NERVOUS DISEASE
Just as with regard to insanity, there is a very common impression
that religion increases the amount of nervous disease in the world and
is responsible for a great deal of what has been called hysteria. Not
a few who think they have a right to an opinion in this matter, and
some of them are physicians--though usually they are rather young--are
quite ready to assert that religion is a fruitful source of nervous
symptoms and very often of rather serious nervous conditions. We saw
in the chapter on Insanity how false is the prevalent impression as to
religion producing tendencies to insanity, though of course a great
many insane people have religious delusions. It is very much the same
with nervous diseases. Many nervous people pay a certain amount of
attention to religion, and not a few of them cling to straws of hope
that they may be able to overcome their neurotic tendencies by
superficial attention to prayer or to some practices of religion which
they seem to look upon about in the same light as patent medicines
recommended for the cure of nervous diseases. People who are deeply
religious, however, very seldom suffer from nervous affections, and
they have in their religion the most beneficent of helpful resources,
if by nature, that is, by heredity or unfortunate development, they
have neurotic tendencies.
{218}
So far from religion increasing nervous disease, then, it has exactly
the opposite effect. We have a number of testimonies to this purport
from prominent neurologists, many of whom were themselves not
believers in religion but who recognized its influence for good over
others. Such expressions are to be found in the writings of men of
every nationality. Not infrequently, in spite of their own religious
affiliations, they acknowledge what a profound influence certain forms
of religion have over certain people. These testimonies have been
multiplying in our medical literature in recent years, because
apparently physicians have come to appreciate by contrast the
influence for good of religion over some of their patients, since they
see so many sufferers from nervous diseases who have not this source
of consolation to which to recur.
In America we have a number of such testimonies. In his "Self Help for
Nervous Women", Doctor John K. Mitchell of Philadelphia, who may be
taken to represent in this matter the Philadelphia School of
Neurologists, to which his father lent such distinction, said:
"It is certainly true that considering as examples two such
separated forms of religious belief as the Orthodox Jews and the
strict Roman Catholics, one does not see as many patients from them
as might be expected from their numbers, especially when it is
remembered that Jews as a whole are very nervous people and that the
Roman Catholic includes in this country among its members numbers of
the most emotional race in the world.
"Of only one sect can I recall no example. It is not in my memory
that a professing Quaker ever came into my hands to be treated for
nervousness. If the opinion I have already stated so often is
correct, namely that {219} want of control of the emotions and the
overexpression of the feelings are prime causes of nervousness, then
the fact that discipline of the emotions is a lesson early and
constantly taught by the Friends would help to account for the
infrequency of this disorder among them and adds emphasis to the
belief in such a causation."
In writing a "Textbook of Psychotherapy" [Footnote 8] eight years
ago one of the appendices was devoted to the relations between
religion and psychotherapy. One of the paragraphs, written for
physicians, and I may say that it has been read by many thousands of
them, puts my own opinion on the dual subject of the nexus between
religion, insanity and nervous disease, as succinctly as I can hope to
put it. There is no doubt that an abiding sense of religion does much
for people in the midst of their ailments and, above all, keeps them
from developing those symptoms due to nervous worry and solicitude
which so often are more annoying to the patient than the actual
sufferings he or she may have to bear. While religion is often said to
predispose to certain mental troubles, it is now well appreciated by
psychiatrists that it is not religion that has the tendency to disturb
the mind, but a disequilibrated mind has the tendency to exaggerate
out of all reason its interest in anything that it takes up seriously.
Whether the object of the attention be business, or pleasure, or
sexuality, or religion, the unbalanced mind pays too much attention to
it, becomes too exclusively occupied with it, and this overindulgence
helps to form a vicious circle of unfavorable influence.
[Footnote 8: Appleton.]
While many people in their insanity, then, show exaggerated interest
in religion, this is only like other {220} exaggerated interests of
the disequilibrated, and religion itself is not the cause but only a
coincidence in the matter.
Some who are interested particularly in this subject, on reading this
will at once revert to the fact that scruples are extremely common
among the religiously inclined and that these are, after all, as a
rule, only nervous symptoms which are surely fostered by religion. To
say this, however, is to misapprehend the real meaning of scruples.
The word is a very old one and means a little sharp stone, as if in
trying to make progress the scrupulous found themselves hindered by
having to walk over little sharp stones which so disturbed them that
they were hampered in getting on. Above all, scruples put them into a
state of mind where they hesitate as to whether they can go on at all
or not.
The subject of scruples was very thoroughly worked out and carefully
described by the older spiritual writers centuries ago. They wrote
elaborate treatises on it, while it was not until our own time that
physicians by their careful study of corresponding conditions entirely
apart from religion came to appreciate that these conditions of the
spiritual life were only expressions of a rather common set of
tendencies altogether independent of religion. They are prone to
develop in people with certain physical and mental characteristics who
are possessed of dispositions and nervous systems particularly likely
to be the subject of these hesitancies and doubts and difficulties for
which there is very little basis in actuality.
The whole chapter of phobias and the other chapter on obsessions and
the third on what the French call _la folie du doute_, the doubting
mania in our modern textbooks of neurology, are really so many
chapters in the {221} literature of scruples of the old time, now
transferred to the textbooks on functional nervous diseases. Some
nervous people who are religiously inclined get into a very disturbed
state of mind from the fear that they may commit sin almost unknown to
themselves or that they may be in sin unawaredly and cut off from
their Creator, and they become extremely miserable as a consequence.
This is, after all, a very familiar picture to the neurologist
accustomed to see patients suffering from functional nervous diseases.
I have patients who suffer quite as much from the dread of dirt as
these scrupulous people do from the dread of sin. Women often suffer
from this dread of dirt--misophobia is the scientific name derived
from the Greek--to an exaggerated degree. A woman patient of mine
makes it extremely uncomfortable for the conductors on the street cars
because, for fear of contaminating her hands, she dreads to touch the
handle bars by which she could mount or descend easily. This adds
greatly to the risks she takes every time she boards a car. She is
constantly washing her hands to get the dirt off, so that in cold
weather she sets up severe skin irritations and makes herself very
uncomfortable. I have a male patient who would not touch the handle of
my door for the world, and whom successive maids have come to know
very well because he stands outside the outer door and has to have
that as well as the inner door opened for him. He has said to me over
and over again, "Doctor, don't ask me to shake hands with you, because
you shake hands with so many people." I have seen him standing outside
of a large department store with the temperature around zero, waiting
for some one to open the door so that he might slip in without
touching it. Nor are such states {222} of mind confined to the
uneducated; on the contrary, they are commonest among those who have a
good education and are quite sensible in other things.
Obsessions were originally described as super-religious states of mind
in which some idea assumed a terrorizing character. The victims of
them dread that they might commit some awful crime and as a
consequence were profoundly miserable. Instead of being confined to
religion, such mental states are quite common in conditions altogether
apart from religious feelings. Women read of a mother killing her
child in some awful way or perhaps accidentally poisoning it or
burning it badly with some escharotic external application. They
become obsessed with the idea that they may do something of this kind
and fear that they may not be able to resist the suggestion. Medical
literature is full of such cases. A typical case is described by Tangi
in his textbook on insanity:
"A young married woman suffered from nervous exhaustion after her
first childbirth. She watched day by day her husband cutting up meat
for his parrots with a pair of scissors, and the action filled her
with disgust which later increased to positive horror. Thus a
repulsive obsession was produced and this in turn engendered the
morbid suggestion to cut the tongue of her dearly loved child in the
same way. The fear that she would not be able to resist this
suggestion made the suggestion more vivid and the idea more
imperative, causing an agonizing struggle each time."
Then there are accounts, some of them most poignant, from Catholic
patients of my own, who were sure that sometime while in the midst of
their devotions or even at the very reception of the sacraments they
would {223} blaspheme. They are people who fear that every pious act
of theirs may just expose them to the risk of committing some awful
sacrilege.
Almost needless to say such states have nothing at all to do with
religion, and when similar conditions occur among the religious
minded, they must be attributed to the general neurotic condition and
not to the incidental religious tendencies. The doubting mania occurs
among the religious minded when they keep on fearing that they have
not done something that they should do. Some of these individuals get
into a profoundly miserable and disturbed state of mind, but that must
not be blamed on religion.
This sad state of mind in people who have no religion at all is
extremely familiar to the neurologist, and it has no necessary
connection with religious practice or religious belief. I have a
patient who has been coming to me for many years now from a city in
the Middle West; he is a broker, and every time there is a panic in
the money market I am almost sure to see him. Whenever he gets very
much disturbed over business matters, as is likely to happen in panic
times, he develops a very striking _folie du doute_, or doubting
mania. He will take a letter to a post box and go back three or four
times, first to see if by chance he did not drop it on the way,
secondly to be sure that it did not get caught in the slot; then, if
the letter is important, he will go back to see if perchance there may
not be some bolts or other obstructions at the top of the box that may
catch it and delay its collection. I have even known him to wait for
some time at the post box to see if the postman might not possibly
drop it when he came to collect the mail. But then he does other
things just as foolish. Occasionally he will {224} get home from his
office and suddenly have the feeling that he forgot to lock his safe.
He will go back and then get part way up town when he is overcome by
the fear that he may not have locked the door after him as he came
out. At times when his _folie du doute_ is at its worst, he has been
known to go back three or four times to close windows or for some
other trivial reason. When he is in reasonably good condition there is
very little of this state of mind manifest, but he can make himself
supremely miserable when the obsession is on him.
It is often said that the declaration by the Church of the idea of
possession by the devil rather encouraged the development of certain
mental and nervous states and thus fostered neurotic manifestations of
many kinds. This whole question of the possibility of direct diabolic
influence over mankind, that is, of some evil spirit deeply
influencing certain human beings, is yet a matter that is not nearly
so settled as a great many physicians who have not been following
scientific work in allied lines seem to think. So distinguished a
scientist as Alfred Russel Wallace, the co-discoverer with Darwin of
the theory of natural selection, had the feeling that spirits
interfered much more in human affairs than a great many people were
willing to admit, and that the evil spirits probably could, under
certain circumstances, deeply affect individuals. Professor Barrett of
Trinity College, Dublin, is even more outspoken in what he has to say
in this regard, and now there is a very general feeling among those
who have investigated spiritistic phenomena most carefully that if
spirits do actually communicate directly with men, it is commonly not
the spirits who claim to do the communicating who are actually
present. Almost needless to say any such conclusion as this would,
{225} if maintained, throw even scientists back to the old idea of
diabolism, which the Church, on the strength of many centuries of
experience, still teaches.
One thing is perfectly sure: that if overzeal on the part of certain
ecclesiastics rather encouraged neurotic manifestations because of the
alluringly suggestive quality of the thought of diabolic possession,
they did no more than physicians did in more modern times by their
suggestive methods in the study of hysteria. A great French
neurologist of to-day has pointed out that major hysteria as studied
by French neurologists of a generation ago has practically
disappeared, or occurs very rarely in our day because it is no longer
unconsciously suggested to patients by physicians that these major
symptoms are being looked for. Overzeal in medicine raised up a whole
series of symptoms that had no existence except in the heated
imagination of their patients under the influence of strong
suggestion.
Another extremely interesting phase of this subject is that in the old
days many of the sensible ecclesiastics and some of the civil
authorities came to recognize that people supposed to be possessed of
evil spirits could be cured of their condition not infrequently by
roundly whipping them. Sir Thomas More particularly called attention
to how much good could be effected in this way. In writing an article
on "Psychoneurosis and the War" (International Clinics, Volume II,
Series 29) I called attention to this in a paragraph that may be
helpful in the understanding of the discussion of diabolic influence.
It has been the custom for many years now, indeed for more than a
generation, to think that the old-fashioned methods of treating many
of the psychoneuroses by {226} punishment and the infliction of pain
were founded on an entirely wrong principle. Sir Thomas More, for
instance, tells the story of a number of folk in his time who suffered
from rather serious complaints; some of them were dumb and some deaf,
and some thought they could not see, and others could not walk. He
says that some people considered them possessed of the devil, and that
it was the presence of this very undesirable spirit that hampered
their activities in various ways and made it impossible for them to
use their powers properly. The description of the cases makes it very
clear that he is referring to hysterical conditions of various kinds
and the sequel as to the successful treatment which he says was
frequently employed on them more than confirms the inference of
hysteria and demonstrates the very definite hysterical character of
the affection. Many a physician down through the ages has been
inclined to think that these people were possessed of a bad spirit of
some kind, even though he might not be quite ready to think that a
personal devil had taken hold of them and was seriously hampering
their functions. We recognize that the real trouble is with their own
spirit, to which may be applied whatever epithets come to mind, and no
one will think them exaggerations; this spirit has lost its control of
their activities, rendering them incapable of exercising their
functions properly.
There is a very widespread tradition, which has found its way into
medical literature especially, that the fervent practice of religion
in women has a very definite tendency to make them neurotic.
Particularly when religious devotion is associated with mortification
and fasting, it is supposed to be serious in its effects. It is the
custom to make references to such pious women as St. Catherine {227}
of Siena and St. Theresa of Spain as typically exemplifying this
neuroticizing tendency.
Any one who really knows the lives of either of these women will not
be likely to think that they were neurotic in any proper sense of that
word at all. Both of them were not weak but had immensely strong
characters, veritable towers of strength in supremely difficult times,
supporting not only their own heavy burdens but helping others around
them to bear theirs. Of Catherine of Siena, Swinburne, the English
poet, surely not a sanctimonious person, whose sentimentality might
lead to admiration for the hysterical bizarre, but who had studied her
career because so many incidents in her life have been the subject of
great paintings by a number of the greatest painters of Italy, said:
"Then in her sacred saving hands
She took the sorrows of the lands,
With maiden palms she lifted up
The sick time's blood-embittered cup,
And in her virgin garment furled
The faint limbs of a wounded world.
Clothed with calm love and clear desire.
She went forth in her soul's attire,
A missive fire."
The great hospital at Siena was rebuilt in honor of Catherine shortly
after her death because of the fact that she had spent many years of
her comparatively brief life there; she died at thirty-two in personal
service of all kinds to the patients suffering from every manner of
disease, even leprosy, who were in the institution. (The lepers were
housed apart from the others.) She placated so many feuds among the
noble families of Siena, feuds that were the cause of as many murders
as the worst {228} of our own in Kentucky, that she was asked to be
the envoy of peace when cities were at war, and it was she who
eventually by her influence brought the Popes back from Avignon to
Rome and thus put an end to the great disorders in the Italian
peninsula.
St. Theresa, the great Spanish mystic of the sixteenth century, the
other "horrible example," held up even by some neurologists, of
hysterical tendencies due to religion and mortification, proves, when
studied in real life, to have been at least as great and strong a
character as Catherine of Siena. She well deserves the name of saint
as a leader in unselfishness, but besides she had a fine sense of
humor. That is what neurotic people lack above all--a sense of humor.
All sorts of distinguished men in the Spain of her time--and in the
sixteenth century Spain was by far the greatest country in Europe, her
sovereigns ruling most of Europe and the greater part of America, and
the nation gave birth to great art, literature, architecture and
philosophy--turned to consult St. Theresa in their difficulties. She
wrote a series of books that have been republished in every cultured
language in Europe at least once a century ever since, and our own
generation has been sedulous in the study of Theresa's writings. No
less than a dozen lives of her have been written in English in the
twentieth century. This Spanish lady who died three hundred and fifty
years ago is still a very living force in the world.
Owing to the special conditions under which much of my work is
accomplished, I am brought in contact with a great many religious
women every year. For some twenty years I have spent some days each
summer with groups of religious communities where large numbers were
assembled for special intellectual and spiritual work. The {229}
mother superior has often consulted me with regard to some of her
daughters who had special nervous manifestations, but it is a
never-ending source of surprise to find how few of them suffer from
the nervous symptoms so common in our time. Considering the fact that
they spend their lives very largely indoors, that they live on very
simple food--and sometimes I have been inclined to think with scarcely
enough nor sufficient variety to make them capable of the amount and
demanding nature of work they have to do--fewer of them suffer from
nervous symptoms or affections than women of the same class who are
living at home and on whom the demands are not nearly so strenuous.
Their religious duties, instead of being in any way a drain on their
nerve force, though I have often heard it said that teachers ought not
to be required to give quite so much time to their religious duties,
represent a reservoir of energy from which they draw strength and
above all placidity of mind and consequent power to accomplish more
than would otherwise be the case.
My duties often bring me into contact with numbers of sisters during
their hours of recreation, so-called, and I do not think that I have
ever seen a happier, heartier group of people than they make during
these periods of relaxation. I have always considered it a privilege
to share recreation after dinner or supper with a dozen sisters when I
am lecturing in one of the smaller towns, and we have often laughed so
heartily together that I have sometimes wondered what the neighbors
would think of us. People with a sense of humor like this are not
likely to have hysterical tendencies. Nervousness is at bottom
selfishness, and there is always a great deal of conceit in it.
Religious women are likely to be humble, and that means much in
keeping them from various magnifications {230} of their ego which so
often result in nervous and mental symptoms.
I have often ventured to say that I was quite sure that a religious
house, especially where there were many young people, in which
laughter came easily and was heard frequently during the times
appropriate for it, was sure to be a place of real spirituality and
happiness. I have often dared to remind them that the one place where
one hears no real laughter, though sometimes sounds are made
resembling it, is an insane asylum. People who are ready to laugh are
usually eminently sane. Above all, they do not take themselves too
seriously. It is taking one's self and one's feelings too seriously
that is the root of a great deal of nervous and mental disturbance in
this little world of ours. Certainly the discipline of heart and mind
and body and the feeling of satisfaction from duty well done that
comes in connection with that complete sacrifice of themselves in a
great religious cause which members of religious orders make, so far
from predisposing them to nervous disease has just exactly the
opposite effect.
Nervous diseases, instead of being fostered or fomented by religion,
are on the contrary repressed rather effectually and equilibrium given
even to those in whom some hereditary elements might have proved
disturbing. This does not mean that all the religious minded are free
from nervous symptoms, and it must not be forgotten that not every one
who says "Lord, Lord," gets into the kingdom of heaven, either on
earth or hereafter, but religion must be counted as an asset and not a
liability in this matter. It will not overcome strong hereditary
tendencies, and it will not help efficaciously those who do not submit
to the discipline that true religious feeling entails, and of {231}
course religion is not a panacea for the ills of mankind, though it
must be counted a therapeutic adjuvant and not a nervous irritant.
Professor Foerster, whom one is tempted to quote because of the
thoroughgoing thoughtfulness of his treatment of many of these
subjects and his wise conservatism founded on that deep consideration,
has discussed the question of repression of self in matters of purity
as a possible source of nervous troubles of various kinds.
Freudianism, as it is called, which has attracted so much attention in
recent years, would seem to suggest the conclusion that a great many
of the nervous symptoms of humanity are due to the repression of sex
impulses. Foerster has pointed out that just the opposite is true, and
that there never was a time when there was so little real
self-repression and also never a time when there was so much
functional nervous disease. He said:
"From this point of view there can be no doubt that the modern
theory of 'living one's nature out' is largely responsible for the
nervous degeneration of to-day, and that the widespread hysteria in
modern life does not spring from those remnants of discipline and
idealism which are still operative amongst us. One is compelled to
ask indeed with astonishment, with what right Freud finds the
dangers of repression so alarming in an age which is conspicuous for
self-indulgence. In reality there has never been an age which was
less influenced by the spirit of abnegation and repression than is
our own. The present age is one of disintegration, in which natural
instincts have largely broken away from their controlling higher
ideals; if, therefore, it suffers to a peculiar degree from
nervousness, one can hardly look for the cause in the fact that it
constitutes a high-water mark of control and {232} discipline. The
precisely opposite conclusion would be nearer the mark."
Professor Foerster admits, however, that it is perfectly possible that
people who have no good motive for self-repression and who suppress
instincts only out of the merest human respect and cowardice as to
results, may very well suffer some of the consequences that Freud has
pointed out. He says:
"There is one point, however, in which one can entirely agree with
Freud, or at any rate allow oneself, through him, to be led to the
recognition of an important psychological and pedagogical truth.
There are to-day certain circles who cling to the old ethical
tradition only through considerations of an outward description, as
the result of a species of timidity which keeps them from breaking
with respectable customs; and yet these people are, at the bottom of
their hearts, believers in a view of life of a totally different
description--one which attaches no value or meaning to self-mastery
and self-denial."
Almost needless to say this obscuration of religious motives with the
result of leaving the individual too much at the mercy of the merely
physical without adequate principles for self-control is not the fault
of religion but of its very opposite--irreligion. Foerster's words are
all-important for the understanding of an important phase of the
discussion of the cause and cure of nervous and psychic symptoms of
various kinds which has attracted much more attention outside of
medical circles than it deserves.
The danger of the absence of religious motives in the world, because
of the persuasion that new discoveries are doing away with the
necessity for faith, has also been emphasized by Professor Foerster,
who said:
{233}
"Along with the disappearance of belief in a spiritual world arises
the danger that even earnest and noble men and women will be
influenced in their consideration of the deeper things of life by
the newest and most tangible facts alone, and will be inaccessible
to all arguments going beyond the scope of mere practical sense and
expediency. It would appear as if the preponderance of an intellect
directed towards external things destroyed not only belief in the
invisible world in a religious sense, but also undermined the power
of grasping the full value and reality of certain _imponderabilia_
in earthly life, and of understanding the deep-growing spiritual
injuries which may proceed from apparently harmless and even
outwardly beneficial things."
{234}