Kitabı oku: «Health Through Will Power», sayfa 12
A great many of the so-called chronic rheumatisms are really the result of dreads to use muscles in the proper way because for the moment something has happened to make their use painful. A direct injury, a wrench, or some incident causes a joint for a time to be painful when used. In sparing it, the muscles around it are used differently than before and as a consequence become sensitive and painful. It is quite easy, then, for people to form bad habits which they cannot break because they have not the strength of will to endure the sore and tender condition which develops when they try to use muscles properly once more. The young athlete who wants to get his muscles in good condition knows that he must pass through a period of soreness and tenderness, sometimes of almost excruciatingly painful character. He does so, however, and does not speak of his condition as involving pains and aches but only soreness and tenderness.
Older people, however, who have to get their muscles back into good condition after a period of disuse following an injury or some inflammatory disturbance, find this period of discomfort very difficult to bear and so keep on using their muscles somewhat abnormally and at mechanical disadvantage. As a consequence, these muscles remain tender, are likely to ache in rainy weather and often give a good deal of discomfort. Until the sufferers can be brought to use their wills properly, so as to win back their muscles to normal use, they will not get well. An application of magnets or a Leyden jar or Mesmer's battery of the eighteenth century, or Perkins' tractors, or neuro-hypnotism, or animal magnetism, or later hypnotism, or Dowie's declaration of their cure, enables them to use their will in this regard and then they proceed to recover. It is surprising how many presumedly intelligent people—at least they have received considerable education—have been cured of conditions that they have endured for years by some remedy or mode of treatment that actually had no physical effect.
St. John Long, the English charlatan who has been mentioned in the chapter on tuberculosis, also succeeded in making a name for himself in connection with the chronic rheumatisms and the so-called rheumatic pains and aches of older people. Between consumption and these conditions, he caught both the young and the old, and thus rounded out his clientele. For consumption he provided an inhalant; for rheumatic conditions, a liniment. This liniment became very famous in that generation for its power to relieve the pains and aches, both acute and chronic, of mankind. So many people were cured by it and above all, so many of them were people of distinction—lords and ladies and the relatives of the nobility—that Parliament was finally petitioned in the interests of suffering humanity to buy the secret of the liniment from its inventor and publish it for the benefit of the world. I believe that a substantial sum, representing many, many thousands of dollars in our time, was actually voted to St. John Long and the recipe for his liniment was published in the British pharmacopeia. In composition, it was, I believe, only a commonplace turpentine liniment made up with yolks of eggs instead of oil, as had been the custom before. Just as soon as this fact became known, the wonderful cures which had occurred in connection with its use ceased to a great extent, for distinguished members of the nobility and their relatives would not be cured by so common-place a medium as an ordinary turpentine liniment. St. John Long was even accused of not having sold his real secret to the Government, but there was no reason at all to think that. He had been producing his cures not by his liniment but by the strong effect of his prestige and reputation as a healer upon the minds of his patients and the consequent release of will power which enabled them to do things which they thought they could not do before. We have had many wonderful curative oils of various kinds since then, with all sorts of names from Alpha to Omega and very often called after a saint,—though St. John Long was as far as possible from being a saint in the ordinary acceptance of that word. These modern curative oils and liniments have been merely counter-irritants, but at times, owing to a special reputation acquired, they have been counter-irritants for the mind and stimulants for the will which have enabled old people to persist through the periods of soreness and tiredness until they reacquired the proper use of their muscles.
CHAPTER XVIII
PSYCHO-NEUROSES
"Look, what I will not, that I cannot do."
Measure for Measure
The psycho-neuroses, that is, the various perversions of nervous energy and inability to supply and conduct nervous impulses properly, consequent upon a mental persuasion which interferes with these activities, have come to occupy an ever larger and larger place in the field of medicine. The war has been illuminating in this matter. A psycho-neurosis is, after all, a hysterical manifestation and it might very well be expected that very few of these would be encountered in armies which took only the men of early adult life and from among those, only persons who had been demonstrated to be physically and, as far as could be determined, mentally normal. Neurologists would seem scarcely to have a place in the war except for wounds of nerves and the cerebral location of missiles and lesions. Certainly none of the army medical departments had the slightest premonition that neurology would bulk larger in their war work than any other department except surgery. That proved to be the case, however.
The surprise was to have, from very early in the war, literally thousands of cases of psycho-neuroses, "shell shock" as unfortunately they came to be called, which included hysterical symptoms of all kinds, mutism, deafness, blindness, paralysis, and contractures. France and England after some time actually had to maintain some fifty thousand beds in their war hospitals mainly for functional nervous diseases, the war neuroses of many kinds. During the first half of the war, one seventh of all the discharges from the British army or actually one third of all the discharges, if those from wounds were not included, were for these war neuroses. They attacked particularly the better educated among the men and were four times as prevalent among officers as among the privates. In proportion to the whole number of those exposed to shells and "war's alarms and dangers" generally, these war neuroses were more common among the men than among the women. Nurses occasionally suffered from them, but not so frequently as the men who shared their dangers in the hospitals and stations for wounded not far from the firing line.
In the treatment of this immense number of cases, a very large amount of the most valuable therapeutic experience for psychoneuroses was accumulated. It was found that suggestion played a very large role in making the cases worse. If these patients were placed in general hospitals where there was much talk of wounds and injuries and the severe trials of battle life they grew progressively worse. They talked of their own experiences, constantly enlarging them; they repeated what they had heard from others as if these represented their own war incidents and auto-suggested themselves into ever worse and worse symptomatic conditions. This was, after all, only the familiar pseudologia hysterica which occurs in connection with hysteria, and which is so much better called by the straightforward name of pathological self-deception or perhaps even just frankly hysterical lying. If these patients were examined frequently by physicians, their symptoms became more and more varied and disabling and their psycho-neurosis involved more external symptoms.
In a word, it was found that their minds were the source of extremely unfavorable factors in their cases. The original shock or the severe trials of war life had unbalanced their self-control and suggestions of various kinds made them still worse. Much attention to their condition from themselves and others simply proved to be constantly disturbing. As was pointed out by Doctor Pearce Bailey, who had the opportunity as United States Chief of the Division of Neurology and Psychiatry attached to the Surgeon General's office to visit France and England officially to make observations on the war neuroses, the experience of the war has amply confirmed Babinski's position with regard to hysteria. The distinguished French neurologist has shown that the classic symptoms of hysteria are the results of suggestion originating in medical examinations or from misapplied medical or surgical treatment. He differs entirely from Charcot in the matter and points out that it was unfortunate misdirected attention to hysterical patients which led to the creation of the many cases of grande hystérie which used to be seen so commonly in clinics in France and have now practically disappeared. They were not genuine pathological conditions in any sense of the word, but merely the reflection of the exaggerated interest shown in them by those interested in neurology, who came to see certain symptoms and were, of course, gratified in this regard by the patients, always anxious to be the center of attention and, above all, the focus of special interest.
The successful treatment of the war neuroses was all founded on the will and not on the mind. Once a careful examination had determined absolutely that no organic morbid condition was present, the patient was given to understand that his case was of no special significance but on the contrary was well understood and had nothing exceptional in it. The unfortunate frequent demonstration of these patients at the beginning of the war as subjects of special interest had been the worst possible thing for them. After experience had cleared the way, they were made to feel that just as soon as the attending physician had the time to give them, he would be able to remove their symptoms without delay. This was almost the only appeal to the mind that was made. It represented the suggestive element of the treatment.
The two other elements were reeducation and discipline. Once suggestion had brought the patient to believe firmly that he would be cured, he was made to understand that his cure would be permanent. Then reeducation was instituted to overcome the bad habit of lack of confidence that had been formed, while discipline broke down the psychic resistance of the patient to the idea of recovery. In such symptoms as mutism or deafness, the patient was told that electricity would cure him and that as soon as he felt the current when the electrode was applied, his power of speech or of hearing would be restored, pari passu, with sensation. The same method was used for blindness and other sensory symptoms. Paralyses were favorably affected the same way, though tremors were harder to deal with. A cure in a single treatment was the best method, for the patient readily relapsed unless he was made to feel that he had recovered his powers completely and that it would be his own fault if he permitted his symptoms to recur.
The most interesting phase of the successful treatment of these war neuroses for us was the fact that the ultimate dependence was placed by the French on a system of management which was called torpillage. Torpillage consists in the brusque application of faradic currents strong enough to be extremely painful in hysterical conditions, and the continuance of the procedure to the point at which the deaf hear, the dumb speak, or those who believe themselves incapable of moving certain groups of muscles come to move them freely. The method has proved highly effective and requires but little time and practically no personnel except the medical officer who applies the treatment and the non-commissioned officer who takes the patient at the end of the treatment and continues the exercise of the afflicted parts. One treatment suffices. The apparatus is of the simplest, the only accessory to the electric supply and the electrodes consisting of an overhead trolley which carries the long connecting wires the whole length of the room, thus making it impossible for the patient to get away from the current which is destined to cure him.
In a word, the man who would insist on maintaining a false attitude of mind towards himself, though that attitude of mind was not deliberate, and least of all not malingering, was simply made to give it up. Sufficient pain was inflicted on him so that he was willing to accept instead of his own false opinion the opinion of his physician that he could accomplish certain functions. Torpillage was, in other words, simply "a method of treatment which gave authority to a medical officer to inflict pain on a patient up to the point at which the patient yields up his neurosis." As a rule, the infliction of very little suffering is needed, for once the demonstration is made that he will have to suffer or give in, it does not take him very long to give in. There is no doubt at all that the method is eminently effective, particularly in those cases which were entirely refractory to other modes of treatment.
It would remind us of some old modes of treatment which were in popular use long ago, but which had gone out entirely in our milder generation because we thought their use almost unjustified. It was not an unusual thing three or four generations ago to rouse a young woman out of an hysterical tantrum, once it was perfectly clear from previous experiences that it was really an hysterical tantrum, by dashing a pitcher of cold water over her. Sir Thomas More relates that he saw a number of people suffering from various forms of possession—and any neurologist will confess that some hysterics must have a devil—who were cured by being roundly whipped. Certain men and women who complained that they were unable to walk or to work and thus became a care for relatives or for the community, were cured by this, as it seemed to later generations, heartless mode of treatment. Now, we have turned to curing the war hysterias by punishment, that is, by the infliction of severe pain, in just the same way. A great many of these patients who suffer from neuroses and psycho-neuroses, and especially from hysterical inhibitions so that they cannot hear or cannot walk or cannot talk, represent inabilities similar to many which are seen in civil life. Patients complain that they cannot do things; their friends say that they will not do them; and the physician sees that the root of the trouble is that they cannot will. Now, however, that war has permitted the use of such remedies, physicians have found that they can, to advantage, force the patients to will and that once the will has been recalled into action, its energy can be maintained.
Of course the compulsory mode of treatment was not represented as a punishment, but on the contrary it was always presented as a form of treatment which was extremely painful but necessary for the condition. Presented as punishment, it would have been resented, and the patient would probably have set about sympathizing with himself and perhaps seek the sympathy of others, and this would prevent the effectiveness of the treatment. It is very evident that as the result of compulsory methods of treatment, and of the recognition of the fact that major hysterical conditions are largely the result of suggestion and must be cured by enabling the patient to secure control over himself again, the outlook for the treatment of the psychoneuroses will be very different as a consequence of the experience that has been gained. Above all, the place of the will will be recognized, and there will no longer be that coddling of patients and that analysis of their minds for long distant psychic insults of various kinds which will explain their condition, that has done so much harm in a great many ways in recent years.
Another feature of the French treatment was that the neurotic patients should be isolated. This isolation was complete. It had been found that association with other patients, the opportunity to tell their troubles and be sympathized with, did them harm invariably and inevitably, so that those whose neurotic symptoms continued were taken absolutely away from all association with others. Not only this, but all other modes of diversion of mind were denied them. They were placed in rooms without reading or writing materials and even without tobacco. This solitary confinement would remind one of the enforced privacy of the old-fashioned rest cure in which the patient was absolutely secluded from all association with relatives or others who might in any way sympathize with them. The soldier patients were kept in this complete isolation until such time as they showed themselves amenable to treatment. This was usually not very long.
As a matter of fact, the isolation rooms had to be used very little but were found necessary and especially effective in the management of relapsed cases. Just as soon as soldier patients learned that such isolating rooms were available, they became much more ready to give up their neuroses, and as a consequence, in most places, the isolating department did not have to be used, and in some places they could even be given over to the lodgment of attendants. It was quite sufficient, however, that they had fulfilled their purpose of changing patients' attitude of mind towards themselves and giving their will control over them.
As Colonel Pearce Bailey, M.C., says, in most of these patients, persuasive measures and contrary suggestion were quite sufficient, but when they failed, disciplinary measures proved effective. How are we going to be able to make such disciplinary measures available in civil life is another question, but at least the war has made clear that neurotic patients who claim that they cannot do something and actually will not do it, must be made to do it, for this will prove the beginning of their cure. It seems probable, as Doctor Bailey adds, that the reason why the treatment of officers was more difficult—and it must not be forgotten that in proportion to their numbers, four times as many officers suffered from so-called shell shock as privates—was exactly because these modes of discipline, amounting practically to compulsion, were not used with them.
CHAPTER XIX
FEMININE ILLS AND THE WILL
"Oh, undistinguished space of woman's will!"
King Lear
It is probable that the largest field for the employment of the will for the cure of conditions that are a source of serious discomfort or at least of complaint is to be found among the special ills of womankind. The reason for this is that the personal reaction has so much to do with the amount of complaint in these affections. Not infrequently the individual is ever so much more important than the condition from which she is suffering. Women who have regular occupation with plenty to do, especially if they are interested in it and take their duties seriously, who get sufficient exercise and are out of doors several hours each day and whose appetites are as a consequence reasonably good, suffer very little from feminine ills, as a rule. If an infection of some kind attacks them, they will, of course, have the usual reaction to it, and this may involve a good deal of pain and even eventually require operation. Apart from this, however, there is an immense number of feminine ills dependent almost entirely on the exaggerated tendency to react to even minor discomforts which characterizes women who have no occupation in which they are really interested, who have very little to do, almost no exercise, and whose appetite and sleep as a consequence are almost inevitably disturbed.
Above all, it must not be forgotten that whenever women do not get out into the air regularly every day—and this means for a time both morning and afternoon—they are likely to become extremely sensitive to pains and aches. This is true of all human beings. Those who are much in the open air complain very little of injuries and bodily conditions that would seem extremely painful to those living sedentary lives and who are much indoors. Riding in the open air is better than not being in the open air at all, but it does not compare in its power to desensitize people with active exercise in the open air. In the older days, when women occupied themselves very much indoors with sewing, knitting and other feminine work, and with reading in the evenings, and when it was considered quite undignified for them to take part in sports, neurotic conditions were even more common than they are at the present time, and young women were supposed to faint readily and were quite expected to have attacks of the "vapors" and the "tantrums."
The interest of young women in sports in recent years and the practice of walking has done a great deal to make them ever so much healthier and has had not a little to do with decreasing the number and intensity of the so-called feminine ills, the special "women's diseases" of the patent medicine advertisements. Much remains to be done in this regard, however, and there are still a great many young women who need to be encouraged to take more exercise in the open than they do and thus to live more natural lives. It is particularly, however, the women of middle age, around forty and beyond it, who need to be encouraged to use their wills for the establishment of habits of regular exercise in the open air as well as the creation of interests of one kind or another that will keep them from thinking too much about themselves and dwelling on their discomforts. These are thus exaggerated until often a woman who has only some of the feelings that are almost normally connected with physiological processes persuades herself that she is the victim of a malady or maladies that make her a pitiable object, deserving of the sympathy of her friends.
A great many of the operations that have been performed on women during the past generation have been quite unnecessary, but have been performed because women felt themselves so miserable that they kept insisting that something must be done to relieve them, until finally it was felt that an operation might do them some good. It would surely do them no harm or at least make them no worse, and there was always the possibility that the rest in the hospital, the firm persuasion that the operation was to do them good, the inculcation of proper habits of eating during convalescence might produce such an effect on their minds as would give them a fresh start in life. Undoubtedly a great many women who were distinctly improved after operations owed their improvement much more to the quiet seclusion of their hospital life, their own strong expectancy and the care bestowed upon them under the hospital discipline without exaggerated sympathy which brought about the formation of good habits of life, than to their operation. Many a woman gained weight after an operation simply because her eating was properly directed, and this was the main part of the improvement which took place.
Operations are sometimes needed and when they are the patient will probably not get well without one; but as a distinguished neurologist, Doctor Dercum of Philadelphia, said in a paper read before the American Medical Association last year, the neurologist is constantly finding patients on whom one or several operations have been performed, some of them rather serious abdominal operations, the source of whose complaints is a neurosis and not any morbid condition of the female or other organs. Occasionally one sees something like this in men, and I shall never forget seeing at Professor Koenig's clinic in Berlin a sufferer from an abdominal neurotic condition on whom no less than three operations for the removal of his appendix had been performed, until finally Professor Koenig felt that he would be justified in tattooing over the right iliac region the words "No Appendix Here." The condition developed in a young soldier as the result of a fall from a horse and his affection resembled very much some of the neuroses that came to be called, unfortunately, "shell shock" during the present war.
The principal trouble in securing such occupation of mind as will prevent exaggerated neurotic reactions to even slight discomforts in women is the creation for them of definite interests in life. The war taught a notable lesson in this regard. Many a physician saw patients whose complaints had been a great source of annoyance to them—and their friends—proceed to get ever so much better as the result of war interests. In one women's prison in an Eastern State, just before the war, a series of crises of major hysteria was proving almost unmanageable. By psychic contagion it had spread among the prisoners until scarcely a day passed without some prisoner "throwing a fit" with screaming and tearing of clothes and breaking of articles that might be near. Prominent neurologists had been consulted and could suggest nothing. When the war began, the prisoners were set to rolling bandages, knitting socks and sweaters and making United States flags for the army. As if by magic, the neurotic crises disappeared. For months there were none of them. The prisoners had an abiding interest that occupied them deeply in other things besides themselves.
The reduction of nervous complaints of various kinds among better-to-do women was very striking. As might be expected, their rather strenuous occupation with war activities kept them from thinking about themselves, though it is true that now they complain about all the details that they had to care for and the lack of coöperation on the part of certain people. It would seem as though many of them had so much to do that they would surely exhaust their energies and so be in worse condition than before, but this very seldom proved to be the case. Literally many thousands of women improved in health because they became interested in other people's troubles instead of their own. David Harum once said that "It is a mighty good thing for a dog to have fleas because it keeps him from thinking too much about the fact that he is a dog." That seems a rather unsympathetic way of putting the case, but there is no doubt at all that what many women need is serious interests apart from themselves in order to prevent the law of avalanche from making minor ills appear serious troubles.
What most women need above all are heart interests rather than intellectual occupations. That was why occupation with war activities did so much good. That is the reason, too, that club life and reading and other similar pursuits often fail to be helpful to women in their ills to the extent that might possibly be expected. Above all, women need interests in children and the ailing, and these can be supplied by visits to hospitals or by taking an active interest in nurseries, though this is often not personal enough in its appeal to catch a woman's deepest attention. One of the great reasons why there are more nervous diseases among women in our time than in the past is because children are fewer, and because so many women are without children and the calls that they inevitably make on their mothers. Unfortunately, the traditions of the present day are to a great extent in opposition to that family life with a number of children, which means not only the deepest interests for woman but also such inevitable occupations in the care of them that she has very little time to think about herself. It may seem quixotic, that is, demanding unnecessary magnanimity to suggest that these modern ideas should be discarded by those who wish to assure themselves such interests in middle life as will prove definitely preventive of many neurotic conditions, but it is manifestly the physician's duty to make such suggestions.
Life has really become full of dreads for many women in this regard. A gradual reduction in the birth rate which has deprived so many women of the heart interests that were particularly valuable at and after middle life; has been the source of a great deal more suffering without any satisfaction, than would be associated in any way with the care of children. It is extremely unfortunate, then, that this phase of social evolution should have taken place, for the quest of ease and pleasure has proved a prolific source of feminine ills. It is well recognized now that the reason for this reduction in the birth rate is not physical but ethical. It is a matter of choice and not necessity. There is a conscious limitation of the number of children in the family accomplished deliberately, and as a rule the women consider that they are justified in the procedure because they thus conserve their own health and provide such few children as they have with healthier bodies than would otherwise have been the case.
Indeed, child-bearing beyond one or two or perhaps three children has become a source of dread in modern times, a dread that supposedly centers around the health of the children, as well as the mother herself. The mother of a few children is supposed to be healthier and the children of small families to be heartier and more vigorous than when there are half a dozen or more children in the family. A woman is actually supposed by many to seriously imperil her life and her health if she has more than two or three children, though as a matter of fact, the history of the older times when families were larger shows us that women were then healthier on the average than they are now, in spite of all the progress that medicine and surgery have since made in relieving serious ills. Above all, it was often the mother of numerous children who lived long and in good health to be a blessing to those around her, and not the old maids nor the childless wives, for longevity is not a special trait of these latter classes of women. The modern dread of deterioration of vitality as the result of frequent child-bearing is quite without foundation in the realities of human experience.
