"Silent Snow, Secret Snow"

Do you remember reading this in junior high or high school? I think it may have been assigned reading. It is a powerful, highly evocative, pretty scary short story about a young boy's descent into catatonic schizophrenia.

I'm reading E. Fuller Torrey and Judy Miller's The Invisible Plague: The Rise of Mental Illness from 1750 to the Present (New Brunswick, N.J.: Rutgers University Press, 2001), at the moment. The book presents a lot of what at first glance seems pretty persuasive statistical evidence that there was a quite dramatic rise in psychosis in England & Wales, Ireland, Canada's Atlantic provinces, and the United States from the 17th through the 20th centuries. There is pretty reliable statistical information from mental hospital admissions and government censuses from the start of the 19th century, and Torrey and Fuller make use of detailed records of doctors and hospitals from the beginning of the seventeenth century to corroborate other data from the 17th and 18th centuries that isn't quite as comprehensive.

What makes this so interesting is that Torrey is a big proponent of the biochemical/genetic origin of schizophrenia. All that I have read leads me to agree. Yet he admits that this dramatic rise in the rates raises interesting questions. I've previously mentioned that some studies show a strong correlation between growing up in an urban area, and developing schizophrenia. The Invisible Plague mentions a variety of studies that show the same, and psychiatrists were noticing the strong correlations between urbanization and psychosis as early as the 1920s. If urbanization explains the rise in psychosis over the last few centuries, then it would suggest that genetics could only be one factor--perhaps a predisposing factor. There would have to be some other specifically urban factor that actuates mental illness.

Anyway, back to "Silent Snow, Secret Snow." The author of that haunting story was Conrad Aiken. The Invisible Plague, p. 294 explains why Aiken was interested in the subject of insanity.

His father, a successful surgeon, killed his wife and then himself because of a delusional belief that his wife was going to have him committed to an insane asylum. Aiken, then age eleven, found their bodies. His younger sister became insane in her early twenties and spent much of her life hospitalized. Aiken himself had periods of depression and made at least one serious suicide attempt. He lived his life fearing that he, too, would become insane and in 1932 wrote "Silent Snow, Secret Snow," which he acknowledged was "a projection of my own inclination to insanity."

UPDATE: Torrey and Miller's book has a discussion at 298-299 that does a nice job of summarizing the evidence for a dramatic increase in mental illness in the United States over a century. They point to the 1880 census of insane persons, and something called the Epidemilogic Catchment Area study "carried out from 1980 to 1985 in New Haven, Baltimore, Durham, St. Louis, and Los Angeles." The ECA study found that 2.2 per cent of adults were diagnosed with schizophrenia and bipolar disorder.

The 1880 census of the insane attempted to identify all mentally ill people--not just those in mental hospitals and workhouses (where a lot of the less dangerous mentally ill were kept in many states). The methodologies aren't quite equivalent, as Torrey and Miller point out.

The 1980s study included some individuals who would not have been counted as insane in 1880 (bipolar disorder II, depression with hypomania), and the 1880 study counted some individuals as insane who would not have been included in the ECA study (e.g., epilepsy with insanity).

Yet the 1880 census of the insane found 0.18 per cent of the total population was insane. Presumably after adjusting for the diagnostic category differences, Torrey and Miller assert that the ECA data shows almost a ninefold increase in insanity.

They also point to the data on those receiving SSI or SSDI payments for "mental disorders other than mental retardation." In 1997, that was 2.5 million people--or 0.94 per cent of the population--more than five times the results of the 1880 census of the insane. It is true that there are people collecting SSI and SSDI who are not insane or even disabled (I've known a few over the years), but I would expect that this is probably roughly balanced by the number of Americans who are so severely mentally ill that they aren't collecting SSI or SSDI.