One source of trouble in the menopause is that it comes at a time in a woman"s life when she is likely to have too much leisure. In no way can a woman so easily handicap her body at this time as by stopping work and being afraid. Those women who have to go on as usual find themselves past the change almost before they know it,-unless they consider themselves abused, and worry over the necessity for working through such a "critical time."
Three Rules. Here are a few pointers which have have been of help to a number of women:
1 Remember that this is a physiological process and therefore abundantly safeguarded by Nature. If you don"t expect trouble you will not be likely to find it.
2 Remember that the sweating and flushing are made worse by notice.
3 Do everything in your power to keep from the public the knowledge that you are no longer a potential mother. If you are past forty, do not mop your face or gasp for breath or carry a fan to the theater! Shun attention and fear, and you will be surprised at the ease with which the "change" is effected.
Nature"s Last Chance. While we are on the subject of the middle-aged woman, it may be well to mention a phenomenon sometimes noticed in the early forties. Often an "old maid" who has considered herself settled for life in her bachelor estate, suddenly takes to herself a husband. (I use the verb advisedly!) Mothers who have thought their child-bearing days long past sometimes find themselves pregnant. "The child of her old age" is not an uncommon occurrence. Unmarried women who have "kept straight" all their lives sometimes go down before temptation at this late time. There is a reason. It is as though Nature were making a last desperate attempt to produce another life before it is too late, speeding up all the internal secretions and flashing insistent messages throughout the whole organism.
It may help some woman who feels herself inexplicably impelled toward the male s.e.x to know that she is not being "tempted by the devil" but merely driven by the insistent chemicals within her body. She is likely to rationalize and tell herself that it is too bad for a worth-while person like herself to leave no progeny behind her; or she may say, as one of my patients did when contemplating running away with another woman"s husband,-that she could make that man so much happier than his wife did, and that she really owed it to him as well as to herself. When a woman knows what is the matter with her, it makes it easier to bide her time and wait for the demands of Nature to subside. Chemicals may not be so romantic as love, but neither are they so melodramatic!
Other Troubles
"Speaking of Operations." Physicians are often called upon to diagnose some such vague symptom as pain in the abdomen, back and head; ache in the legs; constipation, or loss of appet.i.te. Since the patient is very insistent that something shall be done, the physician may be driven to operate, even when he has an uneasy feeling that the trouble is "merely nervous." Sixty per cent. of the operations on women are necessitated by the results of gonorrheal infection. Next in frequency up to recent date, have been operations for nervous symptoms which could in no way be reached by the knife. Only too often a nerve-specialist hears the tale of an operation which was supposed to cure a certain pain but which left it worse rather than better. It is a pleasure to see some of these pains disappear under a little re-education, but one cannot help wishing that the re-education had come before the knife instead of after it.
A skilled surgeon can cut almost anything out of a person"s body, but he cannot cut out an instinct. It sometimes takes great skill to determine whether the trouble is an organic affection or a functional disturbance caused by the misdirected instinct of reproduction. Often, however, the clinical pictures are so different as to leave no room for doubt, provided the diagnostician has his eyes open and is not over-persuaded by the importunity of the poor neurotic, who insists that the surgeon shall remove her appendix, her gall-bladder, her genital organs, and her tonsils, and who finally comes back that he may have a whack at the operation scar.
The Bearing of Children. A number of years ago I became acquainted with a charming young married woman who had all her life recoiled with fear from the phenomena of s.e.x. She had been afraid of menstruation and of marriage, and had at this time almost a phobia for pregnancy and childbirth. Before long she came to me in terror, telling me that she had become pregnant. I explained to her that pregnancy is the time when most women are at their best, that the nausea which is often troublesome in the beginning is caused merely by a mixing of messages from the autonomic nerves, which refer new sensations in the womb to the more usual center of activity in the stomach; and that after the body has become accustomed to these sensations, most women experience a greater sense of well-being and peace than at any other time in life. We had a conversation or two on the subject and everything seemed to go well for a while.
As it happened, this young woman and her husband came to call on me one afternoon just before the baby was expected. During the visit she began to show signs of being in labor. Again she was in terror. Again I explained the phenomena of labor, telling her that the womb-contractions are caused by the presence in the blood of a chemical secretion (hormone) which continues its good work as long as there is a state of confidence, but which sometimes stops under fear or apprehension. I explained that these womb-efforts are a peristaltic movement, a contraction of the upper muscles and a letting go of the purse-string muscle at the mouth of the womb, and that fear only tends to tie up this purse-string muscle, making a difficult process out of one which was intended by Nature to be much more simple. She seemed to understand and to lose a good deal of her fright.
About six o"clock the couple went home on the street car from the upper end of Pasadena to the far end of Los Angeles. The next morning I had a jubilant telephone message from the happy father, announcing that the boy-baby had arrived at midnight and that, wonderful to relate, he had come without the mother"s experiencing any pain whatever.
I give this account for what it is worth, without of course contending that labor could always be as easy as this. It happened that this girl was a normal, healthy woman and that there were no complications of any kind in the process of childbirth. A right att.i.tude of mind could not have corrected any physical difficulty, but it did seem to help her let go of her fear, which would of itself have caused long and painful labor.
A patient once told me that when her first baby came, she happened to be out in the country where she had to call in a doctor whom she did not know. He was an uncouth sort of fellow who inspired fear rather than confidence. She soon found that labor stopped whenever he came into the room, and started again when he went out. She had the good sense to send him out and complete her labor with only the help of her mother. Unfortunate is the obstetrician who does not know how to inspire a feeling of confidence in his patients. Even childbirth may be mightily helped or hindered by the mother"s state of mind.
Summary
A woman"s body has more stability than she knows. It is sometimes out of order, but it is more often misunderstood; usually it is an un.o.btrusive and satisfactory instrument, quite fit for its daily tasks. The average woman is really well put together. We hear about the ones who have difficulty, but not about the great majority who do not. We notice the few who are upset during the menopause, and forget all the others. To be comfortable and efficient most of the time is, after all, merely to be "like folks."
The special functions which Nature has been perfecting in a woman"s body are as a rule, easily carried through unless complicated by false ideas or by fear.
If the woman who has no organic difficulty but who still finds herself handicapped by her body, will cease being either resigned to her languishing lot or envious of her stalwart brothers; if instead she will set out to learn how to be efficient as a woman, she will find that many of her ills are not the blunders of an inefficient Creator, but are home-made products, which quickly vanish in the light of understanding.
CHAPTER XIII
In which we lose our dread of night.
THAT INTERESTING INSOMNIA
The Fear of Staying Awake
To sleep or not to sleep! That is the question. In all the world there is nothing to equal it in importance,-to the man with insomnia. His days are mere interludes between troubled nights spent in restless tossing to and fro and feverish worry over the weary day to come. His mind filled with ideas about the disastrous effects of insomnia, he imagines himself fast sliding down hill toward the grave or the insane-asylum. It is true that his conversation very often politely begins something like this: "Good morning. Did you sleep well last night?" but if we fail to respond by an equally polite "and I hope you had a good night?" he seems restless until he has somehow disillusioned us by stating the exact number of hours and minutes during which he was able to lose himself in slumber.
We must not ridicule the man who doesn"t sleep. We are all very much alike. If any one of us happens to lie awake for a night or two, he is likely to get into a panic, and if the spell should last a week, he begins looking up steamship agents and talking of voyages to Southern seas. The fact is that most people are dreadfully afraid of insomnia. Knowing the effects of a few nights of enforced wakefulness, and having had a little experience with the f.a.gged feeling after a restless night, they believe themselves only logical when they fall into a panic over the prospect of persistent insomnia.
Two Kinds of Wakefulness. As a matter of fact, insomnia is a phantom peril. There is not the slightest danger from lying awake nights, provided one is not kept awake by some irritating physical stimulus. All fear of insomnia is based on ignorance of the difference between enforced wakefulness and deliberate wakefulness, or insomnia. The man who has acquired the habit may stay awake almost indefinitely without appreciable harm, but the one who is kept awake for a week by a pain, by a chemical poison from infection, or by the necessity for staying up on his job, may easily be in a state of exhaustion. Even in cases of prolonged pain or over-exertion, the body tends to maintain its equilibrium by hastening its rate of repair and by falling asleep before the danger point is reached. It is almost impossible to impair permanently the tissue of the brain except in the presence of a chemical irritant. In case of infection we often have to give medicine to neutralize the effect of the poison or to resort to narcotics which make the brain cells less susceptible to irritation. But nervous insomnia is another story.
A Harmless Habit
Long-Lived Insomniacs. A man of my acquaintance once said in all seriousness and with evident alarm: "I am following in the footsteps of my mother. She lived to be seventy years old and she had insomnia all her life." If this man had been preaching a sermon on the harmlessness of chronic insomnia, he could not have chosen a better text, but he seemed just as much concerned about himself as if his mother had died from the effects of three months" wakefulness. People can live healthy lives during twenty or thirty years of insomnia because chronic insomnia is nothing more or less than a habit, and "habit spells ease." The brain cells are not irritated by either internal or external stimuli; there is no effort to keep awake; virtually no energy is expended,-except in restless tossing and worry. If the body is kept still and emotion eliminated, fatigue products are washed away and the reserves are filled in with perfect ease.
Thinking in Circles. Habit means automatic, subconscious activity, with the least expenditure of energy and the least amount of fatigue. We have already noted the ease with which heart and diaphragm muscles carry on their work from the beginning of life to its end. Anything relegated to the subconscious mind can be kept up almost indefinitely without tire, and to this subconscious type of activity belong the thoughts of a chronic insomniac. Despite all a.s.sertions to the contrary, his conscious mind is not really awake. If he is questioned about the happenings of the night, he is likely to have been unaware of the most audible noises. The thoughts that run through his brain are not new, constructive, energy-consuming thoughts, but the same old thoughts that have been going around in circles for days and weeks at a time.
It is true that a person sometimes chooses to wake up and do his constructive planning in the night. This kind of thought does bring fatigue, up to a certain point. After that the body hastens its rate of repair or automatically goes to sleep. Activity of this kind is always a matter of choice. He who really prefers sleep will shut the drawers containing the day"s business and leave them shut until morning.
Day-Dreaming at Night. However, the man who makes a practice of staying awake rarely does much real thinking. He lets the thoughts run through his mind as they will, builds air-castles of things he would like to do and can"t, or other kinds of air-castles about the disastrous effects of his insomnia on the day that is to come; he worries over his health, or his finances, and grieves over his sorrows. He is really indulging himself, thinking the thoughts he likes most to think, and these consume but little energy. Like a horse that knows the rounds, they can go jogging on indefinitely without guidance from the driver.
What Causes the Fatigue
Tossing and Fretting. The thing that tires is not the insomnia but the emotion over the insomnia. If people who fail to sleep are perpetually f.a.gged out, it is not from loss of sleep, but from worry and tossing. Often they spend a good deal of the night feeling sorry for themselves. They turn and toss, exclaiming with each turn: "Why don"t I sleep? How badly I shall feel to-morrow! What a night! What a night!" Such a spree of emotionalism can hardly fail to tire, but it is not fair to blame the insomnia.
He who makes up his mind to it can rest almost as well without sleep as with it, provided he keeps his mind calm and his body relaxed. "Decent hygienic conditions" demand not necessarily eight hours of sleep but eight hours of quiet rest in bed. Tossing about drives away sleep and uses up energy. I make it a rule that my patients shall not turn over more than four times during the night. This is more important than that they should sleep. To be sure, I do not stay awake to enforce the rule, but most people catch the idea very quickly and before they know it they are sleeping.
How to Go to Sleep
Ceasing to Care. The best way to learn to sleep is not to care whether you do or not. Nothing could be better than DuBois"s advice: "Don"t look for sleep; it flies away like a pigeon when one pursues it." [58] Attention to anything keeps the mind awake, and most of all, attention to sleep. More than one person has waked up to see whether or not he was going to sleep. We cannot, however, fool ourselves by merely pretending indifference. The only sensible way is to get the facts firmly fixed in our minds so that we actually realize that we do not need more sleep than our bodies take. As soon as it is realized that insomnia is really of no importance, it tends to disappear.
[58] DuBois: Psychic Treatment of Nervous Disorders, p. 339.
Catching the Idea. There came one day for consultation a very healthy-looking woman, a deaconess of the Lutheran Church. "Doctor," she said, "I came to get relief from insomnia. For twenty years I have not slept more than one or two hours a night." "Why do you want more?" I asked. "Why, isn"t it very unhealthy not to sleep?" she exclaimed in astonishment. "Evidently not," I answered.
This woman had tried every doctor she could think of, including the splendid S. Weir Mitch.e.l.l. Her insomnia had become a preoccupation with her, her chief thought in life. All I did was to explain to her that her body had been getting all the sleep it needed, and that neither body nor mind was in the least run down after twenty years of sleeplessness. "When you cease being interested in your insomnia, it will go away, although from a health standpoint it matters very little whether it does or not." We had two conversations on the subject, and a week later she came back to tell me that she was sleeping eight hours a night.
One woman had had insomnia for thirty years. After I had explained to her that her body had adjusted itself to this way of living and that she need not try to get more sleep, she snored so loud all night and every night that the rest of the family began to complain!
A certain banker proved very quick at catching the idea. He had been so troubled with insomnia and intense weakness that his doctors prescribed a six-months voyage in Southern waters. Knowing that my prescriptions involved a change in point of view rather than in scene, he came to me. Although he had been getting only about half an hour"s sleep a night, he went to sleep in his chair the first evening, and then went upstairs and slept all night. He resumed his duties at the bank, walking a mile and a half the first day and three miles the second. During the months following, he reported, "No more insomnia."
Keeping Account. A bright young college graduate came to me for a number of ailments, chief among them being sleeplessness. She was also overcome by fatigue, having spent four months in bed. A four-mile walk in the canon and a few other such outings soon dispelled the fatigue, but the insomnia proved more obstinate. After she had been with me for a week or two, I took her aside one day for a little talk. "Well?" I said as we sat down. Then she began: "Sunday night I was awake from half-past one to four, Monday from twelve to one, Tuesday from one to three, Wednesday from two to four, Thursday-" By this time she became aware of the quizzical expression on my face and began to be embarra.s.sed. Then she stopped and laughed. "Well," she said, "I did not know that I was paying so much attention to my sleep." She was bright enough to see the point at once, gave up her preoccupation in the all-absorbing topic and promptly forgot to have any trouble with so natural a function as sleep.
Making New a.s.sociations. Examples like this show how natural is childlike slumber when once we take away the inhibitions of a hampering idea. Age-old habits like sleep are not lost, but they may easily be interfered with by a little too much attention. When a person who can scarcely keep his eyes open all the evening is instantly wide awake as soon as his head touches the pillow, we may be sure that a part of his trouble comes from the wrong a.s.sociations which he has built up with the thought of night. When a dear little old lady told me of her constant state of apprehension about going to bed, I said to her: "When I go to my room, the darkness says sleep. When I take off my clothes, the very act says sleep. When I put my head on the pillow, the pillow says sleep." She liked that and found herself able to sleep all night. The next evening she wanted another "sleeping-potion" but as I did not want her to become dependent on anybody"s suggestion, I put my mouth up close to her ear and whispered, "Abra ca dabra, dum, dum, dum." She laughed, but saw the point. After that she slept very well. She merely broke the habit by making a new kind of a.s.sociation with the thought of bed. Nature did the rest.
It seems hardly necessary to remark that drug-taking is the most inefficient way of handling the situation. Everybody knows that narcotics are harmful to the delicate cells of the brain and that the dose has to be continuously increased in cases of chronic insomnia. If a person realizes that the drug is far more harmful than the insomnia itself, he is weak indeed to yield to temptation for the sake of a few nights of sleep. As the cause of insomnia is psychic, so the only logical cure is a new idea and a new att.i.tude of mind.
The Purpose of Insomnia
Like all nervous symptoms, insomnia is not an affliction but an indulgence. Somehow, and in ways unknown to the conscious mind, it brings a certain amount of satisfaction to a part of the personality. No matter how unpleasant it may be, no matter how much we consciously fear it, something inside chooses to stay awake.
Started, as a rule, through suggestion or imitation, insomnia is sometimes kept up as a means of making ourselves seem important,-to ourselves and to others. It at least provides an excuse for thinking and talking about ourselves, and furnishes a certain feeling of distinction. If something within us craves attention, even staying awake may not be too dear a price to pay for that attention. Strange to say, there are other times when the insomnia is chosen by the primitive subconscious mind with the idea of doing penance for supposed sins whose evil effects might possibly be avoided by this kind of expiation. a.n.a.lysis shows that motives like this are not so uncommon as might be supposed. In other cases insomnia is chosen for the chance it gives for phantasy-building. A person denied the right kind of outlet for his instincts may so enjoy the day-dreaming habit that he prolongs it into the night, really preferring it to sleep. Such a state of affairs is not at all incompatible with an intense conscious desire to sleep and a real fear of insomnia. So strange may be the motives hidden away within the depths of the most prosaic individual!
Summary