They had three children, born the twelfth month, the third year, and the fourth year after marriage. After the first child the mother was very well, nursed the baby successfully, and the little family flourished. Then came the unfortunate illness of the husband, which threw him out of work for six months, during which time they lived on an allowance from his union, his savings, and finally ran into debt. This greatly grieved the man and depressed the woman, but both bore up well under it until the birth of the second child, when their circumstances forced them to move to a poorer apartment. The wife was delivered by a dispensary physician, who did his duty well but allowed the woman, who protested she felt well, to get up and care for her husband and baby much earlier than she should have done.

The nursing of this baby was more difficult. The mother's breasts did not seem to be nearly as active as in the previous case. The baby cried a great deal and needed attention a good part of the night. The husband was unable to help as he had previously done and the fatigue of the care of child and man brought a condition where the woman was tired all the time. Still she bore up well, though when the summer came she greatly missed the little two weeks' vacation that she and her husband had yearly taken together from the days of their courtship.

The husband recovered, but his strength came back very slowly. He went to work as soon as possible but worked only part time for six months. At night he came home utterly exhausted and could not help his wife at all.

During the next year both children were sick, first with scarlet fever and then with whooping cough. The mother did most of the nursing, though by this time the father was able to help and did. The necessary expenses so depleted the family treasury that when the summer came neither could afford to go away.

Both noticed that the mother was getting more irritable than was natural to her. She went out very seldom and her youthful good looks had largely been replaced by a sharp-featured anxiety. Though she carried on faithfully she had to rest frequently and at night tossed restlessly, though greatly fatigued.

She became pregnant again, much to her dismay and to the great regret of her husband. At times she thought of abortion, but only in a desperate way. The last few months of her term were in the very hot months of the year and she was very uncomfortable. However, she was delivered safely, got up in a week to help in the care of her other two children and to get the house into shape again. Her milk was fairly plentiful, despite her fatigue and "jumpy nerves." Unfortunately at this time, when they had accumulated a little surplus and she was looking forward to better clothes for her family and more comforts, the plant at which her husband was employed suspended operations because of some "high finance" mix-up. Coming at this time, the news struck terror into her heart; she broke down, became "hysterical" i.e. had an emotional outburst. This passed away, but now she was sleepless, had no appetite, complained of headache and great fatigue.

Though she was assured that the plant would reopen soon (in fact it soon did), she made little progress. That she was suffering from a psychoneurosis was evident; what remained was to bring about treatment.

This was done by enlisting a development of recent days,—the Social Service agencies. Out of the old-time charity has come a fine successor, social service; out of the amateurish, self-consciously gracious and sweet Lady Bountiful has come the social worker. Unfortunately social service has not yet dropped the name "Charity", perhaps has not been able to do so, largely because the well-to-do from whom the money must come like to think of themselves as charitable, rather than as the beneficiaries of the social system giving to the unfortunates of that system.

Let me say one more word about social service and the social worker, though I feel that a volume of praise would be more fitting. The social worker has become an indispensable part of the hospital organization, an investigator to bring in facts, a social adjuster to bring about cure. For a hospital to be without a social service department is to confess itself behind the times and inefficient.

Briefly, this is what was done for this family.

Their prejudices against social aid were removed by emphasizing that they were not recipients of charity. The husband was allowed to pay, or arrange to pay, for a six weeks' stay in the country for the mother and the new baby. The home for this purpose was found by the agency and was that of a kindly elderly couple who took the woman into their hearts as well as over their threshold. The social worker arranged with a nursing organization to send a worker to the man's house each day to clean up the home while the children stayed in a nursery. One way or another the husband and children were made comfortable, and the wife came back from her stay, made over, eager to get back to her work.

It is obvious that in such a case as this the physician is largely diagnostician and director, the actual treatment consisting in getting a selfish and inert social system to help out one of its victims. That a sick man should be left to sink or swim, though he has previously been industrious and a good member of society, is injustice and social inefficiency. That a woman, under such circumstances, should be left with the entire burden on her hands is part of the stupidity and cruelty of society.

How avert such a thing? For one thing do away with the name "Charity" in relief work,—and find some system by which industry will adequately care for its victims. What system will do that? I fear it may be called socialistic to suggest that some of the fifteen billions spent last year on luxuries might better be shifted to social amelioration. The record in automobile production would be more pleasing if it did not mean a shift from real social wealth to individual luxury.

Case II. The over-rich, purposeless woman.

This type is of course the direct opposite of the woman in Case I and represents the kind of woman usually held up as most commonly afflicted with "nervousness." "If she really had something to do," say the critics, "she would not be nervous."

This is fundamentally true of her, though not true of the majority of women whom we have discussed. It seems difficult to believe that hard work and worry may bring the same results as idleness and dissatisfaction, but it is true that both deenergize the organism, the body and mind, and so are kindred evils. What's the matter with the poor is their poverty, while the matter with the rich is their wealth.

Mrs. A. De L. is of middle-class people whose parents lived beyond their means and educated their only daughter to do the same. Here is one of the anomalies of life: bitterly aware of their folly, the extravagant and struggling deliberately push their children into the same road. Mrs. De L. learned early that the chief objects of life in general were to keep up appearances and kill time; that as a means to success a woman must get a rich husband and keep beautiful. Being an intelligent girl and pretty she managed to get the rich husband,—and settled down to the rich housewife's neurosis.

Her husband was old-fashioned despite his rather new wealth, and they had two children,—a large modern American family. Though he allowed her to have servants he insisted that she manage their household, which she did with rebellion for a short time, and then rather quickly broke away from it by turning over the household to a housekeeper. This brought about the silent disapproval of her husband, who let her "have her own way", as he said, "because it's the fashion nowadays."

She became a seeker of pleasure and sensation, drifting from one type of amusement to the other in an intricately mixed cooperation and rivalry with members of her set. She followed every fad that infests staid old Boston, from the esoteric to the erotic. She became an accomplished dancer, ran her own car, followed the races, went to art exhibitions, subscribed to courses of lectures of which she would attend the first, dabbled in new religions, became enthusiastic: about social work for a month or two,—and became a professional at bridge. Summers she rested by chasing pleasure and flirting with male habitues of fashionable summer resorts; part of the winter she recuperated at Palm Beach, where she vied for the leadership of her set with her dearest enemy.

Her husband financed all her ventures with a disillusioned shrug of his shoulders. As she entered the thirties she became intensely dissatisfied with herself and her life, tried to get back to active supervision of her home but found herself in the way, though her children were greatly pleased and her husband sceptical. The need of excitement and change persisted; gradually an intense boredom came over her. Her interest in life was dulled and she began a mad search for some sensation that would take away the distressing self-reproach and dissatisfaction. Shortly after this she lost the power to sleep and had a host of symptoms which need not be detailed here.

The medical treatment was first to restore sleep. I may say that this is a first step of great importance, no matter how the sleeplessness originates. For even if an idea or a disturbing emotion is its cause, the sleeplessness may become a habit and needs energetic attention.

With this done, attention was paid to the social situation, the life habits. It was pointed out that all the philosophies of life were based on simple living and work, and that all the wise men from the beginning of the written word to our own times have shown the futility of seeking pleasure. It was shown that to be a sensation seeker was to court boredom and apathy, and that these had deenergized her.

For interest in the world is the great source of energy and the great marshaler of energy. From the child bored by lack of playmates, who brightens up at the sight of a woolly little dog, to the old and vigorous man who makes the mistake of resigning from work, this function of interest can be shown.

She was advised to get a fundamental, nonegoistic purpose, one that would rally both her emotions and her intelligence into service. Finally she was told bluntly that on these steps depended her health and that from now on any breakdown would be merely a confession of failure in reasonableness and purpose.

That she improved greatly and came back to her normal health I know. Whether she continued to remain well and how far she followed the advice given I cannot say. From the earliest time to this, necessity has been the main spur to purpose, and probably the lure of social competition drew the lady back to her old life. Experience, though the best teacher, seems to have the same need of repetition that all teaching does.

Case III. The physically sick woman who displays nervousness.

Though this is one of the most important of the types of nervous housewife the subject is essentially medical. We shall therefore not detail any case, but it is wise to reemphasize some facts.

There are bodily diseases of which the early and predominant symptoms are classed as "nervousness." Hyperthyroidism, or Graves' Disease, a condition in which there is overactivity of the thyroid gland and which is particularly prevalent among young women, is one of those diseases. In this condition excitability, irritability, emotional outbursts, fatigue, restlessness, digestive disorders, vasomotor disorders, appear before the characteristic symptoms do.

Neuro-syphilis is another such disease. This is an involvement of the nervous system by syphilis. One of the tragedies that distresses even hardened doctors is to find some fine woman who has acquired neuro-syphilis through her husband, though he himself may remain well. In the early stages this disease not only has neurasthenic symptoms but is very responsive to treatment, and thus the early diagnosis is of great importance.

What is known as reflex nervousness arises as a result of minor local conditions, such as astigmatism and other eye conditions, trouble with the nose and throat and trouble with the organs of generation. The latter is especially important in any consideration of nervousness in the housewife, particularly in the woman who has borne children. Frequently too the existence of hemorrhoids, resulting from constipation, acts to increase the irritability of a woman who is perhaps too modest to consult a physician regarding such trouble. Where such modesty exists (and it is found in the very women one would be apt to think were the very last to be swayed by it), then a competent woman physician should be consulted. With good women physicians and surgeons in every large community there is no reason for reluctance to be examined on the part of any woman.

Further details are not necessary. Enough has been said to emphasize the fact that the nervousness of the housewife is first a medical problem and then a social-psychological one.

Case IV. A case presenting bad hygiene as the essential factor.

Bad hygiene is something more than exposure to bad air, poor food, contaminated water, etc. It includes habits and times of eating, attention to the bowels, outdoor exercise, sleep, and in the marital state it includes the sexual indulgence.

The housewife under consideration, Mrs. T.F., aged twenty-eight, married five years, two children, complained mainly of headache, occasional dizziness, great irritability, and fatigue, so that quarrels with her husband were very common, though there seemed nothing to quarrel about. The family was not rich, but lived in a comfortable apartment; there were no serious financial burdens, the children were reasonably healthy and good, and the closest questioning revealed the husband as a kindly man who never took the initiative in quarrels but who was never able to keep silent under provocation. The couple was still in love and there seemed to be no essential incompatibility.

Questioned as to her habits, Mrs. F. said she did all her own housework except the washing and ironing and scrubbing. She had a little girl three times a week to take the baby out. Before marriage she had been a stenographer, but never earned high pay and had no love for her work. In fact she gave it up with relief and found housework with its disagreeable features much more to her taste than business. She had been of a placid, pleasant temperament and could not understand the change in her.

Since all this did not explain her symptoms, closer inquiry was made into her habits. She arose with her husband at seven-thirty, prepared his breakfast, sent the oldest child off to kindergarten and then had her own breakfast, which usually consisted of toast and coffee. At noon she had a very small piece of meat or an egg and a few potatoes with tea. At night she ate sparingly of the dinner, which usually was meat, potatoes, another vegetable, and a dessert. Her husband here stated that she ate at this meal less than the boy of four and a half.

Comparing her buxom figure with the diet a discrepancy was at once apparent. She then confessed with shame that she was a constant nibbler, eating a bit of this or that every half hour or so, and consequently never had an appetite. The food thus nibbled usually was either spicy or sweet, and she consumed quite a bit of candy. Her bowels moved infrequently and she always needed laxatives. In her spare time she felt rather "logy", rarely went out, except now and then at night with her husband, and spent her leisure hours on the couch reading or nibbling.

This in itself would have quite explained much of her trouble. It has been pointed out that body and mind are not separable; that mental functions are based on the bodily functions, and that mood may rest on no more exalted cause then the condition of the bowels. But a more intimate questioning revealed sexual habits which are easily drifted into by people of an amorous turn of character and who are really fond of one another. These both husband and wife frankly said they had not meant to speak of, but with their disclosure it was evident that a good deal of importance was to be attached to them.

The correction of the life habits was of course the fundamental need. The young woman was instructed in detail as to diet, the care of the bowels and outdoor exercise. Since she was in perfect condition except for stoutness she could easily look for recovery, and as an added incentive the restoration of youthful good looks was held out as certain.

The sexual life was frankly discussed, and necessary restrictions were imposed. Both the husband and wife agreed willingly to the changes ordered and promised faithfully to carry out instructions.

The patient made a splendid recovery and very rapidly. Here was a deenergization dependent solely upon the sedentary life of the housewife and upon ignorance of sex hygiene. Here were quarreling and impending marital disaster removed by attention to details in living. Here was a complete proof that not only does a sound mind need a sound body, but that a sound marriage needs one as well.

Case V. The hyperaesthetic woman.

Mrs. J.F. is twenty-seven years of age. She was born in the United States, of middling well-to-do people. Her father was a gruff, hearty man, not in the least bit finicky, who really despised manners and the like, though he was conventional enough in his own way. Her mother was an old-fashioned housewife, fond of her home and family, in fact perhaps more attached to the former than the latter. She hated servants and got along without them (except for a day woman) until she became rather too old to do the work.

J.'s sister and two brothers were duplicates of the parents,—hearty, stolid, and remarkably plain looking. J., the younger sister, though not the youngest in the family, was as different from her family as if she had sprung from another stock. She was slender, very pretty, with a quick, alert mind which jumped at conclusions, because labored analysis fatigued it. Above all, from the very start of life she was sensitive to a degree that perplexed her family, who were however intensely sympathetic because they adored her. This adoration arose from the fact that J. was brighter and prettier than most of her friends, and that her cleverness in many directions—music, writing, talking, handiwork—was the talk of their little group.

This sensitiveness arose from two main factors. First, an egoism fostered by the worship of her friends and the leadership of her group,—an egoism which led her to regard as a sort of insult anything disagreeable. Accustomed to praise, the least criticism implied or outspoken cut like a knife; accustomed to being waited upon, she resented physical discomfort of the slightest kind. Second, there must also have been an actual physical sensitiveness to sights, sounds, smells, tastes, etc. that made her perceive what others failed to notice. This led to an artistry manifested by her nice work in music and decoration and also by an excessive displeasure at the inartistic.

With this training, experience, and natural temperament she should have married a rich collector of art products, who would have added her to his collection and cherished her as his most fragile possession. Instead, through the working of that strange law of contraries by which Nature strikes averages between extremes, she fell in love with a hulk of a man whose ideas on art were limited to calling a picture "pretty", who loved sports and the pleasures of the table, and whose business motto was "Beat the other guy to it." A successful man, troubled with few subtleties either of approach or conscience, he viewed the marriage relationship in the old-fashioned way and the new American indulgence. A man's wife was to be given all the clothes she wanted, servants to help run the home, ought to bear two or three children, and love her indulgent husband. As for any real intimacy, he knew nothing of it. Kindly, self-indulgent, wife-indulgent, child-indulgent, ruthless in business, he may stand as something America has produced without any effort.

From the very first night J.'s world was shattered. We need not enter into details in this matter, but a woman of this type needs finesse in the initiation into marriage more than at any other time. Cave-man style outraged her every fiber, and the man was dumbfounded at her reaction. Though he tried to make amends his very effort and lack of understanding complicated matters.

Aside from this matter, which in the course of time became adjusted, so that though she rebelled desire arose in her, she found herself at odds with her husband's tastes and conduct in little things. Though his table manners were good enough, the gusto of his eating annoyed her and took away her own appetite. When they went to a play together the coarse jokes and the plainly sensuous aroused his enthusiasm. He lacked subtlety and could not understand the "finer" things of life. As he grew settled in matrimony, which he enjoyed in spite of her nerves (which he took for granted as like a woman), he grew stouter and this irritated and jarred her.

She finally realized she no longer loved him. It is doubtful if she realized this before the birth of her first and only child. She lacked maternal feeling and rebelled with a bitter rebellion against the distortion of her figure that came with the pregnancy. The nursing ordered by the doctor and expected by all around her nearly drove her "wild", she said, for she felt like a "cow", a "female." Indeed she reacted bitterly against the femaleness that marriage forced on her and hated the essential maleness of her husband. Her emotional reaction against nursing took away her milk, and finally the disgusted family doctor ordered the baby weaned and he was turned over to a servant.

She went back to her own life, determined to become a housewife, to see if she could not love her husband and her home. But everything he did irritated her, and everything in the house made her feel as in a "luxurious cage." Yet she was by no means a feminist; she detested "noisy suffragettes", thought women doctors and lawyers ridiculous, and had been brought up to regard marriage as indissoluble.

Gradually out of the conflict, the chilling fear that she had made a mistake which could not be rectified, the constant irritation and annoyances, the revolt against her own sex feeling and her life situation, arose the neurosis. It took the form mainly of sudden unaccountable fears with faint dizzy feelings. The family physician on the aside told me that it was "just a case of a damn fool woman with everybody too good to her."

What constitutes a "damn fool" will include every person in the world, according to some one else. It seemed obvious to me that J. was not meant by nature to be a housewife or any kind of wife. Matrimonially she was a misfit, unless she met some man of a type like herself, though I doubt if any man could have pleased her. I doubt if her over-exacting taste would not rebel against the animal in life itself. For though the animal of life is essentially as fine as the human, certain types find it impossible to acknowledge it in themselves.

At any rate I advised separation for a time,—six months at least. I told the woman her reaction to her husband was abnormal and finicky. She answered that she knew this but could not conceive of any change. We discussed the matter in all its ramifications, and though she and her husband agreed to the separation, I knew that he was determined to hold her to her contract. She improved somewhat but I believe that such a temperament is incompatible with marriage, at least to such a man. The outlook is therefore a poor one.

Case VI. The over-conscientious housewife,—the seeker of perfection.

The woman whose history is to be discussed comes from a family of New England stock, i.e. the Anglo-Saxon strain modified by New England climate, diet, history, religion, and tradition into a distinct type. This type, often traditionally conservative and often extraordinarily radical, has this prevailing trait,—standards of right and wrong are set up somehow or other, and a remarkably consistent effort is made to maintain these inflexibly. However, the hyperconscientious are not peculiarly New England alone; I have met Jewish women, Italians, French, Irish, and Negroes who showed the same loyalty to a self-imposed ideal.

This lady, Mrs. F.B., thirty-five years of age, with three children, was brought by her husband against her will. He declared that both she and he were on the verge of nervous prostration; that unless something was done he would start beating her, this last of course representing a type of humorous desperation that usually has a wish concealed in it. She was "worn to a frazzle", always tired, sleepless, of capricious appetite, irritable, complaining, and yet absolutely refused to see a physician. She had taken tonics by the gallon, been overhauled by a dozen specialists, all of whom say, "nothing wrong of any importance—yet she is a wreck and I am getting to be one."

Her husband was a jolly looking personage from the Middle West, in a small business which kept his family comfortably. He looked domestic and admitted he was, which his wife corroborated. Evidently he was exasperated and worried as he gave the history of the case, with his wife now and then putting in a word: "Now, John, you are stretching things there; don't believe him, Doctor; not so bad as all that," etc.

She was a slender person, rather dowdily dressed as compared with her husband, with garments quite a little behind the prevailing mode. Her hair was unbecomingly put up, and it was evident that she disdained cosmetics of any kind, even the innocent rice powder. Her hands were quite unmanicured, though they were, of course, clean and neat. The hat was the simplest straw, home trimmed and neat, but a mere "lid" compared to the creations most women of her class were at the time wearing. That clothes were meant to be ornamental as well as useful was an attitude she completely rejected.

It turned out that life to her was an eternal housekeeping,—from the beginning of the day to the end she was on the job. Though she had a maid this did not relieve her much, for she constantly fretted and fumed over the maid's slackness. Everything had to be spotless all the time; she could not bear the disordered moments of bedtime, of the early morning hours, of wash day, of meal preparation, of the children's room, etc. She was obsessed by cleanliness and order, and her exasperated efforts, her reaction to any untidiness kept her husband and children bound in a fear like her own, though they rebelled and scolded her for it.

"She's always after the children," said her husband. "She is crazy about them, but she has got them so they don't dare call their soul their own. They don't bring their playmates into the house largely because they know that mother, though she wants children to play, goes after them picking up and cleaning."

This restlessness in the presence of disorder was accompanied by the effort to eradicate all vices, all discourtesies, all errors in manners from the children. She feared "bad habits" as she feared immorality. She thought that any rudeness might grow into a habit, must be broken early; any selfish manifestation might be the beginning of a gross selfishness, any lying or pilfering might be the beginning of a career of crime.

Here one might hold forth on the necessity for trial and error in children's lives. They want to try things, they form little habits for a day, a week, a month which they discard after a while; they try out words and phrases, playing with them and then pass on to a new experiment. They are insatiable seekers of experience, untiring in their quest for experiment,—and they learn thereby. Not every mickle grows into a muckle, and the supplanting of habits, the discarding of them as unsatisfactory, is as marked a phenomenon as the formation of habits.

So our patient allowed nothing for imperfections, experimental stages, developing tastes in her children. She was, however, hardest on herself, self-critical, scolded herself constantly because her house was never perfect, her work never done. She never had time to go out; she had become a veritable slave to a conscience that prodded her every time she read a book, took a nap, or went to a picture show.

It was not at first obvious either to her or her husband that her own ideal of cleanliness and perfection was responsible for her neurasthenia. If her "stomach was out of order ought she not have some stomach remedy; if her nerves were out of order would the doctor not prescribe a nerve tonic or a sedative?" The idea of a medicine for everything is still strong in the community and especially amongst dwellers in small towns, and represents a latent belief in magic.

In addition to such medicines as I thought the situation demanded, and to such advice as bore on her attitude to work and play, I hinted that dressing more fashionably might be of value. For the poorly dressed always have a feeling of inferiority in the presence of the better dressed, and this feeling is seriously disagreeable. To raise the ego-feeling one must remove feelings of inferiority, and here was a relatively simple situation. This woman really cared about clothes, admired them, but had got it into her head early in life that it was sinful to be vain about one's looks. Though she had discarded the sin idea the notion lingered in the form of "unworthy of a sensible woman", "extravagance", etc. As she was painfully self-conscious in the presence of others as a result, this was a hidden reason for sticking to her home.

This woman had a really fine intelligence, wanted to be well and made a gallant effort to change her attitude. In this she succeeded, became as she put it more "careless of her things and more careful of her people." Of course one cannot expect her ever to be anything but a fine housekeeper but she manages to be comfortable and has conquered an over-zealous conscience.



CHAPTER XI

OTHER TYPICAL CASES

Case VII. The ambitious woman discontented with her husband's ability.

In the American marriage relationship the woman makes the home and the man makes the fortune. In some countries the wife is an active business partner. This is notably true in France, among the Jews in Russia, and many immigrant races in the United States. The wife may even take the leadership if her superiority clearly shows up. Perhaps the American method works well enough in a majority of cases, but there are superior women yoked to inferior men who finally despair of their husband's advancement, and who, as the phrase goes, ought to be "wearing the trousers" themselves.

Mrs. D.J., thirty-nine years old, married fourteen years, two children, had excellent health before marriage. Her family, originally poor, had been characterized by great success. Her brothers occupy important places in the business world and are wealthy. One of her sisters is married to a man who is successful in law, and the other sister is an executive in a department store.

Before marriage Mrs. J. was in her brother's business, and at the time of her marriage earned a comfortable salary. She married a man who inherited a small business, and when they married she was enthusiastic over the prospects of this business. But unfortunately her husband never followed her plans; he listened impatiently and went ahead in his own way. As a result of his conservatism they had not advanced at all financially. Though they were not poor as compared with the mass of people, they were poor as compared with her brothers and brother-in-law.

In addition to the exasperation over her husband's attitude toward her counsel (which was approved by her brothers), she developed a disrespect for him, a feeling that he was to be a failure and a certain contempt crept into her attitude. Against this she struggled, but as the time went on the feeling became almost too strong to be disguised and caused many quarrels. It is probable that if her own brothers and sisters had not done so well her feeling toward her husband would not have reached the proportions it did, for she became envious of the good things they enjoyed and to a certain extent resented her sisters-in-law's attitude toward her husband and herself as poor. The part futile jealousy and envy play in life will not be underestimated by those who will candidly view their own feelings when they hear of the success of those who are near them. One of the reasons that ostentation and bragging are in such disfavor is because of the unpleasant envy and jealousy they tend involuntarily to arouse.

With disrespect came a distaste for sexual relations, and here was a complicating factor of a decisive kind. She developed a disgust that brought about hysterical symptoms and finally she took refuge in refusal to live as a wife. This aroused her husband's anger and suspicions; he accused her of infidelity and had her watched. The disunion proceeded to the point of actual separation, and she then passed into an acute nervous condition, marked by fear, restlessness, sleeplessness, and fatigue.

The analysis of this patient's reactions was difficult and as much surmised as acknowledged. With her breakdown her husband's affection immediately revived and his solicitude and tenderness awoke her old feeling, together with remorse for her attitude towards his lack of business success. It was obvious to me in the few times I saw her that she was working out her own salvation and that no one's assistance was necessary after she understood herself. Intelligence is a prime essential to cure in such cases,—an ignorant or unintelligent woman with such reactions cannot be dealt with. Gradually her intelligence took command, new resolves and purposes grew out of her illness, and it may confidently be said that though she never will be a phlegmatic observer of her husband's struggles she has conquered her old criticism and hostility.

Case VII. The nondomestic type and the mother-in-law.

That there is a nondomestic type of woman to-day is due to the rise of feminism and the fascination of industry. Where a woman has once been in the swirl of business, has been part of an organization and has tasted financial success, settling down may be possible, but is much more difficult than to the woman of past generations. Such a woman probably has never cooked a meal, or mended a stocking, or washed dishes,—and she has been financially independent. For love of a man she gives all this up, and even under the best of circumstances has her agonies of doubt and rebellion.

Mrs. A. O'L. had added to these difficulties the mother-in-law question. She was an orphan when she married, and was the private secretary of a business man who because she was efficient and intelligent and loyal gave her a good salary. She knew his affairs almost as well as he did and was treated with deference by the entire organization.

She married at twenty-six a man entirely worthy of her love, a junior official in a bank, looked on as a rising man, of excellent personal habits and attractive physique. She resigned her position gladly and went into the home he furnished, prepared to become a good wife and mother.

Unfortunately there already was a woman in the house, Mr. O'L.'s mother. She was a good lady, a widow, and had made her home with the son for some years. She was a capable, efficient housewife, with a narrow range of sympathies, and with no ambitions. There arose at once the almost inevitable conflict between mother-in-law and daughter-in-law.

Some day perhaps we shall know just why the husband's mother and his wife get along best under two roofs, though the husband's father presents no great difficulties. Perhaps in the attachment of a mother to a son there is something of jealousy, which is aroused against the other woman; perhaps women are more fiercely critical of women than men are. Perhaps the mother, if she has a good son, is apt to think no woman good enough for him, and if she is not consulted in the choosing is apt to feel resentment. Perhaps to be supplanted as mistress of the household or to fear such supplantment is the basic factor. At any rate, the old Chinese pictorial representation of trouble as "two women under one roof" represents the state in most cases where mother-in-law and daughter-in-law live together.

The senior Mrs. O'L. began a campaign of criticism against the younger woman. There was enough to find fault with, since the wife was absolutely inexperienced. But she was entirely new to hostile criticism, and it impeded her learning. Furthermore, she was not inclined to try all of the mother-in-law's suggestions; she had books which took diametrically the opposite point of view in some matters. There were some warm discussions between the ladies, and a spirit of rebellion took possession of the wife. This was emphasized by the fact that she found herself very lonely and longed secretly for the hum and stir of the office; for the deference and the courtesy she had received there. Further, the distracted husband, in his roles of husband and son, found himself displeasing both his wife and his mother. He tried to get the girl to subordinate herself, since he knew that this would be impossible for his mother. To this his wife acceded, but was greatly hurt in her pride, felt somehow lowered, and became quite depressed. The house seemed "like a prison with a cross old woman as a jailer", as she expressed it.

Another factor of importance needs some space. The bridal year needs seclusion, on account of a normal voluptuousness that attends it. No outsider should witness the embraces and the kisses; no outsider should be present to impede the tender talks and the outlet of feeling. It sometimes happens that the elderly have a reaction against all love-making; having outlived it they are disgusted thereby, they find it animal like, though indeed it is the lyric poetry of life. So it was in this case; the mother was a third party where three is more than a crowd, and she was a critical, disgusted third party. The young woman found herself taking a similar attitude to the love-making, found herself inhibiting her emotions and had a furtive feeling of being spied on.

The previously strong, energetic girl quickly broke down. Physical strength and energy may come entirely from a united spirit; a disunited spirit lowers the physical endurance remarkably. She became disloyal to matrimony, rebelled against housework, and yet loved her husband intensely. A prey to conflicting ideas and emotions, she fell into a circular thinking and feeling, where depressed thoughts cannot be dismissed and depressed energy follows depressed mood. Prominent in the symptoms were headache, sleeplessness, etc., for which the neurologist was consulted.

How to remedy this situation was to tax the wisdom of a Solomon. It probably would have remained insoluble, had not the statement I made that the main element in the difficulty was the mother-in-law vs. daughter-in-law situation come to the ears of the old lady. Conscientious and well-meaning, that lady announced her determination to take up her residence with a married daughter who already had a well-organized household, and whose husband was a favorite of the mother's. Despite the mother-in-law joke of the humorists, the mother-in-law is far more friendly to a daughter's husband than to a son's wife.

This solved part of my patient's problem. There remained the adjustment to domestic life. This was hard, and though in part successful, it was delayed by the sterility of the marriage. The husband and wife agreed that pending a child she might well become active again in the larger world. Though the best place would have been her old work, pride and convention stood in the way, and so she entered upon more or less amateurish social work. Finally, perhaps as an unconsciously humorous compensation for her own troubles, she became an ardent and thoroughly efficient secretary to a league of housewives that aimed at better conditions. This work took up her time except for the supervising of a servant, and this nondomestic arrangement worked well since she had no children.

Case VIII. The childless, neglected woman.

It happened that two of the severest cases I have seen occurred, one in a Jewish woman and the other in a young Irish woman, with such an identity of symptoms and social domestic background that either case might have been interchanged for the other without any appreciable difference. The factors in the cases might simply be summarized as childlessness, anxiety, neglect, and loneliness, and in each case the main symptoms were anxiety, attacks of cardiac symptoms, fatigue, and sleeplessness.

The young Jewish woman, thirty years of age, had been married since the age of twenty. Before marriage she worked in the needle trades, was well and strong and had no knowledge of any particular nervous or mental disease in her family. She married a man of twenty-four, who had also been in the tailoring business and had branched out in a small way in business. This business required him to go to work at about seven-thirty in the morning and he finished at nine-thirty in the evening. In the earlier years of their marriage he came home rather promptly at the end of his long day and the pair were quite happy.

At about the third year after marriage the woman became quite alarmed at her continued sterility. She commenced to consult physicians and in the course of the next three years underwent three operations with no result. She began to brood over this, especially since about this time her husband began to show a decided lack of interest in the home. He would come home at twelve and later, and she found that he was playing cards,—in fact had become a confirmed gambler. When she first discovered this, she became greatly worried; made a trip to New York where his people lived and induced them to bring pressure to bear on him for reform. This they did, with the result that for about six months he remained away from cards and gave more attention to his wife.

The reform lasted only for a short period and then the husband plunged deeper into gaming than ever, and there were periods of three and four days at a stretch when he would not return home at all. At such times the lonely wife, who still loved her husband, fell into a perturbed and agitated frame of mind, the worse because she confided her difficulties to no one. When he would return, shamefaced and repentant, she would reproach him bitterly and this would bring about renewed attention, gifts, etc., for a week or so,—and then backsliding. Finally even the brief spasmodic reforms grew less common, her reproaches were answered hotly or listened to with indifference, and she became "practically a widow" except for the occasions when the sexual feeling mastered them both.

The neurosis in this case approached almost an insanity. The dwelling alone, the desperate obsessive desire for a child to bring back his love and attentions and to satisfy her own maternal instinct, the pain the sight of happy couples with children gave her and which made her shun other women and their company, the fear that her husband was unfaithful (which fear was probably justified), and the lack of any fixed or definite purpose, the lack of a great pride or self-sufficiency, brought on symptoms that necessitated her removal to a sanitarium.

This of course pricked the conscience of her husband. He visited her frequently, vowed a complete change, promised to bring his business to the point where he would be able to come home at six, etc., etc. Gradually she improved and finally made a partial recovery.

Whether or not the husband kept his promises I cannot say. On the chances he did. Most confirmed gamblers, however, remain gamblers. The lure of excitement is more potent to such men than a wife whose charm has gone, through familiarity, through time itself, through the inconstancy of passion and love. The gambler usually knows no duty; he is kind and generous but only to please himself. He is easily bored and his sympathies rarely stand the disagreeable long; he knows only one constant attraction,—Chance.

The other woman suffered in much the same way except that she was fortunate enough finally to be deserted by her husband. This ended her doubts and fears, broke her down for a short while, and then she went back to industry. In this I have no doubt she found only an incomplete satisfaction for her yearnings and desires, but she had something to take up her time, and built up contacts with others in a way that was impossible in her lonely home.

Case IX. The will to power through weakness; a case of hysteria in the home.

This case is classic in the outspoken value of the symptoms to the woman. It is not of course typical, except as the extreme is typical, and that is what is usually meant, Roosevelt, we say, was a typical American, meaning that he represented in extreme development a certain type of man. So this case shows very clearly what is not so clear at first in many cases of conflict between man and wife.

The woman in question was twenty-seven, of French-Canadian origin, but thoroughly American in appearance and speech. She was of a middle-class rural family and had married a farmer who finally had given up his farm and was a mechanic in a small city.

The young woman had always been irritable, egoistic, and sensitive. As a girl if anything happened to "shock her nerves", i.e. to displease her, she fainted, vomited, or went into "hysterics." As a result her family treated her with great caution and probably were well pleased when she married off their hands and left the home.

Married life soon provided her with sufficient to displease her. Her husband drank but not sufficiently to be classed as a heavy drinker. He was a quiet, rather taciturn man, utterly averse to the pleasures for which his wife longed. She wanted to go to dances, to take in the theaters, to live in more expensive rooms, and especially she became greatly attached to a group of people of a sporty type whom her husband tersely called "tinhorn bluffs" and whom he refused to visit.

They quarreled vigorously and the quarrels always ended one way,—she became sick in one way or other. This usually brought her husband around to her way of thinking, at least for a time, and much against his will he would go with her to her friends.

Finally, however, she set her heart on living with these people, and he set his will firmly against hers. She then developed such an alarming set of symptoms that after a while the physician who asked my opinion had made up his mind that she had a brain tumor. She was paralyzed, speechless, did not eat and seemed desperately ill.

The diagnosis of hysteria was established by the absence of any evidence of organic disease and by the history of the case. The relief of symptoms was brought about by means which I need not detail here, but which essentially consisted in proving to the patient that no true paralysis existed and in tricking her into movement and speech.

When she was well enough to be up and about and to talk freely, she and her husband were both informed that the symptoms arose because her will was thwarted, and that part of their function was to bring the man to his knees. He agreed to this, but she took offense and refused to come any more to see me,—a not unnatural reaction.

The outlook in such a case is that the couple will live like cats and dogs. Such a temperament as this woman's is inborn. She is essentially, in the complete meaning of the word, unreasonable. Her nature demands a sympathetic attention and consideration that her character does not warrant. Throughout life she demands to receive but has no desire to give. Nor is she powerful enough to take, so there arise emotional crises with marked disturbance in bodily energy, and especially symptoms that frighten the onlooker, such as paralyses, blindness, deafness, fainting spells, etc. Whatever is the source of these symptoms, they are frequently used to gain some end or purpose through the sympathy and discomfort of others.

Not all hysteria, either in men or women, is united with such a character as this woman's. Sufficient stress and strain may bring about hysterical symptoms in a relatively normal person and short hysterical reactions are common in the normal woman. The height of cynicism may be found in the discovery that war causes hysteria in some men in much the same way that matrimony causes hysteria in some women. A humorous review of a paper on the domestic neuroses was entitled "Kitchen Shell Shock." But severe hysteria, when it arises in the housewife, springs mainly from her disposition and not from the kitchen.

Case X. The unfaithful husband.

Monogamous marriage is based upon the assumption that loyalty to a single male is moral and possible. It is probable that in no age has this agreement been loyally carried out by the husbands; it is probable that in our own time the single standard of morals has first been strongly emphasized. With the rise of women into equality one of the important demands they have made is that men remain as loyal as themselves. Therefore the reaction to unchastity or unfaithfulness on the part of the man is apt to be more severe than in the past, on the theory that where more is demanded failure in performance is felt the keener.

The housewife, Mrs. F.C., aged thirty-five, is a prepossessing woman, the mother of two children, and has been married for nine years. Her health has always been fairly good, though in the last four years she has been somewhat irritable. She attributed this to struggle to make both ends meet, her husband being a workman with wages just over the border line of sufficiency. They quarreled "no more than other couples do", were as much in love "as other couples are", to use her phrases. She was above her class in education, read what are usually called advanced books, was "strong for suffrage", etc. However she was a good housekeeper, devoted to her children and faithful to her husband. Their sexual relations were normal and up till six months before I saw her she thought herself a well-mated, rather fortunate woman.

Out of a clear sky came proof of long-continued unfaithfulness on the part of her "domestic" husband: a chance bill for women's clothes fluttered out of his pocket and under the bed, so that next morning she found it; an unbelieving moment and then a visit to the address on the bill, and proof plenty that he had been disloyal, not only to her but to the children, who had been obliged to scrimp along while he helped maintain another woman. Humiliated beyond measure by her disaster, unable to endure her past memories of happiness and faith, with an unstable world rocking before her, through the revelation that a quiet, contented, loving man could be completely false, she found no adequate reason for living and became a helpless prey to her troubled mind. "A temporary unfaithfulness, a yielding to sudden temptation" she could understand, but a determined plan of duplicity shattered her whole scheme of values. A very severe psychoneurosis followed, and her children and she were taken over by her parents and cared for.

Sleeplessness was so prominent in her case and so evidently the central physical symptom that its control was difficult and required a regular campaign for success. With sleep restored and the resumption of eating, the most of her acute symptoms were passed, though a profound depression remained.

Her husband, thoroughly abashed and ashamed, made furtive attempts at reconciliation. These were absolutely rejected, and from her attitude it was obvious that no reconciliation was possible. "Had he not been found out," said the wife, "he would still be living with her. I can never trust him again; I would die before I lived with him."

Little by little her pride recovered, for in such cases the deepest wound is to the ego, the self-valuation. The deepest effort of life is to increase that valuation by increasing its power and its respect by others; the keenest hurt comes with the lowering of the valuation of one's own personality. A woman gives herself to a man, without lowering a self-feeling if he is tender and faithful; if he holds her cheap, as by flagrant disloyalty, then her surrender is her most painful of memories.

With the recovery of pride came the restoration of her interest in her children, and her purposes reshaped themselves into definite plans. Part of the process in readjustment in any disordered life is to centralize the dispersed purposes, to redirect the life energies. She agreed that she would accept aid from the husband, as his duty, but only for the children. For herself, as soon as the children were a year or so older, she would go back to industry and become self-supporting. Her plans made, her recovery proceeded to a firm basis, and I have no doubt as to its permanence. Nevertheless, life has changed its complexion for her, and there will be many moments of agony. These are inevitable and part of the recovery process.

I shall not attempt to settle the larger problem of whether she should have forgiven her husband and returned to him. Granting that his repentance was genuine, granting that no further lapse would occur, she would never be able to forget that when he deceived her he had acted the part of a devoted husband. She would never be able fully to trust him, and this would spoil their married happiness entirely. "For the children's sake," cry some readers; well, that is the only strong argument for return. But on the whole it seems to me that an honest separation, an honest revolt of a proud woman is better than a dishonest reunion, or a "patient Griselda" acceptance of gross wrong.

Case XI. The unfaithful wife.

In such cases as the preceding and the one now to be detailed, the difficulties of the physician are multiplied by his entrance into ethics. Ordinarily medicine has nothing to do with morals; to the doctor saint and sinner are alike, and the only immorality is not to follow orders. To do one's duty as a doctor, with one's sole aim the physical health of the patient, may mean to advise what runs counter to the present-day code of morals. This is the true "Doctor's Dilemma." In such cases discretion is the safest reaction, and discretion bids the physician say, "Call in some one else on that matter; I am only a doctor."

A true neurologist must regard himself as something more than a physician. He needs be a good preacher, an astute man of the world, as well as something of a lawyer. The patient expects counsel of an intimate kind, expects aid in the most difficult situations, viz., the conflicts of health and ethics.

Mrs. A.R., thirty-one years of age and very attractive, has been married since the age of eighteen. She has two children, and her husband, ten years her senior, is a man of whose character she says, "Every one thinks he is perfect." A little overstaid and over dignified, inclined to be pompous and didactic, he is kind-hearted and loyal, and successful in a small business. He is an immigrant Swiss and she is American born, of Swiss parentage.

Always romantic, Mrs. A.R. became greatly dissatisfied with her home life. At times the whole scheme of things, matrimony, settled life, got on her nerves so that she wanted to scream. She was bored, and it seemed to her that soon she would be old without ever having really lived. "I married before I had any fun, and I haven't had any fun since I married except"—Except for the incident that broke down her health by swinging her into mental channels that made her long for the quiet domesticity against which she had so rebelled. Her daydreaming was erotic, but romantically so, not realistic.

There are in the community adventurers of both sexes whose main interest in life is the conquest of some woman or man. The male sex adventurers are of two main groups, a crude group whose object is frank possession and a group best called sex-connoisseurs, who seek victims among the married or the hitherto virtuous; who plan a campaign leisurely and to whom possession must be preceded by difficulties. Frequently these gentry have been crude, but as satiation comes on a new excitement is sought in the invasion of other men's homes. Undoubtedly they have a philosophy of life that justifies them.

Since this is not a novel we may omit the method by which one of these men found his way to the secret desires of our patient, and how he proceeded to develop her dissatisfaction into momentary physical disloyalty. She came out of her dereliction dazed; could it be she who had done this, who had descended into the vilest degradation? She broke off all relations with the man, probably much to his surprise and disgust, and plunged into a self-accusatory internal debate that brought about a profound neurasthenia.

Naturally she did not of her own accord speak of her unfaithfulness,—largely because no one knew of it. Her husband did not in the least suspect her; he thought she needed a rest, a change, little realizing how "change" had broken her down. (For after all, the most of infidelity is based on a sort of curiosity, a seeking of a new stimulus, rather than true passion.) The truth was forced out of her when it was evident to me that something was obsessing her.

When she had confessed her difficulty the question arose as to her husband. She was no longer dissatisfied, no longer eager for romance; but could she live with him if she had been unfaithful? Ought she not to tell him; and yet she feared to do this, feared the result to him, for she felt sure he would forgive her. In reality the conflict in her mind arose first from self-depreciation and second from indecision as to confession.

As to the self-accusation, I told her that though she had been very foolish she had punished herself severely enough; that her reaction was that of an essentially moral person; that an essentially immoral woman would have continued in her career, and at least would not have been so remorseful. As to confessing, I told her that I believed that if she came to peace without such a confession wisdom would dictate not to make it, and that perhaps a little romanticism was still present in the quixotic idea of confession. Discretion is sometimes the better part of veracity, and I felt sure that she would not find it difficult to forget her pain.

It may be questioned whether such advice was ethical. I am sure no two professors of ethics could agree on the matter, and where they would disagree I chose the policy of expediency. Moreover, I felt certain that Mrs. R.'s remorse did not need the purge of confession to her husband, that she was not of that deeply fixed nature which requires heroic measures. Her confession to me was sufficient, and since it was apparent that she would not repeat her folly it was not necessary to go to extremes.

The last two cases make pertinent some further remarks on sex. It has previously been stated that the sex field is the one in which arise many of the difficulties which breed the psychoneuroses. It would not be the place here to give details of cases, though every neurologist of experience is well aware of the neuroses that arise in marriage, among both men and women. Some day society will reach the plane where matters relating to the great function by which the world is perpetuated can be discussed with the freedom allowed to the discussion of the details of nutrition.

No one seriously doubts that women are breaking away from traditional ideas in these matters. There was a time (the Victorian Age) in the United States and England when prudery ruled supreme in the manners and dress of women. That this has largely disappeared is a good thing, but whether there is a tendency to another extreme is a matter where division of opinion will occur. A transition from long skirts to dress that will permit complete freedom of movement and resembling in a feminine way the garments of men would be unqualifiedly good. It would remove undue emphasis of sex and accentuate the essential human-ness of woman. But a transition from long skirts to short tight ones, impeding movement, is the transition from prudery to pruriency and is by no means a clear gain. Plenty of scope for art and beauty might be found in a costume of which pantalettes of some kind are the basis. I doubt if women will ever be regarded quite as human beings so long as they paint, wear fantastic coiffures, hobble along on foolish heels, and are clad in over tight short skirts.

Similarly with the literature of the period. The so-called sex story, the sex problem, obsesses the writers. Nor are these frank, free discussions of the essential difficulties in the relation between man and woman. Usually the stories deal with the difficulties of the idle rich woman without children, or concern themselves with trivial triangles. In the type of interminable continued stories that every newspaper now carries, the woman's difficulties range around the most absurd petty jealousies, and she never seems to cook or sew or have any responsibility, and they always end so "sweetly." On the stage the epidemic of girl and music shows has quite displaced the drama. Here sex is exploited to the point of the risque and sometimes beyond it.

Sex is overemphasized by our civilization on its distracting side, its spicy and condimental values, and underemphasized so far as its realities go. The aim seems to be to titillate sex feeling constantly, and a precocious acquaintance with this form of stimulation is the lot of most city children. Such things would have no serious results to the housewife if they did not arouse expectations that marriage does not fulfill at all. This is the great harm of prurient clothes, literature, art, and stage,—it unfits people for sex reality.

In how far the delayed marriages of men and women are good or bad it is almost impossible to decide. That unchastity increases with delay is a certainty, that fewer children are born is without doubt. Whether the fixation of habit makes it harder for the wife to settle down to the household, and the man less domestic, cannot be answered with yes or no. There seems to be no greater wisdom of choice shown in mature than in early marriages, though this would be best answered by an analysis of divorce records.

That contraceptive measures have come to stay; that they are increasing in use, the declining birth rate absolutely evidences. I take no stock in the belief that education reduces fertility through some biological effect; where it reduces fertility it does so through a knowledge of cause, effect, and prevention. Some day it will come to pass that contraceptive measures will be legal, in view of the fact that our jurists and law makers are showing a decline in the size of their own families. When that time comes the discussion of means of this kind consistent with nervous health will be frank, and some part of the neurasthenia of our modern times will disappear. The vaster racial problems that will arise are not material for discussion in this book.

Though not perhaps completely relevant to the nervousness of the housewife, it is not without some point to touch on the "neurosis of the engaged." The freedom of the engaged couple is part of the emancipation of youth in our time. Frankly, a love-making ensues that stops just short of the ultimate relationship, an excitement and a tension are aroused and perpetuated through the frequent and protracted meetings. Sweet as this period of life is, in many cases it brings about a mild exhaustion, and in other cases, relatively few, a severe neurosis. On the whole the engagement period of the average American couple is not a good preparation for matrimony. How to bring about restraint without interfering with normal love-making is not an easy decision to make. But it would be possible to introduce into the teaching of hygiene the necessity of moderation in the engaged period; it would be especially of service to those whose engagement must be prolonged to be advised concerning the matter. Here is a place for the parents, the family friend, or the family physician.

Men and women as they enter matrimony are only occasionally equipped with real knowledge as to the physiology and psychology of the sex life. That a great deal of domestic dissatisfaction and unhappiness could be obviated if wisdom and experience instructed the husband and wife in the matter I have not the slightest doubt. The first rift in the domestic lute often dates from difficulties in the intimate life of the pair, difficulties that need not exist if there were knowledge. That reason and love may coexist, that the beauty of life is not dependent on a sentimentalized ignorance are cardinal in my code of beliefs. He who believes that sentiment disappears with enlightenment is the true cynic, the true pessimist. He who believes that intelligence and knowledge should guide instinct and that happiness is thus more certain is better than an optimist; he is a rationalist, a realist.



CHAPTER XII

TREATMENT OF THE INDIVIDUAL CASES

It is obvious that what is largely a problem of the times cannot be wholly considered as an individual problem. Yet individual cases do yield to treatment (to use the slang of medicine) or at least a large proportion do. The minor cases in point of symptoms are very frequently the most stubborn, since neither the patient nor the family are willing to concede that to alter the life situation is as important as the taking of medicine.

Most housewives are nervous, both in their own eyes and in those of their husbands, yet rightly they are not regarded as sick. They are uncomfortable, even unhappy, and the way out seems impossible to find. I believe that even with things as they are, adjustments are possible that can help the average woman. It is conceded that where the life situation involves an unalterable factor, relief or help may be unobtainable.

It is necessary first of all to rule out physical disease. To do this means a thorough physical study. By doing this a considerable number of women will be immensely helped. Flat feet, varicose veins, injuries to the organs of generation, eye strain, relaxed gastro-intestinal tract, and the major diseases,—these must be remembered as factors that may determine nervousness.

With this question settled, let us assume that there is no such difficulty or it has been remedied, and we have next to consider the life situation of the patient. Here we enter into a difficult place, where knowledge of life and understanding of men and women, as well as tact, are the essentials.

It is necessary to remedy whatever bad hygienic habits exist. A rich woman may have settled down to a deenergizing life, with too much time in bed, too many matinees, too many late nights, too many bonbons, etc. Aside from the psychical injuries that such a life produces, it is bad for "the nerves" in its effects upon digestion, bodily tone, and the sources of mood. On some simple detail of life, some unfortunate habit, the whole structure of misery may rest.

I always keep in mind an incident of some years ago when I lived in a small town in Massachusetts. For some reason our furnace threw coal gas into the house in such a way as nearly to poison us. The landlord sent several plumbers down, and one after the other suggested drastic remedies,—a new chimney, a new furnace, etc. Finally the landlord and I investigated for ourselves. At the bottom of the chimney we found an inconspicuous loose brick which allowed air to enter the chimney beneath the entrance of the pipe from the stove. We got ten cents' worth of lime and fastened the brick in firmly. A complete cure, where the specialists had failed.

So there often exists some drain on the energy and strength of the woman which may be simple and easily changed, and yet is critical in its significance and importance.

An overdomestic woman may stick too closely to the house; an underdomestic one may go too often to movies and suffer the fatigue of mind and body that comes from over-indulgence in this most popular indoor sport. Carelessness about the eating and the care of the bowel functions may have started a vicious chain of things leading through irritability and fatigue into neurasthenia. We say human beings are all the same, but the range of individual susceptibility to trouble is such that a difficulty not important to most people will raise havoc with others who are in most ways perfectly normal.

Look then for the bad hygiene! Look for the evils of the sedentary life Look for the root of the trouble in lack of exercise, poor habits of eating, insufficient air, disturbed sleep! Search for physical difficulties before inquiring into the psychical life.

If poverty exists, then one may inquire into the amount of work done, the character of the home, the opportunities for recreation and recuperation. All or any of the factors I have mentioned in previous chapters may be critical, and the moil and turmoil of a crowded tenement home may be responsible. That such conditions do not break all women down does not prove that they do not break some women down, women with finer sensibilities, or lesser endurance (which often go together). The most depressing problems are met among the poor, the cases where one can see no way out because the social machinery is inadequate to care for its victims.

What is one to do when one meets a poor woman with three or four or more children, living in a crowded way, overworked, racked in her nerves by her fears, worries, and the disagreeable in her life, drudging from morning till night, yearning for better things, despairing of getting them, tormented by desires and ambitions that must be thwarted? "What right has a poor woman anyway to desires above her station, and why does not she resign herself to her lot?" ask the comfortable. Unfortunately philosophy and resignation are difficult even for philosophers and saints, and much more so for the aspiring woman. And our American civilization preaches "Strive, Strive!" too constantly for much philosophy and resignation of an effective kind to be found.

One must give tonics, prescribe rest, try to get social agencies interested, obtain vacations and convalescent care, etc. Can one purge a woman of futile longings and strivings, rid her of natural fears and even of absurd fears? It can be done to a limited degree, if the patient has intelligence and if one gives liberally of one's time and sympathy. But unfortunately the consulting room for the poor is in the crowded clinic, the thronged dispensary, and how is the overworked physician to give the time and energy necessary?

For the time required is the least requirement. To deal adequately with the neurasthenic is to have unending sympathy and patience and an energy that is limitless. Without such energy or endurance the physician either slumps to a prescriber of tonics and sedatives, a dispenser of such stale advice as "Don't worry" and "You need a rest", or else himself gives out.

In dealing with the cases in the better-to-do and the rich, one has more weapons in the armamentarium. The worry is more futile here, more ridiculous, and one can attack it vigorously. Usually it is not overwork in these cases; it is monotony, boredom, discontent with something or other, a vicious circle of depressing thoughts and emotions, some difficulty in the sex life, some reaction against the husband, a rebellion of a weak, futile kind against life, maladjustment of a temperament to a situation.

Some difficulties, even when ascertained and clearly understood, are insurmountable. "The truth shall make ye free" is true only in the very largest sense. Some temperaments are inborn, and are as unchangeable as the nose on one's face. In such cases the ordinary physical therapeutics help the acute symptoms that flare up now and then, and that is as much as one may expect.

But it is certain that in the majority of cases more than this may be accomplished. It is often a great surprise and relief to a woman to realize that her overconscientiousness, her fussiness, her rebellion, and discontent, her reaction to something or other is back of her symptoms. She has feared disease of the brain, tumor, insanity, or has blamed her trouble on some other definite physical basis.

If one deals with intelligence, explanation helps a great deal. The intelligent usually want to be convinced; they do not ask for miracles, they seek counsel as well as treatment.

It is my firm belief that the function of intelligence is to control instinct and emotion, and that temperament, if inborn, is not unchangeable, even at maturity. Once you convince a person that his or her symptoms are due to fear, worry, doubt, and rebellion you enlist the personal efforts to change.

A new philosophy of life must be presented. Less fussiness, less fear, more endurance, less reaction to the trifles of their life are necessary. The aimless drifter must be given a central purpose or taught to seek one; the dissatisfied and impatient must be asked, "Why should life give you all you want?" "What cannot be remedied must be endured!" What a wealth of wisdom in the proverb! One seeks to establish an ideal of fortitude, of patience, of fidelity to duty,—old-fashioned words, but serenity of spirit is their meaning. Suddenly to come face to face with one's self, to strip away the self-imposed disguise, to see clearly that jealousy, impatience, luxurious, and never satisfied tastes, a selfish and restless spirit, are back of ennui and fatigue, pains and aches of body and mind, is to step into a true self-understanding.

If a situation demands action, even drastic action, "surgical" action, then that action must be forthcoming, even though it hurts. To end doubt, perplexity, to cease being buffeted between hither and yon, is to end an intolerable life situation. I have in mind certain domestic situations, such as the effort to keep up in appearance and activity with those of more means and ability.

Sexual difficulties, so important and so common, demand the cooperation of the husband for remedy. He should be seen (for usually the wife consults the physician alone) and the situation gone over with him. Men are usually willing to help, willing to seek a way out. A neurasthenic wife is a sore trial to the patience and endurance of her husband and he is anxious enough to help cure her.

Where there is conflict of other kinds the situation is complicated by the intricacy of the factors. Financial difficulties especially wear down the patience and endurance of the partners, and the physician cannot prescribe a golden cure. In prosperous times there is less neurasthenia than in the unprosperous, just as there is less suicide.

Sometimes it is just one thing, one difficulty, over which the conflict rages. I have in mind two such cases, where one habit of the husband deenergized his wife by outraging her pride and love. When he was induced to yield on this point the wife came back to herself,—a highly strung, very efficient self.

In fact, the basis of treatment is the painstaking study of the individual woman and then the painstaking adjustment of that individual woman. It may mean the adjustment of the whole life situation to that housewife, or conversely the adjustment of the housewife to the life situation.

In many marital difficulties that one sees, not so much in practice as in contact with normal married couples, the trouble reminds one of the orang-outang in Kipling's story who had "too much Ego in his Cosmos." Marriage, to be successful, is based on a graceful recession of the ego in the cosmos of each of the partners. The prime difficulty is this; people do not like to recede the ego. And the worst offenders are the ones who are determined to stand up for the right, which usually is a disguised way of naming their desire.

One might speak of a thousand and one things that every man and every woman knows. One might speak of the death of love and the growth of irritation, the disappearance of sympathy,—these are the hopeless situations. But far more common and important, though less tragic, is the disappearance of the little attentions, the little love-making, the disappearance of good manners. Men are not the only or the worst offenders in this; the nervous housewife is very apt to be the scold and the nag. Perhaps the neurasthenia of the husband arises from his revolt against the incessant demands of his wife, but that's another story.

At any rate, there is what seems to be a cardinal point of difference between men and women, perhaps arising from some essential difference in make-up, perhaps in part due to difference in training. An essential need of the average American-trained woman is sympathy, constantly expressed, constantly manifested. The average man tends to become matter-of-fact, the average woman finds in matter-of-factness the death of love. She acts as if she believed that the little acts of love and sympathy are the more important as manifesting the real state of feeling, that the major duties were of less importance.

On this point most men and women never seem to agree. The man gets impatient over the constant demand for his attention. He thinks it unreasonable and childish. Intent upon his own struggle he is apt to think her affairs are minor matters. He thinks his wife makes mountains out of molehills and lacks a sense of proportion. He forgets that the devotion of the husband is the woman's anchor to windward, her grip on safety,—that his success and struggle are hers only in so far as he and she are intimate and lover-like. And women, even those who trust their husbands absolutely so far as physical loyalty goes, jealously watch them for the appearance of boredom, or lack of interest, for the falling off of the lover's spirit and feeling.

After marriage the rivalry of men expresses itself in business more than in love. Even where a woman does not fear another woman as a rival she fears the rivalry of business,—and with reason. So she craves attention, sympathy, as well as the dull love of everyday life. She ought to have it; it is her recompense for her lot, for her married life, her smaller interests. Now and then some great man intent upon a great work has some excuse for absorption in that work; for the great majority of men there is no such excuse. Their own affairs are also minor and are no more important than those of their wives. Fair play demands that the women they have immured in a home have a prior claim to their company, in at least the majority of the leisure hours. If in the time to come the home alters and a woman who continues to work marries a man who works, and they meet only at night, then it will be ethical for each to go his or her way. Marriage at present must mean the giving up of freedom for the man as well as for the woman, in the interests of justice and the race.

In medicine we prescribe bitter tonics which have the property of increasing appetite and vigor. For the husband of every woman there is this bit of advice; sympathy and attention constitute a sweet tonic, which if judiciously administered is of incomparable power and efficiency.



CHAPTER XIII

THE FUTURE OF WOMAN, THE HOME, AND MARRIAGE

No true sportsman ever prophesies. For the odds are overwhelmingly in favor of the prophet. If he is right, he can brag the rest of his days of his seer-like vision. If he is wrong, no one takes the trouble to reproach or mock him.

Therefore I do not claim to be a prophet in discussing the future of woman, the home, and marriage. At any time just one invention may come along that will totally alter the face of things. Moreover we are now in the midst of great changes in industry, in social relations, in the largest matters of national and international nature. Men and women alike are involved in these changes, but it is impossible to judge the outcome. For history records many abortive reformations, many reactionary centuries and eras as well as successful reformations and progressive ages.

Whether or not it fits woman to be a housewife of the traditional kind, feminism is certain to develop further. Women will enter into more diverse occupations than ever before, they will enter politics, they will find their way to direct power and action. More and more those who work will be specialized and individualized—- the woman executive, the writer, the artist, the doctor, lawyer, architect, chemist, and sociologist—will resist the dictum "Woman's place is the Home." The woman of this group will either be forced into celibacy, or in ever-increasing numbers she will insist on some sort of arrangement whereby she can carry on her work. She will perhaps refuse to bear children and transform domesticity into an apartment hotel life, in which she and her husband eat breakfast and dinner together and spend the rest of the waking time separately, as two men might.

Such a development, while perhaps satisfying the ideas of progress of the feminist, will be bad eugenically. There will be a removal from the race of the value of these women, the intellectual members of their sex. Whether the work this group of women do will equal the value of the children they might have had no one can say.

But after all, the number of women who will enter the professions and remain in them on the conditions above stated will be relatively small. The main function of women will always be childbearing. If ever there comes a time when the drift will be away from this function, then a counter-movement will start up to sway women back into this sphere of their functions. Moreover, the bulk of women entering industry will enter it in the humbler occupations and they will in the main be willing enough to marry and bear children, even in the limited way. Yet since they enter marriage with a wider experience than ever before, the conditions of marriage and the home must change, even though gradually.

So on the whole we may look to an increasing individuality of woman, an increasing feeling of worth and dignity as an individual, an increasing reluctance to take up life as the traditional housewife. Rebellion against the monotony and the seclusive character of the home will increase rather than diminish, and it must be faced without prejudice and without any reliance on any authority, either of church or state, that will force women back to "womanly" ways of thinking, feeling or doing.

Sooner or later we shall have to accept legally what we now recognize as fact,—the restriction of childbearing. Whether we regard it as good or bad, the modern woman will not bear and nurse a large family. And the modern man, though he has his little joke about the modern family, is one with his wife in this matter. With husband and wife agreed there seems little to do but accept the situation.