Preventable Diseases Part 20

The intelligent neurologist, nowadays, has practically no known specific for any form of nervous disease, no remedy which acts directly and curatively upon the nervous system itself. He relies chiefly--and this applies to the asylum physician also--upon intestinal antisepsis, upon rest, upon baths, upon regulation diet, and habits of life.

A number of the more sudden and fatal disturbances of the nervous system, as for instance, the familiar "stroke of paralysis," or apoplexy, of later middle life, are due to a defect, not in the nervous system at all, but in the blood-vessels supplying the brain; rupture of a vessel, and consequent escape of blood, destroys so much of the surrounding brain-tissue as to produce paralysis, and, in extreme cases, death. Just why the blood-vessels of the brain in general, and of one part of the basal ganglia in particular (the _Lenticulostriate_ artery in the internal capsule of the _corpus striatum_, the old jaw ganglion), are so liable to rupture we do not know; but it certainly is chiefly from a defect of the blood-vessels, and not of the brain. All of which brings us to the following important practical conclusions.

First of all, that every attack or touch, however light, of "nervousness," "nerves," "imagination," "neurasthenia," yes, hysteria, _means_ something. It is the cry of protest of a smaller or larger part of the nervous system against underfed blood, under-ventilated muscles, lack of sunlight, lack of exercise, lack of sleep, excess of work, or bad habits. In other words, it is the danger signal, the red light showing the open switch, and we will disregard it at our peril.

Unfortunately, by that power of _esprit de corps_ of the entire system, known as "pluck" or "grit," or the veto-power, physiologically termed inhibition, we may ignore and for a time suppress the symptom, but this in the long run is just as rational as cutting the wire that rings a fire alarm, or blowing out the red light without closing the switch.

Nervousness is a _symptom_ which should always have _something done for it_, especially in children. In fact, it has pa.s.sed into an axiom both with intelligent teachers and with physicians who have much to do with the little ones, that crossness, fretfulness, laziness, lack of initiative, and readiness to weep, in children, are almost invariably the signs of physical disease. And this doctrine will apply to a considerable percentage of children of larger growth.

Unfortunately, one of the first and most decided tendencies on the part of the badly fed or poisoned nervous system, is to exaggerate the difficulties of the situation, and to minimize its good features. The individual "has lost his nerve," is afraid to undertake things, shrinks from responsibility, exaggerates the difficulties that may be in the way; hence the floods of tears, or outbursts of temper, with which nervous children will greet the suggestion of any task or duty, however trifling. If the nervous individual has reached that stage of maturity when she realizes that she is not merely "naughty," but sick, then this same process applies itself to her disease. She is sure that she is going to die, that another attack like that will end in paralysis; as a patient of mine once expressed it to me, "My heart jumps up in my mouth, I bite a couple of pieces off it, and it falls back again." In short, she so obviously and grossly exaggerates every symptom and phase of her disease, that the impression irresistibly arises that the disease itself is a fabrication. This view of her condition by her family or her physician is the tragedy of the neurasthenic.

Broadly speaking, _no_ disease, even of the nervous system, is ever purely imaginary. Some part of the patient's nervous system is poisoned, or he would not imagine himself to be sick. We can all of us find trouble enough in some part of our complex bodily machinery, if we go around hunting for it; but this is precisely what the healthy man, or woman, _never_ does. They have other things to occupy them, and are far more liable to run into danger by pushing ahead at full steam, and neglecting small creakings and jarrings until something important in the gear jams, or goes snap, and brings them to a halt, than they are to be wasting time and energy worrying over things that may never happen.

Worry, in fact, is a sign of disease instead of a cause. To put it very crudely, whenever the blood and fluids of a body become impoverished below a certain degree, or become loaded with fatigue poisons, or other waste products above a certain point, then the nervous system proceeds to make itself felt. Either the perceptive end-organs become color-blind and read yellow for blue, or are astigmatic and report oval for round; or the conducting nerve-strands tangle up the messages, or deliver them to the wrong centre; or the central clearing-house, puzzled by the crooked messages, loses its head, and begins to throw the inkstands about, or goes down in a sulk. In other words, the nervous system goes on a strike. But it is perfectly idle to endeavor to treat it with cheering words, or kindly meant falsehoods, to the effect that "nothing is really the matter." Like any other strike, it can be rationally dealt with only by improving the conditions under which the operatives have to work, and meeting their demands for higher wages, or shorter hours.

We were accustomed at one time to divide diseases into two great cla.s.ses, organic and functional. By the former, we meant those in which there was some positive defect of structure, which could be recognized by the eye or the microscope; by the latter, those diseases in which this could not be discovered, in which, so to speak, the machine was all right, but simply wouldn't work. It goes without saying that the latter cla.s.s was simply a confession of our ignorance, and one which is steadily and rapidly diminishing as science progresses.

If the machine won't work, there is a reason for it somewhere, and our business is to find it out, and not loftily to a.s.sure our patients that there is nothing much the matter, and all they need is rest, or a little cheerful occupation. Furthermore, the most inane thing that a sympathizing friend or kindly physician can do to a neurasthenic, is to advise him to take his mind off himself or his symptoms. The utter inability to do that very thing is one of the chief symptoms of the disease, which will not disappear until the underlying cause has been carefully studied out and removed.

"Nerves," "neurasthenia," "psychasthenia," and "hysteria," are all the names of _symptoms_ of _definite bodily disease_. The modern physician regards it as his duty to study out and discover the nature of this disease, and, if possible, remove it, rather than to give high-sounding, soul-satisfying names to the symptoms, and advise the patient to "cheer up"; which advice costs nothing--and is worth just what it costs.

"But," some one will say at once, "if nervous diseases are simply the reflection of general bodily states, as sanitary conditions improve under civilization, should they not become less frequent? And yet, any newspaper will tell you that nervous diseases are rapidly on the increase." This is a widespread belief, not only on the part of the public, but of many scientists and a considerable number of physicians; but it is, I believe, unfounded.

In the first place, we have no reliable statistical basis for a positive statement, either one way or another. Our ignorance of the precise prevalence of disease in savagery, in barbarism, and even under civilization up to fifty years ago, is absolute and profound. It is only since 1840 that vital statistics of any value, except as to gross deaths and births, began to be kept. So far as we are able to judge from our study of savage tribes by the explorer, the army surgeon, and the medical missionary, the savage nervous system is far less well balanced and adjustable than that of civilized man. Hysteria, instead of occurring only in individual instances, attacks whole villages and tribes. In fact, the average savage lives in a state alternating between nave and childish self-satisfaction and panic-stricken terror, with their resultant cowardice and cruelty on the one hand, and unbridled l.u.s.t and delusions of grandeur on the other. The much-vaunted strain of civilization upon the nervous system is not one-fifth that of savagery.

Think of living in a state when any night might see your village raided, your hut burned, yourself killed or tortured at the stake, and your wife and children carried into slavery. Read the old hymns and see how devoutly thankful our pious ancestors _were every day_ at finding themselves alive in the morning,--"Safely through another night,"--and fancy the nerve-strain of never knowing, when you lay down to sleep, whether some one of the djinns, or voodoos, or vampires would swoop down upon you before morning. Think of facing death by famine every winter, by drought or cyclone every summer, and by open war or secret scalp-raid every month in the year; and then say that the racking nerve-strain of the commuter's time-table, the deadly clash of the wheat-pit, or the rasping grind of office-hours, would be ruinous to the uncivilized nervous system. Certainly, in those belated savages, the dwellers in our slums, hysteria, diseases of the imagination, enjoyment of ill health, and the whole brood of functional nervous disturbances are just as common as they are on Fifth Avenue.

It is not even certain that insanity is increasing. Insanity is quite common among savages; just how common is difficult to say, on account of their peculiar methods of treating it. The stupid and the dangerous forms are very apt to be simply knocked on the head, while the more harmless and fantastic varieties are turned into priests and prophets and become the founders of the earlier religions. A somewhat similar state of affairs of course prevailed among civilized races up to within the last three-quarters of a century. The idiot and the harmless lunatic were permitted to run at large, and the latter, as court and village fools, furnished no small part of popular entertainment, since organized into vaudeville. Only the dangerous or violent maniacs were actually shut up; consequently, the number of insane in a community a century ago refers solely to this cla.s.s. Hence, in every country where statistics have been kept, as larger and larger percentages of these unfortunates have been gathered into hospitals, where they can be kindly cared for and intelligently treated, the number of the registered insane has steadily increased up to a certain point. This was reached some fifteen years ago in Great Britain, in Germany, in Sweden, and in other countries which have taken the lead in asylum reform, and has remained practically stationary since, at the comparatively low rate of from two to three per thousand living. This limit shows signs of having been reached in the United States already; and this gradual increase of recognition and registration is the only basis for the alleged increase of insanity under modern conditions.

It is also a significant fact that the lower and less favorably situated stratum of our population furnishes not only the largest number of inmates, but the largest percentage of insanity in proportion to their numbers, while the most highly educated and highly civilized cla.s.ses furnish the lowest. Immigrants furnish nearly three times as many inmates per thousand to our American asylums as the native born.

It is, however, true that in each succeeding census a steadily increasing number and percentage of the deaths is attributed to diseases of the nervous system. This, however, does not yet exceed fifteen or twenty per cent of the whole, which would be, so to speak, the natural probable percentage of deaths due to failure of one of the five great systems of the body: the digestive, the respiratory, the circulatory, the glandular, the nervous. Two elements may certainly be counted upon as contributing in very large degree to this apparent increase. One is the enormous saving of life which has been accomplished by sanitation and medical progress during the first five years of life, infant mortality having been reduced in many instances fifty to sixty per cent, thus of course leaving a larger number of individuals to die later in life by the diseases especially of the blood-vessels, kidneys, and nervous system, which are most apt to occur after middle life. The other is the great increase in medical knowledge, resulting in the more accurate discovery of the causes of death, and a more correct reporting and cla.s.sifying of the same.

In short, a careful review of all the facts available to date leads us decidedly to the conclusion that the nervous system is the toughest and most resisting tissue of the body, and that its highest function, the mind, has the greatest stability of any of our bodily powers. Only one man in six dies of disease of the nervous system, as contrasted with nearly one in three from diseases of the lungs; and only one individual in four hundred becomes insane, as contrasted with from three to ten times that number whose digestive systems, whose locomotor apparatus, whose heart and blood-vessels become hopelessly deranged without actually killing them.

CHAPTER XIX

MENTAL INFLUENCE IN DISEASE, OR HOW THE MIND AFFECTS THE BODY

One of the dearest delusions of man through all the ages has been that his body is under the control of his mind. Even if he didn't quite believe it in his heart of hearts, he has always wanted to. The reason is obvious. The one thing that he felt absolutely sure he could control was his own mind. If he couldn't control that, what could he control?

Ergo, if man could control his mind and his mind could control his body, man is master of his fate. Unfortunately, almost in proportion as he becomes confident of one link in the chain he becomes doubtful of the other. Nowadays he has quite as many qualms of uncertainty as to whether he can control his mind as about the power of his mind over his body. By a strange paradox we are discovering that our most genuine and lasting control over our minds is to be obtained by modifying the conditions of our bodies, while the field in which we modify bodily conditions by mental influence is steadily shrinking.

For centuries we punished the sick in mind, the insane, loading them with chains, shutting them up in prison-cells, starving, yes, even flogging them. We exorcised their demons, we prayed over them, we argued with them,--without the record of a single cure. Now we treat their sick and ailing bodies just as we would any other cla.s.s of chronic patients, with rest, comfortable surroundings, good food, baths, and fresh air, correction of bad habits, gentleness, and kindness, leaving their minds and souls practically without treatment, excepting in so far as ordinary, decent humanity and consideration may be regarded as mental remedies,--and we cure from thirty to fifty per cent, and make all but five per cent comfortable, contented, comparatively happy.

We are still treating the inebriate, the habitual drunkard, as a minor criminal, by mental and moral means--with what hopeful results let the disgraceful records of our police courts testify. We are now treating truancy by the removal of adenoids and the fitting of gla.s.ses; juvenile crime by the establishment of playgrounds; poverty and pauperism by good food, living wages, and decent surroundings; and all for the first time with success.

In short, not only have all our substantial and permanent victories over bodily ills been won by physical means, but a large majority of our successes in mental and moral diseases as well. Yet the obsession persists, and we long to extend the realm of mental treatment in bodily disease.

That the mind does exert an influence over the body, and a powerful one, in both health and disease, is obvious. But what we are apt to forget is that the whole history of the progress of medicine has been a record of diminishing resort to this power as a means of cure. The measure of our success and of our control over disease has been, and is yet, in exact proportion to the extent to which we can relegate this resource to the background and avoid resorting to it. Instead of mental influence being the newest method of treatment it is the oldest. Two-thirds of the methods of the shaman, the witch-doctor, the medicine-man, were psychic.

Instead of being an untried remedy, it is the most thoroughly tested, most universal, most ubiquitous remedy listed anywhere upon the pages of history, and, it may be frankly stated, in civilized countries, as widely discredited as tested. The proportion to which it survives in the medicine of any race is the measure of that race's barbarism and backwardness. To-day two of the most significant criteria of the measure of enlightenment and of control over disease of either the medical profession of a nation or of an individual physician are the extent to which they resort to and rely upon mental influence and opium.

Psychotherapy and narcotics are, and ever have been, the sheet-anchors of the charlatan and the miracle-worker.

The att.i.tude of the medical profession toward mental influence in the treatment of disease is neither friendly nor hostile. It simply regards it as it would any other remedial agency, a given drug, for instance, a bath, or a form of electricity or light. It is opposed to it, if at all, only in so far as it has tested it and found it inferior to other remedies. Its distrust of it, so far as this exists, is simply the feeling that it has toward half a hundred ancient drugs and remedial agencies which it has dropped from its list of working remedies as obsolete, many of which still survive in household and folk medicine. My purpose is neither to champion it nor to discredit it, and least of all to antagonize or throw doubt upon any of the systems of philosophy or of religion with which it has been frequently a.s.sociated, but merely to attempt to present a brief outline of its advantages, its character, and its limitations, exactly as one might of, say, calomel, quinine, or belladonna.

As in the study of a drug, the chief points to be considered are: What are its actual powers? What effects can be produced with it, both in health and sickness? What are the diseases in which such effects may be useful, and how frequent are they? In what way does it produce its effects, directly or indirectly?

The first and most striking claim that is made for mental influence in disease is based upon the allegation that it has the power of producing disease and even death; the presumption, of course, being that, if able to produce these conditions, it would certainly have some influence in removing or preventing them. Upon this point the average man is surprisingly positive and confident in his convictions. Popular literature and legend are full of historic instances where individuals have not merely been made seriously ill but have even been killed by powerful impressions upon their imaginations. Most men are ready to relate to you instances that have been directly reported to them of persons who were literally frightened to death. But the moment that we come to investigate these widely quoted and universally accepted instances, we find ourselves in a curious position. On the one hand, merely a series of vague tales and stories, without date, locality, name, or any earmark by which they can be identified or tested. On the other, a collection of rare and extraordinary instances of sudden death which have happened to be preceded by a powerful mental impression, many of which bear clearly upon their face the imprint of death by rupture of a blood-vessel, heart failure, or paralysis, in the course of some well-marked and clearly defined chronic disease, like valvular heart-mischief, diabetes, or Bright's disease.

Upon investigation most of these cases which have been seen by a physician previous to death have been recognized as subject to a disease likely to terminate in sudden death; and practically all in which a post-mortem examination has been made have shown a definite physical cause of death. The fright, anger, or other mental impression, was merely the last straw, which, throwing a sudden strain upon already weakened vessels, heart, or brain, precipitated the final catastrophe.

In some cases, even the sense of fright and the premonition of approaching death were merely the first symptoms of impending dissolution.

The stories of death from purely imaginative impressions, such as the victims being told that they were seriously ill, that they would die on or about such and such a date, fall into two great cla.s.ses. The first of these--involving death at a definite date, after it had been prophesied either by the victim or some physician or priest--may be dismissed in a few words, as they lead at once into the realm of prophecy, witchcraft, and voodoo. Most of them are little better than after-echoes of the ethnic stories of the "evil eye," and of bewitched individuals fading away and dying after their wax image has been stuck full of pins or otherwise mutilated. There have occurred instances of individuals dying upon the date at which some one in whose powers of prophecy they had confidence declared they would, or even upon a date on which they had settled in their own minds, and announced accordingly; but these are so rare as readily to come within the percentage probabilities of pure coincidence. Most such prophecies fail utterly; but the failures are not recorded, only the chance successes.

The second group of these alleged instances of death by mental impression is in most singular case. Practically every one with whom you converse, every popular volume of curiosities which you pick up, is ready to relate one or more instances of such an event. But the more you listen to these relations, the more familiar do they become, until finally they practically simmer down to two stock legends, which we have all heard related in some form.

First, and most famous, is the story of a vigorous, healthy man accosted by a series of doctors at successive corners of the street down which he is walking, with the greeting:--

"Why, my dear Mr. So-and-So, what is the matter? How ill you look!"

He becomes alarmed, takes to his bed, falls into a state of collapse, and dies within a few days.

The other story is even more familiar and dramatic. Again it is a group of morbidly curious and spiteful doctors who desire to see whether a human being can be killed by the power of his imagination. A condemned criminal is accordingly turned over to them. He is first allowed to see a dog bled to death, one of the physicians holding a watch and timing the process with, "Now he is growing weaker! Now his heart is failing!

Now he dies!" Then, after having been informed that he is to be bled to death instead of guillotined, his eyes are bandaged and a small, insignificant vein in his arm is opened. A basin is held beneath his arm, into which is allowed to drip and gurgle water from a tube so as to imitate the sounds made by the departing life-blood. Again the death-watch is set and the stages of his decline are called off: "Now he weakens! Now his heart is failing!" until finally, with the solemn p.r.o.nouncement, "Now he dies!" he falls over, gasps a few times and is dead, though the total amount of blood lost by him does not exceed a few teaspoonfuls.

A variant of the story is that the trick was played for pure mischief in the initiation ceremonies of some lodge or college fraternity, with the horrifying result that death promptly resulted.

The stories seem to be little more than pure creatures of the same force whose power they are supposed to ill.u.s.trate, amusing and dramatic fairy-tales, handed down from generation to generation from Heaven knows what antiquity. Death under such circ.u.mstances as these _may_ have occurred, but the proofs are totally lacking. One of our leading neurologists, who had extensively experimented in hypnotism and suggestion, declared a short time ago: "I don't believe that death was ever caused solely by the imagination."

Now as to the scope of this remedy, the extent of the field in which it can reasonably be expected to prove useful. This discussion is, of course, from a purely physical point of view. But it is, I think, now generally admitted, even by most believers in mental healing, that it is only, at best, in rarest instances that mental influence can be relied upon to cure organic disease, namely, disease attended by actual destruction of tissue or loss of organs, limbs, or other portions of the body. This limits its field of probable usefulness to the so-called "functional diseases," in which--to put it crudely--the body-machine is in apparently perfect or nearly perfect condition, but will not work; and particularly that group of functional diseases which is believed to be due largely to the influence of the imagination.

Nowhere can the curious exaggeration and over-estimation of the real state of affairs in this field be better ill.u.s.trated than in the popular impression as to the frequency in actual practice of "imaginary"

diseases. Take the incidental testimony of literature, for instance, which is supposed to hold the mirror up to nature, to be a transcript of life. The pages of the novel are full, the scenes of the drama are crowded with imaginary invalids. Not merely are they one of the most valuable stock properties for the humorist, but whole stories and comedies have been devoted to their exploitation, like Moliere's cla.s.sic "Le Malade Imaginaire," and "Le Medecin Malgre Lui." Generation after generation has shaken its sides until they ached over these pompous old hypochondriacs and fussy old dowagers, whose one amus.e.m.e.nt in life is to enjoy ill health and discuss their symptoms. They are as indispensable members of the _dramatis personae_ of the stock company of fiction as the wealthy uncle, the crusty old bachelor, and the unprotected orphan. Even where they are only referred to incidentally in the course of the story, you are given to understand that they and their kind furnish the princ.i.p.al source of income for the doctor; that if he hasn't the tact to humor or the skilled duplicity to plunder and humbug these self-made sufferers, he might as well retire from practice. In short, the entire atmosphere of the drama gives the strong impression that if people--particularly the wealthy cla.s.ses--would shake themselves and go about their business, two-thirds of the illness in the world would disappear at once.

Much of this may, of course, be accounted for by the delicious and irresistible attractiveness, for literary purposes, of this type of invalid. Genuine, serious illness, inseparable from suffering and ending in death, is neither a cheerful, an interesting, nor a dramatic episode, except in very small doses, like a well-staged death-bed or a stroke of apoplexy, and does not furnish much valuable material for the novelist or the play-writer. Battle, murder, and sudden death, while horrible and repulsive, can be contemplated with vivid, gruesome interest, and hence are perfectly available as interest producers. But much as we delight to talk about our symptoms, we are never particularly interested in listening to those of others, still less in seeing them portrayed upon the stage. On account of their slow course, utter absence of picturesqueness, and depressing character, the vast majority of diseases are quite unsuitable for artistic material. In fact, the literary worker is almost limited to a mere handful, at one extreme, which will produce sudden and dramatic effects, like heart failure, apoplexy, or the ghastly introduction of a "slow decline" for a particularly pathetic effect; and at the other extreme, those imaginary diseases, migraines and vapors, which furnish amus.e.m.e.nt by their sheer absurdity.

Be that as it may, such dramatic and literary tendencies have produced their effect, and the popular impression of the doctor is that of a man who spends his time between rushing at breakneck speed to save the lives of those who suddenly find themselves _in articulo mortis_ and will perish unless he gets there within fifteen minutes, and dancing attendance upon a swarm of old hypochondriacs, neurotics, and nervous dyspeptics, of both s.e.xes. As a matter of fact, these two supposed princ.i.p.al occupations of the doctor are the smallest and rarest elements in his experience.

A few years ago a writer of world-wide fame deliberately stated, in the course of a carefully considered and critical discussion of various forms of mental healing, that it was no wonder that these methods excited huge interest and wide attention in the community, because, if valid, they would have such an enormous field of usefulness, seeing that at least seven-tenths of all the suffering which presented itself for relief to the doctor was imaginary.

This, perhaps, is an extreme case, but is not far from representing the general impression. If a poll were to be taken of five hundred intelligent men and women selected at random, as to how much of the sufferings of all invalids, or sick people who are not actually obviously "sick unto death" or ill of a fever, was real and how much imaginary, the estimate would come pretty close to an equal division.

But when one comes to try to get at the actual facts, an astonishingly different state of affairs is revealed. I frankly confess that my own awakening was a matter of comparatively recent date.

A friend of mine was offered a position as consulting physician to a large and fashionable sanatorium. He hesitated because he was afraid that much of his time would be wasted in listening to the imaginary pains, and soothing the baseless terrors, of wealthy and fashionable invalids, who had nothing the matter with them except--in the language of the resort--"nervous prosperity." His experience was a surprise. At the end of two years he told me that he had had under his care between six and seven hundred invalids, a large percentage of whom were drawn from the wealthier cla.s.ses; and out of this number there were _only five_ whose sufferings were chiefly attributable to their imagination.

Many of them, of course, had comparatively trivial ailments, and others exaggerated the degree or mistook the cause of their sufferings; but the vast majority of them were, as he navely expressed it, "really sick enough to be interesting."

This set me to thinking, and I began by making a list of all the "imaginary invalids" I had personally known, and to my astonishment raked up, from over twenty years' medical experience, barely a baker's dozen. Inquiries among my colleagues resulted in a surprisingly similar state of affairs. While most of them were under the general impression that at least ten to twenty per cent of the illnesses presenting themselves were without substantial physical basis and largely imaginary in character, when they came actually to cudgel their memories for well-marked cases and to consult their records, they discovered that their memories had been playing the same sort of tricks with them that the dramatists and novelists had with popular impressions.