Psychotherapy Part 55

Kronig thinks that the vomiting of pregnancy is an especially favorable subject for suggestive treatment. He inclines to the opinion that the remedies that have been reported to do good and so many of which have subsequently proved unavailing have really owed whatever success they have had to the suggestion that went with them. b.u.mm, in his text-book of obstetrics (Grundriss zum Studium der Geburtshulfe von Dr. Ernst b.u.mm, Wiesbaden, 1902), accepts Kaltenbach's and Ahfeld's conclusions and thinks that the consideration of _hyperemesis_ as an hysterical neurosis is well supported by the success and failure of our therapeutics. All sorts of remedies, any number of drugs, all manner of gynecological procedures short of abortion, though also including abortion, have been reported as doing good. All of them even including abortion have failed in a certain number of cases. Evidently suggestion plays a large role. Hypnosis often proves an excellent remedy.

Excessive Salivary Secretion.--b.u.mm considers that the excess of secretion of saliva which is so often noticed in pregnancy is of the same nature and should be treated rather by suggestion than by any particular remedy, though remedies should be tried because of certain helpful physical effects, and then the psychic element that goes with them. The less importance given to the symptom, the less attention it attracts, the more its pa.s.sing trivial character is emphasized, the sooner it will subside. Solicitude causes it to persist and even increase.

LABOR

Suggestion in Labor.--When the subjects are normal, expectancy has much to do with the severity of labor pains. In recent years so much fuss has been made and so much said and written about woman's burden and travail in the pains of childbirth, that preliminary dread and anxious attention have wrought young women up to such a poignancy of expectation as to make these pains worse than they really are. In the old days child-bearing was as much a matter of course as the husband going out to his daily work, and the taking of the dangers and fatigues of it was a simple matter of duty. Labor was then {458} comparatively easy and, while never pleasant, was also never an over-uncomfortable process. The effect of unfortunate suggestion has been to make it seem ever so much worse than it really is. Multiparae furnish the best proof of this. A healthy woman who has already had more than one child does not dread labor pains very much, or only to a slight degree, because the previous maternities have lessened the physical pain to be experienced, though a healthy woman's tissues are so thoroughly resilient that nature is able to bring about a return to normal conditions so complete that it is not always easy to decide whether a woman has given birth to a child or not. Of course, there are many cases in which tears reveal the former labor, but there are others in which it is not so, and the renewal of the birth process must, therefore, be nearly if not quite as painful as before, especially if it is recalled that succeeding children are usually larger. In spite of this in multiparae, labor has lost most of its terrors because real knowledge of its comparative ease has replaced the previous unfavorable suggestion, and instead there has come a proper appreciation of what will have to be borne, and of the positive pleasure of the relief when it has been borne successfully.

Healthy women of the lower cla.s.ses have so little difficulty in labor that they are quite frank to confess that it means scarcely more than a few severe muscular pains during an hour or so. Some of them mind it so little that up to within half an hour of the birth of the baby they occupy themselves with other things and succeed effectually in distracting their pains away.

In their article on "Hypnotism and Suggestion in Obstetrics" Drs.

Auvard and Secheron [Footnote 37] suggest that hypnotism can be employed with advantage during labor, but it is more difficult to produce it then than in the normal condition. Its only advantage is anesthesia, and this can be obtained during the preliminary pains in many cases. It is frequently impossible to produce complete anesthesia, however. To replace hypnotism they advise that suggestion in the waking state be used and they even suggest the employment of pseudo-choloroform or other like means. This method they consider more advisable than hypnotism, for there are no inconveniences and many real advantages. The nervous condition of the patient after hypnotism during labor is sometimes far from satisfactory.

[Footnote 37: "L'Hypnotisme et la Suggestion en Obstetrique,"

Paris, 1888.]

Nature's Methods.--In obstetrics and labor we have been finding in recent years that we have not trusted nature enough, have not looked sufficiently to the woman herself for a.s.sistance in its difficulties, and have made her too much a pa.s.sive rather than an active factor.

Practically all of the dangers that have accrued to the woman in childbirth, certainly many times more than have come from any other factor, have been due to well-meant but unfortunate attempts to help her while preventing her from helping herself. Before the middle of the nineteenth century most of the puerperal fever was due to infection from over-zealous but unclean attendants. Now men are proudly reporting hundreds of cases of delivery without even a v.a.g.i.n.al examination. Above all, we have failed to take advantage of the occupation of mind that could be used to save women much of the anxiety and suffering of labor. If the parturient woman were allowed to change her position, as she does so naturally and frequently in a state of unsophistication, and to help actively, as she can {459} in many postures, in the delivery of her child, it would mean much in diverting her mind from pain which is emphasized by inactivity. The rule of having the woman lie on her back has been unfortunate in many ways and has required much more external interference than if other positions were adopted, while the pains have been more unbearable because that is actually the position in which the woman suffers most and in which she can do least to lessen them.

I was once told by an Irish grandmother the story of nearly one hundred deliveries without accident of any kind, in which the only rule had been not to touch the woman, but to allow her to change her position and, above all, to facilitate her in getting on her knees in a stooping bent-over posture so as to help herself. The upper mattress was doubled over completely and the woman was encouraged to kneel on the lower straw mattress, which was so arranged that it could be changed completely, or destroyed immediately after labor. This seemed old-fashioned and unscientific twenty years ago, when I heard the story, but I have been interested recently in reading Professor King's address on "The Significance of Posture in Obstetrics." [Footnote 38]

[Footnote 38: _Bulletin of the Lying-in Hospital_, Vol. V, No. IV.]

Professor King is sure that there are many advantages in following certain natural inclinations of the mother to change her position and that this helps her in many ways. Above all, as the psychotherapist sees at once, it will occupy her mind, keep down anxiety and lessen pain in many natural ways, besides encouraging concentration of attention on muscular effort instead of on painful sensation. The whole article is well worth reading, for in it he suggests that certain obstetrical operations, even version, would not be so often necessary, if the woman were sometimes allowed to a.s.sume the squatting position in the course of birth. His ill.u.s.trations make very clear the help that changes of position are in the mechanics of many difficulties of labor. The pressure of the patient's thigh on the abdomen, when she was allowed to a.s.sume a squatting position, enabled him, in a case in which the woman had been in labor twenty-eight hours, in which ergot had been given by the midwife, in which the waters had been discharged and the uterus was tetanically contracted around its contents, to deliver the child without instrumentation and without further delay. In five minutes the arm (for it was an arm presentation) began to recede, and in twenty minutes the child was delivered, head first, and mother and infant both did well. Other cases with similar results have been reported by obstetricians quite as distinguished as Professor King. Many other experienced obstetrical teachers have expressed themselves to the same purpose in recent years.

Postures after Labor.--Allowing changes of position after labor also has its advantages. There is often retention of urine and this can be relieved by allowing the woman to a.s.sume the usual position. It may be impossible owing to the swelling and hyperemia in the neighborhood of her urethra for the woman to pa.s.s water, and yet if she is allowed to sit in the usual position upon a commode, she will in most cases pa.s.s her water in a few minutes without difficulty and the risks attending catheterization will be obviated. The power to urinate is due in these cases partly to the pressure of the thighs upon the abdomen which helps the bladder to contract and undoubtedly also to the suggestive influence that the position has.

{460}

NURSING

The att.i.tude of mind of a woman toward her milk supply is important, as the flow of milk is closely subject to mental influence. The presence of the child and the consequent exercise of maternal instinct does more to bring about the prompt, healthy flow of milk than anything else. Sometimes women in the later months of their first pregnancy upon seeing a mother nursing her child have felt the flow of milk to their b.r.e.a.s.t.s not rarely with such painful overdistention of the milk ducts as to require artificial relief. On the other hand, a fright may stop the flow of milk or make it scanty and a mother's aversion to a child may prevent her being able to nurse it. The sight of the father of the child in a state of intoxication may have a similar result.

How much milk supply may be dependent on the state of mind, or at least the state of the nervous system, can be realized from the animals from which we obtain milk. Any serious disturbance is likely to interfere with the milk supply. When a cow's calf is taken away the animal will often refuse for a time to give milk. If a cow is scared, as by the attack of a wild animal, or by being hit though only slightly injured by an engine, it will often not have milk for several days or even longer. There is an impression prevalent among farmers that if a cow takes a dislike to a particular person they are not likely to "give down" as much milk as would otherwise be the case.

This may be only a curious farmer tradition, that has no basis in fact, although it is supported by so many observations reported from many different countries that it is apparently to be taken as of scientific value.

In modern times many fashionable women do not nurse their children because they have not the proper supply of milk. It is easy to see how this can be brought about through suggestion from many sources and the sight of others neglecting their duty in this matter. Most fashionable women would rather not nurse their children, and yet many of them feel a bounden duty in the matter. Some of these, however, having heard that many mothers of the better cla.s.s are not capable of nursing their children, easily persuade themselves that they come in this category, and so their whole att.i.tude of mind toward nursing is one of extreme doubt. Knowing as we do how the mental state influences nursing we are not surprised when these women prove not to have sufficient milk in the early days of the nursing. If they are to have it they must look forward with confidence to nursing their children and they must be ready and willing to take such food and secure such fresh air as will put them in the best possible condition for this function, always with the thought that nothing can be better for a child than to be nursed by its own mother. Nature has made exactly the form of food suited for the particular child, and it matters not how healthy a wet nurse may be, her milk is not likely to be so suitable. Much depends on the nutrition of the child during this early susceptible period of its life and there is more that pa.s.ses over with the milk than merely the food elements. It is well recognized now that the reason why nurslings are protected from most of the so-called children's diseases and the contagious diseases generally, is that, as a rule, their mothers {461} have had these diseases, have acquired an immunity to them and this immunity is transferred to the child so long as the nursing process is continued. This has been shown to be true over and over again in animals and holds good for human beings.

Professor Von Leyden, the distinguished professor of medicine at the University of Berlin, points out that we are not quite sure as yet just what may happen to the human race from the very general refusal of mothers to nurse their children and the almost universal subst.i.tution of the bovine mother; whether in times to come certain bovine traits, at least as regards susceptibility to disease, may not be stamped upon the human race, cannot be determined until this experiment in ethnology, now being conducted on so large a scale, has been carried to some definite conclusion.

Perhaps this view is groundless, but there is no doubt that milk is more than merely a food and that during the period after birth when the child's nervous system is being formed, the perfectly adapted mother's milk is more likely to be the proper food than anything that human ingenuity can elaborate. We have heard much in recent years of the tendency of education and civilization to lower the birth-rate and to make women less fitted for maternity and for such maternal duties as nursing, but stronger than any deterioration of the physical const.i.tution by the mental development is the unfortunate unfavorable effect of mental suggestion upon such functions, by which the preparation of the organism for their fulfillment is greatly influenced. It is in this respect that the women of to-day differ from the woman of the past much more than in mere physical development.

CHAPTER II

MATERNAL IMPRESSIONS

"Maternal impression" is accepted as a specific designation to signify the real or supposed influence of emotion and especially serious trouble, which may affect the mother's mind during pregnancy and be transferred to the child _in utero_, with the production of deformities or mother's marks. There used to be an almost superst.i.tious belief in the power of the maternal impressions to influence unfavorably the child _in utero_. With the newer developments as to the influence of the subconscious and subliminal there might well occur in some minds an exaggeration of these ideas with the production of much mental suffering at least, if not of more serious results.

Maternal Impressions in Old Literature.--The belief in the influence of maternal impression on the child _in utero_ is so strongly fixed that to most people it will seem paradoxical to question the whole subject. The evidence for it, however, is quite trivial, and none of it rises above the grade of what may be explained by coincidence. But there are many apparently insuperable difficulties, from the standpoint of our modern scientific knowledge, with regard to the whole subject. If we take up the medical books and the popular science, or rather pseudo-science, and the folk stories of a century ago we find overwhelming evidence for the belief in maternal impressions. More recent {462} literature has but few examples, and the more the details are studied the less is the evidence of any kind that the mother's mind influences her unborn child. There is really no more reason why a child should he marked within its mother's womb than that it should be marked while nursing at the breast if something should happen to the mother at that time. This latter effect strikes one at once as absurd; the former, as we shall see, is exactly of the same nature.

Many of the older stories of maternal impressions are reported on no better grounds than the vomiting of snakes and the like, even live mice, which used to be found in old-time medical literature. It is true that there was usually no such morbidity about the stories of maternal impressions, but men wanted to find some explanation for the problem of the occurrence of deformities and markings and the maternal impression idea seemed satisfactory and inviting by its very mystery.

The belief that animals could live for some time in human stomachs is now relegated to the limbo of old-time credulous traditions. Maternal impressions are on the same path and in twenty-five years they will be as great curiosities in serious medical literature as the gastric fauna of two generations ago. Under these circ.u.mstances prospective mothers who are anxious over possibilities and who have dreads of all kinds about their unborn children should be rea.s.sured and informed as to the scientific status of this important question.

Mother and Child Distinct Beings.--There is no direct connection between the mother and her unborn babe. No nerves run in the cord and none pa.s.s from the uterine tissues to the placenta. It is easy to understand the influence of mind on body under ordinary circ.u.mstances, at least the mystery has a rational explanation. The central nervous system rules the nutrition of the body. To cut off the nerve supply has as serious an effect as to cut off the blood supply. Owing to the existence of a chain of neurons, that is, a succession of nervous elements, instead of one continuous nerve fiber from center to periphery, it is possible for one of the neurons of the chain to be so disturbed that the conducting apparatus is interrupted and impulses do not flow. Hence, if a strong impression is produced on the mind with regard to a particular part of the body the neurons leading to it may be so disturbed that trophic nerve impulses do not flow down, the blood supply of the part may be disturbed through the vaso-motor system and consequent changes may take place.

_Absence of Circulatory Connection_.--Since no nerves pa.s.s, as we have said, from mother to babe, disturbances acting on the mother's mind can at most only influence the blood supply to the baby. Most people think that there is a direct blood supply from mother to child and that the mother's blood literally flows in the baby's veins. This is not true. The baby's blood is an entirely independent structure, originating in the child's own body, and always maintaining a distinct and quite different composition from that of the mother. The baby's blood has a higher specific gravity, and it has, in normal condition, nearly double as many red corpuscles to the cubic millimeter as the mother's blood. If the blood supply is disturbed by mental influences, then it is not the baby's blood nor its circulation that is disturbed, but only the circulation through the maternal part of the placenta where an exchange of gases and nutrient elements between mother's and baby's blood takes place. It is {463} impossible to conceive that during this pa.s.sage through a membrane of nutrient elements, soluble proteids, gases, etc., mental influences should also pa.s.s over.

Supposed Examples of Maternal Impression.--The stories that are told would lead us to believe that somehow definite changes in the mother are reproduced in the babe. One case, which in a circle of friends that I knew very well made many a convert to the idea of maternal impressions, was that of a young woman at whom, during an early stage of her first pregnancy, her husband playfully threw a tiny frog. He did not know that she had a mortal dread of frogs. She was seriously frightened and put up her hand to ward off the animal, and as the clammy thing struck her palm she felt a shiver go through her. When her baby was born a curious growth that had some pigment in it and that, by a stretch of the imagination, might be considered to resemble a frog was in the baby's hand--the same hand, by the way, as that which the mother used to ward off the animal. The lack of any nervous connection and of any direct blood connection between mother and child makes the story simply absurd as an ill.u.s.tration of maternal impression.

In recent years such stories have come from more and more distant parts of the country. Kansas was the princ.i.p.al source of them until a generation of great editors arose there. Texas was then their favorite location, but Texas has in recent years become so progressive and so closely connected with the rest of the world that, in spite of its size, it does not produce so many of these wonders. A generation ago the announcement of the birth of six children at once in Austria, or somewhere else in Central Europe, would usually be followed by a report from Texas announcing seven at a birth. Maternal impression stories grew luxuriantly for the benefit of the news-gatherer in dull seasons. A standing type of them is that of the farmer cutting hay on his farm who puts his fingers too far into the hay cutter and has them taken off. His wife binds up the bleeding stump. She is pregnant at the time. When her baby is born--usually two or three months later--just the same fingers are missing on the same hand of the child. Now the mechanism by which such maternal impression could be transferred to the child is incomprehensible. There is no connection between the two, and the old metaphysical axiom (_actio in distans repugnat_) that all action between bodies at a distance from one another, that is without some connecting link between them, is absurd, holds as good in modern times as it did in the Middle Ages. Surely a tendency-to-amputation is not carried over from mother's blood to baby's blood through the membrane in the placenta just as are the gases for respiration and the nutrient elements for food. If it is, we have a greater mystery than ever to solve.

Period of Occurrence.--The infant in the uterus is fully formed before the tenth week of pregnancy and at a time when women are usually almost unconscious of the fact that they are pregnant. Such impressional changes as we have referred to, if produced after this, must be in the nature of backward growth or an inversion of trophic influences or a great perversion of embryonic life. They have nothing to do with the formation of the child, since that is completed. They are as much accidents as if the child should fall after it was born.

We know how fetal limbs are amputated through the formation of amniotic bands, but that maternal impressions should influence the formation of these bands is of itself ridiculously absurd. That it should {464} influence them in a directive and selective way so that certain limbs may be amputated at a certain point reaches a climax of absurdity. A distinguished physician of our generation once said that one might as well hope to absorb a pencil case in one's vest pocket by medicine as to try to bring about absorption of fully formed connective tissue by drugs. We cannot think of any mental influence bringing about such absorption, yet to credit maternal impressions with the production of fetal amputations not only supposes the directive formation of connective tissue within the uterus, quite beyond the domain of the influence of the mother's nervous system, but also a.s.sumes the direction of the anomalous action of that connective tissue in its mutilating procedures in a very exact and definite way.

Some curious things have been explained on the score of maternal impressions and it is this very exaggeration that is perhaps the best proof of how coincidence, imitation, and other factors play a role that has exaggerated the idea of maternal impressions into a causative factor. A typical ill.u.s.tration is the case cited years ago, half in joke, perhaps, half in earnest, by a distinguished professor of obstetrics. It occurred in the days when the elder Sothern was playing Lord Dundreary to crowded houses and when Dundrearyisms were the current witticisms and Dundreary ties and Dundreary clothes and Dundreary whiskers were all the rage. A young woman who was recently married became much taken with the actor and went to see him over and over again, secured an introduction to him, and showed the liveliest interest in him and the performance. Their acquaintance, however, remained merely that of chance friends. Some months after it began, not more than five or six at the most, a boy was born to her.

According to the story this boy, when he began to walk some years later, developed that little skip in his gait which proved so taking to those who crowded the theaters to see Sothern as Lord Dundreary.

By this time the play had lost something of its vogue and most people did not recognize the curious halt in the gait, but it was very clear to the mother and her friends. It was set down as due to a maternal mental impression. Mental transfer seems ludicrous in this case. It is much more likely that the mother was hysterical, and, wishing in a morbid way to attract attention to herself and her child, taught the boy the little skip, or perhaps some curious little skip once taken by the child attracted the mother's attention because of her memory of Sothern, and her surprise at the act impressed the peculiar action upon the boy's mind, who proceeded to attract further attention by repeating it. It is cases like this with their _reductio ad absurdum_ of the whole process that have quite discredited the belief in maternal impressions.

Some Figures and Coincidences.--The occurrence of mothers' marks in connection with various external incidents of pregnancy are only coincidences. Most young mothers dread lest something should happen to their children. About once in a thousand times an infant is marked in some way. Nine hundred mothers rejoice over the fact that their baby is not marked in spite of the fact that they feared it might be, ninety-nine of them never gave the matter any thought and one of them finds to her sorrow that her foreboding has come true. Occasionally a mother who has not dreaded such a result finds that her offspring is marked. Then she recalls all the happenings of her pregnancy and picks out something to which she thinks she may attribute the accident.

{465} There must be some reason for it and she finds it. Sometimes she begins by saying that it must be because she was frightened at such a time, or fell down at such a place, or saw such a thing, and then a week later she tells the story with circ.u.mstantial additions which make it very clear to her friends that she knows exactly the reason and that she had thought about it before and feared it might be so, though the whole matter was hazy until it had been talked over a number of times.

Coincidences have been the most serious detriment in drawing scientific conclusions in every department of medicine. Most of our diseases are self-limited and any medicine that was given being followed by recovery seemed to be the cause of that recovery and the more strictly self-limited a disease the greater the number of remedies. When stories of maternal impressions are a.n.a.lyzed it is found that a great many mothers have had forebodings as to their children being marked and their dreads have not come true. A few have feared and have realized their worst fears. Many women whose children are marked can recall no event in the course of their pregnancy which could have marked their child and they ask the doctor what he thinks must have been the reason. But unintelligent mothers can always find some cause by searching out unpleasant details of their experience during pregnancy.

Intrauterine Nutrition and Nursing.--To explain the occurrence of a frog-like appearance or a mousey patch on a baby as due to its mother having been frightened by one of these little animals while nursing would be the height of absurdity. But it is no more absurd than the supposition that mental impressions in the late months of pregnancy can have the effects that are popularly ascribed to them. If a mother suffers from severe fright, or even if she has a fit of intense anger or other profound mental disturbance, her milk may disagree with her infant. Every physician has seen nursing infants made sick by the change in the milk superinduced by strong mental emotions in the mother. This, however, could have nothing to do with the production of a special lasting physical mark on the outside of the body.

Maternal Solicitude and Superst.i.tion.--The wonderful stories that are told are nearly all in the older literature and are much more reasonably explained on the score of coincidence than on that of any possible direct connection of cause and effect. Mothers, then, may be rea.s.sured and made to understand that the better their own health, the less they worry about their condition, the more likely is their pregnancy to terminate favorably with a perfectly healthy offspring.

This is the source of so much concern in the little world of child-bearing that it is worth while taking it seriously and making mothers understand that the old notions in this matter are but superst.i.tions. Superst.i.tions are not always nor exclusively religious, they are survivals from a previous state of knowledge, the reasons for which are now known to be false. Maternal impression, that is, the belief in the power of the mother's mind over the unborn child, is a superst.i.tion that we must now dismiss.