admi ssions in each of theareas studied . The males have a higher percentage of admissions classified as single than the females

,and the femal es have

a; higher percentage classified as married than the males .

The married group has the lowest incidence of first admissions per general population over age 15 , the singlegroup is next

,followed by the Widowed group

,while the divorced

group has the highest incidence of first admissions . The incidence of Negro admissions class ified as single is higher thanthat Of the whites classified as single

,whereas the incidence

of Negro admissions classified as married is lower than that ofthe married whites .

The widowed and divorced group s have a very high incidenceof first admissions as comp ared with the married group .

46

V

CHRONOLOGIOAL AGE OF FIRST ADMISSIONS

Table XXIII presents the average yearly number of firstadmissions to the state hospitals of Georgia, Al abama, Illinois ,and the United States , by race, sex, and chronological age.

However,this table of raw data is too involved to make analysis

feasible . Table XXIV presents the chronological ages of firstadmiss ions by percentages .

CHRONOLOGICAL AGE OF FIRST ADMISS IONS , B"P ERCENTAGESComp arison by Areas , Disregard/ing Race and S ex : In Geor

gia and Alabama,the age group under 20 contains a much

higher percentage of fir st admissions than the age group under20 in Ill inois or the United States . The age group 60 abovecontains a much hi gher percentage of first admissions in Illinoisand the United States than in Georgi a or Alabama . The percentages of first admi ssions for the ag e group under 20 in theseveral areas , are as follows : Georgia, Alabama, Il

linois,

United States,

The percentages Of first ad

missions between the ages 20-29 are as follows : Georgia,Al abama

,Illinois

,Uni ted States

,For the age

group 3 0 3 9 : Georgia, Alabama,

Illinois , UnitedStates

,For the ag e group 40 49 : Georgia , Al abama

,

Illinois,

United States, For the age group50-5 9 : Georgia, Al abama

,Illinois

,United

States,

For the classifications above 60,the percentag es

are as follows : Georgia, Alabama,

Ill inois,

United States,Inter—raoial Comp ari sons : Negro first admissions have a higher

percentage of patients under age 20 than do the whi tes . Onthe other hand, the whites have a higher percentage of firstadmissions , age 60 and above

,than do the Negroes . The per

centages of first admissions under age 20, by race , are as follows : Georgia— whites, Negroes

,Alabama— whites

,

Negroes,

United States- whites,

Negroes ,The percentages of first admissions age 60 and above are as

follows : Georgia— whites, Negroes, Aabama— whi tes ,Negroes

,United States— whites

,Negroes

,

47

CHRONOLOGICAL AGE OF FIRST ADMISS IONS P ER GENERALP OPULATION

Table XXV presents the chronological age of first admissions to the state hOSp italS of Georgia, Alabama , Illinois , andthe United States

,per general population , for the de

cade 1923 -1932. The curve of the incidence of first admiss ionsin Georgia and Al abama increas es with the age groups up toag e 5 0, takes a slight drop between ages 50-5 9 , and rises ag ainabove age 60. In Il linois and the United States

,however

,the

cur ve of the incidence of first admissions increases steadilywith age. The incidence Of first admissions p er generalpopul ation in Georgia1 for the several age groups i s as followsUnder 20

,20-29

, 3 0-3 9,

40-49,

5 0-5 9,

above 60, The corresponding incidence of first admiss ionsfor the several age groups in Alabama is as follows : under 20,

20-29,

3 0-3 9 , 40-49,

50-5 9,

above60

, The incidence of firs t admissions for the age groupsin Illinois i s as follows : under 20

,20-29

,30-3 9

,

40-49,

5 0-5 9,

above 60,

The incidence offirst admi ss ions for the ag e groups in the Uni ted States is as

follows : under 20,

20-29,

3 0-3 9,

40-49,

5 0-5 9 , above 60,

SUMMARY OF DATA ON CHRONOLOGICAL AGE OF FIRST ADMISSION S

In Georgia and Al abama the age group under 20 contains a

much higher percentage of first admissions than the age groupsunder 20 in Illinois and the United States . The age groups60-above contain a much higher percentage of first admissionsin Illinois and the United States than in Georgia or Alabama .

Negro first admissions have a higher percentage of patientsunder age 20 than do the whites , and the whi tes h ave a

‘ higherpercentage of first admissions in the group 60—above than dothe Negroes .

The curve of the incidence of first adm issions pe rgeneral popul ation in Georgia and Alabama increases with theage groups up to age 50, takes a slight drop between ag es 50-5 9 ,and rises again above age 60. For Illinois and the UnitedStates, the curve of the incidence of first admissions increasessteadily with age .

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V I

ECONOMIC STATUS OF FIRST ADMIS SIONS

Table XXVI presents the averag e yearly number of firstadmissions to the state hospitals Of Georgia, Alabama, Ill inois ,and the United States, by race, sex,

and economic status . TableXXVII presents the economic status of fir st admissions bypercentages . From Table XXVII it can be seen that the rat

ings on economi c status given first admissions vary widelyamong the hospitals in the various areas . This variation mightbe due in large part to the us e ( on the par t of the statisticalclerks in the var ious hospitals who compiled the original data )of subjective judgments concerning the economic status ofpatients at the time of first admi ss ion . For this reason

,little

analysis has been made Of the factor of economi c status .

The percentage of first admiss ions clas sified as independentin the several areas is as follows : Georgia, Alabama ,Illinois

,United States

,The percentag e cla ssified as

marginal is as follows : Georgia, Al abama, Ill inois,United States

,The percentage of first admissions

clas sified as dependent is as follows : Georgia, Alabama,Illinois

,Uni ted States,

5 3

V II

EDUCATIONAL STATUS OF FIRST ADMISSIONS

Table XXVIII presents the average yearly number of firstadmissions to the state hospitals of Georgia

, Alabama, Illinois ,and the United States

,by race

,sex, and educational . status .

Table XXIX presents the educational status of first admissions by percentage .

EDUCATIONAL STATUS OF FIRST ADMISS ION S, B"P ERCENTAGESComp arison by Areas , Disregarding Race and S ex : The per

centag e of first admissions classified as ill iterate is very high inGeorgia and Alabama

,and is relatively low in Illinois and the

Uni ted States . The percentages of total first admissions classified as illiterate in the several areas are as follows : Georgia ,

Alabama,

Illinois,

United States,

The percentages of first admissions clas sified as read and write are as

follows : Georgia, Al abama,

Ill inois,

UnitedStates

,The percentages of first admissions clas sified as

common school are as follows : Georgia, Alabama,Illinois

,United States

,The percentages of first ad

missions classified as high school are as follows : Georgia,Alabama

,Illinois

,United States

,The per

centages of first admissions clas sified as college are as followsGeorgia

,Al abama

,Illinois

,Uni ted States

,

It is seen that the p ercentages of first admi ssions with acommon school education are much higher in Illinois and theUnited States than in Georgia and Alabama.

Inter -racial Comp arisons : The p ercentage of firs t admissionswith relatively low educational achievement is much higher forNegroes than for whites in Georgia and Alabama ( Illinois andUnited States data are not divided by race ) , whereas the percentage of first admissions with relatively high educationalachievement is much lower for Negroe s than for whites . Forexample

,the percentages of first admissions classified as il

literate,by race

,are as follows : Georgia— whites , Negroes ,

Alabama— whites , Negroes , The percentagesof first admissions classified as high school , by race, are as follows : Georgia— whites , Negroes

,Al abama— whites

,

Negroes ,

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V III

SUMMAR"OF THE DATAThe data were gathered to study the comparative incidence

of insanity among Negroes and whites in Georgia, Al abama,Illinois

,and the United States during the decade 1923 -193 2.

The scope of the study includes two major problems

( 1 ) To discover the relative incidence of insanity amongNegroes compared with whites, as shown by the reportsof the state hosp itals in the areas covered .

(2) To present data indicating the influence of the socioeconomic factors of ( a ) environment (urban or rural ) ,(b ) marital status, ( c ) chronological age , economicstatus

, ( e ) educational status of patients .

It is assumed that ( 1 ) under current conditions, the incidenceof insanity is best portrayed by the number of first admissionsto mental hOSp itals ; (2) the mental hospitals selected furnisha sampling adequate for the study of the socio-economic factorsenumerated above .

The data are limited in the following ways

( 1 ) By the scope of the bul letins from which the information is derived.

(2) By the lack Of information on each patient necessary tomake possible a correlation of the various sociO-economicfactors .

( 3 ) By the subjective ratings employed in recording thesoc io-economic status and) other facts concerning thepatient.

(4) By the crowded conditions in many of the state hos

p itals , necessitating the admission of only the more severecas es to such hospitals .

It is felt that the limitations cited above do not seriously im

p air the value of the data for the following reasons :

1 ) The scope of the bulletins and the lack of information oneach patient tend merely to limit the scope of the study .

(2) The subjective ratings employed in recording the socioeconomic status of the p atients relate only to a small portion Of the study .

60

( 3 ) The crowded conditions influencing the number of ad

miss ions introduce an unavoidable source of error ; however

,the sampling Obtained is large enough to justify

the study of the influence of various socio—economi e factors .

FIRS T ADMISSIONS

Alabama has approximately 10 per cent more first admissionsthan Georgia

,and Illinois has over four times as many. Of

the United States total of first admiss ions , Georgia has percent

,Alabama per cent

,and Illinois per cent . Illinois ,

with per cent of the Negro general population of the UnitedStates

, has per cent of the Negro first admi ssions to statehospital s

,whereas Georgia, wi th per cent of the Negro

population,has only per cent Of the Negro first admissions .

Alabama,with per cent of the Negro popul ation, accounts

for per cent of Negro first admissions to mental hospitals .

The relative incidence of firs t admissions per generalpopul ation over age 15 is as follows : Georgia, 47 .77 ; Alabama,

Illinois,

United States,

Males show ahigher incidence of first admissions than do the females . Thedifference between the incidence of males and females in Illinoisis much greater than in Georgia or Alabama .

The relative incidence per general population of Negro first admissions is higher than that of the whi tes in theareas studied

,and there is markedly less race difference in Geor

gia and Alabama than in Illinois, the Illinois Negroes havingover twi ce the incidence of the Illinois whites .

If the incidence of first admissions in the United States isconsidered as the norma l exp ectancy, the incidence of insanityin Georgia and Al abama is very low,

and in Illinois the incidence is high . The females in Georgia and Al abama are nearerthe normal expectancy than the mal es

,whereas in Illinois the

males are above , and the femal es below,the United States inci

dence . Negro admissions in Georgia and Al abam a are nearerthe normal expectancy than are the whites ; in Illinois the Negroadmissions have an incidence times the United States incidence, whereas Il linois whites have the normal expectancy.

READMIS SION S,AND DIS CHARGES AND FURLOUGHS

Georgia and Al abama have approximately the same averagenumber Of readmiss ions ; Illinois has over six times as manyas either state . In Georgia and Alabama

,the percentage Of

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readmi ss ions of the United States totals is approximately thesame as the percentage of first admissions . Illinois

,however,

ac counts for a higher percentag e of al l readmissions in theUni ted States than it does of all first admissions . In Georgiaand Alabama the number of female readmissions exceeds thenumber of male readmi ssions

,whereas in Illinois and the United

States the number of mal e readmissions exceeds the numberof femal e readmiss ions .

In Illinois,the percentage which readmissions constitute of

total admiss ions ( i . e .,

firs t admissions plus readmissions ) ishigher than is found in the other three areas . In general , itmay be said that readmissions constitute one-fifth of the totaladmissions . Whi te readmissions constitute a much higher percentage of the total white admissions than do Negro readmis

sions of the total Negro admissions .

Georgia and Alabama release a much higher p ercentage of

the hospital popul ation than do Illinois and the United States .

A higher percentage Of the white popul ation than of the Negropopul ation is released .

In Georgia and Alabama,the proportion of the discharged

and furloughed patients return ing to the state hospitals is muchlower than the p roportion| for the United States , and in Illinoisthe p roportion of released patients returning to the state hos

p itals is much higher than the proportion for the United States .

Assuming the United States rates as rep resentative , app roxi

mately two-fifths of the patients released from mental hospitalsare readmitted .

Female discharges and furloughs have a higher percentageof readmissions than do males . There is a much lower percentage of readmissions for Negro than for white patients re

leased from mental hospitals .

Some states have a number of discharges and furloughs ex

ceeding the number of total admissions . This discrepancy isexp lained in the discussion which follows (p .

E NVIRONMENT (URBAN OR RURAL ) OF FIRS T ADMISSIONS

Georgia and Alabama have a larger number of rural than ofurban admissions

,and Illinois and the United States have a

larger number of urban than of rural admi ssions .

Urban districts have a higher incidence of first admissions

(per general p opulation over age 15 ) than do rural

62

districts . In Illinois the urban incidence is almost double therural incidence . There is a greater difference between theurban-rural incidence of first admissions in Ill inois than inGeorgia or Al abama .

The female incidence in the urban distr icts ( relative to

the rural female incidence ) is higher than the urban male incidence

,in Georgia and the United States ; the urban-rural ratio

of incidence is about the same for the two sexes in Illinois .

The urban incidence expressed as percentage of the ruralincidence is higher for Negroes than for whites .

MARITAL STATUS OF FIRST ADMISSIONS

The mar ital groups ranked from highest to lowest by thepercentage of first admissions are as follows : married , single ,widowed , divorced . The group classified as married and singletogether account for approximately 7 5 per cent of all fir st admissions. The single group accounts for a higher percentageof the males

,and the mar ried group

,of the females .

The marital groups ranked from lowest to highest by theincidence of insanity per general population over age15 are as foll ows : married, single, widowed, divorced . Theincidence Of Negro admiss ions classified as single is higherthan that of sing le whites . The reverse is true for the mar riedgroups ; i . e. ,

the marr ied whites have a higher incidence thanthe mar ried Negroes .

The widowed and divorced groups both have a very high incidence of first admissions as compared with the married group .

CHRONOLOGICAL AGE OF FIRST ADMISSIONS

In Georgia and Al abama,the lower age groups have a rela

tively high percentage of first admissions as compar ed withIllinois and the United States ; the upper age groups have arelatively higher percentage in Illinois and the United States .

The lower age groups have a higher percentage of the Negroadmis sions than of the white admi ssions .

The curve of the incidence of first admissions pergeneral population in Georgia and Al abama increas es withthe ag e groups up to age 50 , takes a slight drop between ages5 0-5 9

,and rises again above age 60. F or Illinois and the United

States data, the curve of incidence of first admi ssions increasessteadily with age .

63

ECONOMIC STATUS

Data on economic status yielded no reliable results .

EDUCATIONAL STATUS OF FIRST ADMISS ION S

The percentage of first admissions classified as illiterate ishigh in Georgia and Alabama as compared with Illinois and theUnited States ; the percentage with common school and highschool educations is high in Illinois and the United States ascompared with Georgia and Al abama.

The percentage of first admissions with relatively low educational achievement is much higher for Negroes than. for whitesin Georgia and Alabama . ( Illinois and United States data arenot divided by race . )The incidence of ill iterate first admi ssions per Illit

erate population is about twi ce as high in Ill inois and theUnited States as in Georgia and Alabama . The incidence of

illiterate admissions is much higher for males than for females,

and for whites than for Negroes .

64

I"INTERP RETATION OF FINDINGS

FIRST ADMISSION S

A few facts and hyp otheses are advanced in this section inan attemp t to explain some Of the data presented in this studyF irst admissions rep resent the best single criterion availablefor studying the incidence of ins anity, since they rep resent thenumber Of new cases ins titutional ized in a given period . Thedecade 1923 -1932 may not adequately indicate the trends of

mental disorder due to the influence of such factors as thedepression which was precipitated in 1929 , and of the WorldWar . Although the influence of such abnormal social conditions can not be determined di rectly

,their presence tends to

show the incidence of insanity during a strenuous period .

(A) On the basis of per general population, Al abama and Georg ia have a much lower incidence of first ad

missions than do Ill inois and the United States . The numberof first admissions per general population over age 1 5 ,in the different: areas , is as follows : Georgia, 48 ; Alabama,Ill inois

,94 ; Uni ted States, 89 . Several factors and hypotheses

are suggested in an attempt to explain why the incidence Of

first admi ssions in Georgi a and Alabama is below the UnitedStates incidence

,and the incidence in Illinois is above the

Uni ted States incidence .

1 ) The adequacy of institutional facilities influences thenumber of patients admi tted . The institutions are moreadequate in Illinois than in Georgia and Alab ama . Threepoints sup port thi s hypothesis. In the first place

,figures

tak en from the United States bul letin for 193 3 ,“P atients

in Hospitals for Mental Diseas e,

”show that of the areasstudi ed

,Illinois alone had institutional facilities in ex

cess of patient popul ation . The excess of population overcapacity ( a minus denotes excess Of capacity over p opulation ) in the institutional space in the several areas follows : Georgia, per cent ; Alabama, per cent ;Illinois , per cent ; Uni ted States , per cent .

In the second place,the per capita wealth of Illinois

is much higher than the per capita wealth of Georgia orAlabama

,making greater expenditures for state institu

65

tions possible . The per capita tax-paying abil ity in theseveral ar eas i s as follows : Georgia, Alabama,

Illinois,

United States , (Geor

gia E ducation Journal, December, 193 6, p .

In the third place,the percentage of patients dis

charged as sane ( see Table XI ) is much higher in 11linois than in Georgia . One plausible interpretation ofthis finding is that in Georgia, where institutional facilities are not equal to the demand

,only the more severe

cas es are admitted.

The foreign-born population raises the incidence of insanity in Illinois and the United States. Several factssupport thi s conclusion . In the first place

,the foreign

born cons titute a much higher percentag e of the generalpopul ation in Illinois and in the United States than inGeorgia and in Al abama . The proportion of foreignborn in the four areas is as follows ( 1930 census )Georgia

, .5 per cent ; Al abama , per cent ; Illinois ,per cent ; United States , per cent . ( There has beena decrease in the percentage of foreign-born in theUnited States from per cent in 1920 to percent in

In the second place , for the United States as a whole ,per cent of the foreign-born reside in urban areas .

Since the rate of institutionalization is generally higherfor urban than for rural ar eas

,and since Illinois

,as

compared with Georgi a and Alabama, has a higher ratioof foreign-born population and a higher percentag e ofurban population

,i t is only natural to expect a higher

ratio of insani ty in Illinois .

In the third place,the foreign-born have a higher in

cidence of ins anity than the native-born . Thus,for

193 3,the incidence of ins anity per general pop

ulation over age 15 of the same race, in the United States,is as follows : native-born , foreign-born

,

The higher age level of the g eneral population in Illinoisand the United States results in a higher incidence of

insanity in these areas . It is shown,in Section V

,that

the incidence of insani ty increas es with age. The medianage of the general population in the several areas is asfollows ( bas ed on the 193 0 Cens us ) : Georgia ,Alabama

,Illinois

,United States ,

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( 3 ) The mobility of popul ation, a factor increasing the difficulty of proper adjustments to life , is greater amongmales than among femal es in certain instances ( see A,

4,

above ) . Long-distance migration is primarily a malephenomenon

,and certain types of cities offer employ

ment primarily to males ( e . g . ,cities in Illinois ) .

1

(4) Supplementary data2 show that syphilis as an etiological

factor is more prevalent among males than among females . For example

,General P aralysis accounts for the

following number of first admissions per general popul ation over age 15 in the United States : Negroes

-ma1es,

females,

whites— males,

fe

males,

(C ) The difference between the ratio of admissions of malesand females (male incidence higher than female incidence ) inIll inois and the United States is greater than the differencebetween the males and females in Georgia and Alabama . Theincidence of first admissions per general popul ationover age 15 for the areas studied is as foll ows : Georgia— male ,

femal e,

Al abama— mal e, female, Il

linois— male,

female,67 .74 ; United States— male ,

female,7 One hypothesis i s suggested as a partial explana

tion of why the difference between the incidence of the sexesis greater in Illinois and in the United States than in Georgiaand in Alabama . Reasoning from (B ) above, if the hi gherincidence for males in a comp lex environment is due to socialfactors such as greater male responsibility

,selective migration

to cities of an industrial nature,syphilis

,etc . ,

then the morecomplex the environment

,the greater the ratio of insane males

to insane females .

(D ) The incidence of Negro firs t admissions is only slightlyhigher than the incidence of white first admissions in Georgia,Alabama

,and the United States ; but in Illinois the incidence

of Negro first admissions (per general population overage 15 ) is over twice as high as the white incidence . In thisconnection

,the following exp lanatory factors merit cons idera

tion .

( 1 ) Illinois represents a more complex environment thanGeorgia or Alabama . It is probable that the Negro isnot as p repared as the white to make adequate social

l S orok ln , Zimme rman,Ga lp in, S y stematic S ource B ook in Rural S ociology ,

V ol . 3 , p . 48 1 .

2 S e lected f rom unpublish ed data prepared by th e author .

68

and personal adjus tments to a life in the high-pressureareas . It was pointed out (A,

4) that the population inIllinois is more concentrated in' urban areas than the

popul ations of Georgia and Alabama.

2) The difi erentiial mobility Of various elements in the general population is another factor involved . There hasbeen a shift northward in the center of Negro population

,

and the p ercentage increas e Of the Negro popul ation inurban areas between 1920 and 1930 is as follows : Georgia

,16 ; Al abama, 3 6 ; Illinois, 88 ; United States , 45 .

Thus it can be seen that the urbaniz ation of Negro popul ation in Illinois has been twice as high as that in Georgia or Alabama . A shifting popul ation probably servesas a selective etiological factor

,first

,because the less sta

ble individuals are mere likely to migrate ; second, because the median age of a shi fting population is higherthan that of an established

,settled group ; and third,

because males are more likely to migrate than femalesin certa in instances ( see B ,

3,and D

,

( 3 ) There is a relatively greater number of Negro malesthan white males ( as compared with females ) in Illinois,

3

and it has been shown (B ) that males have a h igherincidence of first admissions than females

,except among

Georgia Negroes . It was also shown ( see page 18 ) thatthere is a greater di fference ( in the incidence Of firstadmissions ) between the sexes in Illinois than in Ge or

gia or Al abama .

(4) There is probably less racial discrimination in Ill inoisthan in Georgia or Al abama .

(E ) It was seen that in studying the relative incidence offirst admissions per general population over age 15 inthe three states

,us ing the United States data as a criterion

of the normal expectancy, the females are nearer the normalexpectancy than the males . Males seem to be more suscepti

ble to variations in environmental factors than females ( see B ) ,hence there is less var iation in the female than in the mal eincidence throughout the United States . Expressed in anotherway, the range of female incidence is less broad, being clus teredmore closely around the central tendency .

3 Th e number of males p er 1 00 females over ag e 1 5 , for th e races in theareas s tudied , is as follows : Georg ia— wh ites , 10 1 , Neg roes , 9 4 ; Alabama

wh ites , 1 02, Negroes , 9 4 ; Illinois— wh ites , 104, N egroes , 1 1 6 ; United S tateswh ites , 1 04, Negroes , 9 8 . (Data tak en from an average of the 1 9 20-1 9 3 0

cens us reports . )

69

READMIS SION S, DISCHARGES AND FURLOUGHS

(F ) Illinois has a much higher proportion of the UnitedStates total of readmissions per cent ) than it has of theUnited States total of first admissions per cent ) . In otherareas , the data on first admissions and readmissions representabout the same proportions Of the United States totals . Forexample

,Georgia accounted for per cent of the United

States total of readmissions and per cent of the total firs tadmissions . This discrepancy in the ratio Of readmissions tofirst admissions in Illinois may be explained in part by thefollowing

( 1 ) The facilities in Illinois are more adequate than thefacilities in the other areas studied . This fact was mentioned in the “Discussion of the Data on F irst Admissions . (A,

(2) The complexity of envi ronment in Illinois makes outpatient readjustments more difficul t. It is shown thaturban districts have a higher rate of firs t admissionsthan rural districts

,and it is not illogical to assume that

in modern society certa in etiological factors tend to bringabout a relatively higher rate of readmi ssions in urbandi stricts . Furthermore

,maladjustment probably con

stitutes a more ser ious menace to an urban than to arur al community

,and it is more difi icult in urban than

in rural commun ities to provide appropriate extra insti

tutional care for maladjusted individuals.

(G ) White readmi ssions constitute a much higher percentageof the total white admissions than do Negro readmi ssions of thetotal Negro admissions . One hypothesis is that racial discrimination leads to the practice on the part of some institutions ofaccepting only the more severe cases among Negro applicants ,thus predisposing a smaller percentage of discharges amongNegroes . Data contradictory to this hyp othesis , however, arefound in the high p rop ortion of Negro di scharges and furloughs( relative to whites ) classified as restored ( i . e .

,3 5 per cent for

Uni ted States Negroes,28 per cent for United States whites ) ,

and the low percentage of Negroes discharged as unimproved

( 15 per cent for United States Negroes, 20 per cent for UnitedStates white s ) .

(H ) Negro female readmissions constitute a higher percentageof the total female readmissions than do Negro males of thetotal male readmi ss ions . This is made possible by the fact

70

that a larger percentage of Negro females than of Negro malesare discharged .

( I ) Ill inois discharges and furloughs have a higher percentageof patients released as sane and a lower percentag e released as

unimproved than do the other areas . This may indicate that ,due to les s adequate institutional facilities in other areas, onlythe more severe cases are admi tted, whereas , it is relativelyeas ier to gain admission to the Illinois hospitals . For the samereason

,it is probably necessary to discharge more patients from

the institutions in other areas in order to relieve congestion,

whereas it app ears likely that in Illinois only those patientsshowing improvement tend to be discharged . Another possiblefactor which should be investigated is the amount and difficultyof legal procedure necessary for commitment to the hospitals inthe several areas .

(J) Georgia and Alabama release a higher percentag e oftotal admissions than Illinois and the United States . In thisconnection several explanatory facts and hypotheses appear tobe pertinent.

1 ) It is poss ible that the l ack of adequate institutionalfacilities makes imperative the discharge of patients atthe earliest p ossible moment.

(2) The relatively simple environment Of Georgia and Alabama ( as compared with Illinois ) makes out-patient readj ustments less difficult . It has been pointed out thaturban districts have a higher incidence of insanity thanrural districts .

( 3 ) In this connection the comments of Neil Dayton‘ appear

to be pertinent . . the factor of discharge is reallylargely dep endent upon the age of the patient at thetime of admission . A hospital which draws the largerproportion of its patients from the older age groupswould have a high death rate and a low discharge rateas compared with some Of the institutions admittingpatients from the younger age groups . Some institutions are getting a large number of Older eases

,the senile

and the arteriosclerotie, and this is registered in thehigh averag e admi ssion ag e . Economic status has adecided bearing upon the discharge rate . Evidently thefact that there is a home waiting for the patient

,either

‘“A New S tatistical Sy stem for th e S tudy of Mental Diseases and S ome of

th e Attained Results , reprinted from th e"line Memor ia l B u l letin, April, 1 9 3 4.

7 1

of the marginal or comfortable group,makes a great

difference in whether or not the patient will leave theinstitution . If the family is dependent

,the patient has

much less chance of being discharged.

(") In studying the discharges and fur loughs as percentagesof total admi ssions

,it was seen ( Section II ) that in Georgia

and Al abama the percentages varied from 65 to over 100. Theapparent fal lacy in having more di scharges and furloughs thanadmissions is due in part to the following factors :

( 1 ) The decade studi ed does not include patients admittedpreviously

,but many of those previous admissions were

discharged wi thin the decade .

(2) The individuals on fur lough are not uniformly l istedas readmissions when returned to the hospital .

( 3 ) E ach individual may have been sent out on fur loughseveral times during the decade studi ed . For thesereasons , therefore, the data necessarily show a discrep

ENVIRONMENT OF FIRST ADMIS SION S

(L ) Urban districts have a higher incidence of first admissions per general population over age 15 than dorural di stricts . Several factors may partially explain thisphenomenon .

( 1 ) The comp lexity of the personal and social environmentis probably greater in urban than in rural districts

,

which tends to make life adjus tments more difficult .

(2) There is a much higher percentage of syphilis in crowdedareas , due to the communicable nature of the dis eas e .

For example,in the United States

,syphilitic admissions

per general population over age 15 account forin the urban districts and in the rural dis

tricts .

( 3 ) Maladjus ted individuals in urban districts are more likelyto become public wards than individuals in rural districts , due to their more frequent contact with the p rotective agencies of society, and due to the greater solidarity of the fami ly and adequacy of hous ing in rural areas .

(M) In Illinois , the urban incidence is times the ruralincidence

,whereas in Georgia the urban incidence is only

times the rural incidence ( p er general p opul ation over

72

age In explanation of these findings , the following com

ments are presented .

( 1 ) Illinois probably has an environment much more complexin urban districts than the urban districts of Georgia.

The urban distr icts of Illinois are more thick ly popul atedthan urban districts of Georg ia ( see A,

(2) Illinois has a large percentage of foreign-born, and over80 per cent of the foreign-born in Illinois reside in urbandistricts . It is known that the foreign-born have a higherincidence Of ins anity than the native-born whites ( seeA

,Urban Negroes have a higher incidence of in

sanity than the rural Negroes,and 91 per cent of the

Negroes in Illinois reside in urban distr icts .

( 3 ) There has been a great infl ux of the Negro populationinto Illinois during the decade 1920-193 0. The Negropopulation in the urban di stricts , for example , increased88 per cent during the decade . This mobility of population is one index of social disorganization . It also increases the incidence of insani ty (per generalpopulation ) by acting as a selective factor, in the matterof ages

,the high proportion of males

,etc .

(N ) The urban incidence ( expressed as a percentage of therural incidence ) is higher for Negroes than for whi tes . Itmight be noted that if the foreign-born whites were excluded

,

the compar ative ratios would Show a still grea ter divergence .

Two factors previously mentioned seem most pertinent .

( 1 ) Negroes are less likely than whites to achieve satisfactoryadjustments in extremely complex areas .

(2) Syphilis, which abounds in crowded di stricts,is more

prevalent among Negroes than among whites .

MARITAL STATUS OF FIRS T ADMIS SION S

The study of the marital status of first admissions is indicative of one phas e of personal di sorganization in its relationto mental disease . The relatively high percentage of first ad

mis sions classified as single and married is due to the relativedistribution of single and married persons in the general pOpulation .

(O ) The married group has the lowest incidence of first ad

missions per general popul ation over age 15 . This factprobably indicates that ma rriage has a stabilizing influence ,

73

of the marginal or comfortable group,makes a great

difference in whether or not the patient will leave theinstitution . If the family is dependent

,the patient has

much less chance of be ing di scharged .

(") In studying the discharges and furloughs as percentag esof total admissions

,it was seen ( Section II ) that in Georgia

and Al abama the percentag es varied from 65 to over 100. Theapparent fal lacy in having more di scharges and fur loughs thanadmissions is due in part to the following factors :

( 1 ) The decade studied does not include patients admittedpreviously

,but many of those previous admissions were

discharged within the decade .

(2) The individuals on fur lough are not uniformly listedas readmissions when returned to the hospital .

( 3 ) Each individual may have been sent out on furloughseveral times during the decade studied . For thesereasons

,therefore

,the data necessarily show a discrep

ENVIRONMENT OF FIRST ADMIS S ION S

(L ) Urban districts have a higher incidence of first adm issions per general population over age 15 than dorural districts . Several factors may partially explain this

phenomenon .

( 1 ) The complexity of the personal and social environmentis probably greater in urban than in rural districts

,

which tends to make life adjus tments more difficult .

(2) There is a much hi gher percentag e of syphilis in crowdedareas

,due to the communicable nature of the diseas e .

For example,in the Uni ted States

,syphilitic admissions

per general population over age 15 account forin the urban districts and in the rural dis

tricts .

( 3 ) Maladjus ted individuals in urban di stricts are more likelyto become public wards than individuals in ru ral distr icts , due to their more frequent contact with the p rotective agencies Of society, and due to the greater solidarity of the family and adequacy of hous ing in rural areas .

(M) In Illinois , the urban incidence is times the rur alincidence

,whereas in Georgia the urban incidence is only

times the rural incidence ( p er general p opul ation over

72

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although it is also likely that maladjusted individual s tend tostay single .

(P ) F irst admis sions classified as single have a higher incidence of insan ity than first admiss ions classified as marr ied .

In the single group , insani ty is more likely to be a reason fornot marrying, due to temperamental make-up ,

than to be anetiological factor in mental di sorder.

(") The divorced and widowed groups h ave a very highincidence of first admissions as compared with the incidence offirst admissions for the married group . As in the case of singleadmissions

,insanity might be considered either as cause or

effect. Mental abnormalities (which might later develop intoinsanity ) possibly contribute to marital infelicities leading todivorce before the mate actually becomes insane . (Few states ,if any

,permit insan ity as grounds for divorce . )

(R ) The fact that there is a very high rate of first adm1ss1ons

for widowed as well as for divorced persons suggests that thereare etiological factors involved in the marital status p er se.

Circumstances suggesting this hypothesis include the following :

( 1 ) Maladjustment prior or subsequent to insanity mighteasily lead to divorce, but this factor is not likely ( except in rare ins tances ) to be a caus e of widowhood .

(2) Another factor which influences the incidence of firstadmissions in the widowed group is the age at time of

admi ss ion . For example , the widowed group in Ill inoisaccounts for 45 per cent of the patients with SenileDementia . The stress of home-breaking and difi icultiesof readjustment probably take a greater toll at advancedages

,when habits are more firmly entrenched

,than at

the younger age levels .

( S ) The statistics would show a still greater incidence ofinsanity in connection with broken homes if the group listedas sep arated were taken into account ; unfortun ately, this factorwas not recognized in the reports of the United States Bureauof the Census concerning the general p opulation . Also , thereare no statistical data available here on the number of casesthat took root in the broken homes of the parents of the p atients ,but many studies in recent literature emphas ize the brokenhome as an important etiological factor in maladjustment .

74

CHRONOLOGICAL AGE OF FIRST ADMISSION S

(T ) The age group un der 20 contains a much higher percentage of first admiss ions in Georgi a and Alabama than inIll inois or the United States . The age group (SO-above

,how

ever,contains a much lower percentage of first admissions in

Georgia or Alabama than in I llinois or the United States . Themost pertinent hypothesis to exp lain this discrepancy seemsto be that Illinois and the United States have a much higherpercentage of the mental disorders associated with advan cedage. Data partly confirming this viewpoint are available.

Cerebral Arteriosclerosis and Seni le Dementia account forthe following percentages of first admiss ions in the several areasGeorgia, Al abama, Illin ois

,United States,

Also it is possible that the ag ed, mentally infirm are morefrequently cared for at home in Georgia and Alabama than inIl l inois .

Negroes have a higher percentage of first admiss ions underage 20 than do the whites, and the whites have a higher percentage Of first admissions in the group 60-above than do theNegroes . Thi s is expla ined in p art by the higher mortalityrates at the upper age ranges among Negroes as compared withwhites .

EDUCATIONAL STATUS OF FIRST ADMISSIONS

(U ) The percentag e of first admissions classified as illiterateis very high in Georgia and Al abama as compared with Illinoisand the United States , whereas the percentages of first admissions classified as common school and high school are muchhigher in Illinois and the United States . This reflects the factthat Georgia and Alabama each have a relatively poor educational system as compared with Ill inois and the Uni ted Statesas a whole .

(V ) The percentage of first admi ssions with relatively loweducational achievement is much higher for Negroes than forwhites ( data are available only for Georgia and Alabama ) ,whereas the percentage of first admi ss ions with relatively higheducational achievement is much lower for Negroes than forwhi tes . One possible explanation of this finding lies in the factthat educational facilities for Negroes are much less adequatethan the educational facilities for whites in Georgia and Alabama .

5 Se lected from unpublished data p repared by the author .

7 5

(W ) The incidence of illiterate first admi ssions pergeneral population is almost twice as high in Illi nois and theUnited States as in Georgia and in Alabama . One hyp othesisadvanced to explain this phenomenon is that

, becaus e of thecomplexity of environment, the lack of an adequate educationmakes the problem of personal and social adjus tment muchmore d ifficult in Illinois and the United States as a whole thanin Georgia or Al abama . Cas te and class in the South make adi fferential in the nature of the status to be maintained, andthe Negro “marg inal man

”l tends to leave the South .

(X ) The incidence of illiterate first admissions perilliterate general population is higher for males than for females . This factor is possibly related to the relatively moredifi icult pos ition of the male as chief provider. The male

,as

an earner,is probably much more handicapped by the lack Of

adequate education than the female .

(") The incidence of ill iterate first admissions pergeneral popul ation is higher for whites than for Negroes . Thisfact seems to indicate that the lack of education presents a muchmore serious problem to the whi tes than to the Negroes ; i . e .

,

the Negro can make a fairly comfortable adjustment ( at leastcomparable to other members of his race ) without the benefitof educational training.

The chronological age of first admissions undoubtedly in

fluences the above results , since the Older groups as a wholehave received much less academic training than the youngergroups . Furthermore

,the presence of foreign-born whites in

some ar eas probably alters the relative incidence of insanityin the various educational classifications . The natur e and extent Of any such influence cannot be determined adequatelyfrom the present data .

76

SOURCES OF DATAAnnual Rep orts of th e Board of Trustees of th e Georgia S anitar ium,

Mi lledgevi lle, Georgia, 1923' through 193 2.

Rep or t of th e Trustees of th e Alabama Insane Hospita ls . 1923

through 193 2.

S tate of Illinois , Department of Publ ic Welfare , Rep ort of S tatis tician, 1923 through 193 1 , and 193 3 .

Uni ted S ta tes Depar tment of Commerce, Bureau of th e Census ,P atients in H ospita ls for Menta l Disease, 1923 and 193 3 .

DA"TON , NEIL A. A New S tat is tical Sys tem for th e S tudy ofMental Diseases and S ome of the Atta ined Results , D ivis ion of.S tatis tics and Research , Mas sachusetts S tate Depar tment of MentalD iseases , repr inted from th e"line Memor ia l Bulletin, Apr il , 193 4.

DA"TON , NEIL A. Th e F irs t"ear of th e New S tandard Nomenclature of D iseas es in Mas sachusetts Mental Hospitals ,” repr intedfrom Th e. Amer ican Journal of P sych iatry, November , 1 93 5 .

A B ill , Georgia E ducation Journal, Decembe r , 193 6 , V olume 29 ,

No . 4, p . 9 .

SORO"IN , ZIMZMERMAN,GALP IN , S ys tematic S ource Book in Rural

S ociology . Univers i ty of Minnesota Press , 1932, 3 V olumes .

77