_ERRONEOUS NOTIONS._
It will be readily conceded that in order to treat nervous disease
successfully, we must have some special qualifications for our task. We
need not only learning, but experience and powers of ready observation.
Indeed, mere learning will avail us little in a still undiscovered
country, or in one where the observations of our predecessors have been
so frequently and unavoidably erroneous. But if it be true that all
disease is in a sense nervous disease--an affection of the nerves of
some particular part of the organism--the importance of the study of
neurasthenia cannot be overrated, provided that we study it from Nature,
and do not rely wholly on prevalent teaching concerning the mode of
treatment required.
Mr. Francis Galton, in his able work, “Natural Inheritance,” shows that
tendencies to certain maladies may lie latent in families tainted with
them in the past, and that, on the other hand, these may be increased in
severity by inheritance, and may even bring the family to an end. With
some complaints the rule would seem to be that they are either very
largely inherited by the offspring or not at all. Making some allowance
for difference in circumstance and mode of life of a given generation,
it will be found that where the nervous system has been strengthened,
the family malady has been successfully defied, and that where it has
been enfeebled, the enemy has made his appearance. As regards
consumption especially, it would be easy to give a large number of cases
in point. In the early stages of this terrible malady, when the enemy
had already effected an entrance and was clearly recognised by
physicians, I have known him to be summarily expelled, not by treating
the disease itself, not by sending the patient to warm climates, but by
adopting the very methods which are so effectual in neurasthenia.
Bracing air, frequent nourishment, cold water to the neck and spine,
mild tonics continued for a length of time, and freedom from worry--in
some cases massage and electricity also,--these are the true remedies so
long as remedies are of any use at all. I have known instances where
such a _régime_ has entirely banished the hereditary evil, and the
patient has resumed an ordinary existence.
Almost too much stress has recently been laid on the necessity for moral
treatment of the neurasthenic. Though it is impossible to lay too much
stress on the importance of good surroundings, the term “moral
treatment” has come to be employed in a wrong sense. Doctors and nurses
usually mean by it (not always) keeping the patient in order, making her
forget herself, rousing her, and--too often--irritating her; whereas
good moral treatment should before all things mean gentleness,
cheerfulness, patience, the encouragement of the growth of the patient’s
will--not the enforcement of abject submission to the will of somebody
else,--total freedom from all noise, fatigue, and irritation, and the
constant presence of an improving influence and example. Special
attention must be called to this latter point. Jean Paul Richter tells
us:--
“The first rule to be observed by any one who will give something is,
that he must himself have it.”
In other words, it is useless to attempt to light the fire with an
unlighted match.
Now, the notion that a woman less refined, less highly educated than the
patient, and originally of inferior mental and moral endowment, is to be
permitted to thwart and control her, is one that must, and does, work an
incalculable amount of harm. It is not by saying, “Be unselfish,” “Don’t
think of your ailments,” “Be self-controlled,” &c., that we can do any
good to a suffering invalid. If we have not built up our own
organisations--our characters--impression by impression, in the path of
right reason and true sanity, so that we can benefit others by our
unconscious influence, we had far better let the neurasthenic alone.
I have, moreover, come across neurasthenic patients who were far more
fitted to teach me endurance and sweet temper than I was to teach them.
Even in cases where we justly lament the absence of these virtues, we
should consider what strength of mind it must require to refrain from
irritability of temper, from yielding to constant pain and fatigue, and
from sinking into a state of complete inactivity. The efforts of
neurasthenics in this latter direction are often mistaken; Nature is
indicating the pressing need of rest; but we must nevertheless admire
the vigour of at least one portion of their nervous systems, though
realising that the health of the whole organism should not be sacrificed
to the demands of that one portion. Looking at the matter in this light,
we feel our self-righteousness to be misplaced, and our ready
interference to be an impertinence.
A patient suffering from neurasthenia was once lying ill at a small
nursing home, undergoing massage. A visitor at the house inquired of its
owner, a trained nurse, what ailed the lady.
“Oh, there’s nothing the matter with her,” replied the trained attendant
glibly. “She is only a little odd.”
What a vista of ignorance was opened up by this remark! How could a
patient who was ill enough to be subjected to the _Weir Mitchell_
treatment have nothing the matter with her, unless indeed she had simply
been condemned to imprisonment for the sake of the loaves and fishes she
would thereby be forced to dispense?
Two nurses at a hospital were once puzzling over the case of a
neurasthenic woman then under treatment there. They were perplexed, with
reason, because the woman appeared to be in pain, although the harsh
medical verdict was to the effect that she had no disease. They were
nice, kindly women, and were sorry for the patient. So they found a
middle course between the rival evidences by coming to the conclusion
that, though there was nothing the matter with her, her pains were “real
to her,” and they ought to treat her with gentleness. All I can say is,
if I ever get ill, may I be nursed by those two women. There is
something genuinely heroic about people who refuse to follow powerful
superiors to do evil.
Nevertheless, though their resolution was right and praiseworthy, their
conclusion was wrong. If we are unduly conscious of any part of our
bodies, that part is not in a healthy state. Wherever there is pain,
there is disintegration--disease, and because the medical advisers in
this instance could not find the disease, it by no means followed that
it was not there. “The fact is, we know very little about nerves,” said
a medical man the other day. His candour merits our respect. To say that
a patient can fancy pain is absurd. Pain is but a condition of the
nerves. If it is not there, we cannot feel it. It is objected that, if
we take a patient’s thoughts off her aches and pains, she ceases to feel
them, consequently the pain must be imaginary. But if we cut a finger
while in a state of excitement, we feel no pain. Not because the pain is
there and we are unconscious of it, but that while nervous energy is
diverted into another channel, there can be no pain. Read the account
of the burning of the martyrs of Valenciennes at the time of the Spanish
persecution in the Netherlands.[5] Those brave people were in a state of
ecstasy in which pain was impossible. If there is one thing certain in
past history, it is that they suffered absolutely nothing. The
contemporary evidence on the subject is overwhelming.
But, as far as the neurasthenic are concerned, the practice of taking
their attention off their pains has its dangers. The process is apt to
be fatiguing, so that the patients only have more pain as soon as the
distraction ceases. This fact is very exasperating to the more ignorant
of their attendants. “She was well enough as long as she was thinking of
something else,” the disappointed folks will tell you with an aggrieved
air. One woman, possessing many good qualities, informed me that what
such patients wanted was a “thrashing.” This nurse was a _masseuse_ in
the habit of “Weir Mitchelling” patients. Without supposing that her
views ever took a practical form, their existence could hardly conduce
to a kindly consideration for suffering invalids.
One very favourite notion about the nervous is, that they ought not to
be sympathised with. If any one will try this treatment for a little
while himself, even in health, he will find it necessary to fly pretty
quickly to people possessing natural human feeling, in order to avoid
drifting into permanent lunacy. In disease the danger is still greater.
I have always found that when I sympathised cordially with real causes
of distress, and simply disregarded unmistakably simulated ones, the
simulated ones died a natural death without more ado.
But which symptoms are real and which are simulated? Here the tough or
toughened organisation is usually hopelessly at sea. Here no information
will enlighten, no rules will guide. If we are by nature incapable of
making simple observations correctly, we had better give the whole thing
up and go into another line of business. Even the so-called simulated
symptoms are in a sense real symptoms of a morbid condition of brain;
so, however good observers we may be, if we have not the wisdom and the
patience to deal with these wisely and gently, we are still
disqualified. “But nervous patients are so trying!” Why, of course they
are. “Trying” is not the word. They are sometimes maddening. And nurses
who are overworked, which they ought not to be, will be saints if they
always contrive to keep their temper with them. We must remember,
however, that lunatics and delirious people are trying also, and why
should it be criminal to mismanage one kind of nervous disorder and not
another?
I was once travelling in a railway carriage in France. The stuffiness of
the place was poisonous, and I ventured to lower one of the windows a
few inches. Instantly a French gentleman, seated opposite to me, well
out of the draught, reared himself up and descended upon me with
indignation and with a positive sense of injury. He could not stand the
cold. Why had I opened the window? He must really be permitted to shut
it.
An English gentleman explained that we wished for air. The Frenchman was
amazed.
“It surely cannot hurt you,” he said, with violent gesticulation, “to
have the windows shut. But I, when they are open, I _suffer_.”
It would have been impossible to convince him of the fact that I
suffered when the window was shut as much as he did when it was open.
Some of our nurses are very like this French gentleman. Let the patient
have a cold, and they are quite pleased for her to put her feet in
mustard and water. Let her have a shattered nervous system, and nine out
of ten of them feel injured if they are told to stop their chatter. I
have known women who were in many respects capable nurses rendered
useless, as far as nervous patients were concerned, by the erroneous
notions with which they had been impregnated. One nurse told me
seriously that the proper way to manage a nervous invalid was to make
her afraid of you. She had had no personal experience in the matter, and
the little prattling monkey was hardly likely to inspire much terror;
but that was what she had been taught.
Doctors, too, sometimes indulge in whimsical ideas about these cases. A
nurse, who had recently “Weir Mitchelled” a neurasthenic patient, told
me that the lady, like many others suffering from disorder of the
medulla, had a difficulty in swallowing, and could not take the pills
that were ordered for her. I inquired what happened. She replied that
the doctor, evidently impressed with the belief that the difficulty was
all sham, insisted that she should get those pills down somehow. It was
done. But the nurse informed me that, in the effort, the poor lady
swallowed a whole bottle of water every day, and it was very bad for
her.
A gentleman once asked me if I knew what Beau Brummell was then employed
in doing in the other world. Much surprised at the question, I replied
that I could not imagine.
“Eating raw onions with a steel knife,” he said solemnly. “By and bye,
he will get to cabbage. For a long time he will be allowed no other
food.”
On this principle, what will happen to that doctor who made a sick
person swallow a whole bottle of water daily? But perhaps Beau Brummell
is not suffering merely for having spoken contemptuously of the
“creature” who ate cabbage, but for his indifference to the needs of
others throughout his life. As to the doctor, let us hope he will be
able to show a counterbalancing array of kind actions as a set-off
against his misdemeanour, and so escape penance.
After all, it requires little skill to find fault. The thing is to do
better. Unfortunately, it is just those medical men who have recognised
nervous exhaustion and done their best to treat it who, in the nature of
things, have made the most blunders and have been most blamed. This was
inevitable. It is by failure that we learn. There is all the more need
to draw attention to our failures and to point the moral. We have often
tried hard to treat the person and not the disease; we have even tried
to treat the disease and not the person. We must accustom ourselves to
attacking the enemy on all sides at once. We must realise that not only
the food that we eat and the air we breathe act upon the nervous system,
but every impression conveyed to it through our senses. We may think it
is of little consequence whether we say certain words to a patient or
not. We think they will soon be forgotten, or the damage done by them be
repaired. But no impression on anything in nature can be done away, not
even the impression of the faintest particle of light. The whole
universe throughout eternity is altered by our uttering one sentence or
leaving it unsaid.
Supposing we put a photographic plate into the camera and expose it,
then take it to the dark room and look at it. Can we see any change?
None whatever. But immerse it in the developing solution, and the change
it has undergone becomes apparent,--there is a picture on our plate. If
we take it out into the light without first fixing it, the picture fades
away. Is the plate therefore the same as it was before we took our
picture? No, it is entirely different, and nothing in the world can ever
restore the film on the plate precisely to its former condition.
In like manner outer impressions are every moment altering our nervous
structure, and life’s clock cannot be put back.