Outwitting Our Nerves.
by Josephine A. Jackson and Helen M. Salisbury.
FOREWORD
"Your trouble is nervous. There is nothing we can cut out and there is nothing we can give medicine for." With these words a young college student was dismissed from one of our great diagnostic clinics.
The physician was right. In a nervous disorder there is nothing to cut out and there is nothing to give medicine for. Nevertheless there is something to be done,-something which is as definite and scientific as a prescription or a surgical operation.
Psychotherapy, which is treatment by the mental measures of psycho-a.n.a.lysis and re-education, is an established procedure in the scientific world to-day. Nervous disorders are now curable, as has been proved by the clinical results in scores of cases from civil life, under treatment by Freud, Janet, Prince, Sidis, DuBois, and others; and in thousands of cases of war neuroses as reported by Smith and Pear, Eder, MacCurdy, and other military observers. These army experts have shown that sh.e.l.l-shock in war is the same as nervousness in civil life and that both may be cured by psycho-a.n.a.lysis and re-education.
For more than a decade, in handling nervous cases, I have made use of the findings of recognized authorities on psychopathology. Truths have been applied in a special way, with the features of re-education so emphasized that my home has been called a psychological boarding-school. As the alumni have gone back to the game of life with no haunting memories of usual sanatorium methods, but with the equipment of a fuller self-knowledge and sense of power, they have sent back a call for some word that shall extend this helpful message to a larger circle.
There has come, too, a demand for a book which shall give accurate and up-to-date information to those physicians who are eager for light on the subject of nervous disorders, and especially for knowledge of the significant contributions of Sigmund Freud, but who are too busy to devote time to highly technical volumes outside their own specialties.
This need for a simple, comprehensive presentation of the Freudian principles I have attempted to meet in this primer of psychotherapy, providing enough of biological and psychological background to make them intelligible, and enough application and ill.u.s.tration to make them useful to the general pract.i.tioner or the average layman.
JOSEPHINE A. JACKSON.
Pasadena, California, 1921.
OUTWITTING OUR NERVES
CHAPTER I
In Which Most of Us Plead Guilty to the Charge of "Nerves."
NERVOUS FOLK
Who"s Who
Whenever the subject of "nerves" is mentioned most people begin trying to prove an alibi. The man who is nervous and knows that he is nervous, realizes that he needs help, but the man who has as yet felt no lack of stability in himself is quite likely to be impatient with that whole cla.s.s of people who are liable to nervous breakdown. It is therefore well to remind ourselves at once that the line between the so-called "normal" and the nervous is an exceedingly fine one. "Nervous invalids and well people are indistinguishable both in theory and in practice," [1] and "after all we are most of us more or less neurasthenic." [2] The fact is that everybody is a possible neurotic.
[1] Putnam: Human Motives, p. 117.
[2] DuBois: Physic Treatment of Nervous Disorders, p. 172.
So, as we think about nervous folk and begin to recognize our friends and relatives in this cla.s.s, it may be that some of us will unexpectedly find ourselves looking in the mirror. Some of our lifelong habits may turn out to be nervous tricks. At any rate, it behooves us to be careful about throwing stones, for most of us live in houses that are at least part gla.s.s.
The Earmarks
Am I "Like Folks"? Before we begin to talk about the real sufferer from "nerves," the nervous invalid, let us look for some of the earmarks that are often found on the supposedly well person. All of these signs are deviations from the normal and are sure indications of nervousness. The test question for each individual is this: "Am I "like folks"?" To be normal and to be well is to be "like folks." Can the average man stand this or that? If he can, then you are not normal if you cannot. Do the people around you eat the thing that upsets you? If they do, ten chances to one your trouble is not a physical idiosyncrasy, but a nervous habit. In bodily matters, at least, it is a good thing to be one of the crowd.
Many people who would resent being called anything but normal-in general-are not at all loth to be thought "different," when it comes to particulars. Are there not many of us who are at small pains to hide the fact that we "didn"t sleep a wink last night," or that we "can"t stand" a ticking clock or a crowing rooster? We sometimes consider it a mark of distinction to have a delicate appet.i.te and to have to choose our food with care. If we are frank with ourselves, some of us will have to admit that our own ailments seem interesting, while the other person"s ills are "merely nervous" or imaginary or abnormal. After all, a good many of us will have to plead guilty to the charge of nervousness.
We have only to read the endless advertis.e.m.e.nts of cathartics and "internal baths," or to check up the quant.i.ty of laxatives sold at any drug store, to realize the wide-spread bondage to that great bugaboo constipation. He who is constipated can hardly prove an alibi to "nerves." Then there are the school-teachers and others who are worn out at the end of each year"s work, hardly able to hold on until vacation; and the people who can"t manage their tempers; and those who are upset over trifles; and those who are dissatisfied with life. To a certain degree, at least, all of these are nervous persons. The list grows.
Half-Power Engines. These people are all supposed to be well. They keep going-by fits and starts-and as they are used to running on three cylinders, with frequent stops for repairs, they accept this rate of living as a matter of course, never realizing that they might be sixty horse-power engines, instead of their little thirty or forty. For this large and neglected cla.s.s of people psychotherapy has a stimulating message, and for them many of the following pages have been written.
The Real Sufferers. These so-called normal people are merely on the fringe of nervousness, on the border line between normality and disease. Beyond them there exists a great company of those whose lives have been literally wrecked by "nerves." Their work interrupted or given up for good, their minds hara.s.sed by doubts and fears, their bodies incapacitated, they crowd the sanatoria and the health resorts in a vain search for health. From New England to Florida they seek, and on to Colorado and California, and perhaps to Hawaii and the Orient, thinking by rest and change to pull themselves together and become whole again. There are thousands of these people-lawyers, preachers, teachers, mothers, social workers, business and professional folk of all sorts, the kind of persons the world needs most-laid off for months or years of treatment, on account of some kind of nervous disorder.
Various Types of Nervousness. The psychoneuroses are of many forms. [3] To some people "nerves" means nervous prostration, breakdown, fatigue, weakness, insomnia, the blues, upset stomach, or unsteady heart,-all signs of so-called neurasthenia or nerve-weakness. To others the word "nerves" calls up memories of strange, emotional storms that seem to rise out of nowhere, to sweep the sky clear of everything else, and to pa.s.s as they came, leaving the victim and the family equally mystified as to their meaning. These strange alterations of personality are but one manifestation of hysteria, that myriad-faced disorder which is able to mimic so successfully the symptoms of almost every known disease, from tumors and fevers to paralysis and blindness.
[3] The technical term for nervousness is psycho-neurosis-disease of the psyche. There are certain "real neuroses" such as paralysis and spinal-cord disease, which involve an organic impairment of nerve-tissue. However, as this book deals only with psychic disturbance, we shall, throughout, use the term neuroses and psycho-neuroses indiscriminately, to denote nervous or functional disorders.
To still other people nervous trouble means fear,-just terrible fear without object or meaning or reason (anxiety neuroses); or a definite fear of some harmless object (phobia); or a strange, persistent, recurrent idea, quite foreign to the personality and beyond the reach of reason (obsession); or an insistent desire to perform some absurd act (compulsion); or perhaps, a deadly and pall-like depression (the blues).
As a matter of fact, the neuroses include all these varieties, and various shades and combinations of each. There are, however, certain mental characteristics which recur with surprising regularity in most of the various phases-dissatisfaction, lack of confidence, a sense of being alone and shut in to oneself, doubt, anxiety, fear, worry, self-depreciation, lack of interest in outside affairs, pessimism, fixed belief in one"s powerlessness, along whatever line it may be.
Underneath all these differing forms of nervousness are the same mechanisms and the same kind of difficulty. To understand one is to understand all, and to understand normal people as well; for in the last a.n.a.lysis we are one and all built on the same lines and governed by the same laws. The only difference is, that, as Jung says, "the nervous person falls ill of the conflicts with which the well person battles successfully."
Summary
Since at least seventy-five per cent. of all the people who apply to physicians for help are nervous patients; and since these thousands of patients are not among the mental incompetents, but are as a rule among the highly organized, conscientious folk who have most to contribute to the leadership of the world, it is obviously of vital importance to society that its citizens should be taught how to solve their inner conflicts and keep well. In this strategic period of reconstruction, the world that is being remodeled cannot afford to lose one leader because of an unnecessary breakdown.
There is greater need than ever for people who can keep at their tasks without long enforced rests; people who can think deeply and continuously without brain-f.a.g; people who can concentrate all their powers on the work in hand without wasting time or energy on unnecessary aches and pains; people whose bodies are kept up to the top notch of vitality by well-digested food, well-slept sleep, well-forgotten fatigue, and well-used reserve energy. That such a state of affairs is no Utopian dream, but is merely a matter of knowing how, will appear more clearly in later chapters.
CHAPTER II
In which we learn what "nerves" are not, and get a hint of what they are
THE DRAMA OF NERVES
An Exploded Theory
"Nerves" not Nerves. Pick up any newspaper, turn over a few pages, and you will be sure to come to an advertis.e.m.e.nt something like this:
Tired man, your nerves are sick!
They need rest and a tonic to restore their worn-out depleted cells!
No wonder people have believed this kind of thing. It has been dinned into their ears for many years. They have read it with their breakfast coffee and gazed at it in the street cars and even heard it from their family physicians, until it has become part and parcel of their thinking; yet all the time the fundamental idea has been false, and now, at last, the theory is exploded.
So far as the modern laboratory can discover, the nerves of the most confirmed neurotic are perfectly healthy. They are not starved, nor depleted, nor exhausted; the fat-sheath is not wanting, there is no inflammation, there is nothing lacking in the cell itself, and there is no acc.u.mulation of fatigue products. Paradoxical as it may sound, there is nothing the matter with a nervous person"s nerves. The faithful messengers have borne the blame for so long that their name has gotten itself woven into the very language as symbolic of disease. When we speak of nervous prostration, neurasthenia, neuroses, nervousness, and "nerves" we mean that body and mind are behaving badly because of functional disorder. These terms are good enough as figures of speech, so long as we are not fooled by them; but accepting them in their literal sense has been a costly procedure.
Thanks to the investigations of physiologist and psychologist, usually combined in the person of a physician, "nervousness" has been found to be not an organic disease but a functional one. This is a very important distinction, for an organic disease implies impairment of the tissues of the organ, while a functional disorder means only a disturbance of its action. In a purely nervous disorder there seems to be no trouble with what the nerves and organs are, but only with what they do; it is behavior and not tissue that is at fault. Of course, in real life, things are seldom as clear-cut as they are in books, and so it happens that often there is a combination of organic and functional disease that is puzzling even to a skilled diagnostician. The first essential is a diagnosis as to whether it be an organic disease, with accompanying nervous symptoms, or a functional disturbance complicated by some minor organic trouble. If the main cause is organic, only physical means can cure it, but if the trouble is functional, no amount of medicine or surgery, diet or rest, will touch it; yet the symptoms are so similar and the dividing line is so elusive, that great skill is sometimes required to determine whether a given symptom points to a disturbance of physical tissue or only to behavior.
If the physician is sometimes fooled, how much more the sufferer himself! Nausea from a healthy stomach is just as sickening as nausea from a diseased one. A fainting-spell is equally uncomfortable, whether it come from an impaired heart or simply from one that is behaving badly for the moment. It must be remembered that in functional nervousness the trouble is very real. The organs are really "acting up." Sometimes it is the brain that misbehaves instead of the stomach or heart. In that case it often reports all kinds of pains that have no origin outside of the brain. Pain, of course, is perceived only by the brain. Cut the telegraph wire, the nerve, and no amount of injury to the finger can cause pain. It is equally true that a misbehaving brain can report sensations that have no external cause, that have not come in through the regular channel along the nerve. The pain feels just the same, is every bit as uncomfortable as though its cause were external.
Sometimes, instead of reporting false pains, the brain misbehaves in other ways. It seems to lose its power to decide, to concentrate, or to remember. Then the patient is almost sure to fancy himself going insane. But insanity is a physical disease, implying changes or toxins in the brain cells. Functional disorders tell another story. Their cause is different, even though the picture they present is often a close copy of an organic disease.
Distorted Pictures. It should not be thought, however, that the symptoms of functional and organic troubles are identical. Hysteria and neurasthenia closely simulate every imaginable physical disease, but they do not exactly parallel any one of them. It may take a skilled eye to discover the differences, but differences there are. Functional troubles usually show a near-picture of organic disease, with just enough contradictory or inconsistent features to furnish a clue as to their real nature. For this reason it is important that the treatment of the disease be solely the province of the physician; for only the carefully trained in all the requirements of diagnosis can differentiate the pseudo from the real, the innocuous from the disastrous.
False or nervous neuritis may feel like real neuritis (the result of poisons in the blood), but it gives itself away when it localizes itself in parts of the body where there is no nerve trunk. The exhaustion of neurasthenia sometimes seems extreme enough to be the result of a dangerous physical condition; but when this exhaustion disappears as if by magic under the proper kind of treatment, we know that the trouble cannot be in the body. Let it be said, then, with all the emphasis we can command, "nerves" are not physical. Laboratory investigation, contradictory symptoms, and response to treatment all bear witness to this fact. Whatever symptoms of disturbance there may be in pure nervousness, the nerves and organs can in no way be shown to be diseased.