This article was downloaded by: [The University of Manchester Library]On: 02 November 2014, At: 12:59Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Religious Education: The officialjournal of the Religious EducationAssociationPublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/urea20

IV STATISTICS OF ALCOHOLICMENTAL DISEASEBenjamin MalzbergPublished online: 28 Jul 2006.

To cite this article: Benjamin Malzberg (1944) IV STATISTICS OF ALCOHOLIC MENTAL DISEASE ,Religious Education: The official journal of the Religious Education Association, 39:1, 22-30,DOI: 10.1080/0034408440390105

To link to this article: http://dx.doi.org/10.1080/0034408440390105

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information(the “Content”) contained in the publications on our platform. However, Taylor& Francis, our agents, and our licensors make no representations or warrantieswhatsoever as to the accuracy, completeness, or suitability for any purpose of theContent. Any opinions and views expressed in this publication are the opinions andviews of the authors, and are not the views of or endorsed by Taylor & Francis. Theaccuracy of the Content should not be relied upon and should be independentlyverified with primary sources of information. Taylor and Francis shall not be liablefor any losses, actions, claims, proceedings, demands, costs, expenses, damages,and other liabilities whatsoever or howsoever caused arising directly or indirectly inconnection with, in relation to or arising out of the use of the Content.

This article may be used for research, teaching, and private study purposes. Anysubstantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,systematic supply, or distribution in any form to anyone is expressly forbidden.

Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions

Dow

nloa

ded

by [

The

Uni

vers

ity o

f M

anch

este

r L

ibra

ry]

at 1

2:59

02

Nov

embe

r 20

14

IV

STATISTICS OF ALCOHOLIC MENTALDISEASE*

BENJAMIN MALZBERG**

THE ALCOHOLIC psychoses are ofgreat interest and importance to spe-

cialists in mental diseases because of thevariety of problems that they presentwith respect to etiology and therapeutics.But these psychoses go far beyond theboundaries of medicine. They are inter-woven with problems that appeal to thebiologist and anthropologist, the socio-logist, the statistician and the economist.As in the case of suicide, the centralfigure is the afflicted individual, but fora more complete understanding of theproblem one must consider forms ofgroup behavior.

In the course of my remarks I shalldiscuss the relations of the alcoholicpsychoses to many factors that are bi-ological rather than social, such as sexand race. Nevertheless, I believe thatthe variations in the prevalence of thealcoholic psychoses in relation to thesebiological factors may be better under-stood in terms of culture and of socialbehavior. In other words, the biolog-ical factor is incidental, or rather it isthe background upon which the socialforces operate.

We may begin with a description ofthe prevalence of the alcoholic psychosesin the United States.

Our knowledge of the prevalence ofthe alcoholic psychoses derives from aconsideration of the number of first ad-missions to mental hospitals with such

*Condensed from a lecture delivered at theSchool of Alcohol Studies, Yale University,July 30, 1943.

**New York State Department of Mental Hy-giene

disorders. In addition to the first ad-missions with such disorders, these hos-pitals also receive patients for treatmentfor conditions resulting from alcoholismwithout an accompanying psychosis. Thisprocedure is not uniform, however, fromstate to state. To achieve uniformity,therefore, we shall consider only thoseadmitted to the hospitals with a definitediagnosis of alcoholic psychosis.

In the case of the alcoholic psychoses,it is probable that the overt behavior ofthe patient is such that a relatively small-er proportion fail to reach the hospitalat some stage in the course of the diseasethan is true of other groups of mentaldisorders. Nevertheless, we must recog-nize that the alcoholic psychotics admit-ted to hospitals are only a part, albeit alarge part, of the universe constituted byall alcoholic psychotics. This fact is ofsignificance in interpreting the statisticsof first admissions with such psychosesin relation to their general prevalence.The rate of first admissions may varyfrom place to place for reasons unrelatedto the general prevalence of the diseaseitself. Some communities may be ad-vanced in their social views and provideadequate hospital accommodations forsuch patients. Other communities orstates may be relatively backward insuch respect.

Such considerations will affect the in-terpretation of statistics with respect tothe relative prevalence of the alcoholicpsychoses. The first attempt at measur-ing the prevalence of these disorders maybe found in the report on the insane andfeeble-minded in institutions in the

22

Dow

nloa

ded

by [

The

Uni

vers

ity o

f M

anch

este

r L

ibra

ry]

at 1

2:59

02

Nov

embe

r 20

14

STATISTICS OF ALCOHOLIC MENTAL DISEASE

United States in 1910, issued by the Bu-reau of the Census. In all prior censusreports no attempts had been made todifferentiate patients according to type ofpsychosis. In 1910, however, the Bureauof the Census singled out general paresisand the alcoholic psychoses because oftheir special interest with respect to eti-ology and to the social implications ofthese diseases. In that year 60,769 pa-tients were admitted to all hospitals forthe insane in the United States, of whom6,122, or 10.1 per cent, had an alcoholicpsychosis. The admission rate was 6.7per 100,000 population. The rates variedgeographically within wide limits.

time to any hospital for the treatment ofmental disorders. These standards weregradually introduced into all mental hos-pitals through the joint efforts of theNational Committee for Mental Hygieneand the American Psychiatric Associa-tion, and were used by the Bureau ofthe Census in the analysis of patientsadmitted to hospitals for mental diseasein 1922.

In that year there were 71,676 firstadmissions to all hospitals for mentaldisease in the United States, of whom2,693, or 3.8 per cent, were first admis-sions with alcoholic psychoses. The rateper 100,000 population was 2.6. This

TABLE 1.

NUMBER OF FIRST ADMISSIONS TO HOSPITALS FOR MENTAL DISEASEIN THE UNITED STATES, 1922, CLASSIFIED BY

GEOGRAPHICAL DIVISIONS*First admissions with alcoholic psychoses

Totalfirst

Division admissionsUnited States 71,676New England 7,865Middle Atlantic 15,426East North Central 15,542West North Central 8,028South Atlantic 8,420East South Central 4,490West South Central 4,656Mountain 1,426Pacific 5,823•Compiled from data on pages 170 and 176 ofIssued by Bureau of the Census.

Number2,693

474569758212158

6210767

286

Per cent ofTotalfirst

Admissions3.86.03.74.92.61.91.42.34.74.9

Rate per100,000

generalpopulation

2.66.42.63.51.71.10.71.02.45.1

Patients in Hospitals for Mental Diseases.

Too much stress need not be placedon these results, inasmuch as the report-ing by diagnoses had not been standard-ized and no differentiation was made be-tween new cases of mental disorders andreturn cases. A great refinement in thestatistics of mental disease was made inthe next decade, when a standard classi-fication of mental disorders was drawnup by the American Psychiatric Associ-ation, and it was also decided to measuretheir prevalence on the basis of the num-ber of first admissions, the latter beingdefined as patients admitted for the first

represents a marked decline since 1910.As will be shown presently the year 1922was close to the period of the lowestrates of first admissions with alcoholicpsychoses.

The rates were clearly highest in thedivisions comprising the industrial statesof the North and Northeast, and on thePacific coast, and lowest in the divisionsformed by the southern states. Does thisindicate corresponding differences in thereal prevalence of the alcoholic psycho-ses ? The low rates in the South must beattributed in part to the absence of suffi-

Dow

nloa

ded

by [

The

Uni

vers

ity o

f M

anch

este

r L

ibra

ry]

at 1

2:59

02

Nov

embe

r 20

14

24 RELIGIOUS EDUCATION

cient facilities for treatment, in conse-quence of which many alcoholic psychot-ics failed to be enumerated. This is true,especially, of the southern states withlarge Negro populations, many of whom,perhaps the majority, did not seek ade-quate treatment in the first place, anddoubtless would have found no facilitiesfor treatment even if they had sought it.The results of such a social factor isseen in the fact that Negroes had higherrates than whites in Northern divisionssuch as New England and the MiddleAtlantic, but lower rates in the Southerndivisions. The consequence was that the

of the Southern divisions and the otherdivisions are not as high as implied bythe crude statistics.

Since 1926 the Bureau of the Censushas issued annual statistical reviews deal-ing with patients in state hospitals. Thelatest available data are for 1938. Thesereviews enable us to trace the trends infirst admissions to the state hospitalsduring the years 1926 to 1938, inclusive.

It is true that these data relate only tostate hospitals, but since they includethe great bulk of the patients received inall hospitals for mental disease, thetrends may be considered significant.

NUMBER OF FIRSTHOSPITALS

Division 1926United States 2.0New England 4.8Middle Atlantic 2.8East North Central 2.4West North Central 0.8South Atlantic 1.1East South Central 0.6West South Central 0 SMountain 0.8Pacific 2.6*Compiled from annual

"RHT*PHII of thf* f~*f*n ii1 i 111 CdLl UX l l i C v**vllSL*o»

tNo data available.

ADMISSIONS 'FOR

per1927

2.24.93.03.01.21.60.80.71.02.6

MENTAL100,0001928

2.35.53.03.01.11.10.60.61.34.0

reports on ;

TABLE

WITH

2.

ALCOHOLIC PSYCHOSES TODISEASE IN THE UNITED STATES.

i POPULATION, 1926-1938*1929

2.35.82.92.81.11.70.90.91.32.5

19302.24.72.92.41.1t

0.61.01.72.9

patients in

19312.45.83.32.61.11.90.81.01.33.4

19322.24.53.12.51.21.40.70.81.32.8

19332.75.14.22.71.62.31.2OS1.24.0

i

19342.75.54.22.91.51.60.70.91.43.6

19352.64.84.03.01.21.70.71.11.24.0

hospitals for mental diseases

19362.74.84.13.11.41.80.7131.84.5

STATE

19372.86.24.13.11.31.80.7071.55.3

i, issued by

19382.75.73.73.11.41.60.8081.24.5the

low admission rate for Negroes in theSouth reduced the general rate of firstadmissions with alcoholic psychoses inthe South in the presence of a larger pro-portion of young persons; i. e., thoseunder 20 years of age, for the alcoholicpsychoses are extremely rare at suchages.

On the other hand, it is known thatdrinking is more prevalent in industrial-ized, urban areas, which predominate inthe North. The Pacific coast has prob-lems peculiar to itself, largely because ofthe phenomenon of migration. It isprobable, then, that the rate of alcoholicpsychoses is really lowest in the South,though the differences between the rates

(See Table 2.)

A clearer picture of trends with re-spect to alcoholic disorders may be ob-tained from a consideration of data forstates, with relatively long statistical his-tories such as New York. Standards ofadmission have also been uniform in thisstate during the periods to be considered.(See Table 3.)

Records of first admissions with alco-holic psychoses to the New York civilState hospitals are available since 1909.Because of the long history and the uni-form standards under which these datawere compiled, these data are of greatinterest.

Dow

nloa

ded

by [

The

Uni

vers

ity o

f M

anch

este

r L

ibra

ry]

at 1

2:59

02

Nov

embe

r 20

14

S T A T I S T I C S OF A L C O H O L I C M E N T A L D I S E A S E 25

T h e y show that there was a downwardtrend in such psychoses from 1909 to1920. T h e only exception to the t rendwas a slight increase in 1916, which mayhave resulted from the social excitementfollowing the outbreak of the first W o r l dW a r . Between 1917 and 1920, however,there was a rapid decrease in the rate offirst admissions with such psychoses, un-

of the N e w Y o r k Sta te Depar tment ofMental Hygiene.

T h e rate of first admissions with alco-holic psychoses var ies with the age andsex proport ions of the general popula-tion. The re are practically no such casesprior to the th i rd decade of life andtheir number and rate decrease rapidlyafter 60 years of age. These psychoses

Year19091910191119121913191419151916*19171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942

TABLE 3.FIRST ADMISSIONS WITH ALCOHOLIC PSYCHOSES

TC

Males43345244443443834825521543725720490

167194220302341333440430459445497462556724620638714679725713785745

) T H E NEW

NumberFemales

1281311471311341169082

157976532263256718189

1147978

100102131150160164188163152143155177164

YORK

Total561583591565572464345297594354269122193226276373422422554509537546599593706884784826877831868868962909

CIVIL :STATE HOSPITALS, 1909-1942Per Cent of First

Males15.615.314.714.413.710.47.88.4

12.17.35.82.74.65.16.18.28.88.4

10.19.19.79.09.88.39.3

11.610.110.010.510.110.510.411.210.6

AdmissionsFemales

5.85.05.54.84.73.63.13.54.83.02.01.00.81.01.72.22.32.73.22.02.02.42.42.93.03.13.03.42.82.62.32.52.72.4

Total10.810.510.49.89.47.45.66.18.65.24.01.92.83.24.05.45.7

.5.87.05.96.36.06.55.86.57.86.86.97.06.66.66.77.16.6

Number ;General

per 100,000Population

Males Females Total9.79.99.69.39.27.35.35.98.85.14.01.73.23.64.15.56.25.97.67.27.57.17.87.28.7

11.29.69.8

10.910.310.910.711.711.0

2.92.93.22.82.82.41.92.23.21.91.30.60.50.61.01.31.51.62.01.31.31.61.62.12.32.52.52.92.52.32.12.32.62.4

6.36.46.46.16.14.93.64.16.03.52.61.21.82.12.63.43.83.74.84.34.44.34.74,75.56.86.06.36.66.36.56.57.16.7

*First admissions were for 9 months due to change in fiscal year; rates estimated for 12months.

doubtedly due to W a r time restrictionswith respect to the sale of alcoholic bev-erages. Since 1920, however, the rate offirst admissions has, with a few minorfluctuations, risen steadily, until todaythe rate exceeds that of 1909, and is atthe highest level in the recorded history

are also more frequent among malesthan females. Consequently, variations inrates as between different communitiesor in the same community over long in-tervals of time may be due to shifts inage and sex proportions of the generalpopulation. In order to rule out such

Dow

nloa

ded

by [

The

Uni

vers

ity o

f M

anch

este

r L

ibra

ry]

at 1

2:59

02

Nov

embe

r 20

14

26 RELIGIOUS EDUCATION

shifts, I calculated average annual ratesof first admissions to all hospitals formental disease in New York State inthree periods — 1919 to 1921, 1929 to1931, 1939 to 1941. By appropriate sta-tistical procedures, I made the rates forthe two latter periods comparable witheach other and with the rates for 1919-1921 by using the age and sex propor-tions of the population of New YorkState in 1920 as the standard for com-parison. I then found an average annualrate in 1919-1921 of 3.58 per 100,000population aged 20 years and over. In1929-1931, the rate was 7.95. In 1939-1941 it was 10.60. In 20 years, there-fore, the rate had almost tripled. Amongmales the rate increased from 5.61 in1919-1921, to 13.47 in 1929-1931, to17.60 in 1939-1941. There was a signifi-cant but smaller increase among femalesfrom .64 in 1919-1921 to 2.55 in 1929-1931, to 3.76 in 1939-1941.

Around 1910 first admissions with al-coholic psychoses represented approxi-mately 10 per cent of all first admissionsto the New York civil State hospitals.(See Table 3.) As a result of the down-ward trend from 1909 to 1920, the alco-holic psychoses formed a decreasing pro-portion of all first admissions, reachinga minimum of 1.9 per cent in 1920. Withincreasing rates of first admissions, thealcoholic psychoses formed increasingpercentages of all first admissions, reach-ing 7.0 per cent in 1927. Since the latteryear the percentage has risen at a muchlower rate. This slowing-up process isdue to the fact that other groups of psy-choses, notably psychoses with cerebralarteriosclerosis, have been increasingeven more rapidly than the alcoholicpsychoses.

Now, to what may we attribute theshifts in the trend of first admissionswith alcoholic psychoses? Was the re-duction between 1910 and 1922 due to adecrease in the proportion of the suscep-tible, and did the trend increase after1922 because of a growth in the

proportion of dysgenic individuals?The first part of the trend — theperiod of decline — runs counter to allthat the proponents of the theory of racedegeneration have maintained. They tellus that for various reasons, such as thedifferential birth rate, and mass immi-gration, the categories of the physicallyand mentally defective have increasedsteadily in number for at least half acentury. Obviously, this cannot applyto the alcoholic psychoses prior to 1922,for they were decreasing in prevalence.What, then, about the rising trend since1922 ? Did a period of racial decline setin at that time? This is a rhetorical ques-tion and hardly requires a detailed an-swer. Is it not more reasonable to as-sume that there is a more or less con-stant level of unstable individuals, andthat in addition there may be more orfewer affected individuals, dependingupon the play of social forces that en-courage or discourage excessive drink-ing?

Whatever may have been the reasonfor the declining trend prior to 1915, itis clear that the further decline between1917 and 1920 was due to the social fac-tor of War-time restriction of the saleof alcoholic beverages. Long before therepeal of the 18th Amendment, the rateof first admissions with such psychosesbegan to rise. This period is still closeenough for most of us to recall the his-tory of law-enforcement — or rather in-ability to enforce — and also to recall therelaxing of standards of personal behav-ior in all directions. It is social factorssuch as these that determine the courseof the alcoholic psychoses and that makethe problem of prevention in large parta social rather than an individual task.

We may now consider certain selectedcategories — for the most part demo-graphic — in accordance with whichthere are significant variations in therelative prevalence of the alcoholic psy-choses.

Dow

nloa

ded

by [

The

Uni

vers

ity o

f M

anch

este

r L

ibra

ry]

at 1

2:59

02

Nov

embe

r 20

14

STATISTICS OF ALCOHOLIC MENTAL DISEASE 27

NATIVITY

During the three years ended June 30,1941, native whites in New York Statehad an average annual rate of first ad-missions with alcoholic psychoses of 6.02per 100,000 population. Males and fe-males had rates of 10.38 and 1.77, re-spectively. During the same period, for-eign whites had an average annual rateof 10.26, with averages of 16.26 and 3.96for males and females, respectively.Thus, the foreign rate exceeded that ofnatives in the ratio of 1.7 to 1, an excessof 70 per cent. The rate of foreignmales was in excess by 57 per cent, thatof foreign females by 124 per cent. Butsince we know that the rates are influ-enced by the varying age distributions ofthe several populations, we must correctfor this factor.

If we make the age and sex propor-tions comparable, we then find rates of10.36 and 8.94, for the native and foreignwhites, respectively. In other words, in-stead of being in excess, the foreignwhites really had a lower rate than thenative whites. Foreign white males hada corrected rate of 13.74, compared witha rate of 18.47 for native white males.Foreign white females, however, still re-mained in excess over native white fe-males, with rates of 3.49 and 3.09, re-spectively, though the age adjustment re-duced the excess from 124 per cent toonly 13 per cent. Even this, however, isspurious, because of the influence ofdifferential environment.

I shall show presently that the rates offirst admission are higher in urban thanin rural areas. The rate is also higherin New York City than in the smallerurban communities. Foreigners are con-centrated in urban areas, and especiallyin New York City. We may thereforemake the following direct comparisons.In all urban areas of New York State therate was 22.36 for native white males,and only 14.59 for the foreign whitemales. Among females, the correspond-ing ratios were 4.82 and 3.78. Hence,

for broadly equivalent environments theforeign females had a slightly lower ratethan the natives. In New York City therates were 25.45 and 14.99 for nativeand white foreign males, respectively,and 4.14 and 3.99 for the correspondinggroups of females. In the remainingurban groups, the rates were 18.09 and9.91 for native and foreign white males,respectively, and 3.37 and 2.95 for thecorresponding females.

Among the rural populations, the rateswe're 5.49 and 4.24 for native and foreignmales, respectively. There were no alco-holic psychotics at all among foreign fe-males in the rural population, though na-tive white females had a rate of 0.33.Hence, I conclude, contrary to what hasbeen almost universally believed in thepast, that foreign whites, at least in NewYork State, have lower rates of alcoholicpsychoses than the native born whites. Ifirst showed the probability of this, whenanalyzing the data for New York Statefor the three years 1929 to 1931, and Ithen showed that when we made thecomposition of the native and foreignwhites comparable by adjusting for age,sex, and environment, there was no dif-ference at all in the rates of the twogroups. In the succeeding decade, how-ever, though the rate of first admissionswith alcoholic psychoses increasedamong both native and foreign whites,there was a greater relative increaseamong the native whites.

PARENTAGE

An important basis of comparison isin connection with the parentage of thenative white population. The native pop-ulation is usually divided into three cate-gories, namely: natives of native parent-age, natives of foreign parentage, andnatives of mixed parentage. The dataessential for an analysis along these linesare not yet available for 1940. But apartial analysis was made for New YorkState, using the appropriate first admis-sions during the three years ended June30, 1931. This analysis was partial only,

Dow

nloa

ded

by [

The

Uni

vers

ity o

f M

anch

este

r L

ibra

ry]

at 1

2:59

02

Nov

embe

r 20

14

28 RELIGIOUS EDUCATION

because I was unable to complete theanalysis with respect to environmentaldistribution. By adjusting for age, Ifound that the native and foreign whiteshad the almost equivalent rates of 6.3and 6.7 respectively. Natives of nativeparentage had a lower rate, 4.6, but na-tives of foreign parentage had a rate of8.3, and natives of mixed parentage hada rate of 8.5.

The interesting point is that the for-eign white had a lower rate than eitherof the generations with foreign parent-age. This is not a biological phenom-enon. It could have resulted only fromchanges in the drinking habits of theyounger generations. The latter unques-tionably have acquired the general stand-ards of the larger urban communities,where they reside for the most part, withrespect to both amount and kinds ofliquor consumed.

RACE

We know that attitudes towards theuse of alcohol differ from country tocountry. As there are accompanyingdifferences in these countries with re-spect to race — for example, Italians asagainst Swedes — we might expect racialdifference with respect to the prevalenceof the alcoholic psychoses. Unfortunate-ly, statistics with respect to race are verydifficult to obtain and are notoriouslyuntrustworthy. In the United States theonly racial differences reported upon reg-ularly are those describing the popula-tion in terms of color — white, Negro,Chinese, Japanese, Indian. In New YorkState only the white population and theNegroes furnish sufficient material tojustify any analysis. We may, therefore,consider the relative prevalence of alco-holic psychoses among Negroes andwhites in New York State. It is muchbetter to use such material than to con-sider the country as a whole, or evensome of the Southern states, because inthe latter cases the approximation of firstadmissions to the true total of such casesis grossly in error.

Using first admission to all hospitalsfor mental disease during the years 1929-1931, I showed that average annualstandardized rates of first admissionswith alcoholic psychoses were 22.2 per100,000 Negroes and 6.5 for the whitepopulation, the former being in excess inthe ratio of 3.4 to 1, an excess of 240per cent. Among males, the rates were33.3 and 11.1 for Negroes and whites, re-spectively, or an excess among Negroesof 200 per cent. Among females thecorresponding rates were 11.4 and 2.0,the Negro rate being in excess by 470 percent. Not only do these statistics indi-cate an excessive prevalence of alcoholicmental disease among Negroes, they alsoshow a special problem among femaleNegroes. The rate of white males ex-ceeds that of white females in the ratioof 5.5 to 1, but that of the Negro malesexceeds that of Negro females in theratio of only 2.9 to 1. Thus, the alcoholichabits of Negro females approximatemuch more closely to those of Negromales, than do white females to those ofwhite males.

The experience of New York Stateduring the three years 1939-1941 corrob-orates that of the preceding decade.Using the indirect method of standard-izing, the average annual rate of firstadmissions with alcoholic psychoses toall hospitals for mental disease was 38.26for Negroes and 9.73 for whites, an ex-cess in the ratio of 3.9 to 1. For males,the rates were 60.54 and 16.73, respec-tively, a ratio of 3.6 to 1. Among fe-males, the ratios were 17.78 and 3.15,respectively, a ratio of 5.6 to 1. However,the great bulk of the Negroes were inNew York City, whereas the whites ben-efitted by reason of their relatively largenumbers in the smaller cities and in ruralareas. Basing the comparison upon resi-dents of New York City, I obtained thefollowing results — Males: 69.00 and20.58 for Negroes and whites, respec-tively, a ratio of 3.3 to 1. Females: 18.23and 4.21 for Negroes and whites, respec-

Dow

nloa

ded

by [

The

Uni

vers

ity o

f M

anch

este

r L

ibra

ry]

at 1

2:59

02

Nov

embe

r 20

14

STATISTICS OF ALCOHOLIC MENTAL DISEASE 29

tively, a ratio of 4.3 to 1. Bothsexes: 41.44 and 12.03 for Negroes andwhites, respectively, a ratio of 3.5 to 1.Thus, on a more equivalent environ-mental basis, the relative excess of Negrorates over whites was reduced, thoughthe Negro rates remained much higher.

I have had occasion to give muchthought to the significance of such differ-ences, and I had to decide whether theyare an expression of race or of specialenvironmental conditions. As far asNew York State is concerned, I am in-clined to accept the environmental ex-planation. "Drinking is largely a matterof social stimulation. Where saloonsabound there is much drinking. SinceNegroes are forced to live in neighbor-hoods of low standards, there is in con-sequence a constant encouragement toexcessive drinking. It is highly probablethat any population living in such anenvironment will have high rates of al-coholic psychoses."

However, there is one important qual-ification to the latter conclusion. Jewshave often lived under squalid condi-tions, yet all investigations have shownthat Jews not only have lower rates ofalcoholic psychoses than non-Jews, butthat their rate is phenomenally low. Thishas usually been attributed to the influ-ence of race, it being assumed that selec-tion had weeded out those Jews who be-came addicted to drink. There is noevidence of any such biological selection.On the other hand, we know that amongthe great masses of Jews in Eastern Eu-rope, excessive drinking was rare, be-cause the Jewish tradition was opposedto it. This tradition was largely of areligious origin. Furthermore, Jewishfamily life was very close, and was asso-ciated with a religious rather than witha secular view of life, and strict con-cepts of family life also opposed exces-sive drinking.

The preceding description applies tothe Eastern European Jew. In the courseof the migration westward, the tradition

is being gradually modified. The processis very clear in the United States. Thegeneration of Jews coming to the UnitedStates from about 1880 to 1890 broughtwith them the religious and social tradi-tions of Eastern Europe with respect tothe use of alcohol. This tradition beganto be breeched by the next generation,which rapidly absorbed the more secular-ized atmosphere of this country. Therewas more drinking, but it was still withinmoderate bounds. In the third and con-temporary generation, the habits with re-spect to drink differ very little fromthose to be found among all Americanyouth of similar social class, and thereare few who will deny that drinking hasincreased markedly among Americanyouth in the past two decades.

This indicates so rapid a change insocial habits, that some may be inclinedto question its reality. But it is not sostrange, when we consider that otherchanges sometimes confused with biolog-ical phenomena have occurred even morerapidly. For example, the birth rate hasbeen declining generally. Among Jewsthere also has been a declining birth rate,but the rate of decline is almost phenom-enal. The first generation of Jews in theUnited States, i. e., those coming between1880 and 1890 had families of 10 ormore children. In the next generation,composed partly of those who came tothe United States as children, and partly.of those born in the United States, theaverage number of children per familydropped to no more than 4, a decreasein one generation of at least 60 per cent.The next generation — the grand chil-dren — will almost certainly produce anaverage of no more than 2 children perfamily, and possibly even less. Theirbirth rate is not only less than that ofnon-Jews, but the rate, if continued, willnot permit of group survival. Now, everyinformed person knows that the decreasein the birth rate of Jews has nothing todo with any biological factor. It is dueentirely to social phenomena, primarily

Dow

nloa

ded

by [

The

Uni

vers

ity o

f M

anch

este

r L

ibra

ry]

at 1

2:59

02

Nov

embe

r 20

14

30 RELIGIOUS EDUCATION

an effort to imitate the standards of theAmerican people as a whole, and to per-mit a rise in the economic standard ofliving. At the same time there has beena weakening in the intensity of the Jew-ish religious life, orthodoxy giving placeto secularized views of life.

There are few other groups that canbe identified racially in their entirety,but some further ideas may be gainedthrough a consideration of certain fairlyuniformly foreign white groups. Five ofthese constitute large segments of thetotal population of New York State, forexample, those born in Italy, Germany,Ireland, England and Scandinavia (Den-mark, Sweden, Norway). In these pop-ulations we find great variations in therate of first admissions with alcoholicpsychoses. For example, in 1929-1931the foreign-born Irish had an averageannual rate of first admissions with al-coholic psychoses of 30.5 per 100,000population, a rate far in excess of thatof any other group in the State, includ-ing the Negroes. Scandinavians had arate of 7.9, compared with a rate of 6.7for all foreign-born whites. Those bornin Italy, Germany and England, hadmoderate rates of 4.3, 3.8, and 4.8, re-spectively.

The question of course arises, why isthe rate so high among the Irish? Thebest explanation appears to me to be interms of the concept of "social lag". TheIrish brought with them to the UnitedStates the tradition of heavy drinking.This tradition was an outgrowth of thepeculiarly hard conditions of life existingin Ireland in the early 19th century.While conditions have since changed forthe better, such is the strength of socialtradition that it lingers on long after theconditions which gave rise to it. Someevidence in favor of this interpretationis seen in the fact that native born whitesof Irish ancestry had a rate of first ad-missions with alcoholic psychoses justhalf of that of the foreign-born Irish inNew York State. The same phenomenon

occurred among the Scandinavians, thoseborn in New York State of Scandinavi-an parentage also having a rate abouthalf that of foreign-born Scandinavians.Hence we see an adjustment on the partof the American born offspring, who livein between two cultures, that of nativeAmericans and of their foreign parents.With respect to alcoholism they findthemselves between the two, having low-er rates of alcoholic psychoses than theirparents but a higher rate than nativewhite Americans of native parentage.

SUMMARY

We may now state briefly some ofthe significant statistical results with re-spect to the alcoholic psychoses. Thefrequency of these psychoses, as meas-ured by annual rates of first admissionsto hospitals for mental disorders, variesgeographically. It is highest in theNorthern and Northeastern states andon the Pacific coast, and is lowest in theSouth. The rate has varied in time —it decreased between 1910 and 1920, andthen reversed itself, the trend havingrisen steadily since 1920. It seems to methat the variations with respect to geog-raphy and time can be explained best onsociological grounds.

The data discussed show that the prev-alence of the alcoholic psychoses variedin certain important respects. There wasa much greater prevalence among malesthan females. The prevalence was affect-ed by age — there being practically nosuch psychoses among those under 20years of age, followed by a rise to amaximum rate in the 40s and 50s, and adecline at the older ages. In New YorkState, at least, the foreign-born do nothave higher rates of alcoholic psychosesthan the native born. The rates are veryhigh among Negroes and the Irish, andvery low among Jews, and I tried to givehistorical and sociological explanationsfor such variations. I showed that thosepsychoses are most prevalent in citiesand least prevalent among the farm pop-ulation.

Dow

nloa

ded

by [

The

Uni

vers

ity o

f M

anch

este

r L

ibra

ry]

at 1

2:59

02

Nov

embe

r 20

14