Part 20 (1/2)
The intelligent neurologist, nowadays, has practically no known specific for any form of nervous disease, no remedy which acts directly and curatively upon the nervous system itself. He relies chiefly--and this applies to the asylum physician also--upon intestinal antisepsis, upon rest, upon baths, upon regulation diet, and habits of life.
A number of the more sudden and fatal disturbances of the nervous system, as for instance, the familiar ”stroke of paralysis,” or apoplexy, of later middle life, are due to a defect, not in the nervous system at all, but in the blood-vessels supplying the brain; rupture of a vessel, and consequent escape of blood, destroys so much of the surrounding brain-tissue as to produce paralysis, and, in extreme cases, death. Just why the blood-vessels of the brain in general, and of one part of the basal ganglia in particular (the _Lenticulostriate_ artery in the internal capsule of the _corpus striatum_, the old jaw ganglion), are so liable to rupture we do not know; but it certainly is chiefly from a defect of the blood-vessels, and not of the brain. All of which brings us to the following important practical conclusions.
First of all, that every attack or touch, however light, of ”nervousness,” ”nerves,” ”imagination,” ”neurasthenia,” yes, hysteria, _means_ something. It is the cry of protest of a smaller or larger part of the nervous system against underfed blood, under-ventilated muscles, lack of sunlight, lack of exercise, lack of sleep, excess of work, or bad habits. In other words, it is the danger signal, the red light showing the open switch, and we will disregard it at our peril.
Unfortunately, by that power of _esprit de corps_ of the entire system, known as ”pluck” or ”grit,” or the veto-power, physiologically termed inhibition, we may ignore and for a time suppress the symptom, but this in the long run is just as rational as cutting the wire that rings a fire alarm, or blowing out the red light without closing the switch.
Nervousness is a _symptom_ which should always have _something done for it_, especially in children. In fact, it has pa.s.sed into an axiom both with intelligent teachers and with physicians who have much to do with the little ones, that crossness, fretfulness, laziness, lack of initiative, and readiness to weep, in children, are almost invariably the signs of physical disease. And this doctrine will apply to a considerable percentage of children of larger growth.
Unfortunately, one of the first and most decided tendencies on the part of the badly fed or poisoned nervous system, is to exaggerate the difficulties of the situation, and to minimize its good features. The individual ”has lost his nerve,” is afraid to undertake things, shrinks from responsibility, exaggerates the difficulties that may be in the way; hence the floods of tears, or outbursts of temper, with which nervous children will greet the suggestion of any task or duty, however trifling. If the nervous individual has reached that stage of maturity when she realizes that she is not merely ”naughty,” but sick, then this same process applies itself to her disease. She is sure that she is going to die, that another attack like that will end in paralysis; as a patient of mine once expressed it to me, ”My heart jumps up in my mouth, I bite a couple of pieces off it, and it falls back again.” In short, she so obviously and grossly exaggerates every symptom and phase of her disease, that the impression irresistibly arises that the disease itself is a fabrication. This view of her condition by her family or her physician is the tragedy of the neurasthenic.
Broadly speaking, _no_ disease, even of the nervous system, is ever purely imaginary. Some part of the patient's nervous system is poisoned, or he would not imagine himself to be sick. We can all of us find trouble enough in some part of our complex bodily machinery, if we go around hunting for it; but this is precisely what the healthy man, or woman, _never_ does. They have other things to occupy them, and are far more liable to run into danger by pus.h.i.+ng ahead at full steam, and neglecting small creakings and jarrings until something important in the gear jams, or goes snap, and brings them to a halt, than they are to be wasting time and energy worrying over things that may never happen.
Worry, in fact, is a sign of disease instead of a cause. To put it very crudely, whenever the blood and fluids of a body become impoverished below a certain degree, or become loaded with fatigue poisons, or other waste products above a certain point, then the nervous system proceeds to make itself felt. Either the perceptive end-organs become color-blind and read yellow for blue, or are astigmatic and report oval for round; or the conducting nerve-strands tangle up the messages, or deliver them to the wrong centre; or the central clearing-house, puzzled by the crooked messages, loses its head, and begins to throw the inkstands about, or goes down in a sulk. In other words, the nervous system goes on a strike. But it is perfectly idle to endeavor to treat it with cheering words, or kindly meant falsehoods, to the effect that ”nothing is really the matter.” Like any other strike, it can be rationally dealt with only by improving the conditions under which the operatives have to work, and meeting their demands for higher wages, or shorter hours.
We were accustomed at one time to divide diseases into two great cla.s.ses, organic and functional. By the former, we meant those in which there was some positive defect of structure, which could be recognized by the eye or the microscope; by the latter, those diseases in which this could not be discovered, in which, so to speak, the machine was all right, but simply wouldn't work. It goes without saying that the latter cla.s.s was simply a confession of our ignorance, and one which is steadily and rapidly diminis.h.i.+ng as science progresses.
If the machine won't work, there is a reason for it somewhere, and our business is to find it out, and not loftily to a.s.sure our patients that there is nothing much the matter, and all they need is rest, or a little cheerful occupation. Furthermore, the most inane thing that a sympathizing friend or kindly physician can do to a neurasthenic, is to advise him to take his mind off himself or his symptoms. The utter inability to do that very thing is one of the chief symptoms of the disease, which will not disappear until the underlying cause has been carefully studied out and removed.
”Nerves,” ”neurasthenia,” ”psychasthenia,” and ”hysteria,” are all the names of _symptoms_ of _definite bodily disease_. The modern physician regards it as his duty to study out and discover the nature of this disease, and, if possible, remove it, rather than to give high-sounding, soul-satisfying names to the symptoms, and advise the patient to ”cheer up”; which advice costs nothing--and is worth just what it costs.
”But,” some one will say at once, ”if nervous diseases are simply the reflection of general bodily states, as sanitary conditions improve under civilization, should they not become less frequent? And yet, any newspaper will tell you that nervous diseases are rapidly on the increase.” This is a widespread belief, not only on the part of the public, but of many scientists and a considerable number of physicians; but it is, I believe, unfounded.
In the first place, we have no reliable statistical basis for a positive statement, either one way or another. Our ignorance of the precise prevalence of disease in savagery, in barbarism, and even under civilization up to fifty years ago, is absolute and profound. It is only since 1840 that vital statistics of any value, except as to gross deaths and births, began to be kept. So far as we are able to judge from our study of savage tribes by the explorer, the army surgeon, and the medical missionary, the savage nervous system is far less well balanced and adjustable than that of civilized man. Hysteria, instead of occurring only in individual instances, attacks whole villages and tribes. In fact, the average savage lives in a state alternating between nave and childish self-satisfaction and panic-stricken terror, with their resultant cowardice and cruelty on the one hand, and unbridled l.u.s.t and delusions of grandeur on the other. The much-vaunted strain of civilization upon the nervous system is not one-fifth that of savagery.
Think of living in a state when any night might see your village raided, your hut burned, yourself killed or tortured at the stake, and your wife and children carried into slavery. Read the old hymns and see how devoutly thankful our pious ancestors _were every day_ at finding themselves alive in the morning,--”Safely through another night,”--and fancy the nerve-strain of never knowing, when you lay down to sleep, whether some one of the djinns, or voodoos, or vampires would swoop down upon you before morning. Think of facing death by famine every winter, by drought or cyclone every summer, and by open war or secret scalp-raid every month in the year; and then say that the racking nerve-strain of the commuter's time-table, the deadly clash of the wheat-pit, or the rasping grind of office-hours, would be ruinous to the uncivilized nervous system. Certainly, in those belated savages, the dwellers in our slums, hysteria, diseases of the imagination, enjoyment of ill health, and the whole brood of functional nervous disturbances are just as common as they are on Fifth Avenue.
It is not even certain that insanity is increasing. Insanity is quite common among savages; just how common is difficult to say, on account of their peculiar methods of treating it. The stupid and the dangerous forms are very apt to be simply knocked on the head, while the more harmless and fantastic varieties are turned into priests and prophets and become the founders of the earlier religions. A somewhat similar state of affairs of course prevailed among civilized races up to within the last three-quarters of a century. The idiot and the harmless lunatic were permitted to run at large, and the latter, as court and village fools, furnished no small part of popular entertainment, since organized into vaudeville. Only the dangerous or violent maniacs were actually shut up; consequently, the number of insane in a community a century ago refers solely to this cla.s.s. Hence, in every country where statistics have been kept, as larger and larger percentages of these unfortunates have been gathered into hospitals, where they can be kindly cared for and intelligently treated, the number of the registered insane has steadily increased up to a certain point. This was reached some fifteen years ago in Great Britain, in Germany, in Sweden, and in other countries which have taken the lead in asylum reform, and has remained practically stationary since, at the comparatively low rate of from two to three per thousand living. This limit shows signs of having been reached in the United States already; and this gradual increase of recognition and registration is the only basis for the alleged increase of insanity under modern conditions.
It is also a significant fact that the lower and less favorably situated stratum of our population furnishes not only the largest number of inmates, but the largest percentage of insanity in proportion to their numbers, while the most highly educated and highly civilized cla.s.ses furnish the lowest. Immigrants furnish nearly three times as many inmates per thousand to our American asylums as the native born.
It is, however, true that in each succeeding census a steadily increasing number and percentage of the deaths is attributed to diseases of the nervous system. This, however, does not yet exceed fifteen or twenty per cent of the whole, which would be, so to speak, the natural probable percentage of deaths due to failure of one of the five great systems of the body: the digestive, the respiratory, the circulatory, the glandular, the nervous. Two elements may certainly be counted upon as contributing in very large degree to this apparent increase. One is the enormous saving of life which has been accomplished by sanitation and medical progress during the first five years of life, infant mortality having been reduced in many instances fifty to sixty per cent, thus of course leaving a larger number of individuals to die later in life by the diseases especially of the blood-vessels, kidneys, and nervous system, which are most apt to occur after middle life. The other is the great increase in medical knowledge, resulting in the more accurate discovery of the causes of death, and a more correct reporting and cla.s.sifying of the same.
In short, a careful review of all the facts available to date leads us decidedly to the conclusion that the nervous system is the toughest and most resisting tissue of the body, and that its highest function, the mind, has the greatest stability of any of our bodily powers. Only one man in six dies of disease of the nervous system, as contrasted with nearly one in three from diseases of the lungs; and only one individual in four hundred becomes insane, as contrasted with from three to ten times that number whose digestive systems, whose locomotor apparatus, whose heart and blood-vessels become hopelessly deranged without actually killing them.
CHAPTER XIX
MENTAL INFLUENCE IN DISEASE, OR HOW THE MIND AFFECTS THE BODY
One of the dearest delusions of man through all the ages has been that his body is under the control of his mind. Even if he didn't quite believe it in his heart of hearts, he has always wanted to. The reason is obvious. The one thing that he felt absolutely sure he could control was his own mind. If he couldn't control that, what could he control?
Ergo, if man could control his mind and his mind could control his body, man is master of his fate. Unfortunately, almost in proportion as he becomes confident of one link in the chain he becomes doubtful of the other. Nowadays he has quite as many qualms of uncertainty as to whether he can control his mind as about the power of his mind over his body. By a strange paradox we are discovering that our most genuine and lasting control over our minds is to be obtained by modifying the conditions of our bodies, while the field in which we modify bodily conditions by mental influence is steadily shrinking.
For centuries we punished the sick in mind, the insane, loading them with chains, shutting them up in prison-cells, starving, yes, even flogging them. We exorcised their demons, we prayed over them, we argued with them,--without the record of a single cure. Now we treat their sick and ailing bodies just as we would any other cla.s.s of chronic patients, with rest, comfortable surroundings, good food, baths, and fresh air, correction of bad habits, gentleness, and kindness, leaving their minds and souls practically without treatment, excepting in so far as ordinary, decent humanity and consideration may be regarded as mental remedies,--and we cure from thirty to fifty per cent, and make all but five per cent comfortable, contented, comparatively happy.
We are still treating the inebriate, the habitual drunkard, as a minor criminal, by mental and moral means--with what hopeful results let the disgraceful records of our police courts testify. We are now treating truancy by the removal of adenoids and the fitting of gla.s.ses; juvenile crime by the establishment of playgrounds; poverty and pauperism by good food, living wages, and decent surroundings; and all for the first time with success.
In short, not only have all our substantial and permanent victories over bodily ills been won by physical means, but a large majority of our successes in mental and moral diseases as well. Yet the obsession persists, and we long to extend the realm of mental treatment in bodily disease.
That the mind does exert an influence over the body, and a powerful one, in both health and disease, is obvious. But what we are apt to forget is that the whole history of the progress of medicine has been a record of diminis.h.i.+ng resort to this power as a means of cure. The measure of our success and of our control over disease has been, and is yet, in exact proportion to the extent to which we can relegate this resource to the background and avoid resorting to it. Instead of mental influence being the newest method of treatment it is the oldest. Two-thirds of the methods of the shaman, the witch-doctor, the medicine-man, were psychic.
Instead of being an untried remedy, it is the most thoroughly tested, most universal, most ubiquitous remedy listed anywhere upon the pages of history, and, it may be frankly stated, in civilized countries, as widely discredited as tested. The proportion to which it survives in the medicine of any race is the measure of that race's barbarism and backwardness. To-day two of the most significant criteria of the measure of enlightenment and of control over disease of either the medical profession of a nation or of an individual physician are the extent to which they resort to and rely upon mental influence and opium.