And since most indigestion is in very truth nothing more nor less than an emotional disturbance, worked up by fear, anger, discontent, worry, ignorance, suggestion, attention to bodily functions which are meant to be ignored, love of notice and the conversion of moral distress into physical distress, the best diet list which can be furnished to Mr. Everyman in search of health must read something like this:

MENU

Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, Sunday

A Calm Spirit Plenty of Good Cheer A Varied Diet Commonsense Good Cooking Judicious Neglect of Symptoms Forgetfulness of the Digestive Process A Little Accurate Knowledge A Determination to BE LIKE FOLKS



CHAPTER XI

In which we relearn an old trick

THE BUGABOO OF CONSTIPATION

POPULAR SUPERSTITIONS

In line with the taboos connected with the taking of food are the ceremonials attendant upon its elimination. Taking anxious thought about functions well established by nature is a feature of conversion-hysteria, the displacement of emotional desire from its psychic realm into symbolic physical expression. Whatever other symptoms nervous people may manifest, they are almost sure to be troubled with chronic constipation. It is true that there are many constipated people who do not seem to be nervous and who resent being classed among the neurotics. Everybody knows that the occasional individual who has difficulty in swallowing his food is nervous and that the, trouble lies not in the muscles of his throat but in the ideas of his mind. But very few people seem to realize that the more common individual who makes hard work of that other simple process—elimination of his intestinal waste matter—is suffering from the same kind of disturbance and giving way to a nervous trick. When all the facts are in, the constipated person will have hard work to clear himself of at least one count on the charge of nerves.

An Oft-told Tale. Sooner or later, then, the neurotic, whether he calls himself a neurotic or not, is very likely to begin worrying over his diet or his sedentary occupation. He imagines himself the victim of autointoxication, afflicted with paralysis of the colon or dearth of intestinal secretions. He leaves off eating white bread, berries, cheese, chocolate, and many another innocent food, and insists on a diet of bran-biscuit, flaxseed breakfast-foods, prunes, spinach, cream, and olive-oil with doses of mineral oil between meals. In all probability, he begins a course of massage or he starts to take extra long walks and to exercise night and morning, pulling his knees up to his chin and touching his fingers to his toes. When all these measures fail, he gives in to the morning enema or the nightly pill, in imminent danger of succumbing to a life-long habit.

THE TRUTH ABOUT CONSTIPATION

What the Colon Is For. It is well, then to have a fair understanding of the structure and purpose of our intestinal machinery. Contrary to general opinion, the intestines are not a dumping-ground but a digestive organ. After the food is partly digested in the stomach, it passes through a twenty-two foot tube (the small intestine) into a five-foot tube (the large intestine or colon) where digestion is completed, the nutriment is absorbed, and the waste matter is passed on and out through the rectum. As the food passes along the colon, pushed slowly ahead by the peristaltic wave, or rhythmic muscular contractions of the intestinal wall, it is seized upon by the four hundred varieties of friendly bacteria which inhabit the intestines of every healthy person, and is changed into a form which the body can assimilate. Digestion in the stomach and small intestine is carried on by means of certain digestive juices, but in the large intestine it is the bacteria which do the work. Without them we could not live.

Around the colon is a thick network of little blood vessels, all of which lead straight to the liver, the storehouse of the body. After the food is fully digested, it is passed through the thin intestinal wall into these tiny vessels and carried away to liver and muscles for storage or for immediate use.

This process of absorption is carried on throughout the whole length of the colon. Not until the very end of the intestine is reached is all the nutrition abstracted. The bowel-content can properly be called waste matter only after it has reached the rectum or pouch at the lower end of the colon. Even then, this waste matter is not poison, but merely indigestible material which the body cannot handle.

Food, not Poison. The colon is not a cesspool but a digestive and assimilating organ. Its content is not poison but food. Active elimination is important not so much because delay causes autointoxication or poisoning as because too large a mass is hard to manage and irritates the intestinal wall. The problem is not so much one of toxicology as of simple mechanics. If Nature had put within the body five feet of tubing which could easily become a cesspool and a breeder of poison, it is not at all likely that she would have laid alongside an elaborate system of blood vessels leading not out to the kidneys but into the storehouse of the liver; and if civilized man's changed manner of living had so upset Nature's plans as easily to transform his internal machinery into a chronic source of danger, we may be sure that he would long ago have gone the way of the unfit and succumbed to his own poisons.

Possible Invasions. It is true that the intestinal tract, like the rest of the body, is open to attack by harmful bacteria. But in a great majority of cases, these enemy bacteria are either quickly destroyed by the beneficent microbes within or are immediately cast out as unfit. Any germs irritating to the intestinal wall cause the mucous membrane to produce an unusual flow of mucus which washes away the offending bacteria in what we call a diarrhea.[52]

[Footnote 52: If the invading army proves obstinate and the diarrhea continues a day or so, it is wise to assist Nature by a dose of castor-oil, which gives an additional insult to the intestinal wall, spurs it on to a desperate effort, and hastens the cleansing process. In severe cases the more promptly the castor-oil is administered the better. Such emergency measures are very different from the habitual use of insulting drugs.]

Sometimes the wrong kind of bacteria do persist, causing anemia, rheumatism, sciatica, or neuritis. When these disorders are not the result of infection from teeth, tonsils, or other sources of poison, but are really caused by intestinal bacteria, I have found that a diet of buttermilk (lactic acid bacteria), with turnip-tops or spinach to supply the necessary mineral salts, often succeeds in planting the right bacteria and driving out the disturbing ones. These disorders are invasions from without, like tuberculosis or malaria, and are as likely to attack the person with easy bowel movements as the one with the most chronic constipation.

Autointoxication. A good deal of the talk about autointoxication is just talk. It sounds well and affords an easy explanation for all sorts of ills, but in a large majority of cases the diagnosis can hardly be substantiated. Uninformed writers of newspaper articles on the care of the body, or purveyors of purgatives or apparatus for internal baths are fond of dilating on the "foulness of the colon" as a leading cause of disease. As a rule, they advise either a strict diet, some kind of cathartic, or an elaborate process of washing out the colon to clear the body of its terrible accumulation of poisons.

Cathartics and Enemas. He who makes a practice of flushing out his intestinal tract with high enemas and internal baths is like a person who eats a good dinner and then proceeds to wash out his stomach. In the mistaken idea that he is making himself clean, he is washing what was never intended to be washed and robbing the body of the nutrition which it needs. And the man who persists in the pill habit is making a worse mistake, adding insult to injury and forcing the mucous membrane to toughen itself against such malicious attacks.

Cathartics and Operations. Even in emergencies, the use of purgatives as a routine measure is happily decreasing year by year. For many years I have deplored the use of purgatives before and after operations. That other practitioners are coming to the same conclusion is witnessed by a number of papers recently read in medical societies condemning purgation at the time of operation.

Among the most favorably received papers of the California Medical Societies have been one by Emmet L. Rixford, surgeon of the Stanford University Medical College, read before the Southern California Medical Society at Los Angeles December 8, 1916, and one by W.D. Alvarez at the California Medical Society, Del Monte, 1918,—both condemning the use of purgatives as a routine measure before operations. An article entitled the "Use and Abuse of Cathartics" in the "Journal of the American Medical Association" admirably summarizes the disadvantages of purgation at such a time.[53]

[Footnote 53: "1 Danger of dissemination of infection throughout the peritoneal cavity, in case localized infection exists.

"2 Increased absorption of toxins and greater bacterial activity by reason of the fact that undigested food has been carried down into the colon to serve as pabulum for bacteria, and that liquid feces form a better culture medium than solid feces.

"3 Increased distention of the intestine with gas and fluid, when it should be empty....

"4 Psychic and physical weakness produced by dehydration of the body, disturbance in the salt balance of the system, and the loss of sleep occasioned by the frequent purging during the night preceding the operation. As Oliver Wendell Holmes says: 'If it were known that a prize fighter were to have a drastic purgative administered two or three days before a contest, no one will question that it would affect the betting on his side unfavorably. If this be true for a powerful man in perfect health, how much more true must it be of the sick man battling for life.'

"5 Increase in postoperative distress and danger: thirst, gas pains, and even ileus...."—Journal of American Medical Association, Vol. 73, No. 17, p. 1285, Oct. 25. 1919.]

Four years ago I was called to a near-by city to see a former patient who two days before had had a minor operation,—removal of a cyst of the breast. She was dazed, almost in a state of surgical shock and very near collapse. I found that she had been put through the usual course of purgation before operation and starvation afterward, and I diagnosed her condition as a state bordering on acidosis, or lowering of the alkaline salts of the body. I ordered food at once. She rallied and recovered.

A few months later this same woman had to undergo a much more serious operation for multiple fibroids of the uterus and removal of the appendix. This time I advised the surgeon against the use of any purgative, and he took my remarks so seriously that he did not even allow an enema to be given. This time the patient showed no signs of exhaustion and had very few gas pains. I firmly believe that the day will soon come when a patient under operation, or a patient after childbirth, will no longer be depleted by a weakening and dehydrating cathartic and by a period of starvation, at a time when he needs all the energy he can summon.

Cathartics and Childbirth. The article referred to in the "Journal of the American Medical Association" cites the experiences of Dr. R. McPherson of the Lying-in Hospital of New York, "who showed that the routine purgation after confinement is not only useless but harmful. Of 322 women who were not purged, only three had fever (and one of them a mammary abscess); most of them had normal bowel movements and those who did not were given an enema every third day. Of 322 women who were delivered by the same technique and the same operators but were purged in the usual routine manner, twenty-eight had some fever." This experience of one physician is corroborated by that of others who find that the more we tamper with the natural functions in time of stress the harder do we make the recuperative process. There are certainly times when catharsis is necessary but "one thing is certain, the day for routine purgation is past."[54] Even in emergencies we need to know why we administer cathartics and in chronic cases we may be sure that they are always a mistake.

[Footnote 54: Ibid, p. 1286.]

"An Old Trick." Before we make a practice of interfering with Nature's processes, it is well to remember how old and stable those processes are. As long as there has been the taking in of food, there has been also the casting out of waste matter. The sea-anemone closes in on the little mollusk that floats against its waving petals, assimilates what it can and rejects the rest. In the long line from sea-anemone to man, this automatic process of elimination has gone on without a hitch, adapting itself with perfect success to the changing habits of the varying types of life. So old a process is not easily upset. And, be it noted, in the human body this automatic, involuntary process still goes on with very little trouble until it reaches a point in the body where man, the thinking animal, tries to control it by conscious thought.

A Question of Evacuation. Much of the misconception about constipation arises from the mistaken idea that this is a disorder of the whole intestine or at least of the whole colon. As a matter of fact, the trouble is almost wholly in the rectum. There is no trouble with the general traffic movement, but only with the unloading at the terminus. In my experience, the patient reports that he feels the fecal mass in the lower part of the rectum, but that he is unable to expel it. Examination by finger or by X-ray reveals a mass in the rectal pouch. If there is a piling up of freight further back on the line, it is only because the unloading process has been delayed at the terminus.

So long as the bowel-content is in the region of automatic control, there is very little likelihood of trouble. An occasional case of organic trouble—appendicitis, lead-colic, mechanical obstruction, new growths or spinal-cord disease—may cause a real blockade, but in ninety-nine cases out of every hundred there is little trouble so long as the involuntary muscles, working automatically under the direction of the subconscious mind, are in control. By slow or rapid stages, on time or behind time, the bowel-content reaches the upper part of the rectum and passes through a little valve into the lower pouch. Here is where the trouble begins.

Meddlesome Interference. In the natural state the little human, like the other animals, empties his bowel whenever the fecal mass enters the lower portion of the rectum. The presence of the mass in the rectum constitutes a call to stool which is responded to as unthinkingly as is the desire for air in the taking of a breath. But the tiny child soon has to learn to control some of his natural functions. At the lower end of the rectum there is a purse-string muscle called the Sphincter-ani, an involuntary muscle which may with training be brought partly under voluntary control. Under the demands of civilization, the baby learns to tighten up this muscle until the proper time for evacuation. Then, if he be normal, he lets go, the muscles higher up contract and the bowel empties itself automatically, as it always did before civilization began.

There is, however, a possibility of trouble whenever the conscious mind tries to assume control of functions which are meant to be automatic. Under certain conditions necessary control becomes meddlesome interference. If the child for one reason or another takes too much interest in the function of elimination; if he likes too much the sense-gratification from stimulation of the rectal nerves and learns to increase this gratification by holding back the fecal mass; if he gets the idea that the function is "not nice" and takes the interest that one naturally feels in subjects that are taboo; or if he catches from his elders the suggestion that the bowel movement is a highly important process and that something disastrous is likely to happen unless it is successfully performed every day; then his very interest in the matter tends to interfere with automatic regulation, and to cause trouble.

Just as people often find it hard to let go the bladder muscle and urinate when in a hurry or under observation, and just as an apprehensive woman in childbirth tightens up the purse-string muscle of the womb, so the little child, or the grown up who catches the suggestion of difficulty in the bowel movement, loses the trick of letting go. Instead of merely exercising control by temporarily inhibiting the function, he tries to carry through the process itself by voluntary control—and fails. Constipation is a perfect example of the power of suggestion, and of the troublesome effect of a fear-idea in the realm of automatic functions.

FOOD AND CONSTIPATION

Since the waste matter from all foods finally reaches the rectum, and since constipation is merely a difficulty in the forces of expulsion, it is hard to see how any normal food in the quantities usually eaten could have the slightest effect on the problem. When we remember that it takes food from twelve to twenty-four hours to reach the rectum, and that it has during all that time been subjected to the action of the powerful chemicals of the digestive tract, it is hard to imagine a piece of cheese, of whatever variety, strong enough to stop the contraction of the muscles of the upper rectum or to tie the sphincter-muscle into a knot. It would be difficult to find a food which could pass without effect through twenty-seven feet of intestinal tubing only to become suddenly effective on the wall of the rectum. If the wrong kind of food is the cause of constipation, why does the rectum prove to be the most refractory portion of the tube? On what principle could a piece of chocolate inhibit the call to stool or contract the sphincter muscle? On the other hand, even if it should be conceded that constipation were the result of lack of lubricating secretions in the colon, how could two tablespoonfuls of mineral oil be a sufficient lubricant after being mixed with liquid and solid food through many feet of the intestinal tract?

An Adaptable Apparatus. The lining of the intestines has plenty of secretions to take care of its function. It is as well adapted to the vicissitudes of life as are the other parts of the body. The muscular coat is no more liable to paralysis or spasm than are the voluntary muscles. As the skin adapts itself to all waters and all weathers, and as the lungs adjust themselves to varying air-pressures, so the intestinal wall makes ready adaptation to any common-sense demands, adjusting itself with ease to an athletic or a sedentary life, and to the normal variations of diet. What man has eaten throughout the centuries man may eat to-day. If you will but believe it, your intestines will make no more objection to white bread, blackberries, and cheese, along with all other ordinary articles of food, than the skin makes to varying kinds of water. Naturally, the suggested idea that a food will constipate tends to carry itself out to fulfilment and to prevent the call to stool from rising to the level of consciousness; but the real force lies not in the food but in the suggestion.

The Bran Fad. It is when we try to improve on the normal human diet that we really insult the body. He who leaves off eating nourishing white bread and takes to bran muffins is simply cheating his body. Bran has a small food value, but the human body is not made to extract it. Not only does bran fail to give us any nourishment itself, but it lessens the power of the intestines to care for other food.[55] The fad for bran is based on the well-known fact that we need a certain quantity of bulk in order to stimulate the intestinal wall to normal peristalsis. We do need bulk, but not more than we naturally get from a normal and varied diet including a reasonable amount of fruit and vegetables.

[Footnote 55: See an article entitled "Bread and Bran," Journal of American Medical Association, July 5, 1919, p. 36.]

It is true that the suggestion of the efficacy of bran, dates, spinach, or any other food is frequently quite sufficient to give relief, temporarily, just as massage, manipulation of the vertebrae, the surgeon's knife, or mineral oil may be enough to carry the conviction of power to a suggestible individual. But who wants to take his suggestions in such inconvenient forms as these?

Change of Water. Another popular superstition centers around drinking-waters. There are people who cannot move from one town to another, much less take an extensive trip, without a fit of constipation—or a box of pills. If they only knew it, there is no water on earth which could make a person constipated. A new water, full of unusual minerals, might hasten the bowel movement, but on what possible principle could it retard it? Constipation has nothing to do with food or with water, but solicitous care about either can hardly fail to create the trouble which it tries to avoid.

THE CURE

Taking off the Brakes. Since constipation is wholly due to the acceptance of a false suggestion, the only logical cure must be release from the power of that suggestion. "He is able as soon as he thinks he is able"; not that thought gives the power, but that the right thought releases the inhibition of the mistaken thought. As soon as the brakes are taken off, the internal machinery is quite able to make the wheels go round. The bowel will empty itself if we let it. The function of elimination is not a new trick learned with difficulty by the aged, but a trick as old and as elemental as life itself. Like balancing on a bicycle, it may not be done by any voluntary muscular effort, but it just does itself when one learns how.

Once the sense of power comes, once the mind forgets to be doubtful or afraid, then the old automatic habit invariably reasserts itself. Meddlesome interference may throw the mechanism out of gear, but fortunately it cannot strip the gears. Constipation is an inhibition or restraint of function, but is never a loss of function. No one is too old, no one is too fixed in the bad habit to relearn the old trick. I have had a good many patients with chronic constipation, but I have never had one who failed to learn. Real conviction speedily brings success, and in many cases success seems to outrun conviction. So efficient is Nature if she has only half a chance!

Some People Who Learned. Unless you are over ninety-two, do not despair. One old lady of that age, a sort of patient by proxy, was able to cure herself without even one consultation. Her daughter had been a patient of mine and had been cured of the constipation with which she had been busy for many years. The mother, who believed her own bowel paralyzed, had been in the habit of lying on the bed and taking a copious enema every second day of her life. When, however, she heard of her daughter's cure, the bright old woman gave up her enemas and let her bowels do their own functioning. She stayed cured until her death at ninety-five.

A Fifty-year Habit. Another old lady was not quite so easily convinced. She ridiculed the idea that her son of fifty, who had been "constipated in his cradle" could be cured of his lifelong habit, but he was cured. As long as there is life and the light of reason, so long may Nature's functions be reestablished.

The Whole Family. Nor is any one too young to learn. A tiny baby is easily taught. There came to me for two consultations a mother and her two babies, all three constipated. The four-year-old child, mentally deficient, had been fed on milk of magnesia from his infancy, and the four-months-old baby had been started on the same path. I explained to the mother the mechanism of elimination, told her to give up cathartics, and to set a regular time for herself and the baby, but was a little dubious about the mentally deficient four-year-old. However she soon reported that they had all three promptly acquired the new habit. Four years later she told me that they had never had any more trouble.

A Record History. When Miss H. first came to my house, she told a story that was almost incredible. She said that for many months she had been taking eight tablespoonfuls of mineral oil three times a day besides a cathartic at night, and an enema in the morning. No wonder she was a little dubious over such mild treatment as mine seemed to be!

Constipation was only one of this young woman's troubles. She could not sleep and was so fatigued that she believed herself at the end of her physical capital. When she first came to me she had tears in her eyes most of the time and used to confide to various people that she was sure she was a patient that I could not cure,—a very common belief among nervous invalids! She was sure that I did not understand her case, and that she could not get anything out of this kind of treatment.

It was only a very short time, however, before her bowels were functioning like those of a normal person. She lost her insomnia and her fatigue and went away as well as ever. When she got back to her office, she found that her old position, which she had believed secure to her, had been given to another. She had to go out and hunt a new job and face conditions harder than she had had before, but she came through with flying colors. A short time ago Miss H. came back to see me,—a happy, robust young woman, very different from the person I had first known. She assured me that she had never had any return of her old symptoms and that she was as well as a person could be.

Living up to a Suggestion. Mrs. T. had not had a natural movement of the bowels in twenty-five years. After the birth of a child, twenty-five years before, her physician had told her that her muscles had been so badly torn in labor that they could not carry through a natural movement. After that she had never gone a day without a pill or an enema. I explained to her that when any muscle of the rectum is injured in childbirth, it is the sphincter-ani, and that since this is the muscle whose contraction holds back the bowel content, its injury would tend to over-free evacuation rather than to constipation. She saw the point and within two or three days regained her old power of spontaneous evacuation.

Practical Steps. The first step, then, in acquiring normal habits is the conviction of the integrity of our physical machines and a determination not to interfere by thought, or by physical meddling, with the elemental functions of our bodies. After this all-important step, there are a few practical suggestions which it is well to follow. Most of them are nothing more than the common-sense habits of personal hygiene which are so obvious as to be almost axiomatic, but which are nevertheless often neglected:

1 Eat three square meals a day.

2 Drink when thirsty, having conveniently at hand the facilities for drinking.

3 Heed the call to stool as you heed the call of hunger. When the stool passes the little valve between the upper and lower portions of the rectum, it gives the signal that the time for evacuation has come. If this signal is always heeded, it will automatically start the machinery that leads to evacuation. If it is persistently ignored because one is too busy, or because the mind is filled with the idea of disability, the call very soon fails to rise to the level of consciousness. The feces remain in the rectum, and the bad habit is begun.

4 Choose a regular time and keep that appointment with yourself as regularly as possible. In all the activities of Nature, there is a rhythm which it is well to observe.

5 Take time to acquire the habit. Do not be in a hurry. Do not strain. No amount of effort will start the movement. Just let it come of itself.

6 Finally, should the unconscious suggestion of lack of power stubbornly remain in force, take a small enema on the third day. If the waste matter accumulates for three or more days, the bulk becomes so great that the circular muscles of the rectum are unable to handle it, just as the fingers cannot squeeze down to expel water from too large a mass of wet blankets. Take only a small enema—never over a quart at a time—and expel the water immediately. One or two such measures will bring away the mass in the rectum. The material farther up still contains food elements and is not yet ready for expulsion. Lessen the amount of water each time until no outside help is needed. Once you get the right idea, all enemas will be superfluous.

SUMMARY

If you would have in a nutshell an epitome of the truth about constipation, indigestion, insomnia, and the other functional disturbances common to nervous folk, you can do, no better than to commit to memory and store away for future reference that choice limerick of the centipede, which so admirably sums up the whole matter of meddlesome interference:

A centipede was happy quite Until a frog in fun Said, "Pray, which leg comes after which?" This raised her mind to such a pitch, She lay distracted in the ditch, Considering how to run.

Whoever tries to consider "which leg comes after which" in any line of physiological activity, is pretty sure to find himself in the ditch considering how to run. Wherefore, remember the centipede!



CHAPTER XII

In which handicaps are dropped

A WOMAN'S ILLS

"THE FEMALE OF THE SPECIES"

If ever there was a man who wished himself a woman, he has hidden away the desire within the recesses of his own heart. But one does not have to wait long to hear a member of the female sex exclaim with evident emotion, "Oh, dear, I wish I had been born a man!" It is probable that if these same women were given the chance to transform themselves overnight, they would hesitate long when it actually came to the point. The joys of being a woman are real joys. However, in too many cases these joys seem hardly to compensate for the discomforts of the feminine organism. It is the body that drags. Painful menstrual periods, the dreaded "change of life," various "female troubles" with a number of pregnancies scattered along between, make some of the daughters of Eve feel that they spend a good deal of their lives paying a penalty merely for being women. Brought up to believe themselves heirs to a curse laid on the first woman, they accept their discomforts with resignation and try to make the best of a bad business.

"Since the War." Nothing is quite the same since the war. Among other things we have learned that many of our so-called handicaps were nothing but illusions,—base libels on the female body. Under the stern necessity of war the women of the world discovered that they could stand up under jobs which have until now been considered quite beyond their powers. Society girls, who were used to coddling themselves, found a new joy in hard and continuous work; middle-aged women, who were supposed to be at the time of life when little could be expected of them, quite forgot themselves in service. Ambulance drivers, nurses, welfare workers, farmerettes, Red-Cross workers, street-car conductors and "bell-boys," revealed to themselves and to the world unsuspected powers of endurance in a woman's body. Although some of the heavier occupations still seem to be "man's work," better fitted for a man's sturdier body, we know now that many of these disabilities were merely a matter of tradition and of faulty training.

There still remains, however, a goodly number of women who are continuously or periodically below par because of some form of feminine disability. Some of these women are suffering from real physical handicaps, but many of them need to be told that they are disabled not by reason of being women but by reason of being nervous women.

"Nerves" Again. Despite the organic disturbances which may beset the reproductive organs, and despite the havoc wrought by venereal diseases, it may be said with absolute assurance that the majority of feminine ills are the result neither of the natural frailty of the female body, nor even of man's infringement of the social law, but are the direct result of false suggestion and of false attitudes toward the facts of the reproductive life. The trouble is less a difficulty with the reproductive organs than a difficulty with the reproductive instinct. "Something wrong" with the instinct is translated by the subconscious mind into "something wrong" with the related generative organs, and converted into a physical pain.

That this relation has always been dimly felt is shown by the fact that the early Greeks called nervous disorders hysteria, from the Greek word for womb. It is only lately, however, that the blame has been put in the right place and the trouble traced to the instinct rather than to the organs of reproduction.

Why Women Are Nervous. Although women hold no monopoly, it must be conceded that they are particularly prone to "nerves." The reason is not hard to find. Since the leading factor in a neurosis is a disturbance of the insistent instinct of reproduction, a disturbance usually based on repression, then any class of persons in whom the instinct is particularly repressed would, in the very nature of the case, be particularly liable to nervousness.

No one who thoroughly knows human nature would attempt to deny that woman is as strongly endowed as man with the great urge toward the perpetuation of the race, or that she has had to repress the instinct more severely than has man. The man insists on knowing that the children he provides for are his own children. Whatever the degree of his own fidelity, he must be sure that his wife is true to him. Thus has grown up the insistence that, no matter what man does, woman, if she is to be counted respectable, shall control the urge of the instinct and live up to the requirements of continence set for her by society.

Unfortunately, however, there is more often blind repression than rational control. The measures taken to prevent a girl's becoming a tom-boy are measures of sex-repression quite as much as of sex-differentiation. Over-reaction of sensitive little souls to lessons in modesty often causes distortion of normal sex-development. Ignorance concerning the phenomena of life is commended as innocence, while it really implies a sex-curiosity which has been too severely repressed. The young woman blushes at thoughts of love, while the young man is filled with a sense of dignity. We smile at the picture of "Miss Philura's" confusion as she hesitatingly sends up to her Creator a petition for the much-desired boon of a husband. But really, why shouldn't she want one? Many a young woman, in order to deaden her senses to the unsuspected lure of the reproductive instinct by what is really an awkward attempt at sublimation, makes a fetish of dress and social position and considers only the marriage of convenience; or, on the other hand, she scorns men altogether and throws herself into a "career."

Young men are not so often taught to repress, but neither are they taught to swing their vital energies into altruistic channels through sublimation. Since the woman of his class will not marry him until he has money, the young man too often satisfies his undirected instincts in a commercial way. The statistics of venereal diseases prove that here, as elsewhere, goods subject to barter are subject to contamination. In a late marriage, too often a contaminated body accompanies the material possessions which the standards of society have demanded of a husband.

But the woman pays in still other coin for the repressions arising from faulty childhood training. Unable to find expression for herself either in marriage or in devotion to work, because some old childish repression is still denying all outlet to her legitimate desire, she frequently falls into a neurosis; or if she escapes a real breakdown, she gives expression to unsatisfied longings in some isolated nervous symptoms which in many cases center about the organs of generation. There then results any one of the various functional disturbances which are only too often mistaken for organic disease. What is needed in cases like this is not a gynecologist nor a surgeon, but a psycho-pathologist—or perhaps only a grasp of the facts. Let us look at the more common of these disturbances in order to gain an understanding of the situation.

THE MENSTRUAL PERIOD

Potential Motherhood. Among the normal phenomena of a woman's life is the recurring cycle of potential motherhood. Every three or four weeks a new ovum or egg matures in the ovary and undergoes certain chemical changes, which send into the blood a substance called a hormone. This hormone is a messenger, stimulating the mucous membrane of the womb into making its velvet pile longer and softer, and its nutrient juices more abundant in readiness for the ovum.

The same stimulus causes the whole organism to make ready for a new life. As in hunger, the chemistry of the body produces the muscle-tension that is felt as a craving for food, so this recurring chemical stimulus produces a definite craving in body and mind. This craving brings about an increased irritability or sensitiveness to stimuli which may result either in a joyous or a fretful mood.

During sleep the social inhibitions are felt less distinctly and the sleeper dreams love-dreams woven from messages coming up from all the minute nerve-endings in the expectant reproductive organs. But if no germ-cell travels up the womb-canal and tube to meet and impregnate the ovum, the womb-lining rejects the egg as chemically unfit. All the furbishings are loosened from the walls and slowly cast out, constituting the menstrual flow. The phenomenon as a whole is a physiological function and should be accompanied by a sense of well-being and comfort as is the exercise of any other function, such as digestion or muscular activity. Only too often, however, it is dreaded as an unmitigated disaster, a time for giving up work or fun and going to bed with a hot-water bottle until "the worst is over." Let us see how this perversion comes about.

Why Menstruation Is Painful. What sort of atmosphere is created for the young girl as she attains puberty? Most girls get their first inkling of the menstrual period from the periodic "sick spells" of mother or sister. This knowledge comes without conscious thought and is a direct observation of the subconscious mind, which records impressions with the accuracy and completeness of a photographic plate. Hearing the talk about a "sick-time" and observing the signs of "cramps" among older friends, the young girl's subconscious mind plays up to the suggestion and recoils with fear from the newly experienced sensations in the maturing organs of reproduction.

This recoil of fear interferes with the circulation in the functioning organs, just as fear blanches the face or hinders digestion. There is several times as much blood in the stomach when it is full of food as there is between meals, but we do not for this reason fancy that we have a pain after each meal. There is more blood in the generative organs during their functioning, but this means pain only when fear ties up the circulation and causes undue congestion. Fear acts further on the sturdy muscle of the womb, tying it up into just such knots as we feel in the esophagus when we say that we have a lump in the throat. It is safe to say that ninety-five cases of painful menstruation out of every hundred are caused by fear and by the expectation of pain. The cysts and tumors responsible for pain are so rare as to be fairly negligible, when compared with these other causes.

Dr. Clelia Duel Mosher of Stanford University has for many years carried on careful investigations among the students of the university. After describing in detail certain physical exercises which she has found of value, she continues:

But more important even than this is an alteration of the morbid attitude of women themselves toward this function; and almost equally essential is a fundamental change in the habit of mind on our part as physicians; for do we not tend to translate too much, the whole of a woman's life into terms of menstruation? If every young girl were taught that menstruation is not normally a "bad time" and that pain or incapacity at that period is as discreditable and unnecessary as bad breath due to decaying teeth, we might almost look for a revolution in the physical life of women.... In my experience the traditional treatment of rest in bed, directing the attention solely to the sex-zone of the body, and the accepted theory that it is an inevitable illness while at the same time the mind is without occupation, produces a morbid attitude and favors the development and exaggeration of whatever symptoms there may be.[56]

[Footnote 56: Clelia Duel Mosher: Health and the Woman Movement, pp. 25, 26, 19.]

Pre-Menstrual Discomfort. If it be objected that women often feel badly for a day or two before the period begins, before they know that it is due, and that this feeling of discomfort could not be caused by fear and expectation, it is easy to reply that the subconscious mind knows perfectly what is happening within the body. The emotion of fear, working within the subconscious, is able to translate all the varying bodily sensations into feelings of distress without any knowledge on the part of the conscious mind.

Sometimes before the period begins, a girl feels blue and upset for a day or two, a sign that the instinct is getting discouraged. The whole body is saying, "Get ready, get ready," but it has gotten ready many times before, and to no purpose. Unsatisfied striving brings discouragement. What reaches consciousness is a feeling of pessimism and a general dissatisfaction with life as a whole. If, instead of giving in to the blues or going to bed and predicting a pain, the girl finds other outlets for her energy, she finds that after all, her instinct may be satisfied in indirect ways and that she has strangely come into a new supply of vim.

The Purpose of the Pain. Although suggestion is behind all nervous symptoms, there is a deeper reason for the disturbance. When an unhealthy suggestion is seized and acted upon, it is because some unsatisfied part of the personality sees in it a chance for accomplishing its own ends. The pre-menstrual period is the blooming-time, the mating-time, the springtime of the organism. That means eminently a time for coming into notice, that one's charms may attract the desired complement. But if the rightfully insistent instinctive desires are held in check by unnatural repressions and misapplied social restrictions, the starved instinct can obtain expression only by a concealment of purpose. The disguise assumed is often one of indifference or positive distaste for the allurements of the other sex. But, as we know, an instinctive desire will not be denied. In this case, the misguided instinct which has been given the suggestion that menstruation means illness, fits this conception into the scheme of things and obtains notice in a roundabout way by the attention given to the invalid.

The Treatment. To find that the symptom has a purpose rather than a cause gives the indication for the treatment. Judicious neglect causes the symptom to cease by defeating its very purpose,—that of drawing attention to itself. The person who never mentions her discomfort, thinks about it as little as possible, and goes about her business as usual, is likely to find her trouble gone before she realizes it.[57]

[Footnote 57: Violent exercise at this time is unwise, but continuing one's usual activity helps the circulation and keeps the mind from centering on the affected part. The physiological congestion is unduly intensified by standing; therefore all employments should afford facilities for the woman to sit at least part of the time while continuing work.]

A little explanation gives the patient insight into the workings of her own mind, and usually causes the pain to disappear in short order. Astonished, indeed, and filled with gratitude have been some of my young-women patients who had all their lives been unable to plan any work or social engagements for the time of this functioning. Many of them were the worst kind of doubters when they were told that to go to bed and center their attention on the generative organs only made the muscles tighten up and the circulation congest. They could not conceive themselves up and around, pursuing their normal life during such a time. However, as they have found by experience that this point of view is not an optimistic dream, they have broken up the confidence-game which their subconscious had been playing on them, and have gone on their way rejoicing.

There was one young girl, a doctor's daughter, who suffered continuously from pain in the abdomen, and from back-pain which increased so greatly at the time of the menses that she was in the habit of going to bed for several days, to be waited on with solicitous care by her family. In an attempt to cure the trouble she had undergone an operation to suspend the uterus, but the pain had continued as before. When she came to me, I explained to her that there was no physical difficulty and that her trouble was wholly nervous. I made her play tennis every day and she had just finished a game when her period came on. She stayed up for luncheon, went for a walk in the afternoon, ate her dinner with the family, and behaved like other people. Her mother telephoned that evening and when I told her what her daughter had been doing, she gasped in astonishment. She had difficulty in believing that the new order was not miracle but simply the working out of natural law. Since that time her daughter has had no more trouble.

The Ounce of Prevention. If young girls had wiser counselors in their mothers and physicians, the misconception would never occur, and such an indirect outlet would not be needed; the organic sensations incident to puberty and the recurring menstrual period would have something of the significance of the annunciation to Mary, bringing wonder and a sense of well-being.

When your little daughter arrives at maturity, give her a joyous initiation into the noble order of women. She will welcome the new function as a badge of womanhood and as a harbinger of wonderful things to come.

A girl of fifteen came under my care to be helped out of a mood of increasing depression and uneasiness. Her glance was furtive, yet anxiously expectant. Tears came unbidden as she sat alone or fingered the keys of the piano. Tactful questioning elicited no response as to reasons for her unhappiness. Opportunities for giving confidence were not accepted. At a chance moment our talk drifted to the subject of menstruation. "Your periods are regular and easy; and do you know what they are for?" Then I painted for her a picture of the preparations that are made throughout the whole organism, for the germ-cell that comes each month and has in it all the possibilities of a new little life.

The result of this confidential talk may seem fanciful to any one but an eye-witness. We had only a week's association, but the depression ceased, the furtive look and deprecatory manner were replaced by a joyous buoyancy. In a few weeks the thin neck and awkward body rounded out into the symmetry which usually precedes the establishment of puberty, but which was delayed in this case until the unconscious conflict resolved itself.

In the Large. Looked at from any angle, this subject is an important one. There are involved not only the physical comfort and convenience of the sufferers themselves, but also the economic prospects of women as a whole. If women are to demand equal opportunity and equal pay, they must be able to do equal work without periodic times of illness. When employers of women tell us that they regularly have to hire extra help because some of their workers lose time each month, we realize how great is the aggregate of economic waste, a waste which would assuredly be justified if the health of the country's womanhood were really involved, but which is inefficient and unnecessary when caused merely by ignorant tradition. "Up to standard every day of every week," is a slogan quite within the range of possibility for all but the seriously ill. When reduced to their lowest terms, the inconveniences of this function are not great and are not too dear a price to pay for the possibilities of motherhood.

THE "CHANGE OF LIFE"

Another Phantom Peril. As the young girl is taught to fear the menstrual period, so the older woman is taught to dread the time when the periods shall cease. Despite the general enlightenment of this day and age, the menopause or "change of life" is all too frequently feared as a "critical period" in a woman's life, a time of distressing physical sensations and even of danger to mental balance.

As a matter of fact, the menopause is a physiological process which should be accomplished with as little mental and physical disturbance as accompanies the establishment of puberty. The same internal secretion is concerned in both. When the function of ovulation ceases the body has to find a new way to dispose of the internal secretion of the ovary. Its presence in the blood is the cause of the sudden dilatation of the blood-vessels that is known as the "hot flash."

The matter is altogether a problem of chemistry, with the necessity for a new adjustment among the glands of internal secretion. The body easily manages this if left to itself, but is greatly interfered with by the wrong suggestion and emotion. We have already seen how quickly emotion affects all secretions and how easily the adrenal and thyroid glands are influenced by fear. This is the root of the trouble in many cases of difficult "change." If an occasional body is not quite able to regulate the chemical readjustment, we may have to administer the glands of some other animal, but in the majority of cases, the body, unhampered by an extra burden of fear, is quite able to make its own adjustments. The hot flash passes in a moment, if not prolonged by emotion or if not converted into a habit by attention.

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 sex 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 appetite. 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 sex. 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 attitude 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 unobtrusive 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 fagged 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 assertions 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 fagged 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.

[Footnote 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 Mitchell. 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 embarrassed. 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 Associations. 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 associations 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 association 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 attitude 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. Analysis 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

Nervous insomnia is something which a part of us makes use of and another part fears. It is a mistake on both sides. Although not in the least dangerous, the habit can hardly be considered a satisfactory form of amusement. Nature has provided a better way to spend the night, a way to which she speedily brings us when we choose to let her do it.

We do not have to ask for sleep as for a special boon which may be denied. We simply have to lie down in trust, expecting to be carried away like a child. If our expectation is not at once realized we can still trust, as with relaxed mind and body we lie in calm content, knowing that Nature is, minute by minute, restoring us for another day.



CHAPTER XIV

In which we raise our thresholds

FEELING OUR FEELINGS

FINELY STRUNG VIOLINS

The young girl had been telling me about her symptoms. "You know, Doctor," she said. "I am a very sensitive person. In fact, I have always been told that I am like a finely strung violin." There was pride in every tone of her voice,—pride and satisfaction over possessing an organization so superior to the common clay of the average person. It was a typical remark, and showed clearly that this girl belonged among the nervous folk. For the nervous person is not only over-sensitive, but he accepts his condition with a secret and half-conscious pride as a token of superiority.

It seems that there are a good many kinds of sensitiveness. Whether it is a good or bad possession depends entirely on what kind of things a person is sensitive to. If he is quick to take in a situation, easily impressed with the needs of others, open-doored to beauty and to the appeal of the spiritual, keenly alive to the humorous, even when the joke is on himself and the situation uncomfortable, then surely he has a right to be glad of his sensitiveness. But too often the word means something else. It means feeling, intensely, physical sensations of which most people are unaware, or reacting emotionally to situations which call for no such response. It means, in short, feeling our feelings and liking to feel them. There seems to be nothing particularly praiseworthy or desirable about this kind of sensitiveness. If this is what it means to be a "finely-wrought violin," it might even be better to be a bass drum which can stand a few poundings without ruin to its constitution.

"But," says the sensitive person, "are we not born either violins or drums? Is not heredity rather than choice to blame? And what can a person do about it?" These questions are so closely bound up with the problems of nervous symptoms of indigestion, fatigue, a woman's ills, hysterical pains and sensations, and with all the problems of emotional control, that we shall do well to look more carefully into this question of sensibility, which is really the question of the relation of the individual to his environment.

SELECTING OUR SENSATIONS

Reaction and Over-Reaction. Every organism, if it is to live, must be normally sensitive to its environment. It must possess the power of response to stimuli. As the sea-anemone curls up at touch, and as the tiny baby blinks at the light, so must every living thing be able to sense and to react to the presence of a dangerous or a friendly force. Only by a certain degree of irritability can it survive in the struggle for existence. The five senses are simply different phases of the apparatus for receiving communications from the outside world. Other parts of the machinery catch the manifold messages continually pouring into the brain from within our bodies themselves. These communications cannot be stopped nor can we prevent their impress on the cells of the brain and spinal cord, but we do have a good deal to say as to which ones shall be brought into the focus of attention and receive enough notice to become real, conscious sensations.

Paying Attention. If a human being had to give conscious attention to every stimulus from the outer world and from his own body, to every signal which flashes itself along his sensory nerves to his brain, he would need a different kind of mind from his present efficient but limited apparatus. As it is, there is an admirable provision for taking care of the messages without overburdening consciousness. The stream of messages never stops, not even in sleep. But the conscious mind has its private secretary, the subconscious, to receive the messages and to answer them.

During any five minutes of a walk down a city street a man has hundreds of visual images flashed upon the retina of the eye. His eye sees every little line in the faces of the passers-by, every detail of their clothing, the decorations on the buildings, the street signs overhead, the articles in the shop-windows, the paving of the sidewalks, the curbings and tracks which he crosses, and scores of other objects to most of which the man himself is oblivious. His ear hears every sound within hearing distance,—the honk of every horn, the clang of every bell, the voices of the people and the shuffle of feet. Some part of his mind feels the press of his foot on the pavement, the rubbing of his heel on his stocking, the touch of his clothing all over his body, and all those so-called kinesthetic sensations,—sensations of motion and balance which keep him in equilibrium and on the move, to say nothing of the never-ending stream of messages from every cell of every muscle and tissue of his body.

Out of this constant rush of stimuli our man gives attention to only the smallest fraction. Whatever is interesting to him, that he sees and hears and feels. All other sensations he passes by as indifferent. Unless they come with extraordinary intensity, they do not get over into his consciousness at all.

"Listening-in" on the Subconscious. The subconscious mind knows and needs to know what is happening in the farthermost cell of the body. It needs to know at any moment where the knees are, and the feet; otherwise the individual would fall in a heap whenever he forgot to watch his step. It needs to know just how much light is entering the eye, and how much blood is in the stomach. To this end it has a system of communication from every point in the body and this system is in constant operation. Its messages never cease. But these messages were never meant to be in the focus of attention. They are meant only for the subconscious mind and are generally so low-toned as to be easily ignored unless one falls into the habit of listening for them. Unless they are invested with a significance which does not belong to them, they will not emerge into consciousness as real sensations.

Psychic Thresholds. Boris Sidis has given us a word which has proved very useful in this connection. The limit of sensitivity of a cell—the degree of irritability—he calls the stimulus-threshold.[59] As the wind must come in gusts to drive the rain in over a high doorsill, so must any stimulus—an idea or a sensation—come with sufficient force to get over the obstructions at the doorway of consciousness. These psychic thresholds do not maintain a constant level. They are raised or lowered at will by a hidden and automatic machinery, which is dependent entirely on the ideas already in consciousness, by the interest bestowed upon the newcomer. The intensity of the stimuli cannot be controlled, but the interest we feel in them and the welcome given them are very largely a matter of choice.

[Footnote 59: Sidis: Foundations of Normal and Abnormal Psychology, Chap. XXX.]

Each organism has a wide field of choice as to which ideas and which physical stimuli it shall welcome and which it shall shut out. We may raise our thresholds, build up a bulwark of indifference to a whole class of excitations, shut our mental doors, and pull down the shades; or we may lower the thresholds so that the slightest flicker of an idea or the smallest pin-prick of a sensation finds ready access to the center of attention.

Thresholds and Character. There are certain thresholds made to shift frequently and easily. When one is hungry any food tastes good, for the threshold is low; but the food must be most tempting to be acceptable just after a hearty meal. On the other hand, a fairly constant threshold is maintained for many different kinds of stimuli. These stimuli are always bound together in groups, and make appeal depending upon the predominating interest. As anything pertaining to agriculture is noticed by a farmer, or any article of dress by a fashionable woman, so any stimulus coming from a "warm" group is welcomed, while any from a "cold" group is met by a high threshold. The kind of person one is depends on what kind of things are "warm" to him and what kind are "cold." The superman is one who has gained such conscious control of his psychic thresholds that he can raise and lower them at will in the interests of the social good.

Thresholds and Sensations. The importance of these principles is obvious. The next chapter will show more of their influence on ideas and emotions; but for the present we will consider their lessons in the sphere of the physical. Psychology speaks here in no uncertain terms to physiology. Whoever becomes fascinated by the processes of his own body is bound to magnify the sensations from those processes, until the most insignificant message from the subconscious becomes a distressing and alarming symptom. The person whose mental ear is strained to catch every little creaking of his internal machinery can always hear some kind of rumble. If he deliberately lowers his thresholds to the whole class of stimuli pertaining to himself, there is small wonder that they sweep over the boundaries into consciousness with irresistible force.

The Motives for Sensitiveness. Sensitiveness is largely a matter of choice, but what determines choice? Why is it that one person chooses altruism as the master threshold that determines the level of all the others, while another person who ought to be equally fine lowers his thresholds only to himself? What makes a person too interested in his own sensations and feelings? As usual there is a cause.

The real cause back of most cases of chronic sensitiveness is an abnormal desire for attention. Sometimes this love of attention arises from an under-developed instinct of self-assertion, or "inferiority complex." If there is a sense of inadequacy, a feeling of not being so important as other people, a person is quite likely to over-compensate by making himself seem important to himself and to others in the only way he knows. All unconsciously he develops an extreme sensitiveness which somehow heightens his self-regard by making him believe himself finely and delicately organized, and by securing the notice of his associates.

Or, again, the love of attention may be simply a sign of arrested development, a fixation of the Narcissistic period of childhood which loves to look at itself and make the world look. Or there may be lack of satisfaction of the normal adult love-life, a lack of the love and attention which the love-instinct naturally craves. If this instinct is not getting normal outlet, either directly through personal relationships or indirectly through a sublimated activity, what is more natural than that it should turn in on itself, dissociate its interest in other things and occupy itself with its own feelings, and at the same time secure the coveted attention through physical disability, with its necessity for special ministration?

In any case there is likely to develop a general overreaction to all outside stimulation, a hypersensitiveness to some particular kind of stimulus, or a chronic hysterical pain which somehow serves the personality in ways unknown to itself. No one "feels his feelings" unless, despite all discomfort, he really enjoys them. A hard statement to accept perhaps, but one that is repeatedly proved by a specialist in "nerves"!

DETERMINING CAUSES

Accidental Association. In many cases, the form which the sensitiveness takes is merely a matter of accident. Often it is based on some small physical disability, as when a slight tendency to take cold is magnified into an intense fear of fresh air.

Sometimes a past fleeting pain which has become associated with the stream of thought of an emotional moment—what Boris Sidis calls the moment-consciousness—is perpetuated in consciousness in place of the repressed emotion. "In the determination of the pathology of hysteria, the accidental moment plays a much greater part than is generally recognized; if a painful affect—emotion—originates while eating but is repressed, it may produce nausea and vomiting and continue for months as an hysterical symptom."[60]

[Footnote 60: Freud: Selected Papers, p. 2.]

One of Freud's patients, Miss Rosalie H——, found while taking singing-lessons that she often choked over notes of the middle register, although she took with ease notes higher and lower in the scale. It was revealed that this girl, who had a most unhappy home life, had, during a former period, often experienced this choking sensation from a painful emotion just before she went for her music lesson. Some of the left-over sensations had remained during the singing, and as the middle notes happen to involve the same muscles as does a lump in one's throat, she had often found herself choking over these notes. Later on, while living in a different city and in a wholly different environment, the physical sensations from her throat muscles, as they took these middle notes, brought back the associated sensations of choking,—without, however, uncovering the buried emotion.[61] Many a painful hysterical affliction is based on just such mechanisms as these. As Freud remarks, "The hysteric suffers mostly from reminiscences."[62]

[Footnote 61: Ibid, p. 43.]

[Footnote 62: Ibid, p. 5.]

Subconscious Symbolism. Sometimes, as we have seen, the form which a hypersensitiveness assumes is not determined by any physical sensation, either past or symbolism which acts out in the body the drama of the soul.

Facing the Facts. Whatever the motives and whatever the determining causes, hypersensibility is in any case a feeling of feelings which is not warranted by the present situation. Hypersensitiveness is never anything but a makeshift kind of satisfaction. Despite certain subconscious reasoning, it does not make one more important nor more beloved. Neither does it furnish a real expression for that great creative love-instinct whose outlet, if it is to bring satisfaction, must be a real outlet into the external world. An understanding of the motives is helpful only when it makes clear that they are short-sighted motives and that the real desires back of them may be satisfied in better ways.

SOME LOWERED THRESHOLDS

As the public appetite for specific cases appears to be insatiable, we will give from real life some examples of low thresholds which were raised through re-education. One hesitates to write down these examples because when they are on paper they sound like advertisements of patent medicines. However, there is no magic in any of these cures, but only the working out of definite laws which may be used by other sufferers, if they only know. Re-education through a knowledge of oneself and the laws at work really does remarkable things when it has a chance.

"Danger-Signals" without the Danger. There was the man who had queer feelings all over his body, especially in his head and stomach, and who considered these sensations as danger-signals warning him to stop. This man had worked up from messenger boy to a position next to the president in one of the transcontinental railroad systems. On the appearance of these "danger-signals" he had tried to resign but had been given a year's leave of absence instead. Half the year had gone in rest-cure, but he was still afraid to eat or work, and believed himself "done for." After three weeks of re-education he saw that instead of having overdrawn his capital, he had in another sense overdrawn his sensations. He went away as fit as ever, finished his leave of absence doing hard labor on his farm, and then went back to even harder tasks, working for the Government in the administration of the railroads during the war. He is still at work.

Enjoying Poor Health. There was the woman who had been an invalid for twenty years, doing little else during all that time than to feel her own feelings. Because of the distressing sensations in her stomach, she had for a year taken nothing but liquid nourishment. She had queer feelings in her solar-plexus and indeed a general luxury of over-feeling. She could not leave her room nor have any visitors. She was the star invalid of the family, waited on by her two hard-working sisters who earned the living for them all.

Her sisters had inveigled her to my house under false pretenses, calling it a boarding-house and omitting to mention that I was a doctor, because "she guessed she knew more about her case than any doctor." For the first week I got in only one sentence a day,—just before I slipped out of the door after taking in her "liquid nourishment." But at the end of the week I announced that thereafter her meals would be served in the dining-room. When she found that there was to be no more liquid nourishment, she had to appear at the family table. After that it was only a short time before she was at home, cooking for her sisters. When she saw the role she had been unconsciously playing, she could hardly wish to go on with it.

Feeling His Legs. Mr. R. suffered from such severe and distressing pains in his legs that he believed himself on the verge of paralysis. He was also bothered by a chronic emotional state which made him look like a "weepy" woman. His eyes were always full of tears and his chin a-quiver, and he had, as he said, a perpetual lump in his throat. Under re-education both lump and paralysis disappeared completely and Mr. R. took his wife across the continent, driving his machine with his own hands—and feet.

A Subconscious Association. Mr. D.'s case admirably illustrates the return of symptoms through an unconscious association. He was a lawyer, prominent in public affairs of the Middle West, who had been my patient for several weeks and who had gone home cured of many striking disabilities. Before he came to me, he had given up his public work and was believed by all his associates to be afflicted with softening of the brain, and "out of the game" for good. From being one of the ablest men of his State, he had fallen into such a condition that he could neither read a letter nor write one. He could not stand the least sunshine on his head, and to walk half a mile was an impossibility. He was completely "down and out" and expected to be an invalid for the rest of his life.