THE PLACE OF MENTAL HYGIENE AT DARTMOUTH
Dr. Aurthor H. Ruggles, class of 1902' organized the first Neuro-Psychiatric Unit to serve in the A. E. F. He was commissioned Major in the Medical Reserve Corps August 9th 1917 and went immediately overseas; was stationed for five months in the Craig Lockhart War Hospital, Edinburgh, Scotland, and was then ordered to France as Psychiatrist to the Second Division, serving in the field with that Division until November 12, 1918. He was then ordered to England as Consultant in Neuro-Psychiatry to the Chief-Surgeon A. E. F. land, and later served for three months as Medical Director of Base Hospital 214 the 'largest hospital for the treatment of nervous and mental diseases in the A. E. F. He was awarded the Croix de Guerre by the French Government for service while with the Second Division and was discharged from the service March 21, 1919. He has served for two years as Consultant m Neuro-Psychiatry for Rhode Island in the United States Public Health Service.—EDlTOR.
At the time of the recent announcement that the Trustees of Dartmouth College had voted to establish a Professorship of Mental Hygiene there were, no doubt, many persons who registered interest as to the need and use of such a Chair in a College. To those who have studied the mental health of the nation and have observed the problems of education, especially as applied to certain types of individuals, this decision of the Trustees is welcomed as progressive and constructive. Dartmouth is the first college in this country and, I believe, in any country to establish a Professorship of Mental Hygiene. Other educational institutions have recognized the importance of this work and have undertaken in various way's to meet the need. West Point has secured a physician with special knowledge of nervous and mental diseases to study the problem there and to endeavor to conserve the mental health of the men being trained for service in the army; Princeton has for a number off years taken cognizance of mental maladjustment among the student body,, has provided lectures dealing with fundamental knowledge regarding the development of the nervous system and the maintenance of normal nervous stability, and has had the nervous and mental difficulties presented by some of the students studied by an expert; Harvard has, in connection with the Department of Hygiene, made a survey of the nervous health of the entering class and has correlated these findings with certain physical data obtained with very interesting results; Smith College has conducted for several years a summer school for the training of psychiatric social workers; but, it has remained for Dartmouth to give this branch of medicine adequate recognition and to establish a full-time professorship. There is every reason to believe that this work, dealing with preventive medicine and the treatment of nervous and mental disorders, will, in the near /future, become a recognized part of the armamentarium of all well-organized colleges and schools.
What is the field for mental hygiene in the colleges? President Hopkins has wisely said, "The first duty of the college is to educate the men sent to it; the second, and of almost equal importance, to send the men out from college with, bodies and minds properly equipped to utilize that education to the best advantage." It is with this second obligation of the college that mental hygiene is directly concerned. To promote the better adjustment of the educated man into the national machinery, to prevent the too frequent attempt to fit round pegs into square holes, to attune the nervous system, to the speed for which it was built, and to prevent the all too frequent mental shipwreck of undergraduate and recent alumnus—this is the field that lies open before the newly-created department.
During the past year more than one thousand men have applied for admission to Dartmouth College who could not be admitted. What a wonderful opportunity for the most careful selection of material! The Department of Mental Hygiene should be of service in the selection of the men who are to enter the freshman class, in utilizing special knowledge to exclude those men with tendencies that definitely unfit them for four years of collegiate endeavor; men who have already in their preparatory school duties shown evidences of marked nervous instability, social tendencies or psychotic trends. What will the professor of mental hygiene find to do with the material already selected to constitute the undergraduate body? First, he should serve as a consultant to the Administrative Department examining those men who have become problems in matters of discipline, in social adjustment and difficulty in carrying on with their studies, and should here detect mental maladjustments and neurotic traits in their incipiency and institute the appropriate corrective treatment. Many times a student will be found suffering from a mental conflict with repression because of financial troubles at home, uncertainty over election to a fraternity or fancied critical attitude of fellow students or faculty. Some such conflicts come to nearly all college men. The normal—and fortunately they make up the vast majority of college men—meet these situations without much difficulty and usually need no specially trained helping hand. It is not with the normal, well adjusted majority that the psychiatrist is especially concerned—it is with those whose nervous systems are below par and are, therefore, points of lowered resistance. Here a trained hand can lift the handicapped man out of the beginning entanglement of doubt, fear and discouragement—teaching him so to order his college activities and so readjust his point of view that he may keep well and prevent the college office from dropping a student who was worthy of training and needed only mental readjustment.
The second part of the work of mental hygiene, and probably later the most important part, would be to make a survey of the students' nervous and mental make-up in conjunction with the Department of Physical Hygiene. Here the student must be studied as to emotional control, volitional capacity, judgment ability, insight and social adjustment. In the first year those individuals obviously unsuited by emotional instability, lack of intellectual capacity, defective insight and without social adjustability for a college education, should be eliminated from the college and helped to seek a level of training in keeping with their endowment,, thus avoiding the waste of time, money and collegiate effort that would only result later in actual mental disorder or add to the ranks of failures of college, men. With those having only certain limitations in the mental make-up, this Department of Mental Hygiene can begin a constructive work that will in many cases prevent ill-advised disciplinary action, intellectual mediocrity or the development of a psycho-neurosis. In this connection the Department of Mental Hygiene should seek the co-operation of the Psychological Department in studying the problems of educational psychology that would enable the men under observation to make the best use of their intellectual efforts—to help them discover latent talents and to shape courses toward a definite end. In brief, the co-operation of these two departments should make it possible for a greater number of college students to approximate an intellectual goal than has ever been accomplished with the older method which was concerned principally with a group rather than the individual, and, if with the individual, rather as a student needing education than as a human being made up of emotions, volitional limitations, conflicts, ambitions and intellectual capacities of varying degrees.
The third division of work for this newly created department of preventive medicine may be as a clearing house for students with difficulties not ordinarily brought to the attention of faculty, college physician, parents, or even the family doctor. By this I mean that many students at one time or another have their work and progress interfered with by difficulties presented in the form of feelings of inferiority, sexual problems, defeated ambitions, shattered ideals or tendencies to radicalism. These perplexities often prove the stumbling block over which the previously efficient student trips, and is unable to regain mental poise and stability sufficient to keep up his class standing without help of an adviser who understands how to treat him as an individual made up of powerful instincts, emotions and conflicts, and is able to teach him how best to direct and control this complex nervous mechanism. As this department should be of advisory service in many collegiate problems, its activities should be co-ordinated with the department for vocational guidance—a department which has already been so well organized at Dartmouth, and it must also receive much help from that department. This co-operation can be brought about by the interchange of knowledge as to men's adjustability in their jobs, their ability to work under supervision, the estimate of them by fellow workers and employers, and what proportion of time is being taken from studies by the work done outside of the class room. The records of the Department of Mental Hygiene, showing the result of the examination of a man at the time of entrance into college, would be of value in determining the type of work suitable for the individual who needs remunerative employment in order to continue his college course, and should prevent many failures and the resulting discouragement brought about by unsuitable occupation. An estimate of the student's adjustability and progress in college, taken together with his inclination and special fitness for certain types of work, as determined by the two departments just mentioned, would furnish the most valuable information in the direction of men in their work following graduation and would, I believe, materially reduce the present loss of time in the hesitation shown by the college graduates in choosing their life work and the subsequent frequent change of work brought about by dissatisfaction or unsuitability for the place selected. If Mental Hygiene can serve in the college world —as it already has many times in the industrial world—to fit men more promptly and more efficiently into their proper field of activity, it will do much toward increasing the world's output of .work and in, bringing contentment to the mind of the worker—thus rapidly justifying its own existence.
. This is but a brief outline of some of the more obvious phases of the work that the Board of Trustees and the President of Dartmouth College presumably had in mind when it was voted to create such a department, but it shows in a measure the wisdom of these men in their earnest endeavor to enable the college to fulfill its obligation to those seeking admission by choosing its student body most carefully, by offering the best education and by sending graduates out equipped with bodies and minds best fitted to use that education.
