Science  /  Book Excerpt

On Early 20th-Century America’s Unhealthy Fixation with ‘Hygiene’

Junk Science, paternalism, and a misplaced faith in 'expertise.'
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The story of mental hygiene begins in 1909, when Meyer co-founded the National Committee on Mental Hygiene, with a mission to research the social and environmental causes of mental illness and to develop strategies for ameliorating them.

In setting up this committee, Meyer worked (not always very harmoniously) with former asylum patient and wealthy citizen activist Clifford Beers. In 1908 Beers had published a widely noted memoir, A Mind That Found Itself, in which he described his appalling experiences in a mental hospital. He himself had originally envisioned a movement focused on reforming the often abusive and underfunded state hospital system, and had reached out to Meyer for help. Meyer persuaded Beers to focus instead on reducing the number of people who ended up in such institutions in the first place.

And as mentioned, Meyer coined the term mental hygiene for this initiative, thereby aligning it with other public hygiene movements of this time: social hygiene (which aimed to combat promiscuity and reduce the spread of sexually transmitted diseases), physical hygiene (which aimed to teach habits of cleanliness, good nutrition, and fitness), and what was sometimes called race hygiene (eugenics, in which Meyer of course was also active). All of these movements in turn came of age during a period in the early 20th century known as the Progressive Era, when the United States was first coming to terms with the effects of rapid industrialization, urbanization, and immigration.

The Progressive Era was marked by great moral contradictions. It was a time when so-called robber barons—late 19th-century American businessmen like the Carnegies and the Rockefellers—made huge wealth by exploiting workers and using cutthroat business methods, but it also saw the establishment of the first worker unions and efforts to improve child labor laws. The National Association for the Advancement of Colored People was established in 1909, even as Jim Crow segregation laws structured virtually all aspects of American life. White suffragettes fought to extend the vote to women, but did so in ways that often explicitly contributed to black disenfranchisement. Finally, it was the age of the expert, when lots of things were supposedly going to be fixed by the people who knew best.

With the help of other prominent figures in the field, Meyer and Beers’s movement of experts aimed to broaden psychiatry’s remit along preventive lines. Psychiatrists should no longer sit in their cavernous hospitals, waiting for mentally ill patients to come to them. They should instead seek to combat incipient mental illness before institutionalization was needed. In setting this goal, the mental hygienists created a new kind of patient for psychiatry: the so-called maladjusted person, also a term coined by Meyer.