Jatgeir. I needed sorrow; others there may be who need faith, or joy—or doubt—
King Skule. Doubt as well?
Jatgeir. Ay; but then must the doubter be strong and sound.
King Skule. And whom call you the unsound doubter?
Jatgeir. He who doubts of his own doubt.
King Skule(slowly). That methinks were death.
Jatgeir. 'T is worse; 't is neither day nor night.
King Skule(quickly, as if shaking off his thoughts). Where are my weapons? I will fight and act, not think.
IBSEN:The Pretenders, Act iv.
A gentleman once told me that he rarely passed another in the street without wondering if he had not accosted him in an improper manner. He knew very well that he had not, but the more he dwelt upon the possibility, the more doubtful he became, until the impulse to settle the question became so strong that he would retrace his steps and inquire. He asked ifnux vomicawould help this trouble! I told him he needed mental training.
"I have tried that," he answered. "I keep saying to myself, 'I will not think of it,' but it is no use; my head becomes hot, my sight blurred, my thoughts confused, and the only relief I find is to settle the question."
I tried to point out the direction in which he was tending, and told him he must remind himself that even if he had accosted another improperly, it was a trifling matter compared to the injury to himself of giving way to this compulsion; moreover, the impression he would make upon the other by going back would be even worse than that of having so accosted him; and, finally, he must dwell upon theprobabilitythat he had not offended the man, instead of thepossibilitythat he had. Having pursued this line of thought, he must force himself to think of something else until the besetting impulse was obliterated. I suggested that if a baseball player should become incapacitated for the game, he would not lessen his disappointment by reiterating, "I will not think of baseball," but if he persistently turned his thoughts and his practice to billiards he might in time forget baseball.
"I never played baseball," he replied, "and don't even know the rules."
This represents an extreme case of "doubting folly" a case in which the victim could no longer concentrate his thoughts on the simplest proposition outside the narrow circle to which his doubts had restricted him.
If we once allow ourselves to wonder whether we have turned off the water, enclosed the check, or mailed the letter, it is but a step to an uncomfortable frame of mind which can be relieved only by investigating the matter. This compulsion once acceded to, it becomes more and more easy to succumb. The next step is to blur, by constant repetition, the mental image of the act. In extreme cases the doubter, after turning the gas on and off a dozen times, is finally in doubt whether he can trust his own senses. A certain officer in a bank never succeeded in reaching home after closing hours without returning to try the door of the bank. Upon finding it locked, he would unlock it and disappear within, to open the vault, inspect the securities, and lock them up again. I once saw a victim of this form of doubt spend at least ten minutes in writing a check, and ten minutes more inspecting it, and, after all, he had spelled his own name wrong!
Constant supervision only impairs acts which should have become automatic. We have all heard of the centipede who could no longer proceed upon his journey when it occurred to him to question which foot he should next advance.
To other doubts are often added the doubt of one's own mental balance; but it is a long step from these faulty habits of mind to real mental unbalance, which involves an inability to plan and carry out a line of conduct consistent with one's station.
It took a young man at least fifteen minutes, in my presence, to button his waistcoat. He felt the lower button to reassure himself, then proceeded to the next. He then returned to the lower one, either distrusting his previous observation, or fearing it had become unbuttoned. He then held the lower two with one hand while he buttoned the third with the other. When this point was reached he called his sight to the aid of his feeling, and glued his eyes to the lower while he buttoned the upper, unbuttoning many meantime, to assure himself that he had buttoned them. This young man said he would sometimes stop on his way to the store in doubt whether he was on the right street, a doubt not quieted either by reading the sign or by asking a stranger, because the doubt would obtrude itself whether he could trust his sight and his hearing, indeed, whether he was really there or dreaming. Even this victim of extreme doubting folly conducted his business successfully so long as I knew him, and so comported himself in general as to attract no further comment than that he was "fussy."
These doubts lead to chronic indecision. How often, in deciding which of two tasks to take up, we waste the time which would have sufficed for the accomplishment of one, if not both.
The doubt and the indecision result directly from over-conscientiousness. It is because of an undue anxiety to do the right thing, even in trivial matters, that the doubter ponders indefinitely over the proper sequence of two equally important (or unimportant) tasks. In the majority of instances it is the right thing forhimto pounce uponeither. If he pounces upon the wrong one, and completes it without misgiving, he has at least accomplished something in the way of mental training. The chances are, moreover, that the harm done by doing the wrong thing first was not to be compared to the harm of giving way to his doubt, and either drifting into a state of ineffective revery or fretting himself into a frenzy of anxious uncertainty.
A gentleman once told me that after mailing a letter he would often linger about the box until the postman arrived, and ask permission to inspect his letter, ostensibly to see if he had put on the stamp, but in fact to reassure himself that he had really mailed the missive, although he knew perfectly well that he had done so. The life of the chronic doubter is full of these small deceits, though in most matters such persons are exceptionally conscientious.
This form of over-solicitude is peculiarly liable to attack those in whose hands are important affairs affecting the finances, the lives, or the health of others. I have known more than one case of the abandonment of a chosen occupation on account of the constant anxiety entailed by doubts of this nature. Nor are these doubts limited to the question whether one has done or left undone some particular act. An equally insistent doubt is that regarding one's general fitness for the undertaking.The doubter may spend upon this question more time than it would take to acquire the needed facility and experience.
Some one has said there are two things that no one should worry about: first, the thing that can't be helped; second, the thing that can. This is peculiarly true of the former.
Reflection upon the past is wise; solicitude concerning it is an anachronism. Suppose one has accepted a certain position and finds himself in doubt of his fitness for that position. Nothing can be more important than for him to decide upon his next line of conduct. Shall he resign or continue? Is he fit for the position, or, if not, can he acquire the fitness without detriment to the office? These are legitimate doubts. But the doubter who finds himself in this predicament adds to these legitimate doubts the question, "Ought I to have accepted the office?" This is the doubt he must learn to eliminate. He must remind himself that he has accepted the position, whether rightly or wrongly, and that the acceptance is ancient history. The question what shall he do next is sufficiently weighty to occupy all his attention without loading his mind with anxious doubts regarding the irrevocable past.
Suppose, in fact, the doubter has made a mistake; how shall he banish the worry? By reminding himself that others have made mistakes, why should not he, and that it is somewhat egotistic on his part to insist that, whatever others may do,hemust do everything right. If this line of reasoning fails to console him, let him think of the greater mistakes he might have made. A financial magnate was once asked how he succeeded in keeping his mind free from worry. He replied, by contemplating the two worst things that could happen to him: losing all his property and going to jail. He had learned the lesson thatone thought can be driven out only by another.
With regard to immediate doubts. If the over-scrupulous business or professional man, worn out after an exacting day's work, will stop and reflect, he will realize that much of his exhaustion is due to his having filled the day with such doubts as whether he is doing the wrong thing, or the right thing at the wrong time, whether he or someone else will miss an appointment or fail to meet obligations, and whether he or his assistants may make blunders.
Let him resolve some morning that he will proceed that day from task to task without allowing such thoughts to intrude. If he does so he will find that he has succeeded in his work at least as well as usual, and that he is comparatively fresh in the evening.
Why not try this every day?
So far we have only considered the most obvious and simple among the evidences of doubting folly. A still more obstinate tendency of the doubter is the insistent habit interminably to argue over the simplest proposition, particularly regarding matters pertaining to the health, comfort, and life of the individual himself. A certain patient, of this type, attempts to describe to his physician a peculiar, hitherto undescribed, and even now indescribable sensation "through his right lung." He traces this sensation to what he believes to have been the absorption of a poison some years ago. His line of reasoning is somewhat as follows: 1. The drug was a poison. 2. If he absorbed it he must have been poisoned. 3. If he was poisoned then, he is poisoned now. 4. There is no proof that such a poison cannot produce such a sensation. 5. He has the sensation. Conclusion: He is suffering from poison. In support of this proposition he will spend hours with anyone who will listen. The physician who allows himself to be drawn into the controversy speedily finds himself, instead of giving advice to listening ears, involved in a battle of wits in which he is quite likely to come off second best. He assures the patient, for example, that, as far as scientific methods can establish the fact, the lung is sound.
"But has science established everything? And if it had, is such negative evidence to be weighed against the positive evidence of the sensation in my lung?"
"But the sensation may not be in your lung."
"Can you prove that it isnotin my lung?" Folly scores!
On being urged to direct his attention to some other part of his body, he promptly inquires,
"How can I direct my thoughts elsewhere, when the sensation is there to occupy my attention?" Obviously he can not without changing his mental attitude, so folly scores again.
He is assured that if the poison had been absorbed the effects would have passed away long before this time.
"But do the effects of poisonalwayspass away? And can youprovethat they have passed away in my case? Is not the sensation positive evidence, since you have allowed that you cannot prove that the sensation doesnotcome from the poison?"
Folly scores again, but the victory is an empty one. The vicious circle continues: Attention magnifies sensation—sensation produces fear—fear increases attention; and throughout runs the insistent thought that his sensations shall conform to his ideal.
If the discussion of such comparatively tangible matters can occupy a large part of one's attention, imagine the result of the insistent desire, on the part of the doubter, to solve such problems as "What is thought?" "What is existence?"
If the windings of this intellectual labyrinth have not too far involved us, we have only to recognize the futility of such arguments, and exercise our will-power in the right direction. If we can bring ourselves to take the initiative, it is as easy to step out of the vicious circle, as for the squirrel to leave his wheel. But unless we grasp the logic of the situation, and take this initiative, no amount of abuse, persuasion, or ridicule will effect our freedom.
A word may be in place regarding the anthropological status of the doubting folly and allied mental states. Men of genius have suffered from them all. A long list may be found in Lombroso's "Man of Genius." Underfolie du doutewe find, for example, Tolstoi, Manzoni, Flaubert and Amiel.
Lombroso regards genius as degenerative, and places among the signs of degeneration, deviations from the average normal, whether physical or mental. This plan has been quite generally followed. The nomenclature seems to me unfortunate and hardly justified by the facts. I can think of no more potent objection to such inclusive use of the term degenerate, than the fact that Lombroso includes, under the signs of degeneration, the enormous development of the cerebral speech-area in the case of an accomplished orator. If such evolutional spurts are to be deemed degenerative, the fate of the four-leaved clover is sealed.
The application of the term degeneration may be, and should be, it seems to me, limited to the signs, whether physical or mental, which indicate an obviously downward tendency. I have elsewhere suggested, and the suggestion has already found some acceptance, that when the variation is not definitely downward,deviationanddeviatebe substituted for the unnecessarily opprobrious and often inappropriate terms,degenerationanddegenerate.
Il marche, dort, mange et boit comme tous les autres; mais cela n'empeche pas qu'il soit fort malade.
MOLIERE:Le Malade imaginaire.
The victim of hypochondria may present the picture of health, or may have some real ill regarding which he is unduly anxious. His consultation with a physician is likely to be preceded by letters explaining his exact condition, naming his various consultants and describing the various remedies he has taken. At the time of his visit notes are consulted, lest some detail be omitted. In his description anatomical terms abound; thus, he has pain in his lungs, heart, or kidney, not in his chest or back. Demonstration by the physician of the soundness of these organs is met by argument, at which the hypochondriac is generally adept.
The suggestion that the hypochondriac devotes undue attention to his own condition is met by him with indignant denial. Proposals that he should exercise, travel, engage in games, or otherwise occupy himself, fall on deaf ears, but he is always ready to try a new drug. If a medicine is found with whose ingredients the patient is not already familiar, its use is likely to produce a beneficial effect for a few days, after which the old complaint returns.
The case has come to my attention of a young man who, for fear of taking cold, remains in bed, with the windows of the room tightly closed and a fire constantly burning. He has allowed his hair to grow until it reaches his waist, he is covered with several blankets, wears underclothing under his nightshirt, and refuses to extend his wrist from under the bed-clothes to have his pulse taken.
Such faulty mental habits in minor degree are common. There are those who will not drink from a bottle without first inspecting its mouth for flakes of glass; some will not smoke a cigar which has been touched by another since leaving the factory; some will not shake hands if it can possibly be avoided; another pads his clothing lest he injure himself in falling. Many decline to share the occupations and pleasures of others through fear of possible wet feet, drafts of air, exhaustion, or other calamity. Such tendencies, though falling short of hypochondria, pave the way for it, and, in any event, gradually narrow the sphere of usefulness and pleasure.
No part of the body is exempt from the fears of the hypochondriac, but he is prone to centre his attention upon the obscure and inaccessible organs. The anecdote is told of a physician who had a patient of this type—a robust woman who was never without a long list of ailments. The last time she sent for the doctor, he lost patience with her. As she was telling him how she was suffering from rheumatism, sore throat, nervous indigestion, heart-burn, pains in the back of the head, and what not, he interrupted her:
"Ah," he said in an admiring tone, "what splendid health you must have in order to be able to stand all these complaints!"
The phobias are so closely allied to hypochondria that it will not be out of place to discuss them here. A phobia is an insistent and engrossing fear, without adequate cause as judged by ordinary standards. Familiar instances are fear of open places (agoraphobia), fear of closed places (claustrophobia), and fear of contamination (mysophobia).
The sufferer from agoraphobia cannot bring himself to cross alone an open field or square. The sufferer from claustrophobia will invent any excuse to avoid an elevator or the theatre. When a certain lady was asked if she disliked to go to the theatre or church, she answered, "Not at all, but of course I like to have one foot in the aisle; I suppose everyone does that."
The victim of mysophobia will wash the hands after touching any object, and will, so far as possible, avoid touching objects which he thinks may possibly convey infection. Some use tissue paper to turn the door-knob, some extract coins from the pocket-book with pincers. I have seen a lady in a public conveyance carefully open a piece of paper containing her fare, pour the money into the conductor's hand, carefully fold up the paper so that she should not touch the inside, and afterwards drop it from the tips of her fingers into a rubbish barrel.
The case of a nurse who was dominated by fear of infection has come to my attention. If her handkerchief touched the table it was discarded. She became very adept at moving objects about with her elbows, was finally reduced to helplessness and had to be cared for by others.
Unreasoning fear of one or another mode of conveyance is not rare. It is said that Rossini found it impossible to travel by rail, and that the attempt of a friend to accustom him to it resulted in an attack of faintness (Lombroso).
The sufferer himself realizes, in such cases, that there is no reason in his fear—he knows he can undergo greater dangers with equanimity. Even doubting folly finds no answer to the question why should this danger be shunned and that accepted. The nearest approach to an answer is "I can't," which really means "I haven't."
The origin of the phobia is not always clear, but given the necessary susceptibility, circumstances doubtless dictate the direction the phobia shall take. A startling personal experience, or even reading or hearing of such an experience may start the fear which the insistent thought finally moulds into a fixed habit.
To the hypochondriac who concentrates his attention upon the digestive tract, this part of his body occupies the foreground of all his thoughts. He exaggerates its delicacy of structure and the serious consequences of disturbing it even by an attack of indigestion. A patient to whom a certain fruit was suggested said he could not eat it. Asked what the effect would be, he answered that he did not know, he had not eaten any for twenty years and dared not risk the experiment.
Extreme antipathies to various foods are fostered among this class. A lady told me that she perfectly abominated cereals, that she could not stand vegetables, that she could not bear anything in the shape of an apple, that she could not abide spinach, and that baked beans made her sick at the stomach.
The heart is perhaps the organ most often the object of solicitude on the part of the hypochondriac. When we realize that the pulse may vary in the healthy individual from 60 to over 100, according to circumstances, and that mere excitement may send it to the latter figure, we may appreciate the feelings of one who counts his pulse at frequent intervals and is alarmed if it varies from a given figure.
Inspection of the tongue is a common occupation of the hypochondriac, who is generally more familiar than his medical attendant with the anatomy of this organ.
Insistent desire regarding the temperature is common not only among hypochondriacs, but among others. I do not allude to the internal temperature (though I have been surprised to learn how many people carry a clinical thermometer and use it on themselves from time to time); I refer to the temperature of the room or of the outside air. The wish to feel a certain degree of warmth is so overpowering in some cases that neither work nor play can be carried on unless the thermometer registers the desired figure. A person with this tendency does not venture to mail a letter without donning hat and overcoat; the mere thought of a cold bath causes him to shudder.
Golf has cured many a victim of this obsession. It takes only a few games to teach the most delicately constructed that he can remain for hours in his shirt-sleeves on quite a cold day, and that the cold shower (preferably preceded by a warm one) invigorates instead of depresses him. Further experiment will convince him that he can wear thin underwear and low shoes all winter. Such experiences may encourage him to risk a cold plunge in the morning, followed by a brisk rub and a few simple exercises before dressing.
Morbid fears in themselves produce physical manifestations which add to the discomfort and alarm of the hypochondriac. I allude to the rush of blood to the head, the chill, the mental confusion, and the palpitation. These symptoms are perfectly harmless, and denote only normal circulatory changes. It is true that one cannot at will materially alter his circulation, but he can do so gradually by habit of thought. To convince ourselves of this fact, we need only remember to what a degree blushing becomes modified by change of mental attitude. Similarly, the person who has practiced mental and physical relaxation will find that the blood no longer rushes to his head upon hearing a criticism or remembering a possible source of worry.
The automatic processes of the body are in general performed best when the attention is directed elsewhere. After ordinary care is taken, too minute attention to the digestive apparatus, for example, may retard rather than aid it. Watching the digestion too closely is like pulling up seeds to see if they are growing.
The more attention is paid to the sensations, the more they demand. Nor can the degree of attention they deserve be measured by their own insistence. If one tries the experiment of thinking intently of the end of his thumb, and imagines it is going to sleep, the chances are ten to one that in five minutes it will have all the sensations of going to sleep. If this is true of the healthy-minded individual, how much more must it be so in the person who allows his thoughts to dwell with anxious attention on such parts of his body as may be the immediate seat of his fears. The next step is for various sensations (boring, burning, prickling, stabbing, and the like) to appear spontaneously, and, if attention is paid to them, rapidly to increase in intensity.
It is probable that the mere pressure of part upon part in the body, even the ordinary activity of its organs, would give rise to sensations if we encouraged them. Given an anomalous sensation, or even a pain, for which the physician finds no physical basis, and which, after a term of years, has produced no further appreciable effect than to make one nervous, it is always in place to ask one's self whether the sensation or the pain may not be of this nature.
Medical instructors are continually consulted by students who fear that they have the diseases they are studying. The knowledge that pneumonia produces pain in a certain spot leads to a concentration of attention upon that region which causes any sensation there to give alarm. The mere knowledge of the location of the appendix transforms the most harmless sensations in that region into symptoms of serious menace. The sensible student learns to quiet these fears, but the victim of "hypos" returns again and again for examination, and perhaps finally reaches the point of imparting, instead of obtaining, information, like the patient in a recent anecdote from theYouth's Companion:
It seems that a man who was constantly changing physicians at last called in a young doctor who was just beginning his practice.
"I lose my breath when I climb a hill or a steep flight of stairs," said the patient. "If I hurry, I often get a sharp pain in my side. Those are the symptoms of a serious heart trouble."
"Not necessarily, sir," began the physician, but he was interrupted.
"I beg your pardon!" said the patient irritably. "It isn't for a young physician like you to disagree with an old and experienced invalid like me, sir!"
There is no absolute standard for the proper degree of solicitude regarding one's health, but if the habitual invalid possess a physique which would not preclude the average normal individual from being out and about, even at the expense of a pain, a stomach ache, or a cold, there is probably a hypochondriacal element in the case. It is a question of adjustment of effect to cause.
The term "imaginary" is too loosely applied to the sensations of the hypochondriac. This designation is unjustified, and only irritates the sufferer, rouses his antagonism, and undermines his confidence in the judgment of his adviser. He knows that the sensations are there. To call them imaginary is like telling one who inspects an insect through a microscope that the claws do not look enormous; theydolook enormous—through the microscope—but this does not make them so. The worrier must learn to realize that he is looking at his sensations, as he does everything else,through a microscope.
If a person living near a waterfall ignores the sound, he soon ceases to notice it, but if he listens for it, it increases, and becomes finally unbearable. Common sense teaches him to concentrate his attention elsewhere; similarly, it demands that the victim of "hypos" disregard his various sensations and devote his attention to outside affairs, unless the sensations are accompanied by obvious physical signs. Instead of running to the doctor, let himdosomething—ride horseback, play golf, anything requiring exercise out of doors. Let him devote his entire energy to the exercise, and thus substitute the healthy sensations of fatigue and hunger for the exaggerated pains and the anomalous sensations which are fostered by self-study. Let him remember moreover, that nature will stand an enormous amount of outside abuse, but resents being kept under close surveillance.
In practicing the neglect of the sensations, one should not allow his mind to dwell on the possibility that he is overlooking something serious, but rather on the danger of his becoming "hipped," a prey to his own doubts and fears, and unable to accomplish anything in life beyond catering to his own morbid fancies.
Turning now to the bibliographic study of hypochondria, an interesting and characteristic contrast is offered between Huxley, who called himself a hypochondriac, but apparently was not, and Carlyle, who resented the imputation, though it apparently had some justification in fact.
With regard to Huxley,—the only basis for the diagnosis hypochondria in a given case, is undoubted evidence, by letter or conversation, that the question of health is given undue prominence. I have looked carefully through the volume of Huxley's letters (published by his son), without definitely establishing this diagnosis. The state of his health and the question of his personal comfort received comparatively little attention. Whatever suffering Huxley endured he seems to have accepted in a philosophical and happy spirit, thus:
"It is a bore to be converted into a troublesome invalid even for a few weeks, but I comfort myself with my usual reflection on the chances of life, 'Lucky it is no worse.' Any impatience would have been checked by what I heard about ... this morning ... that he has sunk into hopeless idiocy. A man in the prime of life!"
With regard to Carlyle,—it is true, as claimed by Gould (Biographic Clinics, 1903) that he showed every evidence of eyestrain with resulting symptoms, particularly headache. This does not, however, preclude his having had hypochondria also, and in view of the violent and reiterated complaints running through his letters it seems quite credible that Froude's estimate of his condition was not far wrong. Surely, unless Carlyle was merely trying his pen without intending to be taken seriously, he devoted to the question of health a degree of attention which may be fairly adjudged undue.
The first letter I quote (from those cited by Gould in fortifying his position) is of special interest as presenting in rather lurid terms Carlyle's ideal of health. After reading this letter one cannot help suspecting that the discomforts so vividly described in his other letters were compared by him with this ideal rather than with those of the average individual.
"In the midst of your zeal and ardor,... remember the care of health.... It would have been a very great thing for me if I had been able to consider that health is a thing to be attended to continually, that you are to regard that as the very highest of all temporal things for you. There is no kind of achievement you could make in the world that is equal to perfect health. What to it are nuggets and millions'? The French financier said 'Why is there no sleep to be sold!' Sleep was not in the market at any quotation.... I find that you could not get any better definition of what 'holy' really is than 'healthy.' Completely healthy;mens sana in corpore sano. A man all lucid, and in equilibrium. His intellect a clear mirror geometrically plane, brilliantly sensitive to all objects and impressions made on it and imaging all things in their correct proportions; not twisted up into convex or concave, and distorting everything so that he cannot see the truth of the matter, without endless groping and manipulation: healthy, clear, and free and discerning truly all around him."
The following extracts illustrate his attitude toward his physical shortcomings, whatever they may have been.
... "A prey to nameless struggles and miseries, which have yet a kind of horror in them to my thoughts, three weeks without any kind of sleep, from impossibility to be free from noise."
"I sleep irregularly here, and feel a little, very little, more than my usual share of torture every day. What the cause is would puzzle me to explain. I take exercise sufficient daily; I attend with rigorous minuteness to the quality of my food; I take all the precautions that I can, yet still the disease abates not."
"Ill-health, the most terrific of all miseries."
"Grown sicker and sicker.... I want health, health, health! On this subject I am becoming quite furious.... If I do not soon recover, I am miserable forever and ever. They talk of the benefit of health from a moral point of view. I declare solemnly, without exaggeration, that I impute nine-tenths of my present wretchedness, and rather more than nine-tenths of all my faults, to this infernal disorder in the stomach."
"Bilious, too, in these smothering windless days."
"Broke down in the park;konntenichts mehr, being sick and weak beyond measure."
"Many days of suffering, of darkness, of despondency.... Ill-health has much to do with it."
"Occasionally sharp pain (something cutting hard, grasping me around the heart).... Something from time to time tying me tight as it were, all around the region of the heart, and strange dreams haunting me."
"There is a shivering precipitancy in me, which makesemotionof any kind a thing to be shunned. It is my nerves, my nerves.... Such a nervous system as I have.... Thomas feeling in his breast for comfort and finding bilious fever.... All palpitating, fluttered with sleeplessness and drug-taking, etc.... Weary and worn with dull blockheadism, chagrin (next to no sleep the night before)."
"A headfull of air; you know that wretched physical feeling; I had been concerned with drugs, had awakened at five, etc. It is absolute martyrdom."
"A huge nightmare of indigestion, insomnia, and fits of black impatience with myself and others,—self chiefly.... I am heartily sick of my dyspeptic bewilderment and imprisonment."
"Alas! Alas! I ought to be wrapped in cotton wool, and laid in a locked drawer at present. I can stand nothing. I am really ashamed of the figure I cut."
Froude's statements regarding Carlyle's condition are as follows:
"... The simple natural life, the 'wholesome air, the daily rides or drives, the poor food,... had restored completely the functions of a stomach never so far wrong as he had imagined.... Afterwards he was always impatient, moody, irritable, violent. These humours were in his nature, and he could no more be separated from them than his body could leap off its shadow.... He looked back to it as the happiest and wholesomest home that he had ever known. He could do fully twice as much work there, he said, as he could ever do afterwards in London."
"... If his liver occasionally troubled him, livers trouble most of us as we advance in life, and his actual constitution was a great deal stronger than that of ordinary men.... Why could not Carlyle, with fame and honor and troops of friends, and the gates of a great career flung open before him, and a great intellect and a conscience untroubled by a single act which he need regret, bear and forget too? Why indeed! The only answer is that Carlyle was Carlyle."
These observations carry weight as representing the impartial and judicial estimate of a careful observer desiring only accurately to picture Carlyle as he was. The only logical conclusion, it seems to me, was that Carlyle, in addition to ocular defect with its legitimate consequences, was weighed down by worry over the failure to realize his own exaggerated ideal of health, that he devoted an undue degree of attention to this subject and was unduly anxious about it—in other words, that he had decided hypochondriacal tendencies.
It was a common saying of Myson that men ought not to investigate things from words, but words from things; for that things are not made for the sake of words, but words for things.
Diogenes Laertius.
This term (properly, though not commonly, accented upon the penult), was introduced by Beard to designate the large class of over-worked and worried who crowded his consulting room. The word is derived from the Greekneuronnerve, andastheneiaweakness.
Among the symptoms of this disorder have been included disorders of digestion and circulation, muscular weakness, pains, flushes and chills, and anomalous sensations of every variety. It has been especially applied to cases showing such mental peculiarities as morbid self-study, fear of insanity and the various other phobias, scruples, and doubts with which we have become familiar.
The "American Disease" has been adopted abroad, and volumes have been devoted to it. Neurasthenia has been divided into cerebral, spinal, and otherwise, according as the fears and sensations of the patient are referred to one or another part of his body. While the term neurasthenia is becoming daily more familiar to the general public, it is being, on the whole, used, except as a convenient handle, rather less among neurologists. [Footnote: In substantiation of this statement I need only cite the recent contribution of my friend, Dr. Dana, on the "Partial Passing of Neurasthenia."] The question has arisen whether the symptoms of neurasthenia are always due to simple exhaustion. Advice regarding method, as well as amount, of work, is coming into vogue. Peterson, in a letter published inCollier's Weekly(November 9, 1907) thus arraigns a patient who has told him he is a practical business man, and that his mind has been so occupied with serious matters that he has been unable to attend to his health.
"You, practical! you, a business man! Why, you never had a serious thought in your life until now—at least not since you were a lad in the country.... Since boyhood you have never given a serious thought to health, home, wife, children, education, art, science, racial progress, or to the high destiny of man. You are simply a collector of money for its own sake, with no appreciation of what it might represent if you were really serious and really a business man or man of affairs. There are many like you in our asylum wards, where they are known as chronic maniacs. Here is one who collects bits of glass, old corks, and pieces of string. There sits another with a lap full of pebbles, twigs and straws."
Courtney (in Pyle's "Personal Hygiene") says, "The brain is an organ which, under proper training, is capable of performing an immense amount of work, provided only that the work is of a varied character and does not produce a corresponding amount of mental disquietude. The importance of the emotions, especially the depressing emotions such as grief, anxiety, and worry, as factors in the brain exhaustion, cannot easily be overestimated."
The obvious corollary to this proposition is that the constitutional worrier is likely to break down under an amount of work which produces no such effect upon the average normal individual.
The only quarrel I have with the name neurasthenia is that it diverts attention from the real condition oftenest to be treated, namely, the faulty mental tendency, and directs attention to an assumed debility which may or may not exist. Misdirected energy, rather than weakness, is the difficulty with one who is ready and anxious to walk miles to satisfy a doubt, or to avoid crossing an open square, and who will climb a dozen flights of stairs rather than be shut up in an elevator. Even the exhaustion that follows long attention to business is quite as often due to worry and allied faulty mental habits as to the work itself. In most cases the phobias, the doubts, and the scruples, instead of being the result of breakdown, must be counted among its principal causes.
This is why simple rest and abstinence from work so often fail to accomplish the cure that should follow if the exhaustion were due simply to overwork. In the "neurasthenic" rest from work only redoubles the worries, the doubts and the scruples, and the obsession to improve his time only adds to his nervous exhaustion. If a European trip is undertaken, the temperament responsible for the original breakdown causes him to rush from gallery to gallery, from cathedral to cathedral, so that no moment may be lost. Not infrequently it so happens that the patient returns more jaded than ever.
The neurasthenic is not infrequently a confirmed obsessive, with all the faulty mental habits of this temperament. If he cannot make up his mind it is not because he is tired, but because this is his natural mental trend. If he drums, twitches, and walks the floor, these movements are not always due to exhaustion, but are habits peculiar to the temperament, habits well worth an effort to eliminate while in health, since they doubtless, through precluding bodily repose, contribute their mite toward the very exhaustion of which they are supposed to be the result. If he cannot sleep it is not simply because he is tired, but because he is so constituted that he cannot bring himself to let go his hold on consciousness until he has straightened out his tangles. If, in addition, one has the hypochondriacal tendency, he may worry himself into complete wakefulness by the thought that he has already irreparably injured himself by missing something of the mystic number, eight or nine, or whatever he may deem the number of hours' sleep essential to health.
It is important that the overwrought business or professional man realize the importance of undertaking no more than he can accomplish without fret and worry; the importance of taking proper vacations before he is tired out; the importance of learning to divert his mind, while he can still do so, into channels other than those connected with his business; above all, the importance of cultivating the faculty of relaxing, and of dismissing doubts, indecisions and fears. He must cultivate what my colleague Dr. Paul succinctly terms "the art of living with yourself as you are." If he would "last out" he must learn to proceed with single mind upon whatever work he undertakes, and with equal singleness of mind apply himself, out of hours, to other occupation or diversion, preferably in the open air. For the most effective work, as well as for peace of mind, it is essential that every thought of one's office be shut out by other interests when there is no actual business requiring attention. Mental relaxation is materially hampered by such persistent thoughts of one's place of business as those cited by Dr. Knapp:
"A striking instance of the sort was related to me by a friend remarkably free from any psychopathic taint. It often happens that he does scientific work in the evening at the Agassiz Museum. When he leaves for the night he puts out the gas and then stands and counts slowly up to a given number until his eyes are used to the darkness, in order that he may detect any spark of fire that may have started while he was at work. This is his invariable custom, but it sometimes happens that when he goes back home so strong a feeling of doubt comes over him lest he may that once have omitted to do this, that he is uncomfortable until he returns to the museum to make sure."
Among the predisposing causes for nervous breakdown none is more potent than the inability of the obsessive to adapt himself to change of plan, and to reconcile himself to criticism, opposition, and the various annoyances incident to his occupation.
In dealing with others the following suggestion of Marcus Aurelius may come in play:
"When a man has done thee any wrong, immediately consider with what opinion about good or evil he has done wrong. For when thou hast seen this, thou wilt pity him, and neither wonder nor be angry." Again, in this connection the lines of Cowper are pertinent: