Psychotherapy Part 75

CHAPTER V

PREMONITIONS

A state of mind that disturbs many people seriously, sometimes even producing physical results, because of the burden of dread that hangs over them, is that in which attention is paid to premonitions of evil.

There are two of these general conditions to be considered. In the one there is a definite feeling that some special evil, occasionally very particularly outlined in the mind, as a railroad accident, fire, or a street accident of some kind, is to occur. In another mental condition there is a generic premonition of evil, {635} as if the worst were sure to happen and the patients must be constantly preparing for it.

Occasionally this takes on some such form as an a.s.surance of early breakdown in health, or of death at an untimely age, or of some crippling infirmity. This represents, of course, only one form of lack of control over the mind, but it is surprising how much physical suffering it may occasion. Only those who have had much to do with patients who suffer from this state of mind realize it. Sympathetic knowledge of the conditions that bring it about and of the real significance of premonitions will do more to help patients than anything else.

Every now and then newspapers tell the story of someone who had an impending sense of danger, perhaps of a particular form of accident or misfortune, which he could not shake off and which finally came true.

Sometimes it is a fire that was antic.i.p.ated, though without any reason except the dread, and precautions that eventually proved life-saving to the patient were taken, or at least friends were told of it so that the person seemed actually to have had some warning beforehand of the danger that was to come. Sometimes it is the story of a railroad accident, which some particularly fortunate individual escaped, because of a premonition that made him take another train or make a happy change of cars. Nothing is said of the times when premonitions failed, nor of the disappointments of such dreads. Most people laugh at the stories, but a few individuals become seriously impressed with the possibility of such warnings and then make themselves miserable by having frequent premonitions.

Etiology.--As to the origin of these premonitions it is hard to say.

They occur more frequently on dark days than in bright weather and are complained of much more in spring and fall than during the cold brisk winter or during the summer time. A succession of very hot days, however, brings a series of premonitions, especially with regard to accidents by heat, that is not surprising since the newspapers have many accounts of sunstrokes and there is every suggestion of the possibility of danger of this kind. How large a role suggestion plays in the matter can be realized from the fact that after some particularly serious railroad accident many people have premonitions that they may be hurt and occasionally they put themselves to considerable inconvenience in choosing the car in which they will sit, if the last serious preceding accident of which they have heard happens to have brought death mainly in a particular car of a train.

It is always suggestible people who are likely to have premonitions.

The thought comes very simply at first, they dwell on it a little unwillingly, then they find it impossible to banish it and finally it may become a positive obsession. The soil and the seed for suggestion are both needed to produce premonitions.

Royce suggests that many of the supposedly fulfilled premonitions are really only pseudo-presentiments and represent an instantaneous and irresistible hallucination of memory, which may give rise to the impression that there has been a previous dream or other warning presaging the facts, though no such phenomenon actually took place. In other words, there would be an auto-suggestion consequent upon the hearing of other fulfilled presentiments that sometime some such thing must also occur to us, and then when a happening that reminds us of something in the previous stories of {636} presentiments comes there is the sudden responsive feeling "why, this is what I saw or must have seen in my dream."

Podmore suggests an illusion of memory magnifying or rearranging the details of a recent dream or premonitory impression, so as to make it fit into the happenings. Dreams are so vague that unless they have been written down we are not quite sure of them an hour after they occurred and a day or two later we have only the merest hint of what they were. If this can be made to have any connection with a casualty of any kind that happens subsequently we may very readily recreate the dream with its details concordant to the event. Certainly no reliance can be placed on a story of a dream fulfilled unless the dream was told before the happening.

Premonitions of Death.--Certain premonitions are common and are frequently brought to the physician's notice. Among old people it is not unusual to find that a premonition of death will hang over them for days, seriously disturbing them and their friends, hampering often a healthy reaction against disease and always lowering resistive vitality. Many of them have heard stories which make them credit the belief that such premonitions are likely to come true and therefore they cannot shake them off. They have heard stories of people who have become convinced that they were going to die at a particular time on a particular day and whose conviction has been proven by the event. Like all the other premonitions, whatever truth there may appear to be in them, is due entirely to the fact that nearly everybody has premonitions and occasionally, therefore, one of them must come true.

Those that are fulfilled create such an impression that they are remembered, while those that fail are forgotten, until, though it is not realized, it becomes true that fulfilled premonitions represent exactly that much misunderstood principle that the exception proves the rule. The rule is that premonitions fail. Exceptionally, however, a premonition comes true. Instead of proving that premonitions mean anything, the rarity of their fulfillment proves the rule of their non-significance and demonstrates that they are merely coincidences.

Persuasion of Short Life.--Much mental suffering occurs in nervous people as a consequence of a premonition or persuasion which comes to them in middle life that they are destined not to live very long. This is a commoner impression than is usually thought and comes to nearly everyone at some time in life. Especially is it likely to come to those who have suffered some severe illness and who know how weak they were during their convalescence and, in spite of their thorough recovery of strength, cannot quite persuade themselves but that an ailment which made them so weak must surely have sapped their vitality so as to make long life for them impossible. It is, of course, one of the vague dreads that men always seem to be harboring, but there are times that it becomes so prominent and so influential in the production of depressive feelings that it is worth while to have the means at hand to counteract it as far as possible. In the last ten years I have made it a practice to ask, not only all my patients but most of my acquaintances above 70 years of age whether they had ever experienced such a premonition. I have particularly asked what were their feelings with regard to the hope of long life for them when they were in their forties and fifties. Without exception I have been told by all those who had the education and leisure to {637} be at all introspective, that they had felt sure that they would not have long life.

Most of the men consulted took out life insurance in such a way as to benefit their families after their death rather than themselves during life. Indeed it seems not an unusual thing for men to have some experience with an ailment between 40 and 55 which makes them realize their mortality much more than the deaths of their friends around them had succeeded in doing. Premonitions and impressions, then, of this kind evidently mean nothing, so far as the prospect of long life is concerned. Practically everyone has them, and since, of course, the great majority of men do not live to die of old age, it would seem that their premonition of comparatively short life was fulfilled.

Occasionally a man will be found at the age of fifty unwilling to take up further work or develop his business because of the dread that has come over him that he may not live long enough to make it worth the while. Where there is serious kidney or heart trouble such an abstention from business is commendable, but in many cases it leaves a man without occupation or with insufficient occupation and he becomes short-circuited on himself with more serious results from worry than would have come from work.

Publication of Fulfilled Premonitions.--The publication of fulfilled premonitions has always seemed to me to be an especially fertile source of premonitions for other people. Every now and then someone goes to bed in a hotel having communicated to friends the idea that he fears there may be fire before morning. I do not suppose that one out of ten people who sleep in a strange hotel fail to have some such thought, they do not consider it a premonition, however, but only a suggestion for the taking of proper precautions so as to know where exits and fire escapes and other means of escape are situated, so that in the excitement of the fire they may not have to do any thinking, but may have already made up their minds what they shall do. This sort of premonition, if we call it by that name, has a definite useful purpose. Occasionally it seems marvelously provident. The other makes its possessor toss sleepless a portion of the night, does no good and much harm. If, however, the premonition has been communicated to someone else and then a fire should occur, the reporting of the fulfilled premonition comes to a lot of weak-minded people as a confirmation of their worst fears. It is, of course, only a question of coincidence in a succession of events by no means connected in any causal relation, yet by the unthinking set down as showing the possibility of such premonitions being supremely significant. If we had all the stories of unfulfilled premonitions also published then the true significance of the others would be clear.

An Unfulfilled Premonition.--There is an excellent story of a strong but unfulfilled premonition told by Carl Schurz in his "Recollections," which seems to me such a good antidote to the influence of supposed premonitions, that every physician should know its details for their psychotherapeutic value with patients p.r.o.ne to be troubled in this way. The ease with which the depression consequent upon the premonition was relieved as soon as another forcible suggestion that the danger was past took possession of him, shows how such states of mind can be altered with no more real reason for the alteration than there was for the original depression.

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On the morning of the battle of Chancellorsville General Schurz awoke with the absolute persuasion that at last his time had come and he was to be killed that day. He had never had such a premonition before. He had heard of many cases in which such premonitions proved the forerunner of death. He realized how ridiculous was the idea that he should know anything about what the future held for him, even vaguely, and he tried to shake it off. He found it impossible to do so. He thought that after he took up the routine work of the day the force of the premonition would be lost. It was not, but, on the contrary, seemed to increase in power over him. Finally the idea became so imperative that he sat down and wrote letters of farewell to his wife and friends, telling them that he had been tempted to do so because of this premonition of danger. When he went into battle--and it may be recalled that the Eleventh Corps did some fighting at Chancellorsville that day--he was sure that now the end was not far off. It did not take away his courage, however, and though he was well in the zone of danger, he issued his orders and kept his troops well in hand as we know from the history of the battle.

Finally his aide-de-camp, riding toward the front of the line beside him, was killed by a cannon ball. All in an instant the thought came over him that this was the only danger that was likely to be near him for the day. The burden of premonition lifted from him as if the fact that a friend had been killed beside him gave him an a.s.surance that he himself was not to be taken. There was absolutely no reason for his thinking so, but his feelings of solicitude with regard to himself and his fate faded completely and at once. He continued in the thick of the fight and of danger and was untouched. He himself called attention to the fact that if his premonition had come true, as well it might in the midst of the very serious danger which he faced, it would have seemed a strong confirmation of the impression that premonitions have a meaning other than that of coincidence. It was, however, a magnificent example of a failed premonition quite as striking as any of the stories that are told about premonitions that came true.

Role of Coincidence.--This must be remembered in many of our arguments in medical and other scientific matters. Most diseases are self-limited, therefore anything that is given as a remedy for them just about the time that nature has succeeded in conquering the virulence of the disease and bringing about the cure of the patient, seems to be curative. Such cures, often remedies of supposed wonderful potency, come and go in medicine by the hundred every ten years. Such curious doctrines as that of the influence of maternal impressions in producing deformities and defects in the unborn child are founded on nothing better than these coincidences. They are often very startling, but the rule by which they must be judged is the number of times in which in spite of similar conditions no premonition takes place.

Literally thousands of people go to bed every night who are to be waked by the danger of fire before morning and yet have no premonition of it. Literally millions of people have gone to bed in recent years without any premonition of earthquake, yet have been wakened before morning with their houses tumbling around them. If a few people have premonitions in these cases it is easy to understand that it is coincidence and not anything else, for these are exceptions, and this again is a case of the exception proving the rule.

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Premonitions and Superst.i.tions--Thirteen.--Occasionally premonitions are connected with certain events that are themselves, even though happening quite accidentally, supposed to be portentous. How many people, for instance, feel quite uncomfortable if they sit down thirteen at a table. The very fact of the gathering of thirteen is supposed to be a spontaneous or automatic premonition that is a forewarning of evil that has to come to some of them. Unfortunately, this superst.i.tion continues to have a vogue and an influence over people's minds because stories are told that are supposed to confirm it. Needless to say, when these stories are true, they are merely coincidences. Out of any baker's dozen of people who sit down to dinner it is not surprising if one should die or be killed during the year. Some of the stories, however, are merely sensational inventions worked up to be given to the public because a number of people are interested in this sort of thing. Probably one of the stories that has gone the rounds most and that has served to confirm many people in their uneasiness over the number 13 is that which is told as happening to Matthew Arnold and some friends, supposedly the year the great English litterateur died.

The story runs that just as Mr. Arnold and his friends were about to sit down to the table it was discovered that there were thirteen present. According to the old tradition in the matter it is the one who first gets up from table under these circ.u.mstances that is likely to be affected by the malignant influence. When the end of the dinner had arrived, by previous arrangement Mr. Arnold and two very healthy friends, brothers, arose simultaneously. According to the widely diffused newspaper account of years afterward, Mr. Arnold himself died within the year and one of the brothers was lost in the wreck of an English pa.s.senger vessel off the coast of Australia in six months, while the other brother committed suicide before the end of the year.

Careful investigation of the details has shown, however, that the story was made out of whole cloth. Mr. Arnold himself, who was suffering from heart trouble towards the end of his life, was not likely to take part in any such arrangement because of the constant danger, well-known to himself, of sudden death in his case. This might happen at any time and might seem to confirm the superst.i.tion. The dates of the story, moreover, are all wrong. Matthew Arnold's death and the loss of the English pa.s.senger vessel in Australian waters, referred to, do not occur within five years of each other. The story has gone round the world. The correction will never reach so far. The story is startling; the explanation commonplace. Many people will continue to believe that here, at least, was one striking confirmation of their superst.i.tion.

It is curious how the force of this "13" superst.i.tion has continued in spite of education and enlightenment. Most pa.s.senger vessels now built have no staterooms numbered thirteen. On certain streets in large cities one finds the number 12-1/2 (until this year it was so on my own) subst.i.tuted for thirteen. Sometimes one finds "twelve a" or something similar. In the large hotels, where they have immense banquet halls with the tables numbered so that guests may be able to find their places, I have often noted that there was no table number thirteen. It is said that in some of the new skysc.r.a.per buildings twenty stories and more in height there has been question of skipping the thirteenth floor as a designation, because while most {640} people would be quite undisturbed about it, some do not care to have an office on the thirteenth floor, giving as an excuse that clients or patrons do not care to come to the thirteenth floor. In automobile races men are willing to risk their lives by going a hundred miles an hour on roads never intended for such performances, but they refuse to race behind the fell number thirteen. This, after all, can be readily understood. The slightest thing that takes away a man's complete confidence in himself may be serious in an automobile going as fast as these. Men must not think of fear or they lose some of their power and control over themselves and their machine. They must simply forget everything except the task before them.

The belief in the thirteen superst.i.tion is one form of acceptance of premonitions. That of itself should be enough to enable sensible people to throw them off. Above all, it must be remembered that such supposed malignant influence, when allowed to affect people, impairs their presence of mind and may thus lead up to the accident or mishap which it is supposed to foreshadow. This is the serious feature of such premonitions and dreads. Unless people can be persuaded sensibly to be rid of them they handicap themselves whenever they are placed in danger that causes them to recur to the thought of the premonition or dread. While there is absolutely nothing but coincidence in even the supposed true stories, and many of the stories are merely sensational inventions, yet people need to be persuaded to rid themselves of the incubus that settles over them because of such ideas.

Premonitions and Telepathy.--There are many people who think that premonitions have something to do with telepathy. Somehow the future event is supposed to be able to send some message to specially susceptible minds. Either that, of course, or there is some being in another world whose interest is sufficient to convey some inkling of the future. A little consideration of this subject, however, shows the utter lack of rationality in any such opinion. Future events, having as yet no existence, cannot in any way influence intelligence. Such future events, when dependent on human free will, are quite impossible of being foretold and, as has been said, no being except the Creator Himself knows anything about them. It would be only from Him, then, that information might be supposed to come and it would be hard to think such information would be so vague and indefinite as to leave room for doubt and, besides, often defeat its purpose of protection by seriously disturbing patients and lessening their presence of mind.

There is no reasonable explanation by which a human being can be supposed to obtain knowledge of a future event unless there is a complete overturning of the ordinary laws of nature and then it would be reasonably supposed that no doubt of the significance of the event would be left.

Nearly all of us have premonitions that fail. Only a few especially introspective people who are constantly afraid of what will happen to them, and who are sure that the worst is always preparing for them, have their premonitions come true more than once or twice in life. The striking fulfillments of a few premonitions could be paralleled by an endless number of just as striking failures, only that most people dismiss the idea completely from their minds as too foolish to be further talked about. It is quite the same with dreams. All the world dreams and there would be a serious violation of the theory of probabilities if some dreams did not come true. The great {641} majority of mankind, especially after the age of thirty, is fearful lest something ill is going to happen to them and their premonitions are rather frequent. If some of these did not come true then the mathematics of coincidences as based on the theory of probabilities would prove false.

CHAPTER VI

PERIODICAL DEPRESSION

Fits of periodical depression, familiarly known as "the blues," occur in the experience of practically everyone. In some people they are only slight and pa.s.sing. In others they last for hours and make the individual quite miserable. In still others, without actually running into melancholia, they produce serious discouragement and continuous discomfort which persists even for days and makes life intolerable.

They come and go quite unaccountably. During their occurrence all vitality is lowered, appet.i.te lessened, aches and pains are emphasized, sleep may be disturbed, exercise becomes distasteful, and they usually present an interval when health is at a low ebb.

Ordinarily when described as "the blues" they have no definite connection with any known physical cause. They are pa.s.sing incidents which seem to recur at irregular intervals. When connected with physical ills they are thought of directly as symptoms of these ills.

All forms of disease may be a.s.sociated with such fits of depression and many physical symptoms seem to be due to the fact that during these periods there is a distinct lowering of physical vitality so that the nerve impulses which ordinarily enable functions to be performed without interference are interrupted, or at least are inhibited, to a noteworthy degree. While to a certain extent the condition is a mental disease, it may be modified by the correction of physical derangements, by stimulation and, above all, by suggestion and a change in the point of view.

Serious Pathological Conditions.--Of course, such periodical fits of depression are a.s.sociated with various serious progressive ailments and then are primarily physical, and are only secondarily psychic.

From the standpoint of psychotherapy it is important to remember that certain serious organic lesions may show their first signs in the patient's mental state. It is not unusual, for instance, for the disposition of a patient suffering from kidney disease to change so materially that the attention of friends is called to the change before any physical symptom of the nephritis has been noted. Sometimes for a year there will be a progressive clouding of what had previously been a rather happy disposition. Decisions will be made more slowly than before. The judgment will be impaired. There are some striking examples of this in history, of which the unfortunate Athenian general, Nicias, put to death for incapacity that was undoubtedly pathological, is one. Pleasures will be taken half-heartedly; men who have been bright and jovial will now become saturnine. Men who have been the life of parties will try to hold the place they acquired before, though all around them will perceive how difficult it is for them to maintain the role they have set for themselves. Whenever there is a notable change in disposition, it is well not to attribute it to some pa.s.sing mental condition and, above all, not to dismiss {642} it as a peculiarity unamenable to treatment, but to look for the underlying pathological basis of the new condition.

In this way physical disease will sometimes be discovered long before it otherwise would be. This must be particularly noted when there have been a series of worries. Occasionally it seems enough to many people to ascribe a change of disposition to the troubles that have come over a patient. If a business man fails or pa.s.ses through a crisis in his affairs in which failure is very near, or he has many business worries over a prolonged period, these are sometimes thought to be quite enough to explain a change of disposition. They are, but not to the degree that is often noted, for, in excess, melancholic tendencies are always pathological, that is, they have some basis in a serious mental or physical change. If there is an insidious nephritis already at work, its symptoms will be much exaggerated and its progress accelerated by the worries and disquietude of such a time. If a wife loses her husband, or an only son, or a favorite child, the occurrence of a prolonged period of depression should lead to a careful investigation of physical conditions and of the underlying mental state in the hope of guarding against serious developments.

_Heart Disease_.--Periods of depression are also common in heart disease and are often the first symptom of the beginning of a break in compensation. This effect is not so simple and direct, however, as in the case of the kidneys. Probably the first physical symptom of a break in compensation, where there is real valvular heart disease, is a decrease in the amount of urine. This points to an insufficient elimination of the products of metabolism and to the retention in the circulation of toxic substances. The reason for this is the lessened circulation through the kidneys because of the diseased heart. There is also a lessened circulation through the brain. This impairs the function of the brain and quite naturally leads to mental depression, slowness of decision, and unwillingness to occupy one's self with many things. Besides, because of the lessened function of the kidney the circulating blood not only does not nourish so well but it tends still further to depress the brain cells by the toxic substances that are in it. Depression in such cases is rather to be expected and at the beginning is not continuous but comes in ever longer periods with shortening intervals as the disturbance of the circulation progresses.

At first, like other diminutions of function, it is conservative in order to spare the heart work.

_Respiratory Affections_.--Very curiously an affection of the lungs has exactly the opposite effect and is likely to create in the patient an artificial sense of well-being. _Spes phthisica_, the characteristic hope of consumptive patients, is well known, and has been described by many a careful observer from Hippocrates and Galen to our own time. A lessened amount of oxygen in the blood produces a certain sleepiness, but this seems to be preceded by a period of slight excitation. The most familiar example of this occurs at the beginning of the inhalation of laughing gas. Practically the only direct physical effect of the inhalation of nitrous-dioxide is to shut off our oxygen and it is a slight period of deoxygenation that produces the anesthesia by this agent. Whether we have not in this the explanation of the feeling of the consumptive, so that often on the day before his death he plans a number of things that he is going to do next year, may require more careful {643} investigation, but the suggestion may serve to show how much disposition, both lively and serious, depends on physical factors as well as on the natural state of mind.

MENTAL STATES OF DISAPPOINTMENT

Quite apart from these serious ailments, however, there are pa.s.sing phases of depression that come to nearly everyone after adult life is reached that are likely to be somewhat more frequent as years go on, but that are not entirely unknown even in early years. They are more likely to come to those who feel that life has been somewhat of a failure and that they have accomplished very little in spite of all that they have tried to do. Not infrequently they come, however, to those who in the estimation of other people have made a magnificent success of life. The rich man, after he has made his fortune, unless he continues to engross himself with some time-taking and interest-claiming work, may be the subject of repeated attacks of mental depression. Social leaders among women who begin to feel something of the emptiness of social striving, after they have made what is called a success in society and at the time when they are the envy of many on the social ladder below them, are particularly likely to be subject to attacks of "the blues." The only men and women who are free from them to a great extent, and even they not absolutely, are those who are busily engaged with some occupation not entirely selfish in which they can see that what they are doing is accomplishing something for the people around them.

Very often an attack of depression is ushered in by some small disappointment. As a rule, however, this is not the causative factor but is only an occasion which makes manifest the depressed state that has existed for some time and that now declares itself openly. In the same way only a slight occasion is necessary apparently to dispel clouds that hang over a person in the milder attacks of depression, because, for some time before, relief has been preparing itself and a livelier phase of existence has been gradually coming on. Relief can be promised with absolute a.s.surance, but freedom from relapse cannot be a.s.sured and the only true source of consolation that is helpful is the frank recognition of the fact that these are successive phases of existence quite as likely to be periodic as certain physical facts in life. Depression is likely to be a little more manifest in the morning than at other times, partly because the interests of the day have not yet come to occupy the mind, but mainly because the physical life as indicated by the pulse and the temperature is lower during the morning hours than in the afternoon and evening. Just as soon as people realize the physical nature of certain dispositional changes they give much less depressive significance to them.