In which we learn what "nerves" are not, and get a hint of what they are
THE DRAMA OF NERVES
An Exploded Theory
"Nerves" not Nerves. Pick up any newspaper, turn over a few pages, and you will be sure to come to an advertisement something like this:
Tired man, your nerves are sick!
They need rest and a tonic to restore
their worn-out depleted cells!
No wonder people have believed this kind of thing. It has been dinned into their ears for many years. They have read it with their breakfast coffee and gazed at it in the street cars and even heard it from their family physicians, until it has become part and parcel of their thinking; yet all the time the fundamental idea has been false, and now, at last, the theory is exploded.
So far as the modern laboratory can discover, the nerves of the most confirmed neurotic are perfectly healthy. They are not starved, nor depleted, nor exhausted; the fat-sheath is not wanting, there is no inflammation, there is nothing lacking in the cell itself, and there is no accumulation of fatigue products. Paradoxical as it may sound, there is nothing the matter with a nervous person's nerves. The faithful messengers have borne the blame for so long that their name has gotten itself woven into the very language as symbolic of disease. When we speak of nervous prostration, neurasthenia, neuroses, nervousness, and "nerves" we mean that body and mind are behaving badly because of functional disorder. These terms are good enough as figures of speech, so long as we are not fooled by them; but accepting them in their literal sense has been a costly procedure.
Thanks to the investigations of physiologist and psychologist, usually combined in the person of a physician, "nervousness" has been found to be not an organic disease but a functional one. This is a very important distinction, for an organic disease implies impairment of the tissues of the organ, while a functional disorder means only a disturbance of its action. In a purely nervous disorder there seems to be no trouble with what the nerves and organs are, but only with what they do; it is behavior and not tissue that is at fault.
Of course, in real life, things are seldom as clear-cut as they are in books, and so it happens that often there is a combination of organic and functional disease that is puzzling even to a skilled diagnostician. The first essential is a diagnosis as to whether it be an organic disease, with accompanying nervous symptoms, or a functional disturbance complicated by some minor organic trouble. If the main cause is organic, only physical means can cure it, but if the trouble is functional, no amount of medicine or surgery, diet or rest, will touch it; yet the symptoms are so similar and the dividing line is so elusive, that great skill is sometimes required to determine whether a given symptom points to a disturbance of physical tissue or only to behavior.
If the physician is sometimes fooled, how much more the sufferer himself! Nausea from a healthy stomach is just as sickening as nausea from a diseased one. A fainting-spell is equally uncomfortable, whether it come from an impaired heart or simply from one that is behaving badly for the moment. It must be remembered that in functional nervousness the trouble is very real. The organs are really "acting up." Sometimes it is the brain that misbehaves instead of the stomach or heart. In that case it often reports all kinds of pains that have no origin outside of the brain. Pain, of course, is perceived only by the brain. Cut the telegraph wire, the nerve, and no amount of injury to the finger can cause pain. It is equally true that a misbehaving brain can report sensations that have no external cause, that have not come in through the regular channel along the nerve. The pain feels just the same, is every bit as uncomfortable as though its cause were external.
Sometimes, instead of reporting false pains, the brain misbehaves in other ways. It seems to lose its power to decide, to concentrate, or to remember. Then the patient is almost sure to fancy himself going insane. But insanity is a physical disease, implying changes or toxins in the brain cells. Functional disorders tell another story. Their cause is different, even though the picture they present is often a close copy of an organic disease.
Distorted Pictures. It should not be thought, however, that the symptoms of functional and organic troubles are identical. Hysteria and neurasthenia closely simulate every imaginable physical disease, but they do not exactly parallel any one of them. It may take a skilled eye to discover the differences, but differences there are. Functional troubles usually show a near-picture of organic disease, with just enough contradictory or inconsistent features to furnish a clue as to their real nature. For this reason it is important that the treatment of the disease be solely the province of the physician; for only the carefully trained in all the requirements of diagnosis can differentiate the pseudo from the real, the innocuous from the disastrous.
False or nervous neuritis may feel like real neuritis (the result of poisons in the blood), but it gives itself away when it localizes itself in parts of the body where there is no nerve trunk. The exhaustion of neurasthenia sometimes seems extreme enough to be the result of a dangerous physical condition; but when this exhaustion disappears as if by magic under the proper kind of treatment, we know that the trouble cannot be in the body. Let it be said, then, with all the emphasis we can command, "nerves" are not physical. Laboratory investigation, contradictory symptoms, and response to treatment all bear witness to this fact. Whatever symptoms of disturbance there may be in pure nervousness, the nerves and organs can in no way be shown to be diseased.
The Positive Side
"Nerves" not Imaginary. "But," some one says, "how can healthy organs misbehave in this way? Something must be wrong. There must be some cause. If 'nerves' are not physical, what are they? They surely can't be imaginary." Most emphatically, they are real; nothing could be more maddening than to have some one suggest that our troubles are "mere imagination." No wonder such theories have been more popular with the patient's family than with the patient himself. Many years ago a physician put the whole truth into a few words: "The patient says, 'I cannot'; his friends say, 'He will not'; the doctor says, 'He cannot will.'" He tries, but in the circumstances he really cannot.
The Man behind the Body. The trouble is real; the organs do "act up"; the nerves do carry the wrong messages. But the nerves are merely telegraph wires. They are not responsible for the messages that are given them to carry. Behind the wires is the operator, the man higher up, and upon him the responsibility falls. In functional troubles the body is working in a perfectly normal way, considering the perverted conditions. It is doing its work well, doing just what it is told, obeying its master. The troubles are not with the bodily machine but with the master. The man behind the body is in trouble and he really has no way of showing his pain except through his body. The trouble in nervous disorders is in the personality, the soul, the realm of ideas, and that is not your body, but you. Loss of appetite may mean either that the powers of the physical organism are busily engaged in combating some poison circulating in the blood, or that the ego is "up against" conditions for which it has "no stomach." Paralysis may be due to a hemorrhage into the brain tissues from a diseased blood vessel, or it may symbolize a sense of inadequacy and defeat. Exaggerated exhaustion, halting feet, stammering tongue, may give evidence of a disturbed ego rather than of a diseased brain.
All Body and no Mind.
At last we have begun to realize what we ought to have known all along,—that the body is not the whole man. The medical world for a long time has been in danger of forgetting or ignoring psychic suffering, while it has devoted itself to the treatment of physical disease.
By way of condoning this fault it must be recognized that the five years of medical school have been all too short to learn what is needed of physiology and anatomy, histology, bacteriology, and the various other physical sciences. But at last the medical schools are realizing that they have been sending their graduates out only half-prepared—conversant with only one half of a patient, leaving them to fend for themselves in discovering the ways of the other half. Many an M.D. has gone a long way in this exploration. Native common sense, intuition, and careful study have enabled him to go beyond what he had learned in his text-books. But in the best universities the present-day student of medicine is now being given an insight into the ways of man as a whole—mind as well as body. The movement can hardly proceed too rapidly, and when it has had time to reach its goal, the day of the long-term sentence to nervousness will be past.
In the meanwhile most physicians, lacking such knowledge and with the eye fixed largely on the body, have been pumping out the stomach, prescribing lengthy rest-cures, trying massage, diet, electricity, and surgical operations, in a vain attempt to cure a disease of the personality. Physical measures have been given a good trial, but few would contend that they have succeeded. Sometimes the patient has recovered—in time—but often, apparently, despite the treatment rather than because of it. Sometimes, in the hands of a man like Dr. S. Weir Mitchell, results seem good, until we realize that the same measures are ineffective when tried by other men, and that, after all, what has counted most has been the personality of the physician rather than his physical treatment.
No wonder that most doctors have disliked nervous cases. To a man trained in all the exactness of the physical sciences, the apparent lawlessness and irresponsibility of the psychic side of the personality is especially repugnant. He is impatient of what he fails to comprehend.
All Mind and no Body.
This unsympathetic attitude, often only half conscious on the part of the regular practitioners, has led many thousands of people to follow will-o'-the-wisp cults, which pay no attention to the findings of science, but which emphasize a realization of man's spiritual nature. Many of these cults, founded largely on untruth or half-falsehood, have succeeded in cases where careful science has failed. Despite fearful blunders and execrable lack of discrimination in attempting to cure all the ills that flesh is heir to by methods that apply only to functional troubles, ignorant enthusiasts and quacks have sometimes cured nervous troubles where the conscientious medical man has had to acknowledge defeat.
The Whole Man.
But thinking people are not willing to desert science for cults that ignore the existence of these physical bodies. If they have found it unsatisfactory to be treated as if they were all body, they have also been unwilling to be treated as if they were all mind. They have been in a dilemma between two half-truths, even if they have not realized the dilemma. It has remained for modern psychotherapy to strike the balance—to treat the whole man. Solidly planted on the rock of the physical sciences, with its laboratories, physiological and psychological, and with a long record of investigation and treatment of pathological cases, it resembles the mind cure of earlier days or the assertions of Christian Science about as much as modern medicine resembles the old bloodletting, leeching practices of our forefathers.
For the last quarter-century there have been scattered groups of physicians,—brilliant, patient pioneers,—who, recognizing man as spirit inhabiting body, have explored the realm of man's mind and charted its paths. These pioneers, beginning with Charcot, have been men of acknowledged scientific training and spirit, whose word must be respected and whose success in treating functional troubles stands out in sharp contrast to the fumblings of the average practitioner in this field. The results of their work have been positive, not negative. They have not merely asserted that nervous disorders are not physical; they have discovered what the trouble is and have found it to be discoverable and removable in almost every case, provided only that the right method is used.
Ourselves and Our Bodies.
If the statement that "nervous troubles are neither physical nor imaginary but a disease of the personality," sounds rather mystifying to the average person, it is only because the average person is not very conversant with his own inner life. We shall hope, later on, to find some definite guide-posts and landmarks which will help us feel more at home in this fascinating realm. At present, we are not attempting anything more than a suggestion of the itinerary which we shall follow. A book on physical hygiene can presuppose at least a rudimentary knowledge of heart and lungs and circulation, but a book on mental hygiene must begin at the beginning, and even before the beginning must clear away misconceptions and make clear certain fundamental principles. But the gist of the whole matter is this: in a neurosis, certain forces of the personality—instincts and their accompanying emotions—which ought to work harmoniously, having become tangled up with some erroneous ideas, have lost their power of coöperation and are working at cross purposes, leaving the individual mis-adapted to his environment, the prey of all sorts of mental and physical disturbances.
The fact that the cause is mental while the result is often physical, should cause no surprise. In the physiological realm we are used to the idea that cause and effect are often widely separated. A headache may be caused by faulty eyes, or it may result from trouble in the intestines. In the same way, we should not be too much surprised if the cause of nervous troubles is found to be even more remote, provided there is some connecting link between cause and effect. The difficulty in this case is the apparent gulf between the realm of the spirit and the realm of the body. It is hard to see how an intangible thing like a thought can produce a pain in the arm or nausea in the stomach. Philosophers are still arguing concerning the nature of the relation between mind and body, but no one denies that the closest relation does exist. Every year science is learning that ideas count and that they count physically, as well as spiritually.
Such Stuff as "Nerves" are Made Of.
Dr. Tom A. Williams in the little composite volume "Psychotherapeutics" says that the neuroses are based not on inherently weak nervous constitutions but on ignorance and on false ideas. What, then, are some of these erroneous ideas, these misconceptions, that cause so much trouble? We shall want to examine them more carefully in later chapters, but we might glance now at a few examples of these popular bugaboos that need to be slain by the sword of cold, hard fact.
Popular Misconceptions about the Body.
1 "Eight hours' sleep is essential to health. All insomnia is dangerous and is incompatible with health. Nervous insomnia leads to shattered nerves and ultimately to insanity."
2 "Overwork leads to nervous breakdown. Fatigue accumulates from day to day and necessitates a long rest for recuperation."
3 "A carefully planned diet is essential to health, especially for the nervous person. A variety of food, eaten at the same time, is harmful. Acid and milk—for example, oranges and milk—are difficult to digest. Sour stomach is a sign of indigestion."
4 "Modern life is so strenuous that our nerves cannot stand the strain."
5 "Brain work is very fatiguing. It causes brain-fag and exhaustion."
6 "Constipation is at the root of most physical ailments and is caused by eating the wrong kind of food."
Some of these misconceptions are household words and are so all but universally believed that the thought that they can be challenged is enough to bewilder one. However, it is ideas like this that furnish the material out of which many a nervous trouble is made. Based on a half-knowledge of the human body, on logical conclusions from faulty premises, on hastily swallowed notions passed on from one person to another, they tend by the very power of an idea to work themselves out to fulfilment.
The Power Behind Ideas
Ideas are not the lifeless things they may appear. They are not merely intellectual property that can be locked up and ignored at will, nor are they playthings that can be taken up or discarded according to the caprice of the moment. Ideas work themselves into the very fiber of our being. They are part of us and they do things. If they are true, in line with things as they are, they do things that are for our good, but if they are false, we often discover that they have an altogether unsuspected power for harm and are capable of astonishing results, results which have no apparent relation to the ideas responsible for them and which are, therefore, laid to physical causes. Thinking straight, then, becomes a hygienic as well as a moral duty.
Ideas and Emotions.
Ideas do not depend upon themselves for their driving-power. Life is not a cold intellectual process; it is a vivid experience, vibrant with feeling and emotion. It therefore happens that the experiences of life tend to bring ideas and emotions together and when an idea and an emotion get linked up together, they tend to stay together, especially if the emotion be intense or the experience is often repeated.
The word emotion means outgoing motion, discharging force. This force is like live steam. An emotion is the driving part of an instinct. It is the dynamic force, the electric current which supplies the power for every thought and every action of a human life.
Man is not a passive creature. The words that describe him are not passive words. Indeed, it is almost impossible to think about man at all except in terms of desire, impulse, purpose, action, energy. There are three things that may be done with energy: First, it may be frittered away, allowed to leak, to escape. Secondly, it may be locked up; this results usually in an explosion, a finding of destructive outlets. Finally, it may be harnessed, controlled, used in beneficent ways. Health and happiness depend upon which one of the three courses is taken.
Character and Health
Evidently, it is highly important to have a working knowledge of these emotions and instincts; important to know enough about them and their purpose to handle them rightly if they do not spontaneously work together for our best character and health. The problems of character and the problems of health so overlap that it is impossible to write a book about nervous disorders which does not at the same time deal with the principles of character-formation. The laws and mechanisms which govern the everyday life of the normal person are the same laws and mechanisms which make the nervous person ill. As Boris Sidis puts it, "The pathological is the normal out of place." The person who is master of himself, working together as a harmonious whole, is stronger in every way than the person whose forces are divided. Given a little self-knowledge, the nervous invalid often becomes one of the most successful members of society,—to use the word successful in the best sense.
It Pays to Know. To be educated is to have the right idea and the right emotion in the right place. To be sure, some people have so well learned the secret of poise that they do not have to study the why nor the how. Intuition often far outruns knowledge. It would be foolish indeed to suggest that only the person versed in psychological lore is skilled in the art of living. Psychology is not life; it can make no claim to furnish the motive nor the power for successful living, for it is not faith, nor hope, nor love; but it tries to point the way and to help us fulfil conditions. There is no more reason why the average man should be unaware of the instincts or the subconscious mind, than that he should be ignorant of germs or of the need of fresh air.
If it be argued that character and health are both inherently by-products of self-forgetful service, rather than of painstaking thought, we answer that this is true, but that there can be no self-forgetting when things have gone too far wrong. At such times it pays to look in, if we can do it intelligently, in order that we may the sooner get our eyes off ourselves and look out. The pursuit of self-knowledge is not a pleasurable pastime but simply a valuable means to an end.
Knowing Our Machine
Counting on Ourselves.
Knowing our machine makes us better able to handle it. For, after all, each of us is, in many ways, very like a piece of marvelous and complicated machinery. For one thing, our minds, as well as our bodies, are subject to uniform laws upon which we can depend. We are not creatures of chaos; under certain conditions we can count on ourselves. Freedom does not mean freedom from the reign of law. It means that, to a certain extent, we can make use of the laws. Psychic laws are as susceptible to investigation, verification, and use as are any laws in the physical world. Each person is so much the center of his own life that it is very easy for him to fall into the way of thinking that he is different from all the rest of the world. It is a healthful experience for him to realize that every person he meets is made on the same principles, impelled by the same forces, and fighting much the same fight. Since the laws of the mental world are uniform, we can count on them as aids toward understanding other people and understanding ourselves.
"Intelligent Scrutiny versus Morbid Introspection."
It helps wonderfully to be able to look at ourselves in an objective, impersonal way. We are likely to be overcome by emotion, or swept by vague longings which seem to have no meaning and which, just because they are bound up so closely with our own ego, are not looked at but are merely felt. Unknown forces are within us, pulling us this way and that, until sometimes we who should be masters are helpless slaves. One great help toward mastery and one long step toward serenity is a working-knowledge of the causes and an impersonal interest in the phenomena going on within. Introspection is a morbid, emotional fixation on self, until it takes on this quality of objectivity. What Cabot calls the "sin of impersonality" is a grievous sin when directed toward another person, but most of us could stand a good deal of ingrowing impersonality without any harm.
The fact that the human machine can run itself without a hitch in the majority of cases is witness to its inherent tendency toward health. People were living and living well through all the centuries before the science of psychology was formulated. But not with all people do things run so smoothly. There were demoniacs in Bible times and neurotics in the Middle Ages, as there are nervous invalids and half-well people to-day. Psychology has a real contribution to make, and in recent years its lessons have been put into language which the average man can understand.
Psychology is not merely interested in abstract terms with long names. It is no longer absorbed merely in states of consciousness taken separately and analyzed abstractly. The newer functional psychology is increasingly interested in the study of real persons, their purposes and interests, what they feel and value, and how they may learn to realize their highest aspirations. It is about ordinary people, as they think and act, in the kitchen, on the street cars, at the bargain-counter, people in crowds and alone, mothers and their babies, little children at play, young girls with their lovers, and all the rest of human life. It is the science of you, and as such it can hardly help being interesting.
While psychology deals with such topics as the subconscious mind, the instincts, the laws of habit, and association of ideas and suggestion, it is after all not so much an academic as a practical question. These forces govern the thought you are thinking at this moment, the way you will feel a half-hour from now, the mood you will be in to-morrow, the friends you will make and the profession you will choose, besides having a large share in the health or ill-health of your body in the meantime.
Perhaps it would be well before going farther to summarize what we have been saying. Here in a nutshell is the kernel of the subject:
Disease may be caused by physical or by psychic forces. A "nervous" disorder is not a physical but a psychic disease. It is caused not by lack of energy but by misdirected energy; not by overwork or nerve-depletion, but by misconception, emotional conflict, repressed instincts, and buried memories. Seventy-five per cent. of all cases of ill-health are due to psychic causes, to disjointed thinking rather than to a disjointed spine. Wherefore, let us learn to think right.
In outline form, the trouble in a neurosis may be stated something like this:
Lack of adaptation to the social environment—caused by
Lack of harmony within the personality—caused by
Misdirected energy—caused by
Inappropriate emotions—caused by
Wrong ideas or ignorance.
Working backward, the cure naturally would be:
Right ideas—resulting in
Appropriate emotions—resulting in
Redirected energy—resulting in
Readjustment to the environment.
If the reader is beginning to feel somewhat bewildered by these general statements, let him take heart. So far we have tried merely to suggest the outline of the whole problem, but we shall in the future be more specific. Nervous troubles, which seem so simple, are really involved with the whole mechanism of mental life and can in no way be understood except as these mechanisms are understood. We have hinted at some of the causes of "nerves," but we cannot give a real explanation until we explain the forces behind them. These forces may at first seem a bit abstract, or a bit remote from the main theme, but each is essential to the story of nerves and to the understanding of the more practical chapters in Part III.
As in a Bernard Shaw play, the preface may be the most important part of this "drama of nerves." Nor is the figure too far-fetched, because, strange as it may seem, every neurosis is in essence a drama. It has its conflict, its villain, and its victim, its love-story, its practical joke, its climax, and its denouement. Sometimes the play goes on forever with no solution, but sometimes psychotherapy steps in as the fairy god-mother, to release the victim, outwit the villain, and bring about the live-happily-ever-after ending.