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As the result of the influence of religion other words such as carnal, worldly, have come to be stamped with a meaning which makes people understand much better than would otherwise be the case the real significance of indulgence in bodily or mere earthly pleasure. The words are no longer fashionable, but that is because the deeds which they represent have become quite fashionable, and those who affect them do not want to have the innuendo of decadence and wrongful indulgence which necessarily goes with them applied to their acts. Religion has thus created a state of the public mind that has been extremely helpful against sensual pleasures and their power to ruin health, so long of course as religion held its place of influence over men.
Above all religion has insisted, and it is almost the only agency which continues to do so, that there can be no purity with its power for good for the health of both mind and body if the excitants of sensuality are indulged in. There must not only be no doing of evil, but there must be, as far as possible, no thinking about it, and especially there must be no dwelling on sensual pleasure, for bodily cravings will almost surely be aroused that make temptation almost insuperable. To think of delicate viands when one is hungry causes a flow of saliva, making the mouth water, but we know now that it causes a flow of what are called the appetite juices in the stomach which adds materially to the feeling of hunger and would make it very hard to resist taking food if it were placed before one, even though there might be some rather serious dangers connected with its taking. The thirsty soldier finds it extremely difficult to obey military laws with regard to not drinking any water that has not been examined and declared wholesome by the medical regime{201}of the army, and if he should dwell much on his thirst it would make it ever so much harder to restrain if water from outside military sources should be offered to him.
Other pleasures of sense are even more likely to become the subject of almost insuperable temptations if the objects of them are dwelt on. Religion therefore has insisted, and is still insisting, on the necessity of avoiding attendance at such theaters as quite inevitably set up sensual excitation.
Fashion, which is another word for the world—and religion has always pointed out that the three great enemies of the development of the spirit of man are the world, the flesh, and the devil—has always set itself in opposition to religion in the approval of sensual gratification. That conflict is unending. A great many people declare that they would rather be out of the world than out of fashion, and it is surprising what insensate things fashion leads people to. The present fashion for the slow dance with the partners closely wrapped in one another's arms, for that is of course the essence of all the modern dances, no matter what their varying names may be, is only another development of the unending opposition between fashion and religion. Here once more, as with regard to the theater, religion presents the only serious protest. Dame Fashion insists that she sees no harm in it, but that is of course only a fashion of speech. It is quite impossible for a physician to watch the dancing without becoming convinced that human passions must be aroused by such close contact of human bodies of opposite sexes.
In this, however, as in so many other phases of life, only religion can interfere or protest with any hope of success. Her protest remains often unheard; fashion{202}may be almost all powerful even against the higher calls of duty as well as against common sense. Certainly religious influence has had more to do with keeping a great many women from following the dictates of fashion in emphasizing their sex and therefore exciting the men with whom they come in contact than any other single factor. It has not been entirely successful, it never will be; the conflict will go on and worldliness will constantly come to the surface in some form or other, often to the detriment of health; and religion when properly vital will continue to be the most important factor in keeping evil from gaining such ascendancy as would be seriously detrimental to the healthy mind in a healthy body.
Religion is the only agency in the modern time that tries to regulate the reading of young folks and indeed of others in this dangerous matter of sex excitation. A great many books seem to be written at the present time for no other purpose than to excite sex feeling,—and thereby to make money. They depend for their sale entirely on the fact that for a great many people there is a distinct physical pleasure in reading about sex subjects. This is particularly true of women. A great many of them, and especially those who have not very much else to do and who therefore have no proper outlet for animal spirits and for the energies that tend to accumulate in them because they feed well and sleep long, are prone to indulge in this sort of luxury. Most of them would resent the suggestion that it was wrong for them to indulge their feelings in this way, but religion has always taken a decided stand and insisted that the fomenting of desire and the toying with alluring thoughts and the inviting of temptation are of themselves actually sinful. As John Boyle O'Reilly said,
{203}
"Temptation waits for all, and ills will come;But some go out and ask the devil home."
Physicians have always insisted that the sexual erethism which is excited by the reading of books on sex subjects, the attending of sex problem plays and of shows of various kinds is the worst possible background for healthy living. Such frequent titillation of delicate nervous mechanisms plays sad havoc with general nervous control. Unfortunately just those who are indoors a great deal, who take very little exercise, and who live on dainties are most likely to indulge in these habits of life with regard to reading and the theater and dancing and the like which are most harmful for them. They are irritable in the nervous sense and excitable, and this erethism increases their nervous instability which responds by craving further excitement. A vicious circle is formed which very often leads to nervous breakdown. Just now we are hearing much about sexual repression as the cause of nervous disorders, but sexual repression is as almost nothing in its tendency to produce neurotic or psycho-neurotic affections compared to the partial tantalizing, sexual indulgence which comes from sensual reading or lascivious shows. The plays that are seen, the jokes that are heard, the sex problems that are dwelt on, the stories that are read must get more and more spicy and contain more and more sex "pep" to afford any satisfaction, and the consequence is a disturbance of delicate parts of the nervous system which react more or less seriously to lessen the control over the whole nervous mechanism of the body.
When Doctor S. Weir Mitchell pointed out two generations ago that not only headache, but rather serious nervous disturbance involving often the gastro-intestinal{204}tract and sometimes other large organs like the brain itself, as well as even mental operations, might come from so small a cause as disturbance of accommodation in the eye, most physicians refused to believe that such far-reaching symptoms could come from what was apparently so trivial a factor. The accommodation mechanism of the eye is extremely delicate, however, and requires such nice adjustment that any interference with it causes a waste of nervous energy that is likely to make itself felt at almost any part of the nervous system. In our day disturbances of the eye are confessed by all to be extremely important. In something of the same way disturbances of the sexual system of the body are reflected throughout the whole nervous system.
Religion has counseled, commanded and thundered against any practices, however simple they might seem in themselves, that would serve as excitants for the sex feelings. Without her influence even more harm would have been done than has been. It is the waning of religious power over public morality and public opinion that has led to the orgy of indulgence in sexual excitation, which has had such bad effects and which unfortunately so often leads to sexual acts which are fraught with the hideous dangers of venereal disease, because passion excited will find its satisfaction. Society heedlessly arouses passion but apparently cares not what happens afterwards.
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There is a very prevalent impression that religion is a common, even rather frequent cause of insanity. This is founded on popular experience. It has often been noted that not a few of the people who go insane have delusions on religious subjects. It is also a very common observation that those who are on the road to insanity and have finally to be placed in an asylum have for some time been making themselves conspicuous by their excessive practice of religious observances of one kind or another. It is not surprising then that the familiar fallacypost hoc ergo propter hoc, "after this therefore the result of this", should have come to be applied in these cases, and that religion should be set down as a prominent factor of mental disease and perhaps one of the commonest causes of the condition.
Those who have given most study to the subject, however, know very well that this conclusion is quite as unjustified by the facts of the case as the corresponding one with regard to religion being a frequent source of nervous diseases. We will discuss that in the chapter on Nervous Diseases, and almost necessarily the closely related subject of mental disturbances is touched on somewhat there. Of course it is well understood that a great many of those who are on the road to such mental alienation{206}as will eventually require their internment in an asylum will give many external manifestations of religious feelings, some of them exaggerated beyond reason, as perhaps the very earliest striking symptom of their mental alienation. Religion, as we said in the Introduction, is one of the most universal interests of men. When people go insane, some interest will receive exaggerated attention. The delusions of their insanity are dependent on what the deepest interest of the individual was. If he was interested in money, he will believe himself the richest or perhaps the poorest of men. If he is interested in science, his delusions will be associated with that subject. Delusions concerning some phase of science are probably even more common in our day than those based on religion. Electricity is the source of more delusions than anything else, though hypnotism and telepathy and other sensationally exploited modes of so-called psychology are a close second in this respect. If the patient has recently suffered a severe loss by the death of a friend, sorrow will be the central idea of his mental disturbance; if there has been a disappointment in love, that will be the focus of his mental troubles; if there has been a money loss, that disappointment will be the core of the depression. Almost any human interest may thus become the root of excitement or discouragement leading to mania or melancholia.
The Great War gave us some very interesting material as to mental as well as nervous disease. In nothing was that more interesting than as to the causes from which insanity develops. It might very well have been expected that a great many people would break down under the awful conditions in which they were placed during the war. For instance Poland was fought over some six times,{207}and portions of Austria overrun three times, and Servia was, between war and the ravages of famine and disease, a veritable shambles of its people for three or four years. It is easy to understand the awful states of anxiety and solicitude and almost continuous terror to which the inhabitants of Belgium, occupied by the Germans, were subjected, particularly in the smaller places where they were utterly at the mercy of the German officials whose one idea, fostered by their military teaching, was that the end of the war would be brought about or at least greatly hastened by a policy of frightfulness.
Literally many millions of people were subjected to conditions which would seem to be impossible for human nature to stand for any length of time, and yet they had to bear them continuously for four years or more.
The records of the development of insanity among these people have been rather carefully gathered, and they reveal the astounding fact that the insanity rate was very little higher among all these intense sufferers from the war than it would have been under the ordinary conditions of civil life. Manifestly a certain number of persons had the insanities which would have developed in them in later years anticipated by the trials and the hardships of wartime conditions, but only those suffered from insanity as a rule who might have been expected to do so because their family or personal history revealed tendencies in that direction which would almost surely have made themselves manifest sooner or later even under the inevitable vicissitudes of peace time.
What modern medicine has revealed to us is that apart from certain infectious diseases which produce degeneration of the physical basis of mind and the absorption of certain poisons—alcohol is a typical example—which{208}cause a corresponding degeneration to the infections, the supreme factor in insanity is the inheritance of a predisposition to the affection. Two things have become perfectly clear in the course of modern medical investigation, that insanity and longevity run in families, and that there is almost no other basis on which the two conditions may develop. Infections or intoxications in the broad sense of the word may produce conditions to foster or impair respectively either of them, but even they are of minor significance compared to the original inheritance in either case.
Clouston, the well-known English authority on mental diseases, whose opinion is founded on many years of personal observation, in his book on "Unsoundness of Mind" [Footnote 6] has put the relationship between religion and mental disease very clearly. He said: "It is true that religion, touching as it does, in the most intense way the emotional nature and the spiritual instincts of mankind, sometimes appears to cause and is often mixed up with insanity. But in nearly all such cases the brain of the individual was originally unstable, specially emotional, oversensitive, hyperconscientious and often somewhat weak in the intellectual and inhibitory faculties and, if looked for, other causes will usually be found." He had said just before, "To talk of 'religious insanity' as if it were a definite and definable form is in my judgment a mistake."
[Footnote 6: Methuen, London, 1911. ]
So far from prayer—the principal exercise of religion, that is the raising up of the mind to God, either in petition or in resignation—unsettling people's minds, it has exactly the opposite effect. Professor William James, whom most people are not inclined to think of as likely to be an overstrenuous advocate of religion, in his{209}well-known essay on "The Energies of Men" has a paragraph in which he quotes from a physician who had had long experience in the care of a great many insane and who did not hesitate to say that prayer was a benefit and not in any sense of the word a detriment to his patients.
"Doctor Thomas Hyslop, of the great West Riding Asylum in England, said last year to the British Medical Association that the best sleep-producing agent which his practice had revealed to him was prayer. I say this, he added (I am sorry here that I must quote from memory) purely as a medical man. The exercise of prayer, in those who habitually exert it, must be regarded by us doctors as the most adequate and normal of all the pacifiers of the mind and calmers of the nerves."
It is recognized as a general rule in asylum practice that when patients begin really to pray, a turn for the better has come in their condition, and they are on the high road to recovery. This does not mean, of course, noisy, wordy praying, but quiet raising of the mind to God and acts of resignation to their condition so long as they may be affected.
There is a very general impression among those who have had most to do with the insane as well as among psychologists in general that religion, instead of favoring the development of insanity, rather inhibits it. Professor Münsterberg, in his "Psychotherapy" dwells particularly on this. Almost needless to say Professor Münsterberg did not wear the special favor of religion in the lists and was in no sense her champion. He is proclaiming simply what he knows and feels to be true.
A very curious reflection on the relations of religion and insanity is to be found in the fact that the marked increase in the insane among the population of all the{210}great modern civilized countries and most striking among our own has come since the decay of religion and the decrease of religious belief. The statistics of that increase in the number of the insane are very startling to those who are not familiar with the subject. During a single generation the number of the insane in our institutions has increased to five times what it was before in proportion to the population. There is no doubt that this is due to some extent to the fact that people are much less ready to care for their insane relatives outside of institutions than they were a generation and especially two or three generations ago. We are much less ready to make the personal sacrifices needed to keep our friends at home, which is probably also due to the lowering of our religious sense of obligation in the matter. Fortunately our insane asylums are much better conducted than they were, and this has made people more willing to confide their relatives to them. Giving all due allowance for this, however, there has been an enormous increase in the number of the insane. Such commonwealths as California and Massachusetts, in which there are very large proportions of educated people, present the highest increase in the number of the insane. There are certain critical spirits who would say that it is our education without God and without religion that has fostered this state of affairs, and that it is particularly people of a certain limited intelligence who, when overeducated, lose their faith, who are most prone to lose their minds.
The most important single factor in insanity, not dependent on constitution or heredity but on conduct, is that degeneration of the brain which brings on paresis or general paralysis of the insane. Taken by and large throughout the world generally, nearly one in five of all{211}those who die in insane asylums die from this affection. It is the result of an infection usually consequent upon sexual immorality. The disease is inevitably fatal and once it begins it is steadily progressive from the delusions of grandeur so common at the beginning through various delusional states up to absolute dementia and death, which usually takes place in a little more than three years from the beginning of the disease; five years is a long time for a patient to survive. Nothing has done so much to limit the occurrence of this disease as religious influences, and it has increased to become the modern scourge that it is just in proportion as religion has lost its hold upon the mind of the rising generation. The disease is particularly infrequent among clergymen, and whileluesfrom which the disease develops may be contracted innocently, it is very evident that a regular moral life such as is led under the sway of religious principles is the best possible safeguard against the spread of the disease.
After paresis the most serious form of acquired insanity in modern life is that known as alcoholic insanity, due to excess in the taking of spirituous liquors. It is not necessarily inevitable that a man who frequently indulges to excess in alcoholic liquors will become insane any more than that he will suffer from alcoholic neuritis, but a large number of individuals prove susceptible to the toxic effects of alcohol in these ways. There is an inherent liability in their brain and nervous system to degenerate under the influence of alcohol acting as a poison. This is an extremely common form of insanity, but almost needless to say it occurs much less frequently in those who have any religious principles than in those who are without them, because religion protects from the excesses that predispose to these conditions. Clergymen{212}very rarely suffer from them and though occasionally clerical patients have developed alcoholic insanity or alcoholic neuritis, these cases on careful investigation oftener proved to be due to certain patent medicines which contained alcohol in large percentage than to any direct consumption of spirituous liquor.
Religion by its calming influence keeps a good many people who have hereditary tendencies to insanity from developing outspoken symptoms of the disease. Religious conviction has a definite efficacy in making people humble instead of conceited, and this is an excellent factor for preventing the tendency to insanity. Nearly always the preliminary sign of insanity is an exaggeration of theegoand a hint at least of delusions of grandeur. People who overrate their importance are often on the road to the asylum. Religion, by inculcating humility, at least lessens this tendency and puts off developments that are inevitable so that many more years of reasonable sanity are enjoyed than would otherwise be the case.
Probably the worst thing in the world for those who have any inherited tendency to disequilibration of mind is to have an occupation in life which involves strains and stresses of emotion. The gambler, the speculator, the man who risks his all on some attempt to make a great deal of money, are much more prone to develop insanity than those who have occupations in life at which they work from day to day for a moderate wage, and who get their joy in life out of the fulfillment of domestic duties. Almost needless to say religion has always discouraged gambling and such speculation as resembles it very closely, and the whole tendency of religious influence is to make people so satisfied with their lot in life that they will not take the risks which involve the{213}vehement mental emotions so likely to disturb those with inherited predispositions toward irrationality. Undoubtedly religion has in this way saved a great many men from serious developments in mental alienation which might have come had they felt themselves free to take up the riskier avocations in life from which they were deterred by the feeling of religious disapproval.
After the tendency to exaggeration of the ego and delusions of grandeur, the most common symptom of incipient insanity is delusion of persecution. As regards this, once more, the religious feeling of trust in Providence and the conviction that God will somehow take care of them keeps many people from allowing their delusions of persecution to manifest themselves so soon or so violently as would otherwise be the case. Only comparatively rarely do religious minded people in the midst of their delusions of persecution commit crimes, being deterred therefrom by the underlying consciousness of the wrongness of their acts in taking judgment on their persecutors into their own hands, even though they may have yielded to a belief in their delusions. It is true that a certain number of religious-minded people do commit crime under the influence of delusions, but these are rarer than the cases which occur in people who have never had any sense of religious morality.
In a word religion has meant a very great deal for the limitation of insanity and the tendency to it, for putting off its development and giving patients years of sanity they might not otherwise have enjoyed, and it has had a very definite effect in limiting the crimes consequent upon insanity. It has a very marked tendency to create the atmosphere of placid trust and confidence which means so much for the preservation of sanity. Far from being{214}a provocative of irrational tendencies it soothes patients' minds, prevents them from running into such excesses of emotion as are dangerous for mental balance, and it predisposes those who allow themselves to be deeply influenced by it to live such quiet satisfied lives without inordinate ambition and disordered desires as make for health of mind and body during prolonged life.
It has often been said that religion unfortunately proved harmful to insanity and the insane in the old medieval days, because ecclesiastics, sometimes for the sake of the fees that they might secure for exorcisms, taught very generally the doctrine that the insane were possessed of the devil, and that the one thing to do for them, besides exorcising the evil spirit, was to chain them up and keep them in manacles in dungeons until there was assurance that they had been released from the devil that had gained possession of them.
In spite of the fact that this is a rather common teaching in medical books and is frequently asserted even by physicians and sometimes indeed by specialists in nervous and mental diseases who are supposed to know the subject on which they discourse, there is very little foundation for this prevalent impression. Undoubtedly there was the belief in the possibility of possession by the devil and some such modern scientific minds as Alfred Russel Wallace and Professor Barrett of Trinity College, Dublin, have reverted to that belief because of their studies in spiritism and some of the curious results that follow from overdevotion to the cult of spirits. There was, however, a very definite recognition of the fact during the later Middle Ages that the insane were just ailing persons who had to be taken care of, properly treated, kept from hurting themselves or others, just as delirious individuals{215}would have to be guarded, but who must be looked upon as sick in mind, just as a number of people were sick in body and with more than a hint that the bodily condition had more to do with the insanity than anything else. I have discussed the subject at some length in my volume on "Medieval Medicine" recently published in London. [Footnote 7] Paul of Aegina wrote in the seventh century of melancholy as a primary affection of the brain to be treated with frequent baths and a wholesome and humid diet, together with suitable exhilaration of mind and without any other remedy unless when from its long continuance the offending humor is difficult to evacuate, in which case we must have recourse to more complicated and powerful plans of treatment. Paul was a very popular author much read in the Middle Ages.
[Footnote 7: Black. 1920.]
The Church's view of the subject of insanity is very well expressed in Bartholomew's Encyclopedia. This was a work written particularly for the information of the clergymen of the time, in order to explain to them all references in Scripture and to give them such details of knowledge as were necessary for preaching and for the teaching of their flocks. Bartholomew was very widely read and went through many editions before printing, was put into print very early, and some of the editions are among the greatest of bibliophilic treasures. Bartholomew, usually called the Englishman—his Latin name ofBartholomaeus Anglicusis well known—boiled down all the knowledge of insanity into a single paragraph. He has nothing at all to say of possession by the devil, and his discussion of the whole subject of madness is as modern as can be.
The causes of insanity which this clergyman writer{216}of the middle of the thirteenth century enumerates are those which psychiatrists of the present day are insisting on. The symptoms of infection, considering the brevity of the passage, are very well and clearly described, and the treatment suggested is the very latest in modern practice and consists of improvement of nutrition and the diversion of the insane. With all our supposed advance in knowledge no physician, even of the twentieth century, could have expressed the whole subject of insanity any better than Bartholomew did. This paragraph is a complete refutation of the objections that the Church by its insistence on diabolical possession as the principal cause of insanity did a great deal of harm. Bartholomew said:
"Madness cometh sometime of passions of the soul, as of business and of great thoughts, of sorrow and of too great study, and of dread: sometimes of the biting of a wood (mad) hound, or some other venomous beast; sometimes of melancholy meats, and sometimes of drink of strong wine. And as the causes be diverse, the tokens and signs be diverse. For some cry and leap and hurt and wound themselves and other men, and darken and hide themselves in privy and secret places. The medicine of them is, that they be bound, that they hurt not themselves and other men. And namely, such shall be refreshed, and comforted, and withdrawn from cause and matter of dread and busy thoughts. And they must be gladded with instruments of music, and some deal be occupied."
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Just as with regard to insanity, there is a very common impression that religion increases the amount of nervous disease in the world and is responsible for a great deal of what has been called hysteria. Not a few who think they have a right to an opinion in this matter, and some of them are physicians—though usually they are rather young—are quite ready to assert that religion is a fruitful source of nervous symptoms and very often of rather serious nervous conditions. We saw in the chapter on Insanity how false is the prevalent impression as to religion producing tendencies to insanity, though of course a great many insane people have religious delusions. It is very much the same with nervous diseases. Many nervous people pay a certain amount of attention to religion, and not a few of them cling to straws of hope that they may be able to overcome their neurotic tendencies by superficial attention to prayer or to some practices of religion which they seem to look upon about in the same light as patent medicines recommended for the cure of nervous diseases. People who are deeply religious, however, very seldom suffer from nervous affections, and they have in their religion the most beneficent of helpful resources, if by nature, that is, by heredity or unfortunate development, they have neurotic tendencies.
{218}
So far from religion increasing nervous disease, then, it has exactly the opposite effect. We have a number of testimonies to this purport from prominent neurologists, many of whom were themselves not believers in religion but who recognized its influence for good over others. Such expressions are to be found in the writings of men of every nationality. Not infrequently, in spite of their own religious affiliations, they acknowledge what a profound influence certain forms of religion have over certain people. These testimonies have been multiplying in our medical literature in recent years, because apparently physicians have come to appreciate by contrast the influence for good of religion over some of their patients, since they see so many sufferers from nervous diseases who have not this source of consolation to which to recur.
In America we have a number of such testimonies. In his "Self Help for Nervous Women", Doctor John K. Mitchell of Philadelphia, who may be taken to represent in this matter the Philadelphia School of Neurologists, to which his father lent such distinction, said:
"It is certainly true that considering as examples two such separated forms of religious belief as the Orthodox Jews and the strict Roman Catholics, one does not see as many patients from them as might be expected from their numbers, especially when it is remembered that Jews as a whole are very nervous people and that the Roman Catholic includes in this country among its members numbers of the most emotional race in the world."Of only one sect can I recall no example. It is not in my memory that a professing Quaker ever came into my hands to be treated for nervousness. If the opinion I have already stated so often is correct, namely that{219}want of control of the emotions and the overexpression of the feelings are prime causes of nervousness, then the fact that discipline of the emotions is a lesson early and constantly taught by the Friends would help to account for the infrequency of this disorder among them and adds emphasis to the belief in such a causation."
In writing a "Textbook of Psychotherapy" [Footnote 8] eight years ago one of the appendices was devoted to the relations between religion and psychotherapy. One of the paragraphs, written for physicians, and I may say that it has been read by many thousands of them, puts my own opinion on the dual subject of the nexus between religion, insanity and nervous disease, as succinctly as I can hope to put it. There is no doubt that an abiding sense of religion does much for people in the midst of their ailments and, above all, keeps them from developing those symptoms due to nervous worry and solicitude which so often are more annoying to the patient than the actual sufferings he or she may have to bear. While religion is often said to predispose to certain mental troubles, it is now well appreciated by psychiatrists that it is not religion that has the tendency to disturb the mind, but a disequilibrated mind has the tendency to exaggerate out of all reason its interest in anything that it takes up seriously. Whether the object of the attention be business, or pleasure, or sexuality, or religion, the unbalanced mind pays too much attention to it, becomes too exclusively occupied with it, and this overindulgence helps to form a vicious circle of unfavorable influence.
[Footnote 8: Appleton.]
While many people in their insanity, then, show exaggerated interest in religion, this is only like other{220}exaggerated interests of the disequilibrated, and religion itself is not the cause but only a coincidence in the matter.
Some who are interested particularly in this subject, on reading this will at once revert to the fact that scruples are extremely common among the religiously inclined and that these are, after all, as a rule, only nervous symptoms which are surely fostered by religion. To say this, however, is to misapprehend the real meaning of scruples. The word is a very old one and means a little sharp stone, as if in trying to make progress the scrupulous found themselves hindered by having to walk over little sharp stones which so disturbed them that they were hampered in getting on. Above all, scruples put them into a state of mind where they hesitate as to whether they can go on at all or not.
The subject of scruples was very thoroughly worked out and carefully described by the older spiritual writers centuries ago. They wrote elaborate treatises on it, while it was not until our own time that physicians by their careful study of corresponding conditions entirely apart from religion came to appreciate that these conditions of the spiritual life were only expressions of a rather common set of tendencies altogether independent of religion. They are prone to develop in people with certain physical and mental characteristics who are possessed of dispositions and nervous systems particularly likely to be the subject of these hesitancies and doubts and difficulties for which there is very little basis in actuality.
The whole chapter of phobias and the other chapter on obsessions and the third on what the French callla folie du doute, the doubting mania in our modern textbooks of neurology, are really so many chapters in the{221}literature of scruples of the old time, now transferred to the textbooks on functional nervous diseases. Some nervous people who are religiously inclined get into a very disturbed state of mind from the fear that they may commit sin almost unknown to themselves or that they may be in sin unawaredly and cut off from their Creator, and they become extremely miserable as a consequence. This is, after all, a very familiar picture to the neurologist accustomed to see patients suffering from functional nervous diseases. I have patients who suffer quite as much from the dread of dirt as these scrupulous people do from the dread of sin. Women often suffer from this dread of dirt—misophobia is the scientific name derived from the Greek—to an exaggerated degree. A woman patient of mine makes it extremely uncomfortable for the conductors on the street cars because, for fear of contaminating her hands, she dreads to touch the handle bars by which she could mount or descend easily. This adds greatly to the risks she takes every time she boards a car. She is constantly washing her hands to get the dirt off, so that in cold weather she sets up severe skin irritations and makes herself very uncomfortable. I have a male patient who would not touch the handle of my door for the world, and whom successive maids have come to know very well because he stands outside the outer door and has to have that as well as the inner door opened for him. He has said to me over and over again, "Doctor, don't ask me to shake hands with you, because you shake hands with so many people." I have seen him standing outside of a large department store with the temperature around zero, waiting for some one to open the door so that he might slip in without touching it. Nor are such states{222}of mind confined to the uneducated; on the contrary, they are commonest among those who have a good education and are quite sensible in other things.
Obsessions were originally described as super-religious states of mind in which some idea assumed a terrorizing character. The victims of them dread that they might commit some awful crime and as a consequence were profoundly miserable. Instead of being confined to religion, such mental states are quite common in conditions altogether apart from religious feelings. Women read of a mother killing her child in some awful way or perhaps accidentally poisoning it or burning it badly with some escharotic external application. They become obsessed with the idea that they may do something of this kind and fear that they may not be able to resist the suggestion. Medical literature is full of such cases. A typical case is described by Tangi in his textbook on insanity:
"A young married woman suffered from nervous exhaustion after her first childbirth. She watched day by day her husband cutting up meat for his parrots with a pair of scissors, and the action filled her with disgust which later increased to positive horror. Thus a repulsive obsession was produced and this in turn engendered the morbid suggestion to cut the tongue of her dearly loved child in the same way. The fear that she would not be able to resist this suggestion made the suggestion more vivid and the idea more imperative, causing an agonizing struggle each time."
Then there are accounts, some of them most poignant, from Catholic patients of my own, who were sure that sometime while in the midst of their devotions or even at the very reception of the sacraments they would{223}blaspheme. They are people who fear that every pious act of theirs may just expose them to the risk of committing some awful sacrilege.
Almost needless to say such states have nothing at all to do with religion, and when similar conditions occur among the religious minded, they must be attributed to the general neurotic condition and not to the incidental religious tendencies. The doubting mania occurs among the religious minded when they keep on fearing that they have not done something that they should do. Some of these individuals get into a profoundly miserable and disturbed state of mind, but that must not be blamed on religion.
This sad state of mind in people who have no religion at all is extremely familiar to the neurologist, and it has no necessary connection with religious practice or religious belief. I have a patient who has been coming to me for many years now from a city in the Middle West; he is a broker, and every time there is a panic in the money market I am almost sure to see him. Whenever he gets very much disturbed over business matters, as is likely to happen in panic times, he develops a very strikingfolie du doute, or doubting mania. He will take a letter to a post box and go back three or four times, first to see if by chance he did not drop it on the way, secondly to be sure that it did not get caught in the slot; then, if the letter is important, he will go back to see if perchance there may not be some bolts or other obstructions at the top of the box that may catch it and delay its collection. I have even known him to wait for some time at the post box to see if the postman might not possibly drop it when he came to collect the mail. But then he does other things just as foolish. Occasionally he will{224}get home from his office and suddenly have the feeling that he forgot to lock his safe. He will go back and then get part way up town when he is overcome by the fear that he may not have locked the door after him as he came out. At times when hisfolie du douteis at its worst, he has been known to go back three or four times to close windows or for some other trivial reason. When he is in reasonably good condition there is very little of this state of mind manifest, but he can make himself supremely miserable when the obsession is on him.
It is often said that the declaration by the Church of the idea of possession by the devil rather encouraged the development of certain mental and nervous states and thus fostered neurotic manifestations of many kinds. This whole question of the possibility of direct diabolic influence over mankind, that is, of some evil spirit deeply influencing certain human beings, is yet a matter that is not nearly so settled as a great many physicians who have not been following scientific work in allied lines seem to think. So distinguished a scientist as Alfred Russel Wallace, the co-discoverer with Darwin of the theory of natural selection, had the feeling that spirits interfered much more in human affairs than a great many people were willing to admit, and that the evil spirits probably could, under certain circumstances, deeply affect individuals. Professor Barrett of Trinity College, Dublin, is even more outspoken in what he has to say in this regard, and now there is a very general feeling among those who have investigated spiritistic phenomena most carefully that if spirits do actually communicate directly with men, it is commonly not the spirits who claim to do the communicating who are actually present. Almost needless to say any such conclusion as this would,{225}if maintained, throw even scientists back to the old idea of diabolism, which the Church, on the strength of many centuries of experience, still teaches.
One thing is perfectly sure: that if overzeal on the part of certain ecclesiastics rather encouraged neurotic manifestations because of the alluringly suggestive quality of the thought of diabolic possession, they did no more than physicians did in more modern times by their suggestive methods in the study of hysteria. A great French neurologist of to-day has pointed out that major hysteria as studied by French neurologists of a generation ago has practically disappeared, or occurs very rarely in our day because it is no longer unconsciously suggested to patients by physicians that these major symptoms are being looked for. Overzeal in medicine raised up a whole series of symptoms that had no existence except in the heated imagination of their patients under the influence of strong suggestion.
Another extremely interesting phase of this subject is that in the old days many of the sensible ecclesiastics and some of the civil authorities came to recognize that people supposed to be possessed of evil spirits could be cured of their condition not infrequently by roundly whipping them. Sir Thomas More particularly called attention to how much good could be effected in this way. In writing an article on "Psychoneurosis and the War" (International Clinics, Volume II, Series 29) I called attention to this in a paragraph that may be helpful in the understanding of the discussion of diabolic influence.
It has been the custom for many years now, indeed for more than a generation, to think that the old-fashioned methods of treating many of the psychoneuroses by{226}punishment and the infliction of pain were founded on an entirely wrong principle. Sir Thomas More, for instance, tells the story of a number of folk in his time who suffered from rather serious complaints; some of them were dumb and some deaf, and some thought they could not see, and others could not walk. He says that some people considered them possessed of the devil, and that it was the presence of this very undesirable spirit that hampered their activities in various ways and made it impossible for them to use their powers properly. The description of the cases makes it very clear that he is referring to hysterical conditions of various kinds and the sequel as to the successful treatment which he says was frequently employed on them more than confirms the inference of hysteria and demonstrates the very definite hysterical character of the affection. Many a physician down through the ages has been inclined to think that these people were possessed of a bad spirit of some kind, even though he might not be quite ready to think that a personal devil had taken hold of them and was seriously hampering their functions. We recognize that the real trouble is with their own spirit, to which may be applied whatever epithets come to mind, and no one will think them exaggerations; this spirit has lost its control of their activities, rendering them incapable of exercising their functions properly.
There is a very widespread tradition, which has found its way into medical literature especially, that the fervent practice of religion in women has a very definite tendency to make them neurotic. Particularly when religious devotion is associated with mortification and fasting, it is supposed to be serious in its effects. It is the custom to make references to such pious women as St. Catherine{227}of Siena and St. Theresa of Spain as typically exemplifying this neuroticizing tendency.
Any one who really knows the lives of either of these women will not be likely to think that they were neurotic in any proper sense of that word at all. Both of them were not weak but had immensely strong characters, veritable towers of strength in supremely difficult times, supporting not only their own heavy burdens but helping others around them to bear theirs. Of Catherine of Siena, Swinburne, the English poet, surely not a sanctimonious person, whose sentimentality might lead to admiration for the hysterical bizarre, but who had studied her career because so many incidents in her life have been the subject of great paintings by a number of the greatest painters of Italy, said: