TREATMENT OF THE INDIVIDUAL CASES
It is obvious that what is largely a problem of the times cannot be
wholly considered as an individual problem. Yet individual cases do
yield to treatment (to use the slang of medicine) or at least a large
proportion do. The minor cases in point of symptoms are very frequently
the most stubborn, since neither the patient nor the family are willing
to concede that to alter the life situation is as important as the
taking of medicine.
Most housewives are nervous, both in their own eyes and in those of
their husbands, yet rightly they are not regarded as sick. They are
uncomfortable, even unhappy, and the way out seems impossible to find. I
believe that even with things as they are, adjustments are possible that
can help the average woman. It is conceded that where the life situation
involves an unalterable factor, relief or help may be unobtainable.
It is necessary first of all to rule out physical disease. To do this
means a thorough physical study. By doing this a considerable number of
women will be immensely helped. Flat feet, varicose veins, injuries to
the organs of generation, eye strain, relaxed gastro-intestinal tract,
and the major diseases,--these must be remembered as factors that may
determine nervousness.
With this question settled, let us assume that there is no such
difficulty or it has been remedied, and we have next to consider the
life situation of the patient. Here we enter into a difficult place,
where knowledge of life and understanding of men and women, as well as
tact, are the essentials.
It is necessary to remedy whatever bad hygienic habits exist. A rich
woman may have settled down to a deënergizing life, with too much time
in bed, too many matinées, too many late nights, too many bonbons, etc.
Aside from the psychical injuries that such a life produces, it is bad
for "the nerves" in its effects upon digestion, bodily tone, and the
sources of mood. On some simple detail of life, some unfortunate habit,
the whole structure of misery may rest.
I always keep in mind an incident of some years ago when I lived in a
small town in Massachusetts. For some reason our furnace threw coal gas
into the house in such a way as nearly to poison us. The landlord sent
several plumbers down, and one after the other suggested drastic
remedies,--a new chimney, a new furnace, etc. Finally the landlord and I
investigated for ourselves. At the bottom of the chimney we found an
inconspicuous loose brick which allowed air to enter the chimney beneath
the entrance of the pipe from the stove. We got ten cents' worth of lime
and fastened the brick in firmly. A complete cure, where the specialists
had failed.
So there often exists some drain on the energy and strength of the woman
which may be simple and easily changed, and yet is critical in its
significance and importance.
An overdomestic woman may stick too closely to the house; an
underdomestic one may go too often to movies and suffer the fatigue of
mind and body that comes from over-indulgence in this most popular
indoor sport. Carelessness about the eating and the care of the bowel
functions may have started a vicious chain of things leading through
irritability and fatigue into neurasthenia. We say human beings are all
the same, but the range of individual susceptibility to trouble is such
that a difficulty not important to most people will raise havoc with
others who are in most ways perfectly normal.
Look then for the bad hygiene! Look for the evils of the sedentary life
Look for the root of the trouble in lack of exercise, poor habits of
eating, insufficient air, disturbed sleep! Search for physical
difficulties before inquiring into the psychical life.
If poverty exists, then one may inquire into the amount of work done,
the character of the home, the opportunities for recreation and
recuperation. All or any of the factors I have mentioned in previous
chapters may be critical, and the moil and turmoil of a crowded tenement
home may be responsible. That such conditions do not break all women
down does not prove that they do not break _some_ women down, women with
finer sensibilities, or lesser endurance (which often go together). The
most depressing problems are met among the poor, the cases where one can
see no way out because the social machinery is inadequate to care for
its victims.
What is one to do when one meets a poor woman with three or four or
more children, living in a crowded way, overworked, racked in her nerves
by her fears, worries, and the disagreeable in her life, drudging from
morning till night, yearning for better things, despairing of getting
them, tormented by desires and ambitions that must be thwarted? "What
right has a poor woman anyway to desires above her station, and why does
not she resign herself to her lot?" ask the comfortable. Unfortunately
philosophy and resignation are difficult even for philosophers and
saints, and much more so for the aspiring woman. And our American
civilization preaches "Strive, Strive!" too constantly for much
philosophy and resignation of an effective kind to be found.
One must give tonics, prescribe rest, try to get social agencies
interested, obtain vacations and convalescent care, etc. Can one purge a
woman of futile longings and strivings, rid her of natural fears and
even of absurd fears? It can be done to a limited degree, if the patient
has intelligence and if one gives liberally of one's time and sympathy.
But unfortunately the consulting room for the poor is in the crowded
clinic, the thronged dispensary, and how is the overworked physician to
give the time and energy necessary?
For the time required is the least requirement. To deal adequately with
the neurasthenic is to have unending sympathy and patience and an energy
that is limitless. Without such energy or endurance the physician either
slumps to a prescriber of tonics and sedatives, a dispenser of such
stale advice as "Don't worry" and "You need a rest", or else himself
gives out.
In dealing with the cases in the better-to-do and the rich, one has more
weapons in the armamentarium. The worry is more futile here, more
ridiculous, and one can attack it vigorously. Usually it is not overwork
in these cases; it is monotony, boredom, discontent with something or
other, a vicious circle of depressing thoughts and emotions, some
difficulty in the sex life, some reaction against the husband, a
rebellion of a weak, futile kind against life, maladjustment of a
temperament to a situation.
Some difficulties, even when ascertained and clearly understood, are
insurmountable. "The truth shall make ye free" is true only in the very
largest sense. Some temperaments are inborn, and are as unchangeable as
the nose on one's face. In such cases the ordinary physical therapeutics
help the acute symptoms that flare up now and then, and that is as much
as one may expect.
But it is certain that in the majority of cases more than this may be
accomplished. It is often a great surprise and relief to a woman to
realize that her overconscientiousness, her fussiness, her rebellion,
and discontent, her reaction to something or other is back of her
symptoms. She has feared disease of the brain, tumor, insanity, or has
blamed her trouble on some other definite physical basis.
If one deals with intelligence, explanation helps a great deal. The
intelligent usually want to be convinced; they do not ask for miracles,
they seek counsel as well as treatment.
It is my firm belief that the function of intelligence is to control
instinct and emotion, and that temperament, if inborn, is not
unchangeable, even at maturity. Once you convince a person that his or
her symptoms are due to fear, worry, doubt, and rebellion you enlist the
personal efforts to change.
A new philosophy of life must be presented. Less fussiness, less fear,
more endurance, less reaction to the trifles of their life are
necessary. The aimless drifter must be given a central purpose or taught
to seek one; the dissatisfied and impatient must be asked, "Why should
life give you all you want?" "What cannot be remedied must be endured!"
What a wealth of wisdom in the proverb! One seeks to establish an ideal
of fortitude, of patience, of fidelity to duty,--old-fashioned words,
but serenity of spirit is their meaning. Suddenly to come face to face
with one's self, to strip away the self-imposed disguise, to see clearly
that jealousy, impatience, luxurious, and never satisfied tastes, a
selfish and restless spirit, are back of ennui and fatigue, pains and
aches of body and mind, is to step into a true self-understanding.
If a situation demands action, even drastic action, "surgical" action,
then that action must be forthcoming, even though it hurts. To end
doubt, perplexity, to cease being buffeted between hither and yon, is to
end an intolerable life situation. I have in mind certain domestic
situations, such as the effort to keep up in appearance and activity
with those of more means and ability.
Sexual difficulties, so important and so common, demand the coöperation
of the husband for remedy. He should be seen (for usually the wife
consults the physician alone) and the situation gone over with him. Men
are usually willing to help, willing to seek a way out. A neurasthenic
wife is a sore trial to the patience and endurance of her husband and he
is anxious enough to help cure her.
Where there is conflict of other kinds the situation is complicated by
the intricacy of the factors. Financial difficulties especially wear
down the patience and endurance of the partners, and the physician
cannot prescribe a golden cure. In prosperous times there is less
neurasthenia than in the unprosperous, just as there is less suicide.
Sometimes it is just one thing, one difficulty, over which the conflict
rages. I have in mind two such cases, where one habit of the husband
deënergized his wife by outraging her pride and love. When he was
induced to yield on this point the wife came back to herself,--a highly
strung, very efficient self.
In fact, the basis of treatment is the painstaking study of the
individual woman and then the painstaking _adjustment_ of that
individual woman. It may mean the adjustment of the whole life
situation to that housewife, or conversely the adjustment of the
housewife to the life situation.
In many marital difficulties that one sees, not so much in practice as
in contact with normal married couples, the trouble reminds one of the
orang-outang in Kipling's story who had "too much Ego in his Cosmos."
Marriage, to be successful, is based on a graceful recession of the ego
in the cosmos of each of the partners. The prime difficulty is this;
people do not like to recede the ego. And the worst offenders are the
ones who are determined to stand up for the right, which usually is a
disguised way of naming their desire.
One might speak of a thousand and one things that every man and every
woman knows. One might speak of the death of love and the growth of
irritation, the disappearance of sympathy,--these are the hopeless
situations. But far more common and important, though less tragic, is
the disappearance of the little attentions, the little love-making, the
disappearance of good manners. Men are not the only or the worst
offenders in this; the nervous housewife is very apt to be the scold
and the nag. Perhaps the neurasthenia of the husband arises from his
revolt against the incessant demands of his wife, but that's another
story.
At any rate, there is what seems to be a cardinal point of difference
between men and women, perhaps arising from some essential difference in
make-up, perhaps in part due to difference in training. An essential
need of the average American-trained woman is sympathy, constantly
expressed, constantly manifested. The average man tends to become
matter-of-fact, the average woman finds in matter-of-factness the death
of love. She acts as if she believed that the little acts of love and
sympathy are the more important as manifesting the real state of
feeling, that the major duties were of less importance.
On this point most men and women never seem to agree. The man gets
impatient over the constant demand for his attention. He thinks it
unreasonable and childish. Intent upon his own struggle he is apt to
think her affairs are minor matters. He thinks his wife makes mountains
out of molehills and lacks a sense of proportion. He forgets that the
devotion of the husband is the woman's anchor to windward, her grip on
safety,--that his success and struggle are hers only in so far as he and
she are intimate and lover-like. And women, even those who trust their
husbands absolutely so far as physical loyalty goes, jealously watch
them for the appearance of boredom, or lack of interest, for the falling
off of the lover's spirit and feeling.
After marriage the rivalry of men expresses itself in business more than
in love. Even where a woman does not fear another woman as a rival she
fears the rivalry of business,--and with reason. So she craves
attention, sympathy, as well as the dull love of everyday life. She
ought to have it; it is her recompense for her lot, for her married
life, her smaller interests. Now and then some great man intent upon a
great work has some excuse for absorption in that work; for the great
majority of men there is no such excuse. Their own affairs are also
minor and are no more important than those of their wives. Fair play
demands that the women they have immured in a home have a prior claim to
their company, in at least the majority of the leisure hours. If in the
time to come the home alters and a woman who continues to work marries
a man who works, and they meet only at night, then it will be ethical
for each to go his or her way. Marriage at present must mean the giving
up of freedom for the man as well as for the woman, in the interests of
justice and the race.
In medicine we prescribe bitter tonics which have the property of
increasing appetite and vigor. For the husband of every woman there is
this bit of advice; sympathy and attention constitute a sweet tonic,
which if judiciously administered is of incomparable power and
efficiency.