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Why Worry?
by George Lincoln Walton, M.D.
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WHY WORRY?

BY

GEORGE LINCOLN WALTON, M.D.

CONSULTING NEUROLOGIST TO THE MASSACHUSETTS GENERAL HOSPITAL

The legs of the stork are long, the legs of the duck are short; you cannot make the legs of the stork short, neither can you make the legs of the duck long. Why worry?—Chwang Tsze.

TO MY LONG-SUFFERING FAMILY AND CIRCLE OF FRIENDS, WHOSE PATIENCE HAS BEEN TRIED BY MY EFFORTS TO ELIMINATE WORRY, THIS BOOK IS AFFECTIONATELY DEDICATED.

PREFACE.

No apology is needed for adding another to the treatises on a subject whose importance is evidenced by the number already offered the public.

The habit of worry is not to be overcome by unaided resolution. It is hoped that the victim of this unfortunate tendency may find, among the homely illustrations and commonplace suggestions here offered, something to turn his mind into more healthy channels. It is not the aim of the writer to transform the busy man into a philosopher of the indolent and contemplative type, but rather to enable him to do his work more effectively by eliminating undue solicitude. This elimination is consistent even with the "strenuous life."

One writer has distinguished between normal and abnormal worry, and directed his efforts against the latter. Webster's definition of worry (A state of undue solicitude) obviates the necessity of deciding what degree and kind of worry is abnormal, and directs attention rather to deciding what degree of solicitude may be fairly adjudged undue.

In the treatment of a subject of this character a certain amount of repetition is unavoidable. But it is hoped that the reiteration of fundamental principles and of practical hints will aid in the application of the latter. The aim is the gradual establishment of a frame of mind. The reader who looks for the annihilation of individual worries, or who hopes to influence another by the direct application of the suggestions, may prepare, in the first instance for disappointment, in the second, for trouble.

The thanks of the writer are due to Miss Amy Morris Homans, Director of the Boston Normal School of Gymnastics, for requesting him to make to her students the address which forms the nucleus of these pages.

GEORGE L. WALTON.

BOSTON, April, 1908.



CONTENTS



I. INTRODUCTORY II. EPICURUS AS A MENTAL HEALER III. THE PSYCHO-THERAPY OF MARCUS AURELIUS IV. ANALYSIS OF WORRY V. WORRY AND OBSESSION VI. THE DOUBTING FOLLY VII. HYPOCHONDRIA VIII. NEURASTHENIA IX. SLEEPLESSNESS X. OCCUPATION NEUROSIS XI. THE WORRIER AT HOME XII. THE WORRIER ON HIS TRAVELS XIII. THE WORRIER AT THE TABLE XIV. THE FEAR OF BECOMING INSANE XV. RECAPITULATORY XVI. MAXIMS MISAPPLIED XVII. THE FAD XVIII. HOME TREATMENT XIX. HOME TREATMENT CONTINUED



DEFINITIONS.



WORRY. A state of undue solicitude.

HYPOCHONDRIA. A morbid mental condition characterized by undue solicitude regarding the health, and undue attention to matters thereto pertaining.

OBSESSION. An unduly insistent and compulsive thought, habit of mind, or tendency to action.

DOUBTING FOLLY (Folie du doute.) A state of mind characterized by a tendency unduly to question, argue and speculate upon ordinary matters.

NEURASTHENIA. A form of nervous disturbance characterized by exhaustion and irritability.

PHOBIA. An insistent and engrossing fear without adequate cause, as judged by ordinary standards.

OCCUPATION NEUROSIS. A nervous disorder in which pain, sometimes with weakness and cramp, results from continued use of a part.

PSYCHO-THERAPY. Treatment through the mind.

No other technical terms are used.



I.

INTRODUCTORY

When Thales was asked what was difficult he said, "To know oneself"; and what was easy, "To advise another."



Marcus Aurelius counselled, "Let another pray, 'Save Thou my child,' but do thou pray, 'Let me not fear to lose him.'"

Few of us are likely to attain this level; few, perhaps, aspire to do so. Nevertheless, the training which falls short of producing complete self-control may yet accomplish something in the way of fitting us, by taking the edge off our worry, to react more comfortably to our surroundings, thus not only rendering us more desirable companions, but contributing directly to our own health and happiness.

Under the ills produced by faulty mental tendencies I do not include cancer and the like. This inclusion seems to me as subversive of the laws of nature as the cure of such disease by mental treatment would be miraculous. At the same time, serious disorders surely result from faulty mental tendencies.

In this category we must include, for example, hypochondria, a disturbance shown by undue anxiety concerning one's own physical and mental condition. This disorder, with the allied fears resulting from the urgent desire to be always absolutely safe, absolutely well, and absolutely comfortable, is capable, in extreme cases, of so narrowing the circle of pleasure and of usefulness that the sufferer might almost as well have organic disease.

Neurasthenia (nervous prostration) has for its immediate exciting cause some overwork or stress of circumstance, but the sufferer not infrequently was already so far handicapped by regrets for the past, doubts for the present, and anxieties for the future, by attention to minute details and by unwillingness to delegate responsibilities to others, that he was exhausted by his own mental travail before commencing upon the overwork which precipitated his breakdown. In such cases the occasion of the collapse may have been his work, but the underlying cause was deeper. Many neurasthenics who think they are "all run down" are really "all wound up." They carry their stress with them.

Among the serious results of faulty mental habit must be included also the doubting folly (folie du doute). The victim of this disorder is so querulously anxious to make no mistake that he is forever returning to see if he has turned out the gas, locked the door, and the like; in extreme cases he finally doubts the actuality of his own sensations, and so far succumbs to chronic indecision as seriously to handicap his efforts. This condition has been aptly termed a "spasm of the attention."

The apprehensive and fretful may show, in varying degree, signs of either or all these conditions, according as circumstances may direct their attention.

Passing from serious disorders to minor sources of daily discomfort, there are few individuals so mentally gifted that they are impervious to the distress occasioned by variations of temperature and of weather; to the annoyance caused by criticism, neglect, and lack of appreciation on the part of their associates; to active resentment, even anger, upon moderate provocation; to loss of temper when exhausted; to embarrassment in unusual situations; to chronic indecision; to the sleeplessness resulting from mental preoccupation; and above all, to the futile regrets, the querulous doubts, and the undue anxiety included under the term worry, designated by a recent author "the disease of the age."

Something may be accomplished in the way of lessening all these ills by continuous, properly directed effort on the part of the individual. Every inroad upon one faulty habit strengthens the attack upon all, and each gain means a step toward the acquisition of a mental poise that shall give its possessor comparative immunity from the petty annoyances of daily life.

In modern psycho-therapy the suggestion, whether on the part of the physician or of the patient, plays a prominent part, and it is in this direction, aside from the advice regarding occupation and relaxation, that my propositions will trend. I shall not include, however, suggestions depending for their efficacy upon self-deceit, such as might spring, for example, from the proposition that if we think there is a fire in the stove it warms us, or that if we break a pane in the bookcase thinking it a window, we inhale with pleasure the resulting change of air. The suggestions are intended to appeal to the reason, rather than to the imagination.

The special aim will be to pay attention to the different varieties of worry, and to offer easily understood and commonplace suggestions which any one may practice daily and continuously, at last automatically, without interfering with his routine work or recreation. Indeed the tranquil mind aids, rather than hinders, efficient work, by enabling its possessor to pass from duty to duty without the hindrance of undue solicitude.

In advising the constitutional worrier the chief trouble the physician finds is an active opposition on the part of the patient. Instead of accepting another's estimate of his condition, and another's suggestions for its relief, he comes with a preconceived notion of his own difficulties, and with an insistent demand for their instant relief by drug or otherwise. He uses up his mental energy, and loses his temper, in the effort to convince his physician that he is not argumentative. In a less unreasonable, but equally difficult class, come those who recognize the likeness in the portrait painted by the consultant, but who say they have tried everything he suggests, but simply "can't."

It is my hope that some of the argumentative class may recognize, in my description, their own case instead of their neighbor's, and may of their own initiative adopt some of the suggestions; moreover, that some of the acquiescent, but despairing class will renew their efforts in a different spirit. The aim is, not to accomplish a complete and sudden cure, but to gain something every day, or if losing a little to-day, to gain a little to-morrow, and ultimately to find one's self on a somewhat higher plane, without discouragement though not completely freed from the trammels entailed by faulty mental habit.



II.

EPICURUS AS A MENTAL HEALER

'Tis to believe what men inspired of old, Faithful, and faithfully informed, unfold.

Cowper.



The suggestions offered in the following pages are not new. Many of them were voiced by Epicurus three hundred years before Christ, and even then were ancient history. Unfortunately Epicurus had his detractors. One, Timocrates, in particular, a renegade from his school, spread malicious and unfounded reports of his doings and sayings, reports too easily credited then, and starting, perhaps, the misconception which to-day prevails regarding the aims of this philosopher.

But when Marcus Aurelius, nearly five centuries later, decided to endow a philosophical professoriate he established the Epicurean as one of the four standard schools. The endorsement of such a one should surely predispose us to believe the authentic commentators of Epicurus, and to discredit the popular notion which makes his cult synonymous with the gratification of the appetites, instead of with the mental tranquility to which he regarded sensual pleasures so detrimental that he practically limited his diet, and that of his disciples, to bread and water.

It is of special encouragement to such of us as painfully realize our meagre equipment for reaching a high plane of self-control, to learn that Epicurus was by nature delicate and sensitive. At seven years of age, we are told, he could not support himself on tiptoe, and called himself the feeblest of boys. It is said that in his boyhood he had to be lifted from his chair, that he could not look on the sun or a fire, and that his skin was so tender as to prevent his wearing any dress beyond a simple tunic. These physical characteristics suggest the makings of a first class "fuss" and inveterate worrier. In this event his emancipation from such tendencies must have been due to the practice of his own philosophy.

As an antidote for the fear of death and the miraculous in the heavens Epicurus urges the study of Nature, showing his appreciation of the fact that one thought can only be driven out by another, as well as of the importance of the open air treatment of depressing fears.

That he recognized the doubting folly and its evils is shown by the following Maxim for the Wise man:

"He shall be steady in his opinion and not wavering and doubtful in everything."

To the hypochondriac he said:

"Health in the opinion of some is a precious thing; others rank it among the indifferent." Again:

"If the body be attacked by a violent pain the evil soon has an end; if, on the contrary, the pain be languishing and of long duration it is sensible beyond all doubt of some pleasure therefrom. Thus, most chronical distempers have intervals that afford us more satisfaction and ease than the distempers we labor under cause pain." And further:

"The Wise man takes care to preserve the unequivocable blessing of an undisturbed and quiet mind even amidst the groans and complaints which excess of pain extorts from him." He states, again, that one can be happy though blind.

Regarding insomnia, he recognized the futility of expecting restful sleep to follow a day of fret and worry. He says:

"He shall enjoy the same tranquility in his sleep as when awake."

Epicurus realized that the apparent inability of the old to acquire new habits is due rather to lack of attention, and to indifference or preoccupation, than to lack of aptitude. He placed, in fact, no limit to the age for learning new methods, stating in his letter to Meneceus,—

"Youth is no obstacle to the study of philosophy—neither ought we to be ashamed to concentrate our later years to the labor of speculation. Man has no time limit for learning, and ought never to want strength to cure his mind of all the evils that afflict it."

Epicurus does not counsel seclusion for the cultivation of tranquility, but holds that mental equipoise "may be maintained though one mingles with the world, provided he keeps within the bounds of temperance, and limits his desires to what is easily obtained."

Curiously enough, in view of the idea of epicureanism which has become proverbial, Epicurus regards the avoidance of excess a logical and necessary step toward the tranquil life, and among other admonitions is found the following Maxim:

"The Wise man ought never to drink to excess, neither must he spend the nights revelling and feasting."

We may conclude our selection from the Maxims of Epicurus by one which strikes a body-blow at worry and the allied faulty mental habits:

"That being who is happy and immortal is in no way solicitous or uneasy on any account, neither does he torment or tease others; anger is unworthy of his greatness ... for all these things are the property of weakness."

Such then, was the real Epicurus, not a seeker after effeminate luxury, but a chaste and frugal philosopher, serene of mien, and of gentle disposition, firm in his friendships, but sacrificing to them none of the high ideals which characterized his thought. He erred, doubtless, in the avoidance of responsibilities and in narrowing his efforts to promoting the happiness of his own immediate circle, but he was fearless in the defence of his principles and steadfast in the pursuit of the tranquility which for him included truth.



III.

MARCUS AURELIUS

Such a body of teachers distinguished by their acquirements and character will hardly be collected again; and as to the pupil, we have not had another like him since.

Long.



Marcus Aurelius Antoninus, the philosopher-Emperor, showed by practice as well as by precept that the tranquil mind is not incompatible with a life of action. Destined from birth to stand at the head of a great empire engaged in distant wars, threatened by barbaric invasion, and not without internal dissention, he was prepared not only to command armies but to govern himself. Fortunately we are not without a clue to his methods—he not only had the best of teachers, but continued his training all through his life. When we consider his labors, the claim of the busy man of to-day that he has "no time" seems almost frivolous.

The thoughts of Marcus Aurelius (of which the following citations are from Long's translation) were written, not for self exploration, nor from delight in rounded periods, but for his own guidance. That he was in fact guided by his principles no better illustration offers than his magnanimity toward the adherents of one who would have usurped the throne of the Caesars. The observation of Long that fine thoughts and moral dissertations from men who have not worked and suffered may be read, but will be forgotten, seems to have been exemplified in the comparative oblivion into which the philosophy of Epicurus has fallen.

It is with the ethical side of the philosophy of Marcus Aurelius that we are concerned, and with that portion only which bears on the question of mental equipoise.

"Begin the morning," he says, "by saying to thyself, I shall meet with the busybody, the ungrateful, arrogant, deceitful, envious, unsocial. All these things happen to them by reason of their ignorance of what is good and evil."

With regard to the habit of seclusion common among the self-conscious, he says:

"If thou didst ever see a hand cut off, or a foot, or a head, lying anywhere apart from the rest of the body, such does a man make himself, as far as he can, who is not content with what happens, and separates himself from others, or does any thing unsocial. Suppose that thou hast detached thyself from the natural unity—for thou wast made by nature a part, but now thou hast cut thyself off—yet here there is this beautiful provision, that it is in thy power again to unite thyself. God has allowed this to no other part, after it has been separated and cut asunder, to come together again. But consider the kindness by which he has distinguished man, for he has put it in his power not to be separated at all from the universal; and when he has been separated, he has allowed him to return and to resume his place as a part."

On the futile foreboding which plays so large a part in the tribulation of the worrier, he says:

"Do not disturb thyself by thinking of the whole of thy life. Let not thy thoughts at once embrace all the various troubles which thou mayest expect to befall thee; but on every occasion ask thyself, What is there in this which is intolerable and past bearing? for thou wilt be ashamed to confess. In the next place remember that neither the future nor the past pains thee, but only the present. But this is reduced to a very little, if thou only circumscribest it, and chidest thy mind, if it is unable to hold out against even this." Again: "Let not future things disturb thee, for thou wilt come to them, if it shall be necessary, having with thee the same reason which now thou usest for present things."

On the dismissal of useless fret, and concentration upon the work in hand, he says:

"Labor not as one who is wretched, nor yet as one who would be pitied or admired; but direct thy will to one thing only, to put thyself in motion and to check thyself, as the social reason requires."

Regarding senseless fears he counsels:

"What need is there of suspicious fear, since it is in thy power to inquire what ought to be done? And if thou seest clear, go by this way content, without turning back: but if thou dost not see clear, stop and take the best advisers. But if any other things oppose thee, go on according to thy powers with due consideration, keeping to that which appears to be just. For it is best to reach this object, and if thou dost fail, let thy failure be in attempting this. He who follows reason in all things is both tranquil and active at the same time, and also cheerful and collected."

On irritation at the conduct of others:

"When thou art offended with any man's shameless conduct, immediately ask thyself, Is it possible, then, that shameless men should not be in the world? It is not possible. Do not, then, require what is impossible. For this man also is one of those shameless men who must of necessity be in the world. Let the same considerations be present in thy mind in the case of the knave and the faithless man, and of every man who does wrong in any way."

Regarding the hypochondriacal tendency he reverts to Epicurus, thus:

"Epicurus says, In my sickness my conversation was not about my bodily sufferings, nor did I talk on such subjects to those who visited me; but I continued to discourse on the nature of things as before, keeping to this main point, how the mind, while participating in such movements as go on in the poor flesh, shall be free from perturbations and maintain its proper good.... Do, then, the same that he did both in sickness, if thou art sick, and in any other circumstances;... but to be intent only on that which thou art now doing and on the instrument by which thou doest it."

These quotations will serve to show the trend of the reflections of this remarkable man. After reviewing this epitome of ethical philosophy I might stop and counsel the worrier to study the thoughts of Marcus Aurelius and other philosophers, whose practical suggestions are similar, notwithstanding their diversity of views regarding the ultimate object of the training. I shall venture, however, to elaborate the subject from the present view-point, even though the principles of Marcus Aurelius are as applicable now as they were in the days of the Roman Empire.

No reminder is needed of the wealth and efficacy of suggestion in the Book which contains the statement that "the Kingdom of God is within you," and that "A merry heart doeth good like a medicine; but a broken spirit drieth the bones." One of its suggestions was paralleled by the philosopher-poet when he wrote:

"Latius regnes avidum domando Spiritum, quam si Libyam remotis Gadibus iungas et uterque Poenus Serviat uni."



IV.

ANALYSIS OF WORRY

Of these points the principal and most urgent is that which reaches the passions; for passion is produced no otherwise than by a disappointment of one's desires and an incurring of one's aversions. It is this which introduces perturbations, tumults, misfortunes, and calamities; this is the spring of sorrow, lamentation and envy; this renders us envious and emulous, and incapable of hearing reason.

Epictetus.



Under this rather pretentious title an attempt is made to indicate certain elements of worry. No claim is made that the treatment of the subject is exhaustive.

The motto "Don't Worry" has inspired many homilies. But the mere resolve to follow this guide to happiness will no more instantaneously free one from the meshes of worry than the resolve to perform a difficult gymnastic feat will insure its immediate accomplishment.

The evils of worry as well as of its frequent associate, anger, have been dwelt upon by writers philosophical, religious, and medical. "Worry," says one author, "is the root of all cowardly passions,—jealousy, fear, the belittling of self, and all the introspective forms of depression are the children of worry." The symptoms and the evil results seem to receive more elaborate and detailed attention than the treatment. "Eliminate it," counsels this writer; "Don't worry," advises another. "Such advice is superficial," says their critic, "it can only be subdued by our ascending into a higher atmosphere, where we are able to look down and comprehend the just proportions of life." "Cultivate a quiet and peaceful frame of mind," urges another; and still another advises us to "occupy the mind with better things, and the best—is a habit of confidence and repose."

From such counsel the average individual succeeds in extracting nothing tangible. The last writer of those I have quoted comes perhaps the nearest to something definite in directing us to occupy the mind with better things; in the suggestions I have to offer the important feature is the effort to replace one thought by another, though not necessarily by a better one. If we succeed in doing this, we are making a step toward acquiring the habit of confidence and repose.

The simple admonition not to worry is like advising one not to walk awkwardly who has never learned to walk otherwise. If we can find some of the simpler elements out of which worry is constructed, and can learn to direct our attack against these, the proposition "Don't worry" will begin to assume a tangible form.

We can at least go back one step, and realize that it is by way of the unduly insistent thought that most of these faulty mental habits become established. It might be claimed that fear deserves first mention, but the insistent thought in a way includes fear, and in many cases is independent of it.

The insistent thought magnifies by concentration of attention, and by repetition, the origin of the worry. If my thoughts dwell on my desire for an automobile this subject finally excludes all others, and the automobile becomes, for the time being, the most important thing in the world, hence I worry. Into this worry comes no suggestion of fear—this emotion would be more appropriate, perhaps, if I acquired the automobile and attempted to run it. If, now, I have trained myself to concentrate my attention elsewhere before such thoughts become coercive, the automobile quickly assumes its proper relation to other things, and there is no occasion for worry. This habit of mind once acquired regarding the unessentials of life, it is remarkable how quickly it adapts itself to really important matters.

Take a somewhat more serious question. I fear I may make a blunder. If I harbor the thought, my mind is so filled with the disastrous consequences of the possible blunder that I finally either abandon the undertaking or approach it with a trepidation that invites failure. If, on the other hand, I have learned to say that even if I make a blunder it will only add to my experience, then apply myself whole-minded to the task, I have made a direct attack on worry.

The qualification unduly is not to be forgotten; a certain discrimination must be exercised before entirely condemning the insistent thought. The insistent thought that one's family must be fed is not a morbid sign. In fact, he also errs who can eliminate this thought and enjoy the ball game. It is not for the deviate of this type that I am writing. Nevertheless, the over-solicitous victim of the "New England Conscience" can almost afford to take a few lessons from the ne'er-do-weel.

The practical bearing of this attempt to analyze worry is obvious. If it is through the insistent desire for an automobile that I worry, I must bring my training to bear, not on the worry, which is elusive, but on the desire, which is definite. I must fortify myself with what philosophy I can acquire, and must console myself with such compensations as my situation may offer; and above all, I must get busy, and occupy hands and brain with something else. If, on my travels, I worry over the sluggish movement of the train, it is because of the insistent thought that I must arrive on time. In this event I should practice subduing the insistent thought, rather than vaguely direct my efforts against the worry. In the majority of cases I can bring myself to realize that the question of my arrival is not vital. Even in case I am missing an important engagement I may modify the dominance of the thought by reflecting that I cannot expect to be wholly immune from the misfortunes of mankind; it is due me, at least once in a lifetime, to miss an important engagement,—why fret because this happens to be the appointed time? Why not occupy my thoughts more profitably than in rehearsing the varied features of this unavoidable annoyance?

If we fret about the weather it is because of an insistent desire that the weather shall conform to our idea of its seasonableness. If we complain of the chill of May it is not because the cold is really unbearable, but because we wonder if spring will ever come. If we fume on a hot day in July it is because the weather is altogether too seasonable to suit us.

We spend far too much thought on the weather, a subject that really deserves little attention except by those whose livelihood and safety depend upon it. Suppose a runaway passes the window at which we are sitting, with collar off, handkerchief to our heated brow, squirming to escape our moist and clinging garments, and being generally miserable. We rush out of doors to watch his course, and for the next few minutes we do not know whether it is hot or cold, perspiring less during our exertions, I strongly suspect, than we did while sitting in the chair. At all events, it is obvious that our thoughts played quite as great a part in our discomfort as did the heat of the day.

Suppose now, instead of devoting all our attention to the weather we should reason somewhat as follows:

As long as I live on this particular planet, I shall be subject perhaps three days out of four, to atmospheric conditions which do not suit me. Is it worth my while to fret during those three days and to make it up by being elated on the fourth? Why not occupy myself with something else and leave the weather for those who have no other resource? Or, as someone has said, why not "make friends with the weather?" If one will cultivate this frame of mind he will be surprised to find that a certain physical relief will follow. In the first place, he will lessen the excessive perspiration which is the invariable accompaniment of fret, and which in its turn produces more discomfort than the heat itself.

We have selected, so far, the comparatively unimportant sources of mental discomfort, fret, and worry. The reader who can truthfully say that such annoyances play no part in his mental tribulations may pass them and accept congratulations. The reader who cannot be thus congratulated, but who is impatient to attack the major sources of worry, must be reminded at this point that he must practice on the little worries before he can accomplish anything with the great. The method is the same. The philosophy that will make us content with the weather will do something toward establishing the mental poise which shall enable us to withstand with comparative equanimity the most tragic of misfortunes that may fall to our lot.

To draw an example from the more serious disorders, let us consider the hypochondriac, who harbors the insistent thought that he must be always perfectly well, that each of his sensations must conform to his ideal, and that each function must follow regulations imposed by himself. If he can learn to ignore this thought by realizing that an acute illness is preferable to life-long mental captivity; if he can learn to do what others do, and to concentrate his energies on outside affairs which shall displace the question of health; if he can learn to say "What I am doing is more important than how I am feeling;" he will have cured his hypochondria.

In the foundation of the structure we are studying is found exaggerated self-consciousness. Whatever is said, done, or left undone, by others is analyzed by the worrier with reference to its bearing on himself. If others are indifferent it depresses him, if they appear interested they have an ulterior motive, if they look serious he must have displeased them, if they smile it is because he is ridiculous. That they are thinking of their own affairs is the last thought to enter his mind.

I suppose it would be an affectation for any of us to deny that, as far as we are concerned, we are the centre of the universe. This conceit does us no harm so long as we remember that there are as many centres of the universe as there are people, cats, mice and other thinking animals. When we forget this our troubles begin. If I enter a strange shop and find they desire security, need I take this as a reflection on my credit? Need I expect to be invited to every entertainment I should like to attend, and to be excused from those that bore me, and shall I make no allowance for the attitude of my host? Is it not rather egotistic for me to suppose that others are vitally interested in the fact that I blush, tremble, or am awkward? Why then should I allow my conduct to be influenced by such trivial matters?

The order of training is, then, generally, to modify our self-consciousness by externalizing our thoughts and broadening our interests; specifically, to eliminate the unduly insistent habit of thought.

This analysis of worry and allied mental states may facilitate such training, but the practical value of the suggestions does not depend upon the acceptance of these theoretical considerations.



V.

WORRY AND OBSESSION

So much are men enured in their miserable estate, that no condition is so poore, but they will accept; so they may continue in the same.

Florio's Montaigne.



"You may as well be eaten by the fishes as by the worms," said the daughter of a naval commander to me one day, when discussing the perils of the sea. Such philosophy, applied to each of the vexatious and dangerous situations of daily life, would go far toward casting out worry.

We have already referred to two important elements at the foundation, and in the framework, of the elaborate superstructures we rear with such material as worry, doubts, fears and scruples. The first is exaggerated self-consciousness, the second the tendency to succumb to the compelling thought or impulse, technically termed obsession.

With regard to self-consciousness, the worrier will generally realize that even as a child he was exceptionally sensitive to criticism, censure, ridicule and neglect. He was prone to brood over his wrongs, to play the martyr, and to suffer with peculiar keenness the "slings and arrows of outrageous fortune." I remember once leaving the table on account of some censure or careless remark. I fancied I had thrown the whole family into a panic of contrition. On the first opportunity, I asked what they had said about it, and was told that they had apparently not noticed my departure. This salutary lesson prevented repetition of the act.

To the self-conscious person the mere entrance into a public vehicle may prove an ordeal. It is hard for him to realize that the general gaze has no peculiar relation to himself, and that if the gaze is prolonged this is due to no peculiarity of his beyond the blush or the trepidation that betrays his feeling. If he can acquire indifference to this feature of his case, through the reflection that to others it is only a passing incident, the blush and the trepidation will promptly disappear, and a step will have been taken towards gaining the self-control for which he aims.

The usual cause of stage-fright is exaggerated self-consciousness. The sufferer from stage-fright can hardly fail to be a worrier. A certain shyness, it would seem, may also result from too acute a consciousness of one's audience, as in the case of Tennyson, whom Benson quotes thus:

"I am never the least shy before great men. Each of them has a personality for which he or she is responsible; but before a crowd which consists of many personalities, of which I know nothing, I am infinitely shy. The great orator cares nothing about all this. I think of the good man, and the bad man, and the mad man, that may be among them, and can say nothing. He takes them all as one man. He sways them as one man."

This, I take it, hardly spelled stage-fright. At the same time, it is improbable that one so sensitive to criticism meant to convey the impression that it was of his audience alone he thought in shrinking from the effort.

It appears that Washington Irving suffered from actual stage-fright.

In the Library edition of Irving's works appears the following anecdote from the reminiscences of Mrs. Julia Ward Howe, then a young woman of twenty-three:

"I was present, with other ladies, at a public dinner given in honor of Charles Dickens by prominent citizens of New York. The ladies were not bidden to the feast, but were allowed to occupy a small ante-room which, through an open door, commanded a view of the tables. When the speaking was about to begin, a message came suggesting that we take possession of some vacant seats at the great table. This we were glad to do. Washington Irving was president of the evening, and upon him devolved the duty of inaugurating the proceedings by an address of welcome to the distinguished guest. People who sat near me whispered, 'He'll break down,—he always does.' Mr. Irving rose and uttered a sentence or two. His friends interrupted him by applause, which was intended to encourage him, but which entirely overthrew his self-possession. He hesitated, stammered, and sat down, saying, 'I cannot go on.'"

Cavendish, the chemist, suffered from a constitutional shyness attributable only to self-consciousness. He is said to have carried so far his aversion to contact with others, outside of his colleagues, that his dinner was always ordered by means of a note, and instant dismissal awaited the female domestic who should venture within his range of vision.

Lombroso cites, among his "Men of Genius," quite a list—Corneille, Descartes, Virgil, Addison, La Fontaine, Dryden, Manzoni, and Newton—of those who could not express themselves in public. Whatever part self-consciousness played in the individual case, we must class the peculiarity among the defects, not signs, of genius. "A tender heel makes no man an Achilles."

To the second faulty habit, obsession, I wish to devote special attention. This word we have already defined as an unduly insistent and compulsive thought, habit of mind, or tendency to action. The person so burdened is said to be obsessed.

Few children are quite free from obsession. Some must step on stones; others must walk on, or avoid, cracks; some must ascend the stairs with the right foot first; many must kick posts or touch objects a certain number of times. Some must count the windows, pictures, and figures on the wallpaper; some must bite the nails or pull the eye-winkers. Consider the nail-biter. It cannot be said that he toils not, but to what end? Merely to gratify an obsession. He nibbles a little here and a little there, he frowns, elevates his elbow, and inverts his finger to reach an otherwise inaccessible corner. Does he enjoy it? No, not exactly; but he would be miserable if he discontinued.

An unusual, but characteristic obsession is told by a lady in describing her own childhood. She thought that on retiring she must touch nothing with her hands, after she had washed them, until she touched the inside of the sheets. In case she failed she must return and wash the hands again. The resulting manoeuvres are still fresh in her mind, particularly when her sister had preceded her to bed and she had to climb the footboard.

It is during childhood that we form most of the automatic habits which are to save time and thought in later life, and it is not surprising that some foolish habits creep in. As a rule, children drop these tendencies at need, just as they drop the roles assumed in play, though they are sometimes so absorbing as to cause inconvenience. An interesting instance was that of the boy who had to touch every one wearing anything red. On one occasion his whole family lost their train because of the prevalence of this color among those waiting in the station.

The longer these tendencies are retained in adult life, the greater the danger of their becoming coercive; and so far as the well-established case is concerned the obsessive act must be performed, though the business, social, and political world should come to a stand-still. Among the stories told in illustration of compulsive tendency in the great, may be instanced the touching of posts, and the placing of a certain foot first, in the case of Dr. Johnson, who, it appears, would actually retrace his steps and repeat the act which failed to satisfy his requirements, with the air of one with something off his mind.

A child who must kick posts is father to the man who cannot eat an egg which has been boiled either more or less than four minutes; who cannot work without absolute silence; who cannot sleep if steam-pipes crackle; and who must straighten out all the tangles of his life, past, present, and future, before he can close his eyes in slumber or take a vacation. The boy Carlyle, proud, shy, sensitive, and pugnacious, was father to the man who made war upon the neighbor's poultry, and had a room, proof against sound, specially constructed for his literary labors.

The passive obsessions are peculiarly provocative of worry. Such are extreme aversions to certain animals, foods, smells, sounds, and sights, or insistent discomfort if affairs are not ordered to our liking. A gentleman once told me that at the concert he did not mind if his neighbor followed the score, but when he consulted his programme during the performance it distressed him greatly.

Such instances illustrate the fact that when our obsessions rule us it is not the noise or the sight, but our idea of the fitness of things, that determines the degree of our annoyance. A person who cannot endure the crackling of the steam-pipe can listen with pleasure to the crackling of an open fire or the noise of a running brook.

It is said that the sensitive and emotional Erasmus had so delicate a digestion that he could neither eat fish nor endure the smell of it; but we are led to suspect that obsession played a part in his troubles when we further learn that he could not bear an iron stove in the room in which he worked, but had to have either a porcelain stove or an open fire.

If we can trust the sources from which Charles Reade drew his deductions regarding the character of the parental stock, Erasmus came fairly by his sensitive disposition. In "The Cloister and the Hearth" we find the father of Erasmus, fleeing from his native land, in fear of his life on account of a crime he thought he had committed, frozen, famished and exhausted, unable to enter the door of a friendly inn on account of his aversion to the issuing odors. Forced by his sufferings at last to enter the inn, he visits each corner in turn, analyzing its peculiar smell and choosing finally the one which seems to him the least obnoxious.

I have heard somewhere, but cannot place, the story of a prominent writer who was so disturbed by the mechanical lawn-mower of his neighbor that he insisted upon the privilege of defraying the expense of its replacement by the scythe.

Peculiar sensitiveness to sights, sounds and smells seems to be a common attribute of genius. This sort of sensitiveness has even been credited with being the main-spring of genius, but it is improbable that the curbing of such aversions would in any way endanger it. However this may be, such supersensitiveness ill becomes the rest of us, and these extreme aversions surely clog, rather than accelerate, our efforts.

* * * * *

The natural tendency of the healthy mind is to accustom itself to new sensations, as the ring on the finger, or the spectacles on the nose. The obsessive individual resists this tendency; he starts with the fixed idea that he cannot stand the annoyance, his resentment increases, and his sensations become more, instead of less, acute. His reaction to criticism, slight, and ridicule is similar; he is prepared to start, blush, and show anger on moderate provocation, and can often reproduce both the sensation and its accompanying physical signs by merely recalling the circumstance.

The passive as well as the active obsessions can be overcome by cultivating the commonplace, or average normal, attitude, and resolving gradually to accustom one's self to the disagreeable. This change of attitude can be made in adult life as well as in youth. "You cannot teach an old dog new tricks," we are told. The reason is not that the old dog cannot learn them, but that he does not want to. I met in Germany a British matron who was obsessed with the belief that she could not learn the language. At the end of four years' sojourn she entered a store and asked the price of an article.

"Four marks," was the answer.

"How much in English money?" she inquired.

"Why, madam, a mark is the same as a shilling."

"I don't know anything about that; how much is it in English?"

"Four shillings."

"Ah, quite so; you might have told me at once."

Experience has shown that no time in life precludes the acquirement of new knowledge and new habits by one who thinks it worth while to make the attempt. The elderly person will be surprised at his progress if he will bring to bear upon a new subject a mind free from doubts of its usefulness, doubts of his own ability, worry lest he is wasting valuable time, regrets for the past and plans for the future.

It is not always possible to say just where useful habit merges into obsession. A certain individual, we will say, invariably puts on the left shoe before the right. This is a useful habit, fixed by constant repetition, useful because it relieves the brain of conscious effort. But suppose he decides some morning to put on the right shoe before the left; this new order so offends his sense of the fitness of things that he finds it hard to proceed; if he perseveres, his feet feel wrong to him; the discomfort grows until finally he is impelled to remove the shoes and replace them in the usual order. In this case an act which started as a useful habit has been replaced by an obsession.

Suppose, again, a person obsessed by the fear of poison is prevented from washing his hands before eating. He sits down, perhaps, fully intending to proceed as if nothing had happened, but the thought occurs to him that he may have touched something poisonous, though his reason tells him this is most improbable. He reviews the events of the day and can find no suggestion of poison; still the thought of poison obtrudes itself, and he finds it impossible to put anything which he touches into his mouth. He next wonders if he has not already put something into his mouth. This thought produces a mental panic, the blood mounts to his head, he becomes incapable of coherent thought or speech, and the task of finishing his dinner would now be beyond his power even if he had not lost all taste for it.

Such illustrations of obsession in daily life, by no means rare, could be multiplied indefinitely, and may be perhaps better appreciated than the text-book illustration of the man who neglected to flick off with his whip a certain stone from the top of a wall, and who could not sleep until he had returned to the spot and performed the act.

Suppose a man has always worn high boots and is accustomed to a feeling of warmth about the ankles. The desire for warm ankles may finally so dominate him that he not only cannot wear low shoes in mid-summer, but he cannot wear slippers, even in a warm room; and finally, perhaps, finds that he must wear woollen socks to bed. By this time the desire for a certain sensation is in a fair way to become an obsession. When you assure him that many wear low shoes throughout the winter, he asks if their ankles really feel warm. That is not the question. The question is, can one accustom himself to the ankles feeling cool, just as he accustoms himself to his face feeling cool. If he can, he has conquered a sensory obsession, and has made a step toward fitting himself to meet more serious vicissitudes with equanimity.

Similar instances can be adduced in all realms of sensation, both general and special. One person cannot bear the light, and wears blue glasses; another cannot breathe out-door air, and wears a respirator; another cannot bear to see a person rock or to hear a person drum.

If a family or circle of friends is so constituted that some are obsessed to do certain things and others are obsessed not to stand them the foundation is laid for a degree of irritability inconsistent with mental health. Mrs. X. simply cannot stand hearing Mr. X. tap the floor, and if he continues, her discomfort becomes acute; the sound so dominates her that she can think of nothing else and can accomplish nothing until the sound is stopped. She can stand anything but that. The daughter, Miss X., hardly hears the tapping, and is irritated and impatient to the last degree on account of her mother's "silly" notion. What Miss X. simply cannot bear is hearing her brother continually clear his throat, and if he does not stop she must leave the room or "go wild." Unfortunately, meantime, Mr. X. is so obsessed to tap the floor that he cannot follow his task without it, and Master X. must clear his throat every few moments with a peculiar note because he "has catarrh."

Here we have a common starting-point for family discomfort, and here we have a clue to the advice of the physician who advises isolation as a step toward the cure of the member of the family who first breaks down, not simply under the stress of occupation, but of occupation plus the wear and tear of minor but constant sources of irritation.

* * * * *

It is said that the victim of jiu jitsu, by breaking one hold, places himself in the greater danger from the next. Similarly, after having conquered a few obsessions, one is overwhelmed with the obsession to set every one straight. Soukanhoff was right in warning the obsessive to beware of pedantry.

The question here presents itself whether this line of thought does not foster, rather than lessen, the pedantry and the self-study which it is intended to combat. Why not simply drop the worry and the doubt without further argument? The difficulty is that the mental processes of the over-scrupulous person are such that he cannot summarily drop a habit of thought. He must reason himself out of it. There is no limit to his ability if properly directed; he can gradually modify all his faulty tendencies, and may even finally acquire the habit of automatically dismissing worry, but it would be too much to expect that he suddenly change his very nature at command.

Soukanhoff's description of obsessives is peculiarly apt: "over-scrupulous, disquieted over trifles, indecisive in action, and anxious about their affairs. They are given early to morbid introspection, and are easily worried about their own indispositions or the illnesses of their friends. They are often timorous and apprehensive, and prone to pedantism. The moral sentiments are pronounced in most cases, and if they are, as a rule, somewhat exigent and egotistic, they have a lively sense of their own defects."

A common obsession is the compulsion to dwell upon the past, to reproduce the circumstances, and painfully to retrace the steps which we took in coming to an erroneous decision which led to a foolish, unnecessary, or perhaps even a wrong decision. One of my earliest impressions in golf was the remark of a veteran who was good enough to make a round with me. "If I had only approached better, I should have made that hole in five," I remarked, after taking seven strokes for a hole.

"Perhaps not," he replied; "if you had approached better, perhaps you would have putted worse and taken eight strokes for the hole. At all events, that hole is ancient history now, and you will play this one better if you leave that one alone."

He little realized how many times his advice would recur to me elsewhere than on the links. Retrospective worry can be absolutely eliminated from the most obsessive mind by the practice of the veteran's philosophy.

Mercier says the greatest intellectual gift is the ability to forget.

The conscientious self-analyst spends too much time in weighing his ability or inability to perform some task. Between his fear, his worry over the past, and his indecision whether the task should be attempted, he starts with an overwhelming handicap. If he learns to say, "Other people fail; it will not matter if I do this time," he will find the task already half accomplished.

The Rev. Francis Tiffany has observed that if a ship could think, and should imagine itself submerged by all the waves between here and Europe, it would dread to leave its moorings; but in reality it has to meet but one wave at a time.

The tendency of the average American in this bustling age, whether he is obsessive or not, is to live at least several hours in advance. On the train he takes no comfort and makes no observations, for his mind is upon his destination rather than on his journey.

* * * * *

Though the immediate object of these chapters is the promotion of the mental, and indirectly the physical, health of the individual, I cannot forbear referring to the effect of this training on the position of the individual in society and his relation toward his surroundings.

The endeavor to overcome obsessions is likely to be ignored by two classes: the self-centered individuals who see no reason for learning what they do not want to learn, and the individuals who have no time for, or interest in, self-training because of absorption in subjects of wider relation, as art, or science, or reform. The philosophy of Haeckel applies to both:

"Man belongs to the social vertebrates, and has, therefore, like all social animals, two sets of duties—first to himself, and secondly to the society to which he belongs. The former are the behests of self-love, or egoism, the latter love for one's fellows, or altruism. The two sets of precepts are equally just, equally natural, and equally indispensable. If a man desires to have the advantage of living in an organized community, he has to consult not only his own fortune, but also that of the society, and of the 'neighbors' who form the society. He must realize that its prosperity is his own prosperity, and that it cannot suffer without his own injury."

The individual who is ruled by his obsessions not only paves the way for needless and ultimate breakdown, but is in danger of gradually narrowing his field of usefulness and pleasure until he is in little better case than Simeon Stylites, who spent nearly half a century on the top of a monument. Nor has he even Simeon's consolation that he could come down if he chose; for it seems that the authorities sent messengers demanding his return, with orders to let him stay if he showed willingness to come down—and he stayed.



VI.

THE DOUBTING FOLLY

Jatgeir. I needed sorrow; others there may be who need faith, or joy—or doubt—

King Skule. Doubt as well?

Jatgeir. Ay; but then must the doubter be strong and sound.

King Skule. And whom call you the unsound doubter?

Jatgeir. He who doubts of his own doubt.

King Skule (slowly). That methinks were death.

Jatgeir. 'T is worse; 't is neither day nor night.

King Skule (quickly, as if shaking off his thoughts). Where are my weapons? I will fight and act, not think.

IBSEN: The Pretenders, Act iv.



A gentleman once told me that he rarely passed another in the street without wondering if he had not accosted him in an improper manner. He knew very well that he had not, but the more he dwelt upon the possibility, the more doubtful he became, until the impulse to settle the question became so strong that he would retrace his steps and inquire. He asked if nux vomica would help this trouble! I told him he needed mental training.

"I have tried that," he answered. "I keep saying to myself, 'I will not think of it,' but it is no use; my head becomes hot, my sight blurred, my thoughts confused, and the only relief I find is to settle the question."

I tried to point out the direction in which he was tending, and told him he must remind himself that even if he had accosted another improperly, it was a trifling matter compared to the injury to himself of giving way to this compulsion; moreover, the impression he would make upon the other by going back would be even worse than that of having so accosted him; and, finally, he must dwell upon the probability that he had not offended the man, instead of the possibility that he had. Having pursued this line of thought, he must force himself to think of something else until the besetting impulse was obliterated. I suggested that if a baseball player should become incapacitated for the game, he would not lessen his disappointment by reiterating, "I will not think of baseball," but if he persistently turned his thoughts and his practice to billiards he might in time forget baseball.

"I never played baseball," he replied, "and don't even know the rules."

This represents an extreme case of "doubting folly" a case in which the victim could no longer concentrate his thoughts on the simplest proposition outside the narrow circle to which his doubts had restricted him.

If we once allow ourselves to wonder whether we have turned off the water, enclosed the check, or mailed the letter, it is but a step to an uncomfortable frame of mind which can be relieved only by investigating the matter. This compulsion once acceded to, it becomes more and more easy to succumb. The next step is to blur, by constant repetition, the mental image of the act. In extreme cases the doubter, after turning the gas on and off a dozen times, is finally in doubt whether he can trust his own senses. A certain officer in a bank never succeeded in reaching home after closing hours without returning to try the door of the bank. Upon finding it locked, he would unlock it and disappear within, to open the vault, inspect the securities, and lock them up again. I once saw a victim of this form of doubt spend at least ten minutes in writing a check, and ten minutes more inspecting it, and, after all, he had spelled his own name wrong!

Constant supervision only impairs acts which should have become automatic. We have all heard of the centipede who could no longer proceed upon his journey when it occurred to him to question which foot he should next advance.

To other doubts are often added the doubt of one's own mental balance; but it is a long step from these faulty habits of mind to real mental unbalance, which involves an inability to plan and carry out a line of conduct consistent with one's station.

It took a young man at least fifteen minutes, in my presence, to button his waistcoat. He felt the lower button to reassure himself, then proceeded to the next. He then returned to the lower one, either distrusting his previous observation, or fearing it had become unbuttoned. He then held the lower two with one hand while he buttoned the third with the other. When this point was reached he called his sight to the aid of his feeling, and glued his eyes to the lower while he buttoned the upper, unbuttoning many meantime, to assure himself that he had buttoned them. This young man said he would sometimes stop on his way to the store in doubt whether he was on the right street, a doubt not quieted either by reading the sign or by asking a stranger, because the doubt would obtrude itself whether he could trust his sight and his hearing, indeed, whether he was really there or dreaming. Even this victim of extreme doubting folly conducted his business successfully so long as I knew him, and so comported himself in general as to attract no further comment than that he was "fussy."

These doubts lead to chronic indecision. How often, in deciding which of two tasks to take up, we waste the time which would have sufficed for the accomplishment of one, if not both.

The doubt and the indecision result directly from over-conscientiousness. It is because of an undue anxiety to do the right thing, even in trivial matters, that the doubter ponders indefinitely over the proper sequence of two equally important (or unimportant) tasks. In the majority of instances it is the right thing for him to pounce upon either. If he pounces upon the wrong one, and completes it without misgiving, he has at least accomplished something in the way of mental training. The chances are, moreover, that the harm done by doing the wrong thing first was not to be compared to the harm of giving way to his doubt, and either drifting into a state of ineffective revery or fretting himself into a frenzy of anxious uncertainty.

A gentleman once told me that after mailing a letter he would often linger about the box until the postman arrived, and ask permission to inspect his letter, ostensibly to see if he had put on the stamp, but in fact to reassure himself that he had really mailed the missive, although he knew perfectly well that he had done so. The life of the chronic doubter is full of these small deceits, though in most matters such persons are exceptionally conscientious.

This form of over-solicitude is peculiarly liable to attack those in whose hands are important affairs affecting the finances, the lives, or the health of others. I have known more than one case of the abandonment of a chosen occupation on account of the constant anxiety entailed by doubts of this nature. Nor are these doubts limited to the question whether one has done or left undone some particular act. An equally insistent doubt is that regarding one's general fitness for the undertaking. The doubter may spend upon this question more time than it would take to acquire the needed facility and experience.

Some one has said there are two things that no one should worry about: first, the thing that can't be helped; second, the thing that can. This is peculiarly true of the former.

Reflection upon the past is wise; solicitude concerning it is an anachronism. Suppose one has accepted a certain position and finds himself in doubt of his fitness for that position. Nothing can be more important than for him to decide upon his next line of conduct. Shall he resign or continue? Is he fit for the position, or, if not, can he acquire the fitness without detriment to the office? These are legitimate doubts. But the doubter who finds himself in this predicament adds to these legitimate doubts the question, "Ought I to have accepted the office?" This is the doubt he must learn to eliminate. He must remind himself that he has accepted the position, whether rightly or wrongly, and that the acceptance is ancient history. The question what shall he do next is sufficiently weighty to occupy all his attention without loading his mind with anxious doubts regarding the irrevocable past.

Suppose, in fact, the doubter has made a mistake; how shall he banish the worry? By reminding himself that others have made mistakes, why should not he, and that it is somewhat egotistic on his part to insist that, whatever others may do, he must do everything right. If this line of reasoning fails to console him, let him think of the greater mistakes he might have made. A financial magnate was once asked how he succeeded in keeping his mind free from worry. He replied, by contemplating the two worst things that could happen to him: losing all his property and going to jail. He had learned the lesson that one thought can be driven out only by another.

With regard to immediate doubts. If the over-scrupulous business or professional man, worn out after an exacting day's work, will stop and reflect, he will realize that much of his exhaustion is due to his having filled the day with such doubts as whether he is doing the wrong thing, or the right thing at the wrong time, whether he or someone else will miss an appointment or fail to meet obligations, and whether he or his assistants may make blunders.

Let him resolve some morning that he will proceed that day from task to task without allowing such thoughts to intrude. If he does so he will find that he has succeeded in his work at least as well as usual, and that he is comparatively fresh in the evening.

Why not try this every day?

* * * * *

So far we have only considered the most obvious and simple among the evidences of doubting folly. A still more obstinate tendency of the doubter is the insistent habit interminably to argue over the simplest proposition, particularly regarding matters pertaining to the health, comfort, and life of the individual himself. A certain patient, of this type, attempts to describe to his physician a peculiar, hitherto undescribed, and even now indescribable sensation "through his right lung." He traces this sensation to what he believes to have been the absorption of a poison some years ago. His line of reasoning is somewhat as follows: 1. The drug was a poison. 2. If he absorbed it he must have been poisoned. 3. If he was poisoned then, he is poisoned now. 4. There is no proof that such a poison cannot produce such a sensation. 5. He has the sensation. Conclusion: He is suffering from poison. In support of this proposition he will spend hours with anyone who will listen. The physician who allows himself to be drawn into the controversy speedily finds himself, instead of giving advice to listening ears, involved in a battle of wits in which he is quite likely to come off second best. He assures the patient, for example, that, as far as scientific methods can establish the fact, the lung is sound.

"But has science established everything? And if it had, is such negative evidence to be weighed against the positive evidence of the sensation in my lung?"

"But the sensation may not be in your lung."

"Can you prove that it is not in my lung?" Folly scores!

On being urged to direct his attention to some other part of his body, he promptly inquires,

"How can I direct my thoughts elsewhere, when the sensation is there to occupy my attention?" Obviously he can not without changing his mental attitude, so folly scores again.

He is assured that if the poison had been absorbed the effects would have passed away long before this time.

"But do the effects of poison always pass away? And can you prove that they have passed away in my case? Is not the sensation positive evidence, since you have allowed that you cannot prove that the sensation does not come from the poison?"

Folly scores again, but the victory is an empty one. The vicious circle continues: Attention magnifies sensation—sensation produces fear—fear increases attention; and throughout runs the insistent thought that his sensations shall conform to his ideal.

If the discussion of such comparatively tangible matters can occupy a large part of one's attention, imagine the result of the insistent desire, on the part of the doubter, to solve such problems as "What is thought?" "What is existence?"

If the windings of this intellectual labyrinth have not too far involved us, we have only to recognize the futility of such arguments, and exercise our will-power in the right direction. If we can bring ourselves to take the initiative, it is as easy to step out of the vicious circle, as for the squirrel to leave his wheel. But unless we grasp the logic of the situation, and take this initiative, no amount of abuse, persuasion, or ridicule will effect our freedom.

* * * * *

A word may be in place regarding the anthropological status of the doubting folly and allied mental states. Men of genius have suffered from them all. A long list may be found in Lombroso's "Man of Genius." Under folie du doute we find, for example, Tolstoi, Manzoni, Flaubert and Amiel.

Lombroso regards genius as degenerative, and places among the signs of degeneration, deviations from the average normal, whether physical or mental. This plan has been quite generally followed. The nomenclature seems to me unfortunate and hardly justified by the facts. I can think of no more potent objection to such inclusive use of the term degenerate, than the fact that Lombroso includes, under the signs of degeneration, the enormous development of the cerebral speech-area in the case of an accomplished orator. If such evolutional spurts are to be deemed degenerative, the fate of the four-leaved clover is sealed.

The application of the term degeneration may be, and should be, it seems to me, limited to the signs, whether physical or mental, which indicate an obviously downward tendency. I have elsewhere suggested, and the suggestion has already found some acceptance, that when the variation is not definitely downward, deviation and deviate be substituted for the unnecessarily opprobrious and often inappropriate terms, degeneration and degenerate.



VII.

HYPOCHONDRIA

Il marche, dort, mange et boit comme tous les autres; mais cela n'empeche pas qu'il soit fort malade.

MOLIERE: Le Malade imaginaire.



The victim of hypochondria may present the picture of health, or may have some real ill regarding which he is unduly anxious. His consultation with a physician is likely to be preceded by letters explaining his exact condition, naming his various consultants and describing the various remedies he has taken. At the time of his visit notes are consulted, lest some detail be omitted. In his description anatomical terms abound; thus, he has pain in his lungs, heart, or kidney, not in his chest or back. Demonstration by the physician of the soundness of these organs is met by argument, at which the hypochondriac is generally adept.

The suggestion that the hypochondriac devotes undue attention to his own condition is met by him with indignant denial. Proposals that he should exercise, travel, engage in games, or otherwise occupy himself, fall on deaf ears, but he is always ready to try a new drug. If a medicine is found with whose ingredients the patient is not already familiar, its use is likely to produce a beneficial effect for a few days, after which the old complaint returns.

The case has come to my attention of a young man who, for fear of taking cold, remains in bed, with the windows of the room tightly closed and a fire constantly burning. He has allowed his hair to grow until it reaches his waist, he is covered with several blankets, wears underclothing under his nightshirt, and refuses to extend his wrist from under the bed-clothes to have his pulse taken.

Such faulty mental habits in minor degree are common. There are those who will not drink from a bottle without first inspecting its mouth for flakes of glass; some will not smoke a cigar which has been touched by another since leaving the factory; some will not shake hands if it can possibly be avoided; another pads his clothing lest he injure himself in falling. Many decline to share the occupations and pleasures of others through fear of possible wet feet, drafts of air, exhaustion, or other calamity. Such tendencies, though falling short of hypochondria, pave the way for it, and, in any event, gradually narrow the sphere of usefulness and pleasure.

No part of the body is exempt from the fears of the hypochondriac, but he is prone to centre his attention upon the obscure and inaccessible organs. The anecdote is told of a physician who had a patient of this type—a robust woman who was never without a long list of ailments. The last time she sent for the doctor, he lost patience with her. As she was telling him how she was suffering from rheumatism, sore throat, nervous indigestion, heart-burn, pains in the back of the head, and what not, he interrupted her:

"Ah," he said in an admiring tone, "what splendid health you must have in order to be able to stand all these complaints!"

The phobias are so closely allied to hypochondria that it will not be out of place to discuss them here. A phobia is an insistent and engrossing fear, without adequate cause as judged by ordinary standards. Familiar instances are fear of open places (agoraphobia), fear of closed places (claustrophobia), and fear of contamination (mysophobia).

The sufferer from agoraphobia cannot bring himself to cross alone an open field or square. The sufferer from claustrophobia will invent any excuse to avoid an elevator or the theatre. When a certain lady was asked if she disliked to go to the theatre or church, she answered, "Not at all, but of course I like to have one foot in the aisle; I suppose everyone does that."

The victim of mysophobia will wash the hands after touching any object, and will, so far as possible, avoid touching objects which he thinks may possibly convey infection. Some use tissue paper to turn the door-knob, some extract coins from the pocket-book with pincers. I have seen a lady in a public conveyance carefully open a piece of paper containing her fare, pour the money into the conductor's hand, carefully fold up the paper so that she should not touch the inside, and afterwards drop it from the tips of her fingers into a rubbish barrel.

The case of a nurse who was dominated by fear of infection has come to my attention. If her handkerchief touched the table it was discarded. She became very adept at moving objects about with her elbows, was finally reduced to helplessness and had to be cared for by others.

Unreasoning fear of one or another mode of conveyance is not rare. It is said that Rossini found it impossible to travel by rail, and that the attempt of a friend to accustom him to it resulted in an attack of faintness (Lombroso).

The sufferer himself realizes, in such cases, that there is no reason in his fear—he knows he can undergo greater dangers with equanimity. Even doubting folly finds no answer to the question why should this danger be shunned and that accepted. The nearest approach to an answer is "I can't," which really means "I haven't."

The origin of the phobia is not always clear, but given the necessary susceptibility, circumstances doubtless dictate the direction the phobia shall take. A startling personal experience, or even reading or hearing of such an experience may start the fear which the insistent thought finally moulds into a fixed habit.

To the hypochondriac who concentrates his attention upon the digestive tract, this part of his body occupies the foreground of all his thoughts. He exaggerates its delicacy of structure and the serious consequences of disturbing it even by an attack of indigestion. A patient to whom a certain fruit was suggested said he could not eat it. Asked what the effect would be, he answered that he did not know, he had not eaten any for twenty years and dared not risk the experiment.

Extreme antipathies to various foods are fostered among this class. A lady told me that she perfectly abominated cereals, that she could not stand vegetables, that she could not bear anything in the shape of an apple, that she could not abide spinach, and that baked beans made her sick at the stomach.

The heart is perhaps the organ most often the object of solicitude on the part of the hypochondriac. When we realize that the pulse may vary in the healthy individual from 60 to over 100, according to circumstances, and that mere excitement may send it to the latter figure, we may appreciate the feelings of one who counts his pulse at frequent intervals and is alarmed if it varies from a given figure.

Inspection of the tongue is a common occupation of the hypochondriac, who is generally more familiar than his medical attendant with the anatomy of this organ.

Insistent desire regarding the temperature is common not only among hypochondriacs, but among others. I do not allude to the internal temperature (though I have been surprised to learn how many people carry a clinical thermometer and use it on themselves from time to time); I refer to the temperature of the room or of the outside air. The wish to feel a certain degree of warmth is so overpowering in some cases that neither work nor play can be carried on unless the thermometer registers the desired figure. A person with this tendency does not venture to mail a letter without donning hat and overcoat; the mere thought of a cold bath causes him to shudder.

Golf has cured many a victim of this obsession. It takes only a few games to teach the most delicately constructed that he can remain for hours in his shirt-sleeves on quite a cold day, and that the cold shower (preferably preceded by a warm one) invigorates instead of depresses him. Further experiment will convince him that he can wear thin underwear and low shoes all winter. Such experiences may encourage him to risk a cold plunge in the morning, followed by a brisk rub and a few simple exercises before dressing.

Morbid fears in themselves produce physical manifestations which add to the discomfort and alarm of the hypochondriac. I allude to the rush of blood to the head, the chill, the mental confusion, and the palpitation. These symptoms are perfectly harmless, and denote only normal circulatory changes. It is true that one cannot at will materially alter his circulation, but he can do so gradually by habit of thought. To convince ourselves of this fact, we need only remember to what a degree blushing becomes modified by change of mental attitude. Similarly, the person who has practiced mental and physical relaxation will find that the blood no longer rushes to his head upon hearing a criticism or remembering a possible source of worry.

The automatic processes of the body are in general performed best when the attention is directed elsewhere. After ordinary care is taken, too minute attention to the digestive apparatus, for example, may retard rather than aid it. Watching the digestion too closely is like pulling up seeds to see if they are growing.

The more attention is paid to the sensations, the more they demand. Nor can the degree of attention they deserve be measured by their own insistence. If one tries the experiment of thinking intently of the end of his thumb, and imagines it is going to sleep, the chances are ten to one that in five minutes it will have all the sensations of going to sleep. If this is true of the healthy-minded individual, how much more must it be so in the person who allows his thoughts to dwell with anxious attention on such parts of his body as may be the immediate seat of his fears. The next step is for various sensations (boring, burning, prickling, stabbing, and the like) to appear spontaneously, and, if attention is paid to them, rapidly to increase in intensity.

It is probable that the mere pressure of part upon part in the body, even the ordinary activity of its organs, would give rise to sensations if we encouraged them. Given an anomalous sensation, or even a pain, for which the physician finds no physical basis, and which, after a term of years, has produced no further appreciable effect than to make one nervous, it is always in place to ask one's self whether the sensation or the pain may not be of this nature.

Medical instructors are continually consulted by students who fear that they have the diseases they are studying. The knowledge that pneumonia produces pain in a certain spot leads to a concentration of attention upon that region which causes any sensation there to give alarm. The mere knowledge of the location of the appendix transforms the most harmless sensations in that region into symptoms of serious menace. The sensible student learns to quiet these fears, but the victim of "hypos" returns again and again for examination, and perhaps finally reaches the point of imparting, instead of obtaining, information, like the patient in a recent anecdote from the Youth's Companion:

It seems that a man who was constantly changing physicians at last called in a young doctor who was just beginning his practice.

"I lose my breath when I climb a hill or a steep flight of stairs," said the patient. "If I hurry, I often get a sharp pain in my side. Those are the symptoms of a serious heart trouble."

"Not necessarily, sir," began the physician, but he was interrupted.

"I beg your pardon!" said the patient irritably. "It isn't for a young physician like you to disagree with an old and experienced invalid like me, sir!"

* * * * *

There is no absolute standard for the proper degree of solicitude regarding one's health, but if the habitual invalid possess a physique which would not preclude the average normal individual from being out and about, even at the expense of a pain, a stomach ache, or a cold, there is probably a hypochondriacal element in the case. It is a question of adjustment of effect to cause.

The term "imaginary" is too loosely applied to the sensations of the hypochondriac. This designation is unjustified, and only irritates the sufferer, rouses his antagonism, and undermines his confidence in the judgment of his adviser. He knows that the sensations are there. To call them imaginary is like telling one who inspects an insect through a microscope that the claws do not look enormous; they do look enormous—through the microscope—but this does not make them so. The worrier must learn to realize that he is looking at his sensations, as he does everything else, through a microscope.

If a person living near a waterfall ignores the sound, he soon ceases to notice it, but if he listens for it, it increases, and becomes finally unbearable. Common sense teaches him to concentrate his attention elsewhere; similarly, it demands that the victim of "hypos" disregard his various sensations and devote his attention to outside affairs, unless the sensations are accompanied by obvious physical signs. Instead of running to the doctor, let him do something—ride horseback, play golf, anything requiring exercise out of doors. Let him devote his entire energy to the exercise, and thus substitute the healthy sensations of fatigue and hunger for the exaggerated pains and the anomalous sensations which are fostered by self-study. Let him remember moreover, that nature will stand an enormous amount of outside abuse, but resents being kept under close surveillance.

In practicing the neglect of the sensations, one should not allow his mind to dwell on the possibility that he is overlooking something serious, but rather on the danger of his becoming "hipped," a prey to his own doubts and fears, and unable to accomplish anything in life beyond catering to his own morbid fancies.

* * * * *

Turning now to the bibliographic study of hypochondria, an interesting and characteristic contrast is offered between Huxley, who called himself a hypochondriac, but apparently was not, and Carlyle, who resented the imputation, though it apparently had some justification in fact.

With regard to Huxley,—the only basis for the diagnosis hypochondria in a given case, is undoubted evidence, by letter or conversation, that the question of health is given undue prominence. I have looked carefully through the volume of Huxley's letters (published by his son), without definitely establishing this diagnosis. The state of his health and the question of his personal comfort received comparatively little attention. Whatever suffering Huxley endured he seems to have accepted in a philosophical and happy spirit, thus:

"It is a bore to be converted into a troublesome invalid even for a few weeks, but I comfort myself with my usual reflection on the chances of life, 'Lucky it is no worse.' Any impatience would have been checked by what I heard about ... this morning ... that he has sunk into hopeless idiocy. A man in the prime of life!"

With regard to Carlyle,—it is true, as claimed by Gould (Biographic Clinics, 1903) that he showed every evidence of eyestrain with resulting symptoms, particularly headache. This does not, however, preclude his having had hypochondria also, and in view of the violent and reiterated complaints running through his letters it seems quite credible that Froude's estimate of his condition was not far wrong. Surely, unless Carlyle was merely trying his pen without intending to be taken seriously, he devoted to the question of health a degree of attention which may be fairly adjudged undue.

The first letter I quote (from those cited by Gould in fortifying his position) is of special interest as presenting in rather lurid terms Carlyle's ideal of health. After reading this letter one cannot help suspecting that the discomforts so vividly described in his other letters were compared by him with this ideal rather than with those of the average individual.

"In the midst of your zeal and ardor,... remember the care of health.... It would have been a very great thing for me if I had been able to consider that health is a thing to be attended to continually, that you are to regard that as the very highest of all temporal things for you. There is no kind of achievement you could make in the world that is equal to perfect health. What to it are nuggets and millions'? The French financier said 'Why is there no sleep to be sold!' Sleep was not in the market at any quotation.... I find that you could not get any better definition of what 'holy' really is than 'healthy.' Completely healthy; mens sana in corpore sano. A man all lucid, and in equilibrium. His intellect a clear mirror geometrically plane, brilliantly sensitive to all objects and impressions made on it and imaging all things in their correct proportions; not twisted up into convex or concave, and distorting everything so that he cannot see the truth of the matter, without endless groping and manipulation: healthy, clear, and free and discerning truly all around him."

The following extracts illustrate his attitude toward his physical shortcomings, whatever they may have been.

... "A prey to nameless struggles and miseries, which have yet a kind of horror in them to my thoughts, three weeks without any kind of sleep, from impossibility to be free from noise."

"I sleep irregularly here, and feel a little, very little, more than my usual share of torture every day. What the cause is would puzzle me to explain. I take exercise sufficient daily; I attend with rigorous minuteness to the quality of my food; I take all the precautions that I can, yet still the disease abates not."

"Ill-health, the most terrific of all miseries."

"Grown sicker and sicker.... I want health, health, health! On this subject I am becoming quite furious.... If I do not soon recover, I am miserable forever and ever. They talk of the benefit of health from a moral point of view. I declare solemnly, without exaggeration, that I impute nine-tenths of my present wretchedness, and rather more than nine-tenths of all my faults, to this infernal disorder in the stomach."

"Bilious, too, in these smothering windless days."

"Broke down in the park; konnte nichts mehr, being sick and weak beyond measure."

"Many days of suffering, of darkness, of despondency.... Ill-health has much to do with it."

"Occasionally sharp pain (something cutting hard, grasping me around the heart).... Something from time to time tying me tight as it were, all around the region of the heart, and strange dreams haunting me."

"There is a shivering precipitancy in me, which makes emotion of any kind a thing to be shunned. It is my nerves, my nerves.... Such a nervous system as I have.... Thomas feeling in his breast for comfort and finding bilious fever.... All palpitating, fluttered with sleeplessness and drug-taking, etc.... Weary and worn with dull blockheadism, chagrin (next to no sleep the night before)."

"A head full of air; you know that wretched physical feeling; I had been concerned with drugs, had awakened at five, etc. It is absolute martyrdom."

"A huge nightmare of indigestion, insomnia, and fits of black impatience with myself and others,—self chiefly.... I am heartily sick of my dyspeptic bewilderment and imprisonment."

"Alas! Alas! I ought to be wrapped in cotton wool, and laid in a locked drawer at present. I can stand nothing. I am really ashamed of the figure I cut."

Froude's statements regarding Carlyle's condition are as follows:

"... The simple natural life, the 'wholesome air, the daily rides or drives, the poor food,... had restored completely the functions of a stomach never so far wrong as he had imagined.... Afterwards he was always impatient, moody, irritable, violent. These humours were in his nature, and he could no more be separated from them than his body could leap off its shadow.... He looked back to it as the happiest and wholesomest home that he had ever known. He could do fully twice as much work there, he said, as he could ever do afterwards in London."

"... If his liver occasionally troubled him, livers trouble most of us as we advance in life, and his actual constitution was a great deal stronger than that of ordinary men.... Why could not Carlyle, with fame and honor and troops of friends, and the gates of a great career flung open before him, and a great intellect and a conscience untroubled by a single act which he need regret, bear and forget too? Why indeed! The only answer is that Carlyle was Carlyle."

These observations carry weight as representing the impartial and judicial estimate of a careful observer desiring only accurately to picture Carlyle as he was. The only logical conclusion, it seems to me, was that Carlyle, in addition to ocular defect with its legitimate consequences, was weighed down by worry over the failure to realize his own exaggerated ideal of health, that he devoted an undue degree of attention to this subject and was unduly anxious about it—in other words, that he had decided hypochondriacal tendencies.



VIII.

NEURASTHENIA

It was a common saying of Myson that men ought not to investigate things from words, but words from things; for that things are not made for the sake of words, but words for things.

Diogenes Laertius.



This term (properly, though not commonly, accented upon the penult), was introduced by Beard to designate the large class of over-worked and worried who crowded his consulting room. The word is derived from the Greek neuron nerve, and astheneia weakness.

Among the symptoms of this disorder have been included disorders of digestion and circulation, muscular weakness, pains, flushes and chills, and anomalous sensations of every variety. It has been especially applied to cases showing such mental peculiarities as morbid self-study, fear of insanity and the various other phobias, scruples, and doubts with which we have become familiar.

The "American Disease" has been adopted abroad, and volumes have been devoted to it. Neurasthenia has been divided into cerebral, spinal, and otherwise, according as the fears and sensations of the patient are referred to one or another part of his body. While the term neurasthenia is becoming daily more familiar to the general public, it is being, on the whole, used, except as a convenient handle, rather less among neurologists. [Footnote: In substantiation of this statement I need only cite the recent contribution of my friend, Dr. Dana, on the "Partial Passing of Neurasthenia."] The question has arisen whether the symptoms of neurasthenia are always due to simple exhaustion. Advice regarding method, as well as amount, of work, is coming into vogue. Peterson, in a letter published in Collier's Weekly (November 9, 1907) thus arraigns a patient who has told him he is a practical business man, and that his mind has been so occupied with serious matters that he has been unable to attend to his health.

"You, practical! you, a business man! Why, you never had a serious thought in your life until now—at least not since you were a lad in the country.... Since boyhood you have never given a serious thought to health, home, wife, children, education, art, science, racial progress, or to the high destiny of man. You are simply a collector of money for its own sake, with no appreciation of what it might represent if you were really serious and really a business man or man of affairs. There are many like you in our asylum wards, where they are known as chronic maniacs. Here is one who collects bits of glass, old corks, and pieces of string. There sits another with a lap full of pebbles, twigs and straws."

Courtney (in Pyle's "Personal Hygiene") says, "The brain is an organ which, under proper training, is capable of performing an immense amount of work, provided only that the work is of a varied character and does not produce a corresponding amount of mental disquietude. The importance of the emotions, especially the depressing emotions such as grief, anxiety, and worry, as factors in the brain exhaustion, cannot easily be overestimated."

The obvious corollary to this proposition is that the constitutional worrier is likely to break down under an amount of work which produces no such effect upon the average normal individual.

The only quarrel I have with the name neurasthenia is that it diverts attention from the real condition oftenest to be treated, namely, the faulty mental tendency, and directs attention to an assumed debility which may or may not exist. Misdirected energy, rather than weakness, is the difficulty with one who is ready and anxious to walk miles to satisfy a doubt, or to avoid crossing an open square, and who will climb a dozen flights of stairs rather than be shut up in an elevator. Even the exhaustion that follows long attention to business is quite as often due to worry and allied faulty mental habits as to the work itself. In most cases the phobias, the doubts, and the scruples, instead of being the result of breakdown, must be counted among its principal causes.

This is why simple rest and abstinence from work so often fail to accomplish the cure that should follow if the exhaustion were due simply to overwork. In the "neurasthenic" rest from work only redoubles the worries, the doubts and the scruples, and the obsession to improve his time only adds to his nervous exhaustion. If a European trip is undertaken, the temperament responsible for the original breakdown causes him to rush from gallery to gallery, from cathedral to cathedral, so that no moment may be lost. Not infrequently it so happens that the patient returns more jaded than ever.

The neurasthenic is not infrequently a confirmed obsessive, with all the faulty mental habits of this temperament. If he cannot make up his mind it is not because he is tired, but because this is his natural mental trend. If he drums, twitches, and walks the floor, these movements are not always due to exhaustion, but are habits peculiar to the temperament, habits well worth an effort to eliminate while in health, since they doubtless, through precluding bodily repose, contribute their mite toward the very exhaustion of which they are supposed to be the result. If he cannot sleep it is not simply because he is tired, but because he is so constituted that he cannot bring himself to let go his hold on consciousness until he has straightened out his tangles. If, in addition, one has the hypochondriacal tendency, he may worry himself into complete wakefulness by the thought that he has already irreparably injured himself by missing something of the mystic number, eight or nine, or whatever he may deem the number of hours' sleep essential to health.

It is important that the overwrought business or professional man realize the importance of undertaking no more than he can accomplish without fret and worry; the importance of taking proper vacations before he is tired out; the importance of learning to divert his mind, while he can still do so, into channels other than those connected with his business; above all, the importance of cultivating the faculty of relaxing, and of dismissing doubts, indecisions and fears. He must cultivate what my colleague Dr. Paul succinctly terms "the art of living with yourself as you are." If he would "last out" he must learn to proceed with single mind upon whatever work he undertakes, and with equal singleness of mind apply himself, out of hours, to other occupation or diversion, preferably in the open air. For the most effective work, as well as for peace of mind, it is essential that every thought of one's office be shut out by other interests when there is no actual business requiring attention. Mental relaxation is materially hampered by such persistent thoughts of one's place of business as those cited by Dr. Knapp:

"A striking instance of the sort was related to me by a friend remarkably free from any psychopathic taint. It often happens that he does scientific work in the evening at the Agassiz Museum. When he leaves for the night he puts out the gas and then stands and counts slowly up to a given number until his eyes are used to the darkness, in order that he may detect any spark of fire that may have started while he was at work. This is his invariable custom, but it sometimes happens that when he goes back home so strong a feeling of doubt comes over him lest he may that once have omitted to do this, that he is uncomfortable until he returns to the museum to make sure."

Among the predisposing causes for nervous breakdown none is more potent than the inability of the obsessive to adapt himself to change of plan, and to reconcile himself to criticism, opposition, and the various annoyances incident to his occupation.

In dealing with others the following suggestion of Marcus Aurelius may come in play:

"When a man has done thee any wrong, immediately consider with what opinion about good or evil he has done wrong. For when thou hast seen this, thou wilt pity him, and neither wonder nor be angry." Again, in this connection the lines of Cowper are pertinent:

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