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THE STRESS OF MODERN LIFE. ERNEST JONES, M.D. [Lecture delivered before the Charing Cross Road Literary Society on January 18, 190J, and specially reported for the "Cymro and Celt." ] The opportunities that a medical man has for addressing a lay audience are so infrequent that they carry with them a corresponding responsi- bility. I feel this so acutely, that I am im- pelled to address you on a serious subject, but I shall try to stimulate your interest by putting before you some novel aspects of one of the borderlands of medicine, a subject, however, that connects itself with many other spheres of thought, and which constitutes one of the most important problems that modern civilisation now has to face. It is becoming more and more impossible to deal with the larger issues of medical problems without coming into contact social problems "that so often lie at their root. This, of course, is recognised in the case of many physical ailments. The purely medical problem of the prevention of such diseases as tuberculosis, diphtheria, &c., has already been solved. The Science of Medicine can tell you how these diseases may with certainty be prevented. The problem as to the actual prevention of them is purely a social one, depending largely on whether the community thinks it worth while to take adequate measures to prevent them by the adjustment of certain social arrangements. In some instances, chiefly through popular fright at the particular disease, various communities have already done this. Thus England has thought it worth while to abolish hydrophobia, and has of course succeeded. Germany has thought it worth while to abolish small pox, and has similarly succeeded. At some distant date it may occur to us to do the same with a number of other diseases. In the meantime the toll of victims sacrifized to our lazy conservatism on these matters steadily grows. The ultimate ramifications, therefore, of medical and social problems are seen to be inextricably intertwined, and there is no doubt that this is even truer of the problems of mental health than of those of the physical. That this is not often realised in the case of mental suffering is due to the way that we look up3n it, as being due either to personal sin or to inevitable social conditions or to an ex- pression of the evil of the universe, and not, as in the case of physical sufferings, as a patho- logical state that every effort should be made to cure, and one equally amenable to expert treatment. Now I want to try to put before you to- night some connected picture of one aspect of the problem of unhappiness, viewing it as a result of what may be called the stress of modern life. Being fundamentally an optimist, I hold that consideration of this darker side of life may prove a source of hope and stimulation, and not be the gloomy proceeding it would, at first sight, appear. At the same time I differ from those people who use the word optimism to indicate a glossing over certain facts of life, an ignoring of its painful aspects in short, what they call, looking only on the bright side of life. This ostrich-like policy might be successful if, not believing in the existence of misfortune enabled us to avoid or at least ignore it, but unfor- tunately sooner or later we run the risk of being fatally driven into direct contact with certain facts, in such a manner that we can no longer ignore them, and then, if we have previously been denying their existence, we have all the elements necessary for a mental tragedy. I consider that the dark side of life is one emphati- cally to be looked upon as well as the bright side, if we want to attain personal happiness, that is to say, mental health, or to do what we can to secure the happiness of those around us. It is by courageously facing trouble and sorrow that we can best minimise their effects. This, of course, is sharply to be distinguished from the outlook of a pessimist, who maintains the eternal preponderance of evil, against which our struggles are unavailing. While many of us t,9 r5 have moments when there seems to be more than a grain of truth in the pessimistic position, when we seem to have forgotten the savour of life and can find little hope for the future, these moments, as a rule, are but temporary, and we know that sooner or later the joy of life with its interests and satisfactions will return, and we shall be whole again. At least this is so with the healthy mind, but what of the morbid ? What of the mind to whom the world is like a wintry sea, always sullen, grey and threatening, the advancing tide of which may be staved back for a little while, but which sooner or later is bound to engulf us and suck us into its depths where who knows what horrors await us ? There are in this city many thousands of people of whom this description is literally true, who stagger through the world, feebly fighting their Ing n way with black despair ever at their hearts, and who cling to life more from blind instinct than because they find in it anything worth the having. Most of these people started out on their campaign blithely enough and reached their present position, either after a series of crushing reverses, or more often worn out, their courage slowly eroded, by the process we have called the Stress of Modern Life. As we are all more or less exposed to its action, and in danger of its effects, it behoves us all to attempt to under- stand some of the significance of the process, for it is only by cool determination to consider, to face, and to deal with the problems concerned that we can guard ourselves with any certainty from its influence. Now it has been pointed out by some scien- tists that the people I have just described as having failed in life, have gone under in the struggle for existence, that they were therefore not suited to their environment, that the world was too much for them. All this cannot be denied, but the scientists have gone on to main- tain that such individuals were badly equipped at the outset, that they were born to suffering, and that their destruction was the best thing that could happen in a world that wants only the strong and healthy. I need hardly mention how opposed this is to the Christian position, that all, strong and weak, are equally co- inheritors in the kingdom of man, and have all equally souls to be saved, and bodies to be cared for. There are also purely Scientific grounds for dissenting from the conclusions just mentioned, and I propose briefly to deal with these. Modern Psychology, by the investigation of un- happiness and mental misery, with their causes, has shown that the problem is by no means so simple as it would appear to be in the mere statement that certain individuals are unfit or unsuitable for their surroundings or environ- ment. To get a clearer insight into the meaning of this statement, it will be necessary to leave the subject of the human race for a moment, and consider some points in the evolution of the lower animals. It is known that in Nature the survival of a race or species of animals or plants, depends almost entirely on what is called its adaptation to its environment. Under the term environ- ment is included all those external conditions with which the animal or plant may come into relation and which may affect it either bene- ficially or harmfully. Animals that can deal satisfactorily with their surroundings, that can face the emergencies of their environment and conquer its difficulties are likely to survive, whilst those who cannot, tend to be eliminated in the struggle for existence the former class is said to be suitable or adapted to its environ- ment, the latter unsuitable or maladapted. But it is important to note that the environment is not a fixed thing, but is constantly changing to a greater or less degree, and when this happens the race has to change also if it is going to sur- vive. There is no use in a race being well ad- apted to an environment that has ceased to exist; it must keep pace with the times, else it gets out of date. And getting out of date in the world of Nature is a more serious matter than it is in the world of commerce there is no convenient Bankruptcy Court to give the ruined race a fresh start in life it simply drops out of the running, once and for ever. Therefore this race must progress if it wants to survive. A de- scription of how it tries to do this, sometimes succeeding, sometimes failing, would be a de- scription of the great Drama of Evolution, one scene of which I want you presently to view. This gradual evolution of a species to suit its changing conditions is not the only defence that may be adopted against its environment, as we shall see in a moment, but it may be said that the more lowly organised is the animal in ques- tion, the more it is restricted to this method of defence. That is to say, that simple forms of life with a relatively simple environment, deal with changes in this by becoming changed them- selves, so as suit the new conditions. But the higher up in the scale is an animal, the more developed is its power of dealing with such a. change in a second way, namely by actually preventing the objectionable change in the environment. In the history of the world it has many times happened that a race threatened with a dangerous innovation, such as the im- portation of a serious rival, has managed entirely to exterminate this innovation and so go on living once more under unchanged conditions- It is evident that this method, like the first, stakes its existence on success Nature makes no allowance for failure. A study of the behaviour of the higher animals as contrasted with the lower might enable on to predict that man, the highest of all, must depend for his existence much more on the second method of dealing with an adverse environment than on the first, and this we find to be true. Man's capacity to modify his environment is truly enormous; though until our present jostling Anarchy is replaced by unified co-ordination of effort we can have no possible conception as to the extent of this capacity. Slight indications of his power are afforded by reflecting on the way in which whole species of animals have melted away before his ruthless approach even in the past generation it is appalling to think of the extermination he must have effected in the 100,000 years of hig. existence. The undeveloped potentialities of man's capacity for effecting and resisting modifications in his environment compensate for his unstable position that results from the great complexities of his environment. Were it not for this, wholesale failure would ensue, for the more complex the environment the more diffi- cult it is to secure suitability to it by the slow adapting process of evolution. Everthing indi- cates, therefore, that in the future man will rely more and more on his power of modifying an adverse environment, and will develope his intelligence further in this direction, rather than on the tedious process of evolving the whole race so as gradually to adapt it to each little varia- tion in its environment. The facts that these variations are in his case so manifold and in many instances of his own making serve only to emphasise this conclusion and to make us sceptically inclined towards any lightly- suggested proposals to secure more perfect adaptation by gradual evolution through elimi- nation of the unfit. Now it is especially these unfit, the unhappy failures that have gone under in life's struggle, that we are concerned with to- night. Why do they fail ? Can we, and if so, ought we to prevent their failure ? As I hinted above, there are many authorities who maintain that these failures should be eliminated as they are in Nature, and that we should help the elimination of unfit individuals so that the race may become purified, stronger and happier. They would, for instance, not allow people with a family history of insanity or consumption to marry, and would discourage the marriage of highly nervous individuals and those diseased in any way. In spite of the apparent callousness about these Spartan views there is in them a certain quality of grandeur, of public spirited- ness. and of idealism that attracts one. The whole programme has such simplicity, its analogy with what we see in Nature is so manifest, its commonsense seems so obvious, that many even, philanthropic people, have been led into accepting the views. Nevertheless, a