Title: Outwitting Our Nerves - A Primer of Psychotherapy
Author: Jackson, Josephine A., Salisbury, Helen M.
Language: English
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OUTWITTING OUR
NERVES

A PRIMER OF PSYCHOTHERAPY

BY

JOSEPHINE A. JACKSON, M.D.
HELEN M. SALISBURY

[Illustration]

NEW YORK
THE CENTURY CO.
1922

1921, by
THE CENTURY CO.

PRINTED IN U.S.A.



TO

MARY PATTERSON MANLY

A LOVER OF TRUTH



FOREWORD


"Your trouble is nervous. There is nothing we can cut out and there is
nothing we can give medicine for." With these words a young college
student was dismissed from one of our great diagnostic clinics.

The physician was right. In a nervous disorder there is nothing to cut
out and there is nothing to give medicine for. Nevertheless there is
something to be done,--something which is as definite and scientific
as a prescription or a surgical operation.

Psychotherapy, which is treatment by the mental measures of
psycho-analysis and re-education, is an established procedure in the
scientific world to-day. Nervous disorders are now curable, as has
been proved by the clinical results in scores of cases from civil
life, under treatment by Freud, Janet, Prince, Sidis, DuBois, and
others; and in thousands of cases of war neuroses as reported by Smith
and Pear, Eder, MacCurdy, and other military observers. These army
experts have shown that shell-shock in war is the same as nervousness
in civil life and that both may be cured by psycho-analysis and
re-education.

For more than a decade, in handling nervous cases, I have made use of
the findings of recognized authorities on psychopathology. Truths have
been applied in a special way, with the features of re-education so
emphasized that my home has been called a psychological
boarding-school. As the alumni have gone back to the game of life
with no haunting memories of usual sanatorium methods, but with the
equipment of a fuller self-knowledge and sense of power, they have
sent back a call for some word that shall extend this helpful message
to a larger circle.

There has come, too, a demand for a book which shall give accurate and
up-to-date information to those physicians who are eager for light on
the subject of nervous disorders, and especially for knowledge of the
significant contributions of Sigmund Freud, but who are too busy to
devote time to highly technical volumes outside their own specialties.

This need for a simple, comprehensive presentation of the Freudian
principles I have attempted to meet in this primer of psychotherapy,
providing enough of biological and psychological background to make
them intelligible, and enough application and illustration to make
them useful to the general practitioner or the average layman.

JOSEPHINE A. JACKSON.

Pasadena, California, 1921.



CONTENTS

PART I: THE STRANGE WAYS OF NERVES

CHAPTER I
                                                     PAGE

In which most of us plead guilty to the charge of "nerves."

NERVOUS FOLK      3

CHAPTER II

In which we learn what "nerves" are not and get a hint of
what they are.

THE DRAMA OF NERVES      10


PART II: "HOW THE WHEELS GO ROUND"

CHAPTER III

In which we find a goodly inheritance.

THE STORY OF THE INSTINCTS      33

CHAPTER IV

In which we learn more about ourselves.

THE STORY OF THE INSTINCTS (Continued)      51

CHAPTER V

In which we look below the surface and discover a veritable
wonderland.

THE SUBCONSCIOUS MIND      77

CHAPTER VI

In which we learn why it pays to be cheerful.

BODY AND MIND     118

CHAPTER VII

In which we go to the root of the matter.

THE REAL TROUBLE      141


PART III: THE MASTERY OF "NERVES"

CHAPTER VIII

In which we pick up the clue.

THE WAY OUT      183

CHAPTER IX

In which we discover new stores of energy and relearn the
truth about fatigue.

THAT TIRED FEELING      219

CHAPTER X

In which the ban is lifted.

DIETARY TABOOS      250

CHAPTER XI

In which we learn an old trick.

THE BUGABOO OF CONSTIPATION      278

CHAPTER XII

In which handicaps are dropped.

A WOMAN'S ILLS      300

CHAPTER XIII

In which we lose our dread of night.

THAT INTERESTING INSOMNIA      322

CHAPTER XIV

In which we raise our thresholds.

FEELING OUR FEELINGS      333

CHAPTER XV

In which we learn discrimination.

CHOOSING OUR EMOTIONS      359

CHAPTER XVI

In which we find new use for our steam.

FINDING VENT IN SUBLIMATION      379

GLOSSARY      386

BIBLIOGRAPHY      390

INDEX      393



OUTWITTING OUR NERVES



CHAPTER I

_In Which Most of Us Plead Guilty to the Charge of "Nerves."_

NERVOUS FOLK

WHO'S WHO


Whenever the subject of "nerves" is mentioned most people begin trying
to prove an alibi. The man who is nervous and knows that he is
nervous, realizes that he needs help, but the man who has as yet felt
no lack of stability in himself is quite likely to be impatient with
that whole class of people who are liable to nervous breakdown. It is
therefore well to remind ourselves at once that the line between the
so-called "normal" and the nervous is an exceedingly fine one.
"Nervous invalids and well people are indistinguishable both in theory
and in practice,"[1] and "after all we are most of us more or less
neurasthenic."[2] The fact is that everybody is a possible neurotic.

[Footnote 1: Putnam: _Human Motives_, p. 117.]

[Footnote 2: DuBois: _Physic Treatment of Nervous Disorders_, p. 172.]

So, as we think about nervous folk and begin to recognize our friends
and relatives in this class, it may be that some of us will
unexpectedly find ourselves looking in the mirror. Some of our
lifelong habits may turn out to be nervous tricks. At any rate, it
behooves us to be careful about throwing stones, for most of us live
in houses that are at least part glass.


THE EARMARKS

=Am I "Like Folks"?= Before we begin to talk about the real sufferer
from "nerves," the nervous invalid, let us look for some of the
earmarks that are often found on the supposedly well person. All of
these signs are deviations from the normal and are sure indications of
nervousness. The test question for each individual is this: "Am I
'like folks'?" To be normal and to be well is to be "like folks." Can
the average man stand this or that? If he can, then you are not normal
if you cannot. Do the people around you eat the thing that upsets you?
If they do, ten chances to one your trouble is not a physical
idiosyncrasy, but a nervous habit. In bodily matters, at least, it is
a good thing to be one of the crowd.

Many people who would resent being called anything but normal--in
general--are not at all loth to be thought "different," when it comes
to particulars. Are there not many of us who are at small pains to
hide the fact that we "didn't sleep a wink last night," or that we
"can't stand" a ticking clock or a crowing rooster? We sometimes
consider it a mark of distinction to have a delicate appetite and to
have to choose our food with care. If we are frank with ourselves,
some of us will have to admit that our own ailments seem interesting,
while the other person's ills are "merely nervous" or imaginary or
abnormal. After all, a good many of us will have to plead guilty to
the charge of nervousness.

We have only to read the endless advertisements of cathartics and
"internal baths," or to check up the quantity of laxatives sold at any
drug store, to realize the wide-spread bondage to that great bugaboo
constipation. He who is constipated can hardly prove an alibi to
"nerves." Then there are the school-teachers and others who are worn
out at the end of each year's work, hardly able to hold on until
vacation; and the people who can't manage their tempers; and those who
are upset over trifles; and those who are dissatisfied with life. To a
certain degree, at least, all of these are nervous persons. The list
grows.

=Half-Power Engines.= These people are all supposed to be well. They
keep going--by fits and starts--and as they are used to running on
three cylinders, with frequent stops for repairs, they accept this
rate of living as a matter of course, never realizing that they might
be sixty horse-power engines, instead of their little thirty or forty.
For this large and neglected class of people psychotherapy has a
stimulating message, and for them many of the following pages have
been written.

=The Real Sufferers.= These so-called normal people are merely on the
fringe of nervousness, on the border line between normality and
disease. Beyond them there exists a great company of those whose lives
have been literally wrecked by "nerves." Their work interrupted or
given up for good, their minds harassed by doubts and fears, their
bodies incapacitated, they crowd the sanatoria and the health resorts
in a vain search for health. From New England to Florida they seek,
and on to Colorado and California, and perhaps to Hawaii and the
Orient, thinking by rest and change to pull themselves together and
become whole again. There are thousands of these people--lawyers,
preachers, teachers, mothers, social workers, business and
professional folk of all sorts, the kind of persons the world needs
most--laid off for months or years of treatment, on account of some
kind of nervous disorder.

=Various Types of Nervousness.= The psychoneuroses are of many
forms.[3] To some people "nerves" means nervous prostration,
breakdown, fatigue, weakness, insomnia, the blues, upset stomach, or
unsteady heart,--all signs of so-called neurasthenia or
nerve-weakness. To others the word "nerves" calls up memories of
strange, emotional storms that seem to rise out of nowhere, to sweep
the sky clear of everything else, and to pass as they came, leaving
the victim and the family equally mystified as to their meaning. These
strange alterations of personality are but one manifestation of
hysteria, that myriad-faced disorder which is able to mimic so
successfully the symptoms of almost every known disease, from tumors
and fevers to paralysis and blindness.

[Footnote 3: The technical term for nervousness is
_psycho-neurosis_--disease of the psyche. There are certain "real
neuroses" such as paralysis and spinal-cord disease, which involve an
organic impairment of nerve-tissue. However, as this book deals only
with psychic disturbance, we shall, throughout, use the term
_neuroses_ and _psycho-neuroses_ indiscriminately, to denote nervous
or functional disorders.]

To still other people nervous trouble means fear,--just terrible fear
without object or meaning or reason (anxiety neuroses); or a definite
fear of some harmless object (phobia); or a strange, persistent,
recurrent idea, quite foreign to the personality and beyond the reach
of reason (obsession); or an insistent desire to perform some absurd
act (compulsion); or perhaps, a deadly and pall-like depression (the
blues).

As a matter of fact, the neuroses include all these varieties, and
various shades and combinations of each. There are, however, certain
mental characteristics which recur with surprising regularity in most
of the various phases--dissatisfaction, lack of confidence, a sense of
being alone and shut in to oneself, doubt, anxiety, fear, worry,
self-depreciation, lack of interest in outside affairs, pessimism,
fixed belief in one's powerlessness, along whatever line it may be.

Underneath all these differing forms of nervousness are the same
mechanisms and the same kind of difficulty. To understand one is to
understand all, and to understand normal people as well; for in the
last analysis we are one and all built on the same lines and governed
by the same laws. The only difference is, that, as Jung says, "the
nervous person falls ill of the conflicts with which the well person
battles successfully."


SUMMARY

Since at least seventy-five per cent. of all the people who apply to
physicians for help are nervous patients; and since these thousands of
patients are not among the mental incompetents, but are as a rule
among the highly organized, conscientious folk who have most to
contribute to the leadership of the world, it is obviously of vital
importance to society that its citizens should be taught how to solve
their inner conflicts and keep well. In this strategic period of
reconstruction, the world that is being remodeled cannot afford to
lose one leader because of an unnecessary breakdown.

There is greater need than ever for people who can keep at their tasks
without long enforced rests; people who can think deeply and
continuously without brain-fag; people who can concentrate all their
powers on the work in hand without wasting time or energy on
unnecessary aches and pains; people whose bodies are kept up to the
top notch of vitality by well-digested food, well-slept sleep,
well-forgotten fatigue, and well-used reserve energy. That such a
state of affairs is no Utopian dream, but is merely a matter of
knowing how, will appear more clearly in later chapters.



CHAPTER II

_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 Count.= 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.


SUMMARY

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
      Harmony--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.



PART II: "HOW THE WHEELS GO ROUND"



CHAPTER III

_In which we find a goodly inheritance_

THE STORY OF THE INSTINCTS

EACH IN HIS OWN TONGUE

    A fire mist and a planet,
    A crystal and a cell,
    A jelly-fish and a saurian,
    And caves where cavemen dwell;
    Then a sense of law and beauty,
    And a face turned from the clod;
    Some call it evolution
    And others call it God.[4]


If we begin at the beginning, we have to go back a long way to get our
start, for the roots of our family tree reach back over millions of
years. "In the beginning--God." These first words of the book of
Genesis must be, in spirit at least, the first words of any discussion
of life. We know now, however, that when God made man, He did not
complete His masterpiece at one sitting, but instead devised a plan by
which the onward urge within and the environment without should act
and interact until from countless adaptations a human being was made.

[Footnote 4: William Herbert Carruth.]

As the late Dr. Putnam of Harvard University says, "We stand as the
representative of a Creative Energy that expressed itself first in far
simpler forms of life and finally in the form of human instincts."[5]
And again: "The choices and decisions of the organisms whose lives
prepared the way through eons of time for ours, present themselves to
us as instincts."[6]

[Footnote 5: Putnam: _Human Motives_, p. 32.]

[Footnote 6: Putnam: _Human Motives_, p. 18.]


INTRODUCING THE INSTINCTS

=Back of Our Dispositions.= What is it that makes the baby jump at a
noise? What energizes a man when you tell him he is a liar? What makes
a young girl blush when you look at her, or a youth begin to take
pains with his necktie? What makes men go to war or build tunnels or
found hospitals or make love or save for a home? What makes a woman
slave for her children, or give her life for them if need be?
"Instinct" you say, and rightly. Back of every one of these well-known
human tendencies is a specific instinct or group of instincts. The
story of the life of man and the story of the mind of man must begin
with the instincts. Indeed, any intelligent approach to human life,
whether it be that of the mother, the teacher, the preacher, the
social worker or the neurologist, leads back inevitably to the
instincts as the starting-point of understanding. But what is
instinct?

We are apt to be a bit hazy on that point, as we are on any
fundamental thing with which we intimately live. We reckon on these
instinctive tendencies every hour of the day, but as we are not used
to labeling them, it may help in the very beginning of our discussion
to have a list before our eyes. Here, then, is a list of the
fundamental tendencies of the human race and the emotions which drive
them to fulfilment.

THE SPECIFIC INSTINCTS AND THEIR EMOTIONS (AFTER MCDOUGALL)

_Instinct_             _Emotion_

Nutritive Instinct    Hunger
Flight                Fear
Repulsion             Disgust
Curiosity             Wonder
Self-assertion        Positive Self-feeling (Elation)
Self-abasement        Negative Self-feeling (Subjection)
Gregariousness        Emotion unnamed
Acquisition           Love of Possession
Construction          Emotion unnamed
Pugnacity             Anger
Reproductive Instinct Emotion unnamed
Parental Instinct     Tender Emotion

These are the fundamental tendencies or dispositions with which every
human being is endowed as he comes into the world. Differing in degree
in different individuals, they unite in varying proportions to form
various kinds of dispositions, but are in greater or less degree the
common property of us all.

There flows through the life of every creature a steady stream of
energy. Scientists have not been able to decide on a descriptive term
for this all-important life-force. It has been variously called
"libido," "vital impulse" or "élan vital," "the spirit of life,"
"hormé," and "creative energy." The chief business of this life-force
seems to be the preservation and development of the individual and the
preservation and development of the race. In the service of these two
needs have grown up these habit-reactions which we call instincts. The
first ten of our list belong under the heading of self-preservation
and the last two under that of race-preservation. As hunger is the
most urgent representative of the self-preservative group, and as
reproduction and parental care make up the race-preservative group,
some scientists refer all impulses to the two great instincts of
nutrition and sex, using these words in the widest sense. However, it
will be useful for our purpose to follow McDougall's classification
and to examine individually the various tendencies of the two groups.

=In Debt to Our Ancestors.= An instinct is the result of the
experience of the race, laid in brain and nerve-cells ready for use.
It is a gift from our ancestors, an inheritance from the education of
the age-long line of beings who have gone before. In the struggle for
existence, it has been necessary for the members of the race to feed
themselves, to run away from danger, to fight, to herd together, to
reproduce themselves, to care for their young, and to do various other
things which make for the well-being or preservation of the race. The
individuals that did these things at the right time survived and
passed on to their offspring an inherited tendency to this kind of
reaction. McDougall defines an instinct as "an inherited or innate
psycho-physical disposition which determines its possessor to perceive
or pay attention to objects of a certain class, to experience an
emotional excitement of a particular quality upon perceiving such an
object, and to act in regard to it in a particular manner, or at least
to experience an impulse to such action." This is just what an
instinct is,--an inherited disposition to notice, to feel, and to want
to act in certain ways in certain situations. It is the something
which makes us act when we cannot explain why, the something that goes
deeper than reason, and that links us to all other human
beings,--those who live to-day and those who have gone before.

It is true that East is East and West is West, but the two do meet in
the common foundation of our human nature. The likeness between men
and between races is far greater and far more fundamental than the
differences can ever be.

=Firing Up the Engine.= Purpose is writ large across the face of an
instinct, and that purpose is always toward action. Whenever a
situation arises which demands instantaneous action, the instinct is
the means of securing it. Planted within the creature is a tendency
which makes it perceive and feel and act in the appropriate way. It
will be noticed that there are three distinct parts to the process,
corresponding to intellect, emotion, will. The initial intellectual
part makes us sensitive to certain situations, makes us recognize an
object as meaningful and significant, and waves the flag for the
emotion; the emotion fires up the engine, pulls the levers all over
the body that release its energy and get it ready for action, and
pushes the button that calls into the mind an intense, almost
irresistible desire or impulse to act. Once aroused, the emotion and
the impulse are not to be changed. In man or beast, in savage or
savant, the intense feeling, the marked bodily changes, and the
yearning for action are identical and unchangeable. The brakes can be
put on and the action suppressed, but in that case the end of the
whole process is defeated. Could anything be plainer than that an
instinct and its emotion were never intended to be aroused except in
situations in which their characteristic action is to be desired? An
emotion is the hot part of an instinct and exists solely for securing
action. If all signs of the emotion are to be suppressed, all
expression denied, why the emotion?

But although the emotion and the impulse, once aroused, are beyond
control, there is yet one part of the instinct that is meant to be
controlled. The initial or receptive portion, that which notices a
situation, recognizes it as significant, and sends in the signal for
action, can be trained to discrimination. This is where reason comes
in. If the situation calls for flight, fear is in order; if it calls
for fight, anger is in order; if it calls for examination, wonder is
in order; but if it calls for none of these things, reason should show
some discrimination and refuse to call up the emotion.

=The Right of Way.= There is a law that comes to the aid of reason in
this dilemma and that is the "law of the common path."[7] By this is
meant that man is capable of but one intense emotion at a time. No one
can imagine himself strenuously making love while he is shaken by an
agony of fear, or ravenously eating while he is in a passion of rage.
The stronger emotion gets the right of way, obtains control of mental
and bodily machinery, and leaves no room for opposite states. If the
two emotions are not antagonistic, they may blend together to form a
compound emotion, but if in the nature of the case such a blending is
impossible, the weaker is for the time being forgotten in the
intensity of the stronger. "The expulsive power of a new affection" is
not merely a happy phrase; it is a fact in every day life. The
problem, then, resolves itself into ways of making the desirable
emotion the stronger, of learning how to form the habit of giving it
the head start and the right of way. In our chapter on "Choosing the
Emotions," we shall find that much depends on building up the right
kind of sentiments, or the permanent organization of instincts around
ideas. However, we must first look more closely at the separate
instincts to acquaint ourselves with the purpose and the ways of each,
and to discover the nature of the forces with which we have to deal.

[Footnote 7: Sherrington: _Integrative Action of the Nervous System_.]


I THE SELF-PRESERVATIVE INSTINCTS

=Hunger.= Hunger is the most pressing desire of the egoistic or
self-preserving impulse. The yearning for food and the impulse to seek
and eat it are aroused organically within the body and are behind much
of the activity of every type of life. As the impulse is so familiar,
and its promptings are so little subject to psychic control, it seems
unnecessary to do more than mention its importance.

=Flight and Fear.= All through the ages the race has been subject to
injury. Species has been pitted against species, individual against
individual. He who could fight hardest or run fastest has survived and
passed his abilities on to his offspring. Not all could be strongest
for fight, and many species have owed their existence to their ability
to run and to know when to run. Thus it is that one of the strongest
and most universal tendencies is the instinct for flight, and its
emotion, fear. "Fear is the representation of injury and is born of
the innumerable injuries which have been inflicted in the course of
evolution."[8] Some babies are frightened if they are held too
loosely, even though they have never known a fall. Some persons have
an instinctive fear of cats, a left-over from the time when the race
needed to flee from the tiger and others of the cat family. Almost
every one, no matter in what state of culture, fears the unknown
because the race before him has had to be afraid of that which was not
familiar.

[Footnote 8: Crile: _Origin and Nature of the Emotions_.]

The emotion of fear is well known, but its purpose is not so often
recognized. An emotion brings about internal changes, visceral changes
they are called, which enable the organism to act on the emotion,--to
accomplish its object. There is only so much energy available at a
given moment, stored up in the brain cells, ready for use. In such an
emergency as flight every ounce of energy is needed. The large muscles
used in running must have a great supply of extra energy. The heart
and lungs must be speeded up in order to provide oxygen and take care
of extra waste products. The special senses of sight and hearing must
be sensitized. Digestion and intestinal peristalsis must be stopped in
order to save energy. No person could by conscious thought accomplish
all these things. How, then, are they brought about?

=Internal Laboratories.= In the wonderful internal laboratory of the
body there are little glands whose business it is to secrete chemicals
for just these emergencies. When an object is sighted which arouses
fear, the brain cells flash instantaneous messages over the body,
among others to the supra-renal glands or adrenals, just over the
kidneys, and to the thyroid gland in the neck. Instantly these glands
pour forth adrenalin and thyroid secretion into the blood, and the
body responds. Blood pressure rises; brain cells speed up; the liver
pours forth glycogen, its ready-to-burn fuel; sweat-glands send forth
cold perspiration in order to regulate temperature; blood is pumped
out from stomach and intestines to the external muscles. As we have
seen, the body as a whole can respond to just one stimulus at a time.
The response to this stimulus has the right of way. The whole body is
integrated, set for this one thing. When fear holds the switchboard no
other messages are allowed on the line, and the creature is ready for
flight.

But after flight comes concealment with the opposite bodily need, the
need for absolute silence. This is why we sometimes get the opposite
result. The heart seems to stop beating, the breath ceases, the limbs
refuse to move, all because our ancestors needed to hide after they
had run, and because we are in a very real way a part of them.

=Old-Fashioned Fear.= There is one passage from Dr. Crile's book which
so admirably sums up these points that it seems worth while to insert
it at length.

     We fear not in our hearts alone, not in our brains alone, not in
     our viscera alone--fear influences every organ and tissue. Each
     organ or tissue is stimulated or inhibited according to its use
     or hindrance in the physical struggle for existence. By thus
     concentrating all or most of the nerve force on the
     nerve-muscular mechanism for defense, a greater physical power is
     developed. Hence it is that under the stimulus of fear animals
     are able to perform preternatural feats of strength. For the same
     reason, the exhaustion following fear will be increased as the
     powerful stimulus of fear drains the cup of nervous energy even
     though no visible action may result.... Perhaps the most striking
     difference between man and animals lies in the greater control
     which man has gained over his primitive instinctive reactions. As
     compared with the entire duration of organic evolution, man came
     down from his arboreal abode and assumed his new rôle of
     increased domination over the physical world but a moment ago.
     And now, though sitting at his desk in command of the complicated
     machinery of civilization, when he fears a business catastrophe
     his fear is manifested in the terms of his ancestral physical
     battle in the struggle for existence. He cannot fear
     intellectually, he cannot fear dispassionately, he fears with all
     his organs, and the same
     organs are stimulated and inhibited as if, instead of its being a
     battle of credit, or position, or of honor, it were a physical
     battle with teeth and claws.... Nature has but one means of
     response to fear, and whatever its cause the phenomena are always
     the same--always physical.[9]

[Footnote 9: Crile: _Origin and Nature of the Emotions_, p. 60 ff.]

       *       *       *       *       *

The moral is as plain as day: Learn to call up fear only when speedy
legs are needed, not a cool head or a comfortable digestion. Fear is a
costly proceeding, an emergency measure like a fire-alarm, to be used
only when the occasion is urgent enough to demand it. How often it is
misused and how large a part it plays in nervous symptoms, both mental
and physical, will appear more clearly in later chapters.

=Repulsion and Disgust.= Akin to the instinct of flight is that of
repulsion, which impels us, instead of fleeing, to thrust the object
away. It leads us to reject from the mouth noxious and disgusting
objects and to shrink from slimy, creepy creatures, and has of course
been highly useful in protecting the race from poisons and snakes. It
still operates in the tendency to put away from us those things,
mental or physical, toward which we feel aversion or disgust. Recent
psychological discoveries have revealed how largely a neurosis
consists in putting away from us--out of consciousness,--whatever we
do not wish to recognize, and so it happens that disgust plays an
unexpected part in nervous disorders.

=Curiosity and Wonder.= Fortunately for the race, it has not had to
wait until different features of the environment prove to be helpful
or harmful. There is an instinct which urges forward to exploration
and discovery and which enables the creature not only to adapt itself
to the environment but to learn how to adapt the environment to
itself. This is the instinct of curiosity. It is the impulse back of
all advance in science, religion, and intellectual achievement of
every kind, and is sometimes called "intellectual feeling."

=Self-Assertion.= It goes almost without saying that one of the
strongest and most important impulses of mankind is the instinct of
self-assertion; it often gets us into trouble, but it is also behind
every effort toward developed character. At its lowest level
self-assertion manifests itself in the strutting of the peacock, the
prancing of the horse, and the "See how big I am," of the small boy.
At its highest level, when combined with self-consciousness and the
moral sentiments acquired from society and developed into the
self-regarding sentiment, it is responsible for most of our ideas of
right, our conception of what is and what is not compatible with our
self-respect.

=Self-Abasement.= Self-assertion is aroused primarily by the presence
of others and especially of those to whom we feel in any way
superior, but when the presence of others makes us feel small, when we
want to hide or keep in the background, we are being moved by the
opposite instinct of self-abasement and negative self-feeling. It may
be either the real or the fancied superiority of the spectators that
arouses this feeling,--their wisdom or strength, beauty or good
clothes. Sometimes, as in stage-fright, it is their numerical
superiority. Bashfulness is the struggle between the two
self-instincts, assertion and abasement. Our impulse for self-display
urges us on to make a good impression, while our feeling of
inferiority impels us to get away unnoticed. Hence the struggle and
the painful emotion.

=Gregariousness.= Man has been called a gregarious animal. That is,
like the animals, he likes to run with his kind, and feels a
pronounced aversion to prolonged isolation. It is this
"herd-instinct," too, which makes man so extremely sensitive to the
opinions of the society in which he lives. Because of this impulse to
go with the crowd, ideas received through education are accepted as
imperative and are backed up by all the force of the instinct of
self-regard. When the teachings of society happen to run counter to
the laws of our being, the possibilities of conflict are indeed
great.[10]

[Footnote 10: For a thorough discussion of the importance of this
instinct, see Trotter's _Instincts of the Herd in Peace and War_.]

=Acquisition.= Another fundamental disposition in both animals and
men is the instinct for possession, the instinct whose function it is
to provide for future needs. Squirrels and birds lay up nuts for the
winter; the dog hides his bone where only he can find it. Children
love to have things for their "very own," and almost invariably go
through the hoarding stage in which stamps or samples or bits of
string are hoarded for the sake of possession, quite apart from their
usefulness or value. Much of the training of children consists in
learning what is "mine" and what is "thine," and respect for the
property of others can develop only out of a sense of one's own
property rights.

=Construction.= There is an innate satisfaction in making
something,--from a doll-dress to a poem,--and this satisfaction rests
on the impulse to construct, to fashion something with our own hands
or our own brain. The emotion accompanying this instinct is too
indefinite to have a name but it is nevertheless a real one and plays
a large part in the sense of power which results from the satisfaction
of good work well done. Later it will be seen how closely related is
this impulse to the creative instinct of reproduction and how useful
it can be in drawing off the surplus energy of that much denied
instinct.

=Pugnacity and Anger.= What is it that makes us angry? A little
thought will convince us that the thing which arouses our fury is not
the sight of any special object, but the blocking of any one of the
other instincts. Watch any animal at bay when its chance for flight
has gone. The timidest one will turn and fight with every sign of
fury. Watch a mother when her young are threatened,--bear, or cat or
lion or human. Fear has no place then. It is entirely displaced by
anger over the balking of the maternal instinct of protection.
Strictly speaking, pugnacity belongs among the instincts neither of
self-preservation nor of race-preservation, but is a special device
for reinforcing both groups.

As fear supplies the energy for running, so anger fits us for
fight,--and for nothing but fight. The mechanism is almost identical
with that of fear. Brain and liver, adrenals and thyroid are the
means, but the emotion presses the button and releases the energy,
stopping all digestion and energizing all combat-muscles. The blood is
flooded with fuel and with substances which, if not used, are harmful
to the body. We were never meant to be angry without fighting. The
habit of self-control has its distinct advantages, but it is hard on
the body, which was patterned before self-control came into fashion.
The wise man, once he is aroused, lets off steam at the woodpile or on
a long, vigorous walk. He probably does not say to himself that he is
a motor animal integrated for fight and that he must get rid of
glycogen and adrenalin and thyroid secretion. He only knows that he
feels better "on the move."

The wiser man does not let himself get angry in the first place unless
the situation calls for fight. However, the fight need not be a
hand-to-hand combat with one's fellow man. William James has pointed
out that there is a "moral equivalent for war," and that the energy of
this instinct may be used to reinforce other impulses and help
overcome obstacles of all sorts. A good deal of the business man's
zest, the engineer's determination, and the reformer's zeal spring
from the fight-instinct used in the right way. As James, Cannon, and
others have pointed out, the way to end war may be to employ man's
instinct of pugnacity in fighting the universal enemies of the
race--fire, flood, famine, disease, and the various social
evils--rather than let it spend its force in war between nations. Even
our sports may be offshoots of the fight-instinct, for McDougall holds
that the play-tendency has its root in the instinct of rivalry, a
modified form of pugnacity. Evidently fighting-blood is a useful
inheritance, even to-day, and rightly directed is a necessary part of
a complete and forceful personality.

This, then, completes the list of self-preservative instincts, those
which are commonly called egoistic and which have been given us for
the maintenance of our own individual personal lives. But our
endowment includes another set of impulses which are no less important
and which must be reckoned with if human conduct is to be understood.



CHAPTER IV

_In which we learn more about ourselves_

THE STORY OF THE INSTINCTS (Continued)

II. THE RACE-PRESERVATIVE INSTINCTS


=Looking beyond Ourselves.= We sometimes speak of self-preservation as
though it were the only law of life, while as a matter of fact it is
but half the story. Nature has seen to it that there shall be planted
in every living creature an innate urge toward the larger life of the
race. Although the creature may never give a conscious thought to the
welfare of the race, he still bears within himself a set of instincts
which have as their end and aim, not the individual at all, but
society as a whole, and the life of generations that are to come. He
is bigger than he knows. Although he may have no notion why he feels
and acts as he does, and although he may pervert the purpose for his
own selfish end, he is continually being moved by the mighty impulse
of the race-life, an impulse which often outrivals the desire I or his
own personal existence. The craving to reproduce ourselves and the
craving to cherish and protect our young are among the most dynamic
forces in life. The two desires are so closely bound together that
they are often spoken of as one under the name of the sex-instinct, or
the family instincts. Let us look first at that part of the yearning
which urges toward perpetuating our own life in offspring.

=Watching Nature Work.= It is wonderful, indeed, to watch Nature in
the long process of Evolution, as she adapts her methods to the
growing complexity of the organism. With a variety and ingenuity of
means, but always with the same steady purpose, she works from the
lowest levels,--where there is no true reproduction, only
multiplication by division,--on through the beginning of reproduction
proper, where a single parent produces the offspring; then on to the
level where it takes two parents of different structure to produce a
new organism, and sex-life begins. At first Nature does not even
demand that father and mother shall come near each other. In the
water, the female of this type lays an egg, and the male, guided by
his instinct, swims to it and deposits his fertilizing fluid. In plant
life, bird and bee, attracted by wonderfully planned perfumes and
color and honey, are called in to carry the pollen from male to female
cell.

But it is when we come to the highest level that we find even more
subtle ways planned to accomplish the desired end. Here we enter the
realm of individual initiative, for it is not now enough to leave to
external forces the joining of the two life-elements. In order to make
a new individual, father and mother must be drawn together, and so
there enters into the situation a personal relationship with all that
that implies. Because Nature has had to provide ways of drawing
individuals to one another, she has put into the higher types of life
the power of mutual attraction,--a power which in man, the highest of
all types, is responsible for many outgrowths that seem far removed
from the original purpose.

=The Love-Motif.= On the one hand, there is the persistent desire to
be attractive, which manifests itself in the subtlest ways. How many
of the yearnings and activities of human life have their roots in this
ancient and honorable desire! The love of pretty clothes,--however it
may seem to be motivated and however it may be complicated by other
motives,-draws its energy, fundamentally, from the same need that
provides the gay plumage and limpid song of the bird or the painted
wings of the butterfly.

On the other hand, there is the capability of being attracted, with
all the personal relationships which spring from the power of admiring
and loving another person. The interest in others does not expend its
whole force on its primary objects,--mate and children. It flows out
into all human relationships, developing all the possibilities of
loving which mean so much in human life; the love of man for man and
woman for woman, as well as mutual love of man and woman. A force like
this, once planted, especially in the higher types of life, does not
spend all its energies in its main trunk. It sends out branches in
many directions, bearing by-products which are rich in value for all
of life.

Many of our richest relationships, our best impulses, and our most
firmly fixed social habits spring from the family instincts of
reproduction and parental care. The social life of our young people,
so well calculated to bring young men and women together; all the
beauty of family life and, as we shall later see, all the broader
benevolent activities for society in general, are energized by the
same love-instincts which form so large a part of human nature.


LEARNING TO LOVE

=A Four-Grade School.= It is impossible to watch the growth of the
love-life of a human being, to trace its development from babyhood up
to its culmination in mating and parenthood, without a sense of wonder
at the steady purpose behind it all. We used to believe that the love
for the young girl that suddenly blooms forth in the callow youth was
an entirely new affair, something suddenly planted in him as he
developed into manhood; but now we know, thanks to the uncovering of
human nature by the painstaking investigations of the psycho-analytic
school of psychologists, that the seeds of the love-life are planted,
not in puberty, but with the beginning of life itself. Looked at in
one way, all infancy and childhood are a preparation, a training of
the love-instinct which is to be ready at the proper time to find its
mate and play its part in the perpetuation of the race. Nature begins
early. As she plants in the tiny baby all the organs that shall be
needed during its lifetime, so she plants the rudiments of all the
impulses and tendencies that shall later be developed into the
full-grown instincts. There have been found to be four periods in the
love-life of the growing child, three of them preparatory steps
leading up to maturity; periods in which the main current of love is
directed respectively toward self, parents, comrades, and finally
toward lover or mate.

=Like Narcissus.= In the first stage, the baby's interest is in his
own body. He is getting acquainted with himself, and he soon finds
that his body contains possibilities of pleasurable sensations which
may be repeated by the proper stimulation. Besides the
hunger-satisfaction that it brings, the act of sucking is pleasurable
in itself, and so the baby begins to suck his thumb or his quilts or
his rattle. Later, this impulse to stimulate the nerves about the
mouth finds its satisfaction in kissing, and still later it plays a
definite part in the wooing process; but at first the child is
self-sufficient and finds his pleasure entirely within himself. Other
regions of the body yield similar pleasure. We often find a tiny child
rubbing his genital organs or his thighs or taking exaggerated
pleasure in riding on someone's foot in order to stimulate these
nerves, which he has discovered at first merely by chance. When he
begins to run around, he loves to exhibit his own body, to go about
naked. None of this is naughtiness or perversion; it is only Nature's
preparation of trends that she will later need to use. The child is
normally and naturally in love with himself.[11] But he must not
linger too long in this stage. None of the channels which his
life-force is cutting must be dug too deep, else in later life they
will offer lines of least resistance which may, on occasion, invite
illness or perversion.

[Footnote 11: This is the stage which is technically known as
auto-eroticism or self-love.]

=In Love with His Family.= Presently Nature pries the child loose from
love of himself and directs part of his interests to people outside
himself. Before he is a year old, part of his love is turned to
others. In this stage it is natural that at first his affection should
center on those who make up his home circle,--his parents and other
members of the household. Even in this early choice we see a
foreshadowing of his future need. The normal little boy is especially
fond of his mother, and the normal little girl of her father. Not all
the love goes to the parent of the opposite sex, but if the child be
normal, a noticeably larger part finds its way in that direction.
Observing parents can often see unmistakable signs of jealousy: toward
the parent of the same sex, or the brother or sister of the same sex.
The little boy who sleeps with his mother while his father is away, or
who on these occasions gets all the attention and all the petting he
craves, is naturally eager to perpetuate this state of affairs. Many a
small boy has been heard to say that he wished his father would go
away and stay all the time,--to the horror of the parents who do not
understand. All this is natural enough, but it is not to be
encouraged. The pattern of the father or the mother must not be
stamped too deep in the impressionable child-mind. Too little love and
sympathy are bad, leading to repression and a morbid turning in of the
love-force; but too much petting, too many caresses are just as bad.
Sentimental self-indulgence on the part of the parents has been
repeatedly proved to be the cause of many a later illness for the
child. As the right kind of family love and comradeship, the kind that
leads to freedom and self-dependence, is among the highest forces in
life, so the wrong kind is among the worst. Parents and their
substitutes--nurses, sisters, and brothers--are but temporary
stopping-places for the growing love, stepping-stones to later
attachments which are biologically more necessary. The small boy who
lets himself be coddled and petted too long by his adoring relatives,
who does not shake off their caresses and run away to the other boys,
is doomed to failure, and, as we shall later see, probably to
illness.[12]

[Footnote 12: One of the best discussions of this theme is found in
the chapter "The Only or Favorite Child," by A.A. Brill, in
_Psychoanalysis_.]

In the later infantile period, the child, besides wanting to exhibit
his own body, shows marked interest in looking at the bodies of
others, and marked curiosity on sex-questions in general. He
particularly wants to know "where babies come from." If his questions
are unfortunately met by embarrassment or laughing evasion, or by
obvious lying about the stork or the doctor or the angels, his
curiosity is only whetted, and he comes to the very natural conclusion
that all matters of sex are sinful, disgusting, and indecent, and to
be investigated only on the sly. This conception cannot be brought
into harmony with the unconscious mental processes arising from his
race-instincts nor with his instinctive sense that "whatever is is
right." The resulting conflict in some four-year-old children is
surprisingly intense. Astonished indeed would many parents be if they
knew what was going on inside the heads of their "innocent" little
children; not "bad" things, but pathetic things which a little candor
would have avoided.

Alongside the rudimentary impulses of showing and looking, there is
developed another set of trends which Nature needs to use later on,
the so-called sadistic and masochistic impulses, the desire to
dominate and master and even to inflict pain, and its opposite impulse
which takes pleasure in yielding and submitting to mastery. These
traits, harking back to the time when the male needed to capture by
force, are of course much more evident in adolescence and especially
in love-making, but have their beginning in childhood, as many a
mother of cruel children knows to her sorrow. In adolescence, when
sex-differentiation is much more marked, the dominating impulse is
stronger in the boy and the yielding impulse in the girl; but in
little children the differentiation has not yet begun.

=Gang and Chum.= At about four or five years the child leaves the
infantile stage of development, with its self-love and its intense
devotion to parents and their substitutes. He begins to be especially
interested in playmates of his own sex, to care more for the opinions
of the gang--or if it be a little girl, of the chum--than for those of
the parents. The life-force is leading him on to the next step in his
education, freeing him little by little from a too-hampering
attachment to his family. This does not mean that he does not love
his father and mother. It means only that some of his love is being
turned toward the rest of the world, that he may be an independent,
socially useful man.

This period between infancy and puberty is known as the latency
period. All interest in sex disappears, repressed by the spontaneously
developing sense of shame and modesty and by the impact of education
and social disapproval. The child forgets that he was ever curious on
sex-matters and lets his curiosity turn into other, more acceptable
channels.

=The Mating-Time.= We are familiar with the changes that take place at
puberty. We laugh at the girl who, throwing off her tom-boy ways,
suddenly wants her skirts let down and her hair done up. We laugh at
the boy who suddenly leaves off being a rowdy, and turns into a
would-be dandy. We scold because this same boy and girl who have
always been so "sweet and tractable" become, almost overnight, surly
and cantankerous, restive under authority and impatient of family
restraint. We should neither laugh nor scold, if we understood. Nature
is succeeding in her purpose. She has led the young life on from self
to parents, from parents to gang or chum, and now she is trying to
lead it away from all its earlier attachments, to set it free for its
final adventure in loving. The process is painful, so painful that it
sometimes fails of accomplishment. In any case, the strain is
tremendous, needing all the wisdom and understanding which the family
has to offer. It is no easy task for any person to free himself from
the sense of dependence and protection, and the shielding love that
have always been his; to weigh anchors that are holding him to the
past and to start out on the voyage alone.

At this time of change, the chemistry of the body plays an important
part in the development of the mental traits; all half-developed
tendencies are given power through the maturing of the sex-glands,
which bind them into an organization ready for their ultimate purpose.
The current is now turned on, and the machinery, which has been
furnished from the beginning, is ready for its task. After a few false
starts in the shape of "puppy love," the mature instinct, if it be
successful, seeks until from among the crowd it finds its mate. It has
graduated from the training-school and is ready for life.


CIVILIZATION'S PROBLEM

=When Nature's Plans Fall Through.= We have been describing the normal
course of affairs. We know that all too often the normal is not
achieved. Inner forces or outer circumstances too often conspire to
keep the young man or the young woman from the culmination toward
which everything has been moving. If the life-force cannot liberate
itself from the old family grooves to forge ahead into new channels,
or if economic demands or other conditions make postponement
necessary, then marriage is not possible. All the glandular secretions
and internal stimuli have been urging on to the final consummation,
developing physical and emotional life for an end that does not come;
or if it does come, is not sufficient to satisfy the demands of the
age-old instinct which for millions of years knew no restraint. In any
case, man finds himself, and woman herself, face to face with a
pressing problem, none the less pressing because it is in most cases
entirely unrecognized.

=Blundering Instincts.= The older a person is, the more fixed are his
habits. Now, an instinct is a race-habit and represents the
crystallized reactions of a past that is old. Whatever has been done
over and over again, millions of times, naturally becomes fixed,
automatic, tending to conserve itself in its old ways, to resist any
change and to act as it has always acted. This conserves energy and
works well so long as conditions remain the same. But if for any
reason there comes a change, things are likely to go wrong. By just so
far as things are different, an automatic habit becomes a handicap
instead of a help.

This having to act under changed conditions is exactly the trouble
with the reproductive instinct. Under civilization, conditions have
changed but the instinct has not. It is trying to act as it always
has acted, but civilized man wills otherwise. The change that has come
is not in the physical, external environment, but in man himself and
in the social environment which he has created. There is in man an
onward urge toward new and better things. Side by side with the desire
to live as he always has lived, there is a desire to make new
adaptations which are for the advancement of the whole race-life.
Besides the natural wish to take his desires as he finds them, there
is also the wish to modify them and use them for higher and more
socially useful ends.

As the race has found through long experience that monogamy is to be
preferred to promiscuous mating; that the highest interests of life
are fostered by loyalty to the institution of the family; that the
careful rearing of several children rather than the mere production of
many is in the long run to be desired; and that a single standard of
morality is practicable; so society has established for its members a
standard which is in direct opposition to the immeasurable urge of the
past. To make matters worse, there have at the same time grown up in
many communities a standard of living and an economic competition
which still further limit the size of the family and the satisfaction
of the reproductive impulse.

=The Perpetual Feud.= There thus arises the strategic struggle
between that which the race has found good in the past and that which
the race finds good in the present. As the older race-experience is
laid in they body and built into the very fiber of the individual,
inherited as an innate impulse, it has become an integral part of
himself, an individual need rather than a social one. On the other
hand, man has, as another innate part of his being, the desire to go
with the herd, to conform to the standards of his fellows, to be what
he has learned society wants him to be. Hence the struggle, insistent,
ever more pressing, between two sets of desires within the man
himself; the feud between the past and the present, between the
natural and the social, between the selfish and the ideal. On one
side, there is the demand for instinctive satisfaction; on the other,
for moral control; on one side the demand for pleasure; on the other,
the demands of reality.[13]

[Footnote 13: "All the burdens of men or society are caused by the
inadequacies in the association of primal animal emotions with those
mental powers which have been so rapidly developed in
man-kind."--Shaler quoted by Hinkle: Introduction to Jung's
_Psychology of the Unconscious_.]

Two factors intensify the conflict. In the first place, the older
habits have the head start. Compared with the almost limitless extent
of our past history, our desire for the control of the instincts is
very new indeed. It requires the long look and the right perspective
to understand how very lately we have entered into our new conditions
and how old a habit we are trying to break. In the second place, the
larger part of the stimulus comes from within the body itself. When
studying the other instincts, we saw that the best way to control was
to refuse to stimulate when the situation was not suitable for
discharge. But with the organically aroused sex-instinct there is no
such power of choice. We may fan the flame by the thoughts we think or
the environment we seek, or we may smother the flame until it is out
of sight, but we cannot extinguish it by any act of ours. The issue
has always been too important to be left to the individual. The
stimulation comes, primarily, not by way of the mind but by way of the
body. With this instinct we cannot "stop before we begin," because
Nature has taken the matter out of our hands and begins for us.


THE BULWARK WE HAVE BUILT

With the competing forces so strong and the issues so great, it is not
to be wondered at that society has had to build up a massive bulwark
of public opinion, to establish regulations and fix penalties that are
more stringent than those imposed in any other direction. Nor is it
remarkable that in its effort to protect itself, society has sometimes
made mistakes.

These blunders seem to lie in two directions. Assuming that it is
nearly impossible for the male to control his instincts, and that,
after all, it does not matter so much whether he does or not, society
has blinked at license in men, and thus has fostered a demoralizing,
anti-social double standard which has broken up countless homes, has
been responsible for the spread of venereal diseases, and has been
among the greatest curses of modern civilization. At the same time
society, in its efforts to maintain its standards for woman, has
taught its children, especially its girls, that anything savoring of
the word "sexual" is sinful, disgusting, and impure. To be sure, very
many women have modified their childish views, but an astonishingly
large number conserve, even in maturity, their warped ideas about the
whole subject of sex. Many a mature woman secretly believes that she,
at least, is not guilty of harboring anything so "vulgar" as a
reproductive instinct, not realizing that if this were so, she would
be, in very truth, a freak of nature.

Of course, woman is by nature as fully endowed with sex instincts as
is man. Kipling portrays the female of the species as "deadlier than
the male" in that the very framework of her constitution outlines the
one issue for which it was launched,--stanch against any attack which
might endanger the carrying on of life. Feeling the force of this
instinctive urge, she braces herself against precipitancy in response
by what seems almost a negation.

Just as we lean well in when riding around a corner, in order to keep
ourselves from falling out, so by an "over-compensation" for what is
unconsciously felt to be danger woman increases her feeling of safety
by setting up a taboo on the whole subject of sex. It is time that we
freed our minds from the artificial and perverted attitude toward this
dominant impulse; time to rescue the word "sex" from its implications
of grossness and sensuousness, and to recognize the instinct in its
true light as one of the necessary and holy forces of life, a force
capable of causing great damage, but also holding infinite
possibilities for good if wisely directed.

Society only gets its members into trouble when, even by implication,
it attempts to deny its natural make-up, and allows little children to
grow up with the false idea that one of their strongest impulses is to
be shunned by them as a thing of shame. We cannot dam back the flood
by building a bulwark of untruth, and then expect the bulwark to hold.

=Adaptable Energy.= We neither have to give in to our over-insistent
desires nor to deny that they exist. Man has a power of adaptation.
Just when we seem to run up against a dead wall, to face an
irreconcilable conflict, we find a wonderful power of indirect
expression that affords satisfaction to all the innate forces without
doing violence to the ethical standards which have proved so necessary
for the development of character.

Hunger, which, like the reproductive instinct, is stimulated by the
changing chemistry of the body, can be satisfied only by achieving its
primary purpose, the taking of material food; but the creative impulse
to reproduce oneself possesses a unique ability to spiritualize itself
and expend its energy in other lines of creative endeavor. There seems
to be some sort of close connection between the especially intense
energy of the reproductive instinct and the modes of expression of the
instinct for construction; a connection which makes possible the
utilization of threatening destructive energy by directing it toward
socially valuable work. Just as we harness the mountain stream and use
its wild force to light our cities, or catch the lightning to run our
trolley cars, so we find man and woman--under the right
conditions--easily and naturally switching over the power of their
surplus sex-energy to ends which seem at first only slightly related
to its original aim, but which resemble it in that they too are
self-expressive and creative. If a person is able to express himself
in some real way, to give himself to socially needed work; if he can
reproduce himself intellectually and spiritually in artistic
production, in invention, in literature, in social betterment, he is
drawing on an age-old reservoir of creative energy, and by so doing is
relieving himself of inner tension which would otherwise seek less
beneficent ways of expression.

The world knew all this intuitively for a long time before it knew it
theoretically. The novelists, who are unconsciously among the best
psychologists, have thoroughly worked the vein. The average man knows
it. "He was disappointed in love," we say, "and we thought he would go
to pieces, but now he has found himself in his work"; or, "She will go
mad if she doesn't find some one who needs her." It is only lately
that science has caught up with intuition, but now the physicians and
psychologists who have had the most intimate and first-hand
acquaintance with the human heart are recognizing, to a man, this
unique power of the love-instinct and its possibilities for creative
work of every sort.[14]

[Footnote 14: Among those who have shown this connection between the
love-force and creative work are Freud, Jung, Jelliffe, White, Brill,
Jones, Wright, Frink, and the late Dr. Putnam of Harvard University,
who writes: "Freud has never asserted it as his opinion and it
certainly is not mine, that this is the only root from which artistic
expression springs. On the other hand, it is probable that all
artistic productions are partly referable to this source. A close
examination of many of them would enable any one to justify the
opinion that it is a source largely drawn upon."--_Human Motives_. p.
87.]


=Higher Levels.= Freud has called this spiritualization of natural
forces by a term borrowed from chemistry. As a solid is "sublimated"
when transformed into a gas, so a primal impulse is said to be
"sublimated" when it is diverted from its original object and made to
serve other ends. By this power of sublimation the little
exhibitionist, who loved to show himself, may become an actor; the
"cruel" boy who loved to dissect animals may become a surgeon; the
sexually curious child may turn his curiosity to other things and
become a scholar; the "born mother," if denied children of her own or
having finished with their upbringing, may take to herself the
children of the city, working for better laws and better care for
needy little ones; the man or woman whose sex-instinct is too strong
to find expression in legitimate, direct ways, may find it a valuable
resource, an increment of energy for creative work, along whatever
line his talent may lie.

There is no more marvelous provision in all life than this power of
sublimation of one form of energy into another, a provision shadowing
forth almost limitless possibilities for higher adaptations and for
growth in character. As we think of the distance we have already
traveled and the endless possibilities of ever higher excursions of
the life-force, we feel like echoing Paul's words: "He who began a
good work in you will perfect it unto the end." The history of the
past holds great promise for the future.

=When Sublimation Fails.= But in the meantime we cannot congratulate
ourselves too heartily. Sublimation too often fails. There are too
many nervous wrecks by the way, too many weak indulgers of original
desires, too many repressed, starved lives with no outlet for their
misunderstood yearnings; and, as we shall see, too many people who, in
spite of a big lifework, fail to find satisfaction because of
unnecessary handicaps carried over from their childhood days.
"Society's great task is, therefore, the understanding of the
life-force, its manifold efforts at expression and the way of
attaining this, and to provide as free and expansive ways as possible
for the creative energy which is to work marvelous things for the
future."

If "the understanding of the life force" is to be available for use,
it must be the property of the average man and woman, the fathers and
mothers of our children, the teachers and physicians who act as their
advisers and friends.[15] This chapter is intended to do its bit
toward such a general understanding.

[Footnote 15: "Appropriate educational processes might perhaps guide
this enormous impulsive energy toward the maintenance instead of the
destruction of marriage and the family. But up to the present time,
education with respect to this moral issue has commonly lacked any
such constructive method. The social standard and the individual
impulse have simply collided, and the individual has been left to
resolve the conflict, for the most part by his own resources."--G.A.
Coe: _Psychology of Religion_, p. 150.]


PARENTAL INSTINCT AND TENDER EMOTION

=Until They Can Fly.= Only half of Nature's need is met by the
reproductive instinct. Her carefulness in this direction would be
largely wasted without that other impulse which she has planted, the
impulse to protect the new lives until they are old enough to fend for
themselves. The higher the type of life and the greater the future
demands, the longer is the period of preparation and consequent period
of parental care. This fact, coupled with man's power for lasting
relationships through the organization of permanent sentiments, has
made the, bond between parent and child an enduring one. Needless to
say, this relationship is among the most beautiful on earth, the
source of an incalculable amount of joy and gain. However, as we have
already suggested, there lurks here, as in every beneficent force, a
danger. If parents forget what they are for, and try to foster a more
than ordinary tie, they make themselves a menace to those whom they
most love. Any exaggeration is abnormal. If the childhood bond is
over-strong, or the childhood dependence too long cultivated, then the
relationship has overstepped its purpose, and, as we shall later see,
has laid the foundation for a future neurosis.

=Mothering the World.= Probably no instinct has so many ways of
indirect expression as this mothering impulse of protection. Aroused
by the cry of a child in distress, or by the thought of the weakness,
or need, or ill-treatment of any defenseless creature, this
mother-father impulse is at the root of altruism, gratitude, love,
pity, benevolence, and all unselfish actions.

There is still a great difference of opinion as to how man's spiritual
nature came into being; still discussion as to whether it developed
out of crude beginnings as the rest of his physical and mental
endowment has developed, or whether it was added from the outside as
something entirely new. Be that as it may, the fact remains that man
has as an innate part of his being an altruistic tendency, an
unselfish care for the welfare of others, a relationship to society as
a whole,--a relationship which is the only foundation of health and
happiness and which brings sure disaster if ignored. The egoistic
tendencies are only a part of human nature. Part of us is naturally
socially minded, unselfish, spiritual, capable of responding to the
call to lose our lives in order that others may find theirs.


SUMMARY

Civilized man as he is to-day is a product of the past and can be
understood only as that past is understood. The conflicts with which
he is confronted are the direct outcome of the evolutional history of
the race and of its attempt to adapt its primitive instincts to
present-day ideals.

Character is what we do with our instincts. According to Freud, all
of a man's traits are the result of his unchanged original impulses,
or of his reactions against those impulses, or of his sublimation of
them. In other words, there are three things we may do with our
instincts. We may follow our primal desires, we may deny their
existence, or we may use them for ends which are in harmony with our
lives as we want them to be. As the first course leads to degeneracy,
the second to nervous illness, and the third to happy usefulness, it
is obviously important to learn the way of sublimation. Sometimes this
is accomplished unconsciously by the life-force, but sometimes
sublimation fails, and is reestablished only when the conscious mind
gains an understanding of the great forces of life. This method of
reeducation of the personality as a means of treatment in nervousness
is called psycho-therapy.

=Religion's Contribution.= If it be asked why, amid all this
discussion of instincts and motives we have made no mention of that
great energizer religion, we answer that we have by no means forgotten
it, but that we have been dealing solely with those primary tendencies
out of which all of the compound emotions are made. Man has been
described as instinctively and incurably religious, but there seems no
doubt that religion is a compound reaction, made up of
love,--sympathetic response to the parental love of God,--fear,
negative self-feeling, and positive self-feeling in the shape of
aspiration for the desired ideal of character; all woven into several
compound emotions such as awe, gratitude, and reverence.

It goes almost without saying that religion, if it be vital, is one of
the greatest sources of moral energy and spiritual dynamic, and that
it is and always has been one of the greatest aids to sublimation that
man has found. A force like the Christian religion, which sets the
highest ideal of character and makes man want to live up to it, and
which at the same time says, "You can. Here is strength to help you";
which unifies life and fills it with purpose; which furnishes the
highest love-object and turns the thought outward to the good of
mankind--such a force could hardly fail to be a dynamic factor in the
effort toward sublimation. This book, however, deals primarily with
those cases for which religion has had, to call science to her aid in
order to find the cause of failure, to flood the whole subject with
light, and to help cut the cords which, binding us to the past, make
it impossible to utilize the great resources that are at hand for all
the children of men.

=Where We Keep Our Instincts.= It must have been impossible to read
through these two chapters on instinct without feeling that, after
all, we are not very well acquainted with ourselves. The more we look
into human nature, the more evident it becomes that there is much in
each one of us of which we are only dimly aware. It is now time for us
to look a little deeper,--to find where we keep these instinctive
tendencies with which it is possible to live so intimately without
even suspecting their existence. We shall find that they occupy a
realm of their own, and that this realm, while quite out of sight, is
yet open to exploration.



CHAPTER V

_In which we look below the surface and discover a veritable
wonderland_

THE SUBCONSCIOUS MIND

STRANGERS TO OURSELVES


=Hidden Strings.= A collie dog lies on the hearthrug. A small boy with
mischievous intent ties a fine thread to a bone, hides himself behind
a chair, and pulls the bone slowly across the floor. The dog is thrown
into a fit of terror because he does not know about the hidden string.

A Chinese in the early days of San Francisco stands spell-bound at the
sight of a cable car. "No pushee. No pullee. Go allee samee like
hellee!" He does not know about the hidden string.

A woman of refinement and culture thinks a thought that horrifies her
sensitive soul. It is entirely out of keeping with her character as
she knows it. In her misunderstanding she considers it wicked and
thrusts it from her, wondering how it ever could have been hers. She
does not know about the hidden string.

In the last two chapters we thought together about some of these
strings, examining the fibers of which they are made and learning in
what directions they pull. We found them to be more powerful than we
should have supposed, more insistent and less visible. We found that
instinctive desire is the string, the cable that energizes our every
act, but that our desires are neither single nor simple, and are but
rarely on the surface. Many of us live with them a long time, feeling
the tug, but not recognizing the string.

=There's a Reason.= We take our thoughts and feelings and actions for
granted, without stopping very often to wonder where they come from.
But there is always a reason. When the law of cause and effect reaches
the doorsill of our minds, it does not stop short to give way to the
law of chance. We wake up in the morning with a certain thought on
top. We say it "just happens." But nothing ever just happens. No
thought that ever comes into our heads has been without its
history,--its ancestors and its determining causes. But what about
dreams? They, at least, you say, have no connections, no past and no
future, only a weird, fantastic present. Strange to say, dreams have
been found to be as closely related to our real selves, as interwoven
with the warp and woof of our lives as are any of our waking thoughts.
Even dreams have a reason.

We find ourselves holding certain beliefs and prejudices, interested
in certain things and indifferent to others, liking some foods, some
colors and disliking others. Search our minds as we will, we find no
clue to many of these inner trends. Why?

The answer is simple. The cause is hidden below the surface. If we try
to explain ourselves on the basis of the open-to-inspection part of
our minds, we must come to the conclusion that we are queer creatures
indeed. Only by assuming that there is more to us than we know, can we
find any rational basis for the way we think and feel and act.

=A Real Mind.= We learn of our internal machinery by what it does. We
must infer a part of our minds which introspection does not reveal, a
mind within the mind, able to work for us even while we are unaware of
its existence. This inner mind is usually known as the subconscious,
the mind under the level of consciousness.[16] We forget a name, but
we know that it will come to us if we think about something else.
Presently, out of somewhere, there flashes the word we want. Where was
it in the meanwhile, and what hunted it out from among all our other
memories and sent it up into consciousness? The something which did
that must be capable of conserving memories, of recognizing the right
one and of communicating it,--surely a real mind.

[Footnote 16: Writers of the psycho-analytic school use the word
"unconscious" to denote the lower layers of this region, and
"fore-conscious" to denote its upper layers. Morton Prince uses the
terms "unconscious" and "conscious" to denote the different strata. As
there is still a good deal of confusion in the use of terms, it has
seemed to us simpler to use throughout only the general term
"subconscious."]

One evening my collaborator fumbled unsuccessfully for the name of a
certain well-known journalist and educator. It was on the tip of her
tongue, but it simply would not come, not even the initial letter. In
a whimsical mood she said to herself just as she went to sleep,
"Little subconscious mind, you find that name to-night." In the middle
of the night she awoke, saying, "Williams--Talcott Williams." The
subconscious, which has charge of her memories, had been at work while
she slept.

The history of literature abounds in stories of under-the-surface
work. The man of genius usually waits until the mood is on, until the
muse speaks; then all his lifeless material is lighted by new
radiance. He feels that some one outside himself is dictating. Often
he merely holds the pen while the finished work pours itself out
spontaneously as if from a higher source.

But it is not only the man of genius who makes use of these unseen
powers. He may have readier access to his subconscious than the rest
of us, but he has no monopoly. The most matter-of-fact man often says
that he will "sleep over" a knotty problem. He puts it into his mind
and then goes about his business, or goes to sleep while this unseen
judge weighs and balances, collects related facts, looks first at one
side of the question and then at the other, and finally sends up into
consciousness a decision full of conviction, a decision that has been
formulated so far from the focus of attention that it seems to be
something altogether new, a veritable inspiration.

We must infer the subconscious from what it does. Things
happen,--there must be a cause. Some of the things that happen
presuppose imagination, reason, intelligence, will, emotion, desire,
all the elements of mind. We cannot see this mind, but we can see its
products. To deny the subconscious is to deny the artist while looking
at his picture, to disbelieve in the poet while reading his poem, and
to doubt the existence of the explosive while listening to the report.
The subconscious is an artist, a poet, and an explosive by turns. If
we deny its existence, a good portion of man's doings are
unintelligible. If we admit it, many of his actions and his
afflictions which have seemed absurd stand out in a new light as
purposeful efforts with a real and adequate cause.

=The Submerged Nine Tenths.= The more deeply psychologists and
physicians have studied into these things, the more certainly have
they been forced to the conclusion that the conscious mind of man, the
part that he can explore at will, is by far the smaller part of his
personality. Since this is to some people a rather startling
proposition, we can do no better than quote the following statement
from White on the relation of consciousness to the rest of the psychic
life:

     Consciousness includes only that of which we are _aware_, while
     outside of this somewhat restricted area there lies a much wider
     area in which lie the deeper motives for conduct, and which not
     only operates to control conduct, but also dictates what may and
     what may not become conscious. Stanley Hall has very forcibly put
     the matter by using the illustration of the iceberg. Only
     one-tenth of the iceberg is visible above water; nine-tenths is
     beneath the surface. It may appear in a given instance that the
     iceberg is being carried along by the prevailing winds and
     surface currents, but if we keep our eyes open we shall sooner or
     later see a berg going in the face of the wind, and, so,
     apparently putting to naught all the laws of aerodynamics. We can
     understand this only when we come to realize that much the
     greater portion of the berg is beneath the surface and that it is
     moving in response to invisible forces addressed against this
     submerged portion.

     Consciousness only arises late in the course of evolution and
     only in connection with adjustments that are relatively complex.
     When the same or similar conditions in the environment are
     repeatedly presented to the organism so that it is called upon to
     react in a similar and almost
     identical way each time, there tends to be organized a mechanism
     of reaction which becomes more and more automatic and is
     accompanied by a state of mind of less and less awareness.[17]

[Footnote 17: White: _Mechanisms of Character Formation_.]

It is easy to see the economy of this arrangement which provides
ready-made patterns of reaction for habitual situations and leaves
consciousness free for new decisions. Since an automatic action,
traveling along well-worn brain paths, consumes little energy and
causes the minimum of fatigue, the plan not only frees consciousness
from a confusing number of details, but also works for the
conservation of energy. While consciousness is busy lighting up the
special problems of the moment, the vast mass of life's demands are
taken care of by the subconscious, which constitutes the bulk of the
mind. "Properly speaking, the unconscious is the real psyche."[18]

[Footnote 18: Freud: _Interpretation of Dreams_, p. 486.]

=The Heart of Psychology.= In the face of all this, it is not to be
wondered at that the problem of the subconscious has been called not
one problem of psychology but the problem. It cannot be denied that
the discoveries which have already been made as to its activities have
been of immense practical importance in the understanding of normal
conduct and in the treatment of the psycho-neuroses.

If some of the methods--such as hypnosis, automatic writing, and
interpretation of dreams--which are used to investigate its activities
seem to savor of the charlatan and the mountebank, it is because they
have occasionally been appropriated by the ignorant and the
unscrupulous. Their real setting is the psychological laboratory and
the physician's office. In the hands of men like Sigmund Freud, Boris
Sidis, and Morton Prince, they are as scientific as the apparatus of
any other laboratory and their findings are as susceptible of proof.
We may, then, go forward with the conviction that we are walking on
solid ground and that the main paths, at least, will turn into beaten
highways.


ANCESTRAL MEMORIES

=Race-Memories.= An individual as he stands at any moment is the
product of his past,--the past which he has inherited and the past
which he has lived. In other words, he is a bundle of memories
accumulated through the experience of the race, and through his own
experience as a person. Some of these memories are conscious, and
these he calls his, while others fail to reach consciousness and are
not recognized as part of his assets.

The instincts form the starting-point of mind, conscious and
subconscious, and are the foundation upon which the rest is built.
They often show themselves as part of our conscious lives, but their
roots are laid deep in the subconscious from which they can never be
eradicated. This deepest-laid instinctive layer of the subconscious is
little subject to change. It represents the earlier adjustments of the
race, crystallized into habit. It takes no account of the differences
between the present and the past. It knows no culture, no reason, no
lately acquired prudence. It is all energy and can only wish, or urge
toward action. But since only those race-memories became instincts
which had proved needful to the race in the long run, they are on the
whole beneficent forces, working for the good of the race and the good
of the individual, if he learns how to handle them aright and to adapt
them to present conditions.

This instinctive urge toward action arouses in the individual an
organic response that is felt as a tension or craving and is mainly
dependent upon its own chemical constitution at the moment. Hunger is
the sensation caused by the little muscular contractions in the
stomach when the body is low in its food supply. Sudden fright is felt
as an all-gone sensation "at the pit of the stomach." What really
happens is a tightening up of the circular muscles of the
blood-vessels lying in the network of the solar plexus, and a spasm of
the muscles of the digestive tract. The hungry stomach impels to
action until satisfied; the physical discomfort in fear impels toward
measures of safety. The apparatus that is made use of by the
subconscious in carrying out this instinctive urge is called the
autonomic nervous system.[19] It regulates all the functions of
living, not only under the stress of emotion, but during every moment
of waking or sleeping.

[Footnote 19: Kempf: "The Tonus of Automatic Segments as a Cause of
Abnormal Behavior," _Journal of Nervous and Mental Diseases_, January,
1921.]

=A Capable Manager.= The conscious mind could not possibly send
messages to the numerous glands that fit the body for action, nor
attend to all the delicate adjustments that enter into the process.
The conscious mind in most of us does not even know of the existence
of the organs and secretions involved, but something sends the
messages and it is something that has a remarkable likeness to mind as
we usually think of mind,--something which takes advantage of the past
and gages means to an end with a nicety that excites our wonder.

=Take no Anxious Thought.= We take food into our stomachs and forget
about it, if we are wise; and this subconscious overseer who through
millions of years of experience has learned how to digest food does
the rest. As with digestion, so with our heart-action; we lie down at
night fairly sure that there will be no break in the regular rhythm of
its beat. The subconscious overseer is "on the job" and he never
rests. No matter how hard we sleep, he never lets us forget to take a
breath; and if we trust him, he is very likely to wake us up at the
appointed time in the morning. Also, if we trust him, he carries us
off to sleep as though we were babies. Has he not had long practice in
the days before insomnia was invented?

=First Aid to the Injured.= In times of infection or injury, this
subconscious manager is better than any doctor. The doctors say with
truth that they only assist nature. If the infection is internal,
antitoxins are produced within the body. If the injury is external,
like a cut, the messages fly, and white blood-corpuscles are marshaled
to take care of poisons and build up the tissue. If the injury is of
the kind that needs rest, the subconscious doctor knows it. He
therefore causes pain and rigidity, in order to induce us to hold the
injured part still until it is restored.

Crile reminds us of a fact that is often noticed by surgeons. If
patients under ether are handled roughly, especially in the intestinal
region, respiration quickens and there are tremors and even convulsive
efforts which interfere with the surgeon's work. The conscious mind
cannot feel. It is asleep. But the subconscious mind, whose business
it is to protect the body, is trying to get away from injury. The body
uses up as much energy as though it had run for miles, and when the
patient wakes up, we say that he is suffering from shock. The
subconscious mind which is not affected by ether, has been exhausting
itself in a vain attempt to get the body away from harm.

=A Tireless Servant.= When the conscious mind undertakes a job, it is
always more or less subject to fatigue. But the subconscious after its
long practice seems never to tire. We say that its activities have
become automatic. With all its inherited skill, the subconscious, if
left to itself, can be depended upon to run the bodily machinery
without effort and without hitch. The only things that can interfere
with its work are the wrong kind of emotions and the wrong kind of
suggestions from the conscious mind. Barring these, it goes its way
like a trusty servant, looking after details and leaving its master's
mind free for other things. Having been "in the family" for
generations, it knows its business and resents any interference with
its duties or any infringement of its rights.

No man, then, comes into this world without inheritance: he receives
from his ancestors two goodly sets of heirlooms, the instincts and the
mechanism which carries on bodily functions. This is the capital with
which man starts life; but immediately he begins increasing this
capital, adding memories from his own experience to the accumulated
race-records.


PERSONAL MEMORIES

No more startling secret has been unearthed by science than the
discovery of the length and minuteness of our memories. No matter how
much one may think he has forgotten, the tablets of his mind are
closely written with records of infinitesimal experiences, shadowy
sensations, old happenings which the conscious self has lost entirely
and would scarcely recognize as its own. Many of these brain records,
or neurograms, as Prince calls them, are never aroused from their
dormant conditions. But others, aroused by emotion or association of
ideas, may after years of inactivity, come forth again either as
conscious memories or as subconscious forces, or even as physiological
memories,--bodily repetitions of the pains, palpitations, and tremors
of old emotional experiences.

=Irresistible Childhood.= An experience that is forgotten is not
necessarily lost. Although the first few years of childhood are lost
to conscious memory, these years outweigh all others in their
influence on character. The Jesuit priest was right when he said,
"Give me a child until he is six years old, and he will be a Catholic
all his life." As Frink has so ably shown, the determining factors
that enter into any adult choice, such as the choice of the Catholic
or the Protestant faith, are in a large measure made up of
subconscious memories from early childhood, forgotten memories of
Sunday-school and church, of lessons at home or passages in
books,--experiences which no voluntary effort could recall, but which
still live unrecognized in our mature judgments and beliefs. Naturally
we do not acknowledge these subconscious motives. We like to believe
that all our decisions are based on reason, and so we invent plausible
arguments for our attitudes and our actions, arguments which we
ourselves implicitly believe. This process of substituting a plausible
reason for a subconscious one is known as rationalization, a process
which every one of us engages in many times a day.

It is indeed true that the child is father to the man. Those first
impressionable years, when we believed implicitly whatever any one
told us and when through ignorance we reacted emotionally to ordinary
experiences, are molding us still, making us the men and women we are
to-day, coloring with childish ideas many of the attitudes of our
supposedly reasoning life. Bergson says:

     The unconscious is our historical past. In reality the past is
     preserved automatically. In its entirety probably it follows us
     at every instant; all that we have felt, thought and willed from
     our earliest infancy is there, leaning over the present which is
     about to join it, pressing against the portals of consciousness
     that would fain leave it outside.

=Spontaneous Outbursts.= "How do we know all this?" some one says.
"What is the evidence for these sweeping statements? If we cannot
remember, how can we discover these strange memories that are so
powerful but so elusive? If they are below the level of consciousness,
are they not, in the very nature of the case, forever hidden from
view, in the sphere of the occult rather than that of science?"

The answer to these questions is determined by one important fact; the
line between the conscious and subconscious minds does not always
remain in the same place; the "threshold of consciousness" is
sometimes displaced, automatically allowing these buried memories to
come to the surface. In sleep and delirium, in trance and
hallucination, in hysteria and intoxication, the tables are turned;
the restraining hand of the conscious mind is loosened and the
submerged self comes forth with all its ancient memories.

It is a common experience to have a patient in delirium repeat
long-forgotten verses or descriptions of events that the "real man"
has lost entirely. The renowned servant-girl, quoted by Hudson, who in
delirium recited passage after passage of Hebrew, Latin, and Greek,
which she had heard her one-time master repeat in his study, is
typical of many such instances.[20]

[Footnote 20: Hudson: _The Law of Psychic Phenomena_, p. 44. Quoted
from _Coleridge's Biographia Literaria_, Vol. I, p. 117 (edit. 1847).]

A young girl of nineteen, a patient of mine, lapsed for several weeks
into a dissociated state in which she forgot all the memories and
ideas of her adult life, and returned to the period of her childhood.
She used to say that she saw things inside her head and would
accurately describe events that took place before she was two years of
age,--scenes which she had completely forgotten in her normal life.
One day when I asked her to tell me what she was seeing, she began to
talk about "little sister" (herself) and "little brother." "Little
sister and brother were the two little folks that lived with their
mother and their daddy and they were playing on the sand-pile. You
know there was only one sand-pile, not like all the ones they have
down here (at the seaside), and they had a bucket that they would put
sand in and they would dump it out again and they would make nice
things, you know; they would play with their little dog Ponto and he
was white with black and brown spots on him. Little brother had white
hair and he was bigger than little sister and he had a little waist
with ruffles down the front and around the collar and a black coat
that came down to his knees and it had two little white bands around
it. Some of the waists he wore had blue specks and some had red and
black specks in it.

"Little sister had yellow curls and she had a blue coat with jiggly
streaks of white in it, and she had a little white bonnet that was
crocheted, and she had little blue mittens on that were tied to a
string that went around her neck and down the other arm. It got pretty
cold where they lived. Little sister and little brother would go out
to the pile of leaves and jump on them and bounce and they would
crackle. The leaves came down from the trees all of a sudden when they
got tired, and they were different colors, brown and red. Little
sister could walk then but she could not walk one other time before
then; she could stand up by holding to a chair, but she could not go
herself. One morning Big Tom said 'Run to Daddy' and she went to her
daddy, and after that she always walked; they were glad and she was
glad. She walked all day long. Big Tom was a man who used to help
Daddy and little sister always liked him. He was a nice man."

The mother verified this scene of the first walking, saying that it
had occurred on her own wedding-anniversary when the child was
twenty-three months old.

One night I heard the same patient talk in her sleep in the slow and
hesitating manner of a child reading phonetically from a printed page.
I soon recognized the words as those of a poem of Tagore's, called "My
Prayer," and remembered that a magazine containing the poem had been
lying on the bed during the day. When she had finished I wakened her,
saying, "Now tell me what you have been dreaming." She answered in
her childish way, "I think I do not dream." She went to sleep
immediately and again repeated the poem, word for word, without a
single mistake. Again I awakened her with the words, "Now tell me what
you have been dreaming." And again she answered, "I think I do not
dream." I said: "But yes; don't you remember you were just saying,
'When the time comes for me to go'?" (the last line of the poem). "Oh,
yes," she said, "I was seeing it, and I think I'll not go to sleep
again. It tires me so to see it."

While she was awake she had no recollection of having seen the poem
and was indeed in her dissociated state quite incapable of
understanding its meaning. Asleep, she saw every word as plainly as if
the page had been before her eyes.

The distorted pictures of dreams are always made of the material which
past experiences have furnished and which have in many cases been
dropped out of consciousness for years only to rise out of their long
oblivion when the conscious mind has been put to sleep.

=Unearthing Old Experiences.= However, psychology does not have to
wait for buried memories to come forth of their own free will. It has
a number of successful ways of summoning them from their hiding-place
and helping them across the line into consciousness. In the hands of
skilled investigators and therapeutists, hypnosis, hypnoidization,
automatic writing, crystal-gazing, abstraction, free association,
word-association, and interpretation of dreams have all been
repeatedly successful in bringing to light memories which apparently
have been for many years completely blotted out of mind. As we become
better acquainted with these technical devices we shall find that
there are four kinds of experiences whose records are carefully stored
away in our minds. Some were always so far from the center of our
attention that we could swear they never had been ours; others,
although once present in consciousness, were so trivial and
unimportant that it seems ridiculous to suppose them conserved; others
never came into our waking minds at all and entered our lives only in
special states, such as sleep or delirium or dreams. All these we
should expect to forget; the astonishing thing is that they ever were
conserved. But there is a fourth class that is different. It is made
up of experiences that were so vital, so emotional, so closely woven
into the fiber of our being that it seems impossible that they ever
could be forgotten. Let us look at a few examples of records of all
these four kinds of experiences, examples chosen from hundreds of
their kind as illustrations of the all-embracing character of buried
memories.[21]

[Footnote 21: For further examples see Prince, _The Unconscious_;
Prince, _The Dissociation of a Personality_, and Hudson, _The Law of
Psychic Phenomena_.]

=Out of the Corners of Our Eyes.= In the first place, we are much
more observing than we imagine. We may be so interested in our own
thoughts that details of our environment are entirely lost on the
conscious mind, but the subconscious has its eyes open, and its ears.
People in hypnosis have been known to repeat verbatim whole passages
from newspapers which they had never consciously read. While they were
busy with one column, their wide-awake subconscious was devouring the
next one, and remembering it. Prince relates the story of a young
woman who unconsciously "took in" the details of a friend's
appearance:

     I asked B.C.A. (without warning and after having covered her
     eyes) to describe the dress of a friend who was present and with
     whom she had been conversing perhaps some twenty minutes. She was
     unable to do so beyond saying that he wore dark clothes. I then
     found that I myself was unable to give a more detailed
     description of his dress, although we had lunched and been
     together about two hours. B.C.A. was then asked to write a
     description automatically. Her hand wrote as follows (she was
     unaware that her hand was writing):

     "He has on a dark greenish gray suit, a stripe in it--little
     rough stripe; black bow cravat; shirt with three little stripes
     in it; black laced shoes; false teeth; one finger gone; three
     buttons on his coat."

     The written description was absolutely correct. The stripes in
     the coat were almost invisible. I had not noticed
     his teeth or the loss of a finger and we had to count the buttons
     to make sure of their number owing to their partial concealment
     by the folds of the unbuttoned coat. The shoe-strings I am sure
     under the conditions would have escaped nearly every one's
     notice.[22]

[Footnote 22: Prince: _The Unconscious_, p. 53.]

Automatic writing, the method used to uncover this subconscious
perception, is a favorite method with some investigators and is often
used by Morton Prince. The hand writes without the direction of the
personal consciousness and usually without the person's being aware
that it is writing. A dissociated person does this very easily; other
people can cultivate the ability, and perhaps most of us approach it
when we are at the telephone, busily writing or drawing remarkable
pictures while the rest of us is engaged in conversation.

The present epidemic of the Ouija board shows how many persons there
are who are able to switch off the conscious mind and let the
subconscious control the muscles that are used in writing. The fact
that the writer has no understanding of what he is doing and believes
himself directed by some outside power, in no way interferes with the
subconscious phenomenon.

=Everyday Doings.= Besides perceptions which were originally so far
from the focus of attention that the conscious mind never caught them
at all, there are the little experiences of everyday life, fleeting
thoughts and impressions which occupy us for a minute and then
disappear. Every experience is a dynamic fact and no matter how
trivial the experience may be or how completely forgotten, it still
exists as a part of the personality.

An amusing example of the everyday kind of forgotten experience
occurred during the writing of this chapter. I wrote a sentence which
pleased me very well. This is the sentence: "In the esthetic processes
of evolution they [man's desires] have sunk below the surface as soon
as formed, and have been covered over by an elastic and snug-fitting
consciousness as the skin covers in the tissues and organs of the
body." After showing this passage to my collaborator and remarking
that this figure had never been used before, I was partly chagrined
and partly amused to have her bring me the following sentence from
White and Jelliffe: "Consciousness covered over and obscured the inner
organs of the psyche just as the skin hides the inner organs of the
body from vision." My originality had vanished and I was close to
plagiarism. Indeed, if a history of plagiarism could be written, it
would probably abound in just such stories. I had read the article
containing this sentence only once, about three years before, and had
never quoted it or consciously thought of it. It had lain buried for
three years, only to come forth as an original idea of my own. Who
knows how many times we all do just this thing without catching
ourselves in the trick?

=Back-Door Memories.= There are other kinds of memories which hide in
the subconscious, memories of experiences which have not come in by
the front door, but have entered the mind during special states, such
as sleep, delirium, intoxication, or hypnosis. What is known as
post-hypnotic suggestion is the functioning of a suggestion received
during hypnosis and emerging later as an impulse without being
recognized as a memory. A man in a hypnotic state is told that at five
o'clock he will take off his clothes and go to bed, without
remembering that such a suggestion has been given him. He awakens with
no recollection of the suggestion, but at five o'clock he suddenly
feels impelled to go to bed, even though his unreasonable desire puts
him into a highly embarrassing position. The suggestion, to be thus
effective, must have been conserved somewhere in his mind outside of
consciousness.

Suggestions that enter the mind during the normal sleep are also
recorded,--a fact that carries a warning to people who are in the
habit of talking of all sorts of matters while in the room with
sleeping children. I have sometimes suggested to sleeping patients
that on waking they will remember and tell me the cause of their
symptoms. The following example shows not only the conservation of
impressions gained in sleep, but also the sway of forgotten ideas of
childhood, still strong in mature years. This young woman, a trained
nurse, with many marked symptoms of hysteria, had been asked casually
to bring a book from the Public Library. She cried out in
consternation, "Oh, no, I am afraid!" After a good deal of urging she
finally brought the book, although at the cost of considerable effort.
Later, while she was taking a nap, I said to her, "You will not
remember that I have talked to you. You will stay asleep while I am
talking and while you are asleep there will come to your mind the
reasons why you are afraid to go to the Public Library. When you
waken, you will tell me all about it." Upon awakening, she said: "Oh,
do you know, I can tell you why I have always been afraid to go to the
Public Library. While I was in Parochial School, Father ---- used to
come in and tell us children to use the books out of the school
library and never to go to the Public Library." I questioned her
concerning her idea of the reason for such an injunction and what she
thought was in the books which she was told not to read. She
hesitatingly stated that it was her idea, even in childhood, that the
books dealt with topics concerning the tabooed subject of the birth of
children and kindred matters.

=Smoldering Volcanoes.= Let us now consider those emotional
experiences which seem far too compelling to be forgotten, but which
may live within us for years without giving any evidence of their
existence. Memories like these are apt to be anything but a dead past.

Many of my own patients have uncovered emotional memories through
simply talking out to me whatever came into their minds, laying aside
their critical faculty and letting their minds wander on into whatever
paths association led them. This is known as the free-association
method, and simple as it seems, is one of the most effective in
uncovering memories which have been forgotten for years. One of my
patients, a refined, highly educated woman of middle age, had suffered
for two years with almost constant nausea. One day, after a long talk,
with no suggestion on my part, only an occasional, "What does that
remind you of?" she told with great emotion an experience which she
had had at eighteen years of age, in which she had for a moment been
sexually attracted to a boy friend, but had recoiled as soon as she
realized where her impulse was leading her. She had been so horrified
at the idea of her degradation, so nauseated at what she considered
her sin, that she had put it out of her mind, denied that such a
thought had ever been hers, repressed the desire into the
subconscious, where it had continued to function unsatisfied,
unassimilated with her mature judgments. Her nausea was the symbol of
a moral disgust. Physical nausea she was willing to acknowledge, but
not this other thing. Upon reciting this old experience, with every
sign of the original shame, she cried: "Oh, Doctor! why did you bring
this up? I had forgotten it. I haven't thought of it in thirty years."
I reminded her that I couldn't bring it up,--I had never known
anything about it. With the emotional incoming of this memory and the
saner attitude toward it which the mature woman's mind was able to
take, the nausea disappeared for good. This case is typical of the
psycho-neuroses and we shall have occasion to refer to it again. The
present emphasis is on the fact that an emotional memory may be buried
for many years while it still retains the power of reappearing in more
or less disguised manifestation.

=Repressed Memories.= If we ask how so burning a memory could escape
from the consciousness of a grown woman, we are driven to the
conclusion that this forgetting can be the result of no mere quiet
fading away, but that there must have been some active force at work
which kept the memory from coming into awareness. It was not lost. It
was not passive. Out of sight was not out of mind. There must have
been a reason for its expulsion from the personal consciousness. In
fact, we find that there is a reason. We find that whenever a vital
emotional experience disappears from view, it is because it is too
painful to be endured in consciousness. Nor is it ever the pain of an
impersonal experience or even the thought of what some one else has
done to us that drives a memory out of mind. As a matter of fact, we
never expel a memory except when it bears directly on ourselves and on
our own opinion of ourselves. We can stand almost anything else, but
we cannot stand an idea that does not fit in with our ideal for
ourselves. This is not the pious ideal that we should like to live up
to and that we hope to attain some day, not the ideal that we think we
ought to have--like never speaking ill of others or never being
selfish--but the secret picture that each of us has, locked away
within him, the specifications of ourselves reduced to their lowest
terms, below which we cannot go. Energized by the instinct of positive
self-feeling, and organized with the moral sentiments which we have
acquired from education and the ideals of society, especially those
acquired in early childhood, this ideal of ourselves becomes
incorporated into our conscience and is an absolute necessity for our
happiness.

We have found that when two emotions clash, one drives out the other.
So in this case, the woman's positive self-feeling of self-respect,
combined with disgust, drove from the field that other emotion of the
reproductive instinct which was trying to get expression. Speaking
technically, one repressed the other. The woman said to herself, "No,
I never could have had such a thought," and promptly forgot it.
Needless to say, this kind of handling did not kill the impulse.
Buried in the depths of her soul, it continued to live like a live
coal, until in later years, fanned by the wind of some new experience,
it burst into flame.

In this case the wish had originally flashed into awareness for an
instant, but very often the impulse never gets into consciousness at
all. The upper layers of the subconscious, where the acquired ideals
live, automatically work to keep down any desires which are thought to
be out of keeping with the person as he knows himself. He then would
emphatically deny that such desires had ever had any place in his
life.

Freud has called this repressing force the psychic censor. To get into
consciousness, any idea from the subconscious must be able to pass
this censor. This force seems to be a combination of the
self-regarding and herd-instincts, which dispute with the instinct for
reproduction the right to "the common path" for expression.

A considerable part of any person's subconscious is made up of
memories, wishes, impulses, which are repressed in this way. Of course
any instinctive desire may be repressed, but it is easy to understand
why the most frequently denied impulse, the instinct of reproduction,
against whose urgency society has cultivated so strong a feeling,
should be repressed more frequently than any other.[23]

[Footnote 23: See foot-note, p. 145, Chap. VII.]

=Past and Present.= It matters not, then, in what state experiences
come to us, whether in sleep or delirium, intoxication or hypnosis, or
in the normal waking condition. They are conserved and may exert great
influence on our normal lives. It matters not whether the experiences
be full of meaning and emotion or whether they be so slight as to pass
unnoticed, they are conserved. It matters not whether these
experiences be mere sense-impressions, or inner thoughts, whether they
be unacknowledged hopes or fears, undesirable moods and unworthy
desires or fine aspirations and lofty ideals. They are conserved and
they may at a later day rise up to bless or to curse us long after we
had thought them buried in the past. The present is the product of the
past. It is the past plus an element of choice which keeps us from
settling down in the despair of fatalism and enables us to do
something toward making the present that is, a help and not a
stumbling-block to the present that is to be.


SOME HABITS OF THE SUBCONSCIOUS

=The Association of Ideas.= It is only by something akin to poetic
license that we can speak of lower and higher strata of mind. When we
carry over the language of material things into the less easily
pictured psychic realm, it is sometimes well to remind ourselves that
figures of speech, if taken too literally, are more misleading than
illuminating. When we speak of the deep-laid instinctive lower levels
of mind and the higher acquired levels, we must not imagine that these
strata are really laid in neat, mutually exclusive layers, one on top
of the other in the chambers of the mind. Nor must we imagine the
mental elements of instinct, idea, and memory as jumbled together in
chaotic confusion, or in scattered isolated units. As a matter of
fact, the best word to picture the inside of our minds is the word
"group." We do not know just how ideas and instincts can group
themselves together, but we do know that by some arrangement of brain
paths and nerve-connections, the laws of association of ideas and of
habit take our mental experiences and organize them into more or less
permanent systems. Instinctive emotions tend to organize themselves
around ideas to form sentiments; ideas or sentiments, which through
repetition or emotion are associated together, tend to stay together
in groups or complexes which act as a whole; complexes which pertain
to the same interests tend to bind themselves into larger systems or
constellations, forming moods, or sides to one's character. It is not
highly important to differentiate in every case a sentiment from a
complex, or a complex from a constellation, especially as many writers
use "complex" as the generic term for all sorts of groups; but a
general understanding of the much-used word "complex" is necessary
for a comprehension of modern literature on psychology, psychotherapy
or general education.

"=What Is a Complex=?" Reduced to its lowest terms, a complex is a
group. It may be simply a group of associated movements, like lacing
one's shoes or knitting; it may be a group of movements and ideas,
like typewriting or piano-playing, which through repetition have
become automatic or subconscious; it may be merely a group of ideas,
such as the days of the week, the alphabet or the multiplication
table. In all these types it is repetition working through the law of
habit that ties the ideas and movements together into an organic
whole. Usually, however, the word complex is reserved for psychic
elements that are bound together by emotion. In this sense, a complex
is an emotional thought-habit. Frink's definition, which is one of the
simplest, recognizes only this emotional type: "A complex is a system
of connected ideas, having a strong emotional tone, and displaying a
tendency to produce or influence conscious thought and action in a
definite and predetermined direction."[24]

[Footnote 24: Frink: "What Is a Complex?" _Journal American Medical
Assoc_., Vol. LXII, No. 12, Mar. 21, 1914.]

Emotion and repetition are the great welders of complexes. Emotion is
the strongest cement in the world. A single emotional experience
suffices to bind together ideas that were originally as far apart as
the poles.

Sometimes a complex includes not only ideas, movements, and emotions,
but physiological disturbances and sensations. Some people cannot go
aboard a stationary ship without vomiting, nor see a rose, even though
it prove to be a wax one, without the sneezing and watery eyes of
hay-fever. This is what is known as a "conditioned reflex." Past
associations plus fear have so welded together idea and bodily
manifestation that one follows the other as a matter of course, long
after the real cause is removed. In such ways innumerable nervous
symptoms arise. The same laws which form healthy complexes, and,
indeed, which make all education possible, may thus be responsible for
the unhealthy mal-adaptive association-habits which lie back of a
neurosis. Fortunately, a knowledge of this fact furnishes the clue to
the re-education that brings recovery.

A complex may be either conscious or unconscious, but as it usually
happens that either all or part of its elements are below the surface,
the word is oftenest used to mean those buried systems of the
subconscious mind that influence thought or behavior without
themselves being open to scrutiny. It is these buried complexes,
memory groups, gathered through the years of experience, that
determine action in uniform and easily prophesied directions. Every
individual has a definite complex about religion, about politics,
about patriotism, about business, and it is the sum of these buried
complexes which makes up his total personality.

=Displacement.= Association or grouping is, then, an intrinsic power
of mind; but as all life seems to be built on opposites--light and
darkness, heat and cold, love and hate--so mind, which is capable of
association, is capable also of displacement or the splitting apart of
elements which belong together. There is such a thing as the simple
breaking up of complexes, when education or experience or neglect
separate ideas and emotions which had been previously welded together;
but displacement is another matter. Here there is still a path between
idea and emotion; they still belong to the same complex, but the
connection is lost sight of. The impulse or emotion attaches itself to
another substitute idea which is related to the first but which is
more acceptable to the personality. Sometimes the original idea is
forgotten; repressed, or dissociated into the subconscious, as in
anxiety neurosis; and sometimes it is merely shorn of its emotional
interest and remembered as an unrelated or insignificant idea, as in
compulsion neurosis.

=Transference.= Another kind of displacement which seems hard to
believe possible until it is repeatedly encountered in intelligent
human beings is the process called transference, by which everybody at
some time or other acts toward the people he meets, not according to
rational standards but according to old unconscious attitudes toward
other people. Each of us carries, within, subconscious pictures of the
people who surrounded us when we were children; and now when we meet a
new person we are likely unconsciously to say to ourselves--not, "This
person has eyebrows like my mother, or a voice like my nurse," or,
"This person bosses me around as my father used to do," but, "This is
my mother, this is my nurse, this is my father." Whereupon we may
proceed to act toward that person very much as we did toward the
original person in childhood.

Transference is subconsciously identifying one person with another and
behaving toward the one as if he were that other. Analysis has
discovered that many a man's hostile attitude toward the state or
religion or authority in general, is nothing more than this kind of
displacement of his childhood's attitude toward authority in the
person of his perhaps too-domineering father. Many a woman has married
a husband, not for what he was in himself, but because she
unconsciously identified him with her childish image of her father.

Students of human nature have always recognized the kind of
displacement which transfers the sense of guilt from some major act or
attitude to a minor one which is more easily faced, just as _Lady
Macbeth_ felt that by washing her hands she might free herself from
her deeper stain. This is a frequent mechanism in the
psychoneuroses--not that neurotics are likely to have committed any
great crime, but that they feel subconsciously that some of their
wishes or thoughts are wicked.

=The Phenomena of Dissociation.= When an idea or a complex, a
perception or a memory is either temporarily or permanently shoved out
of consciousness into the subconscious, it is said to be dissociated.
When we are asleep, the part of us that is usually conscious is
dissociated and the submerged part takes the stage. When we forget our
surroundings in concentration or absent-mindedness, a part of us is
dissociated and our friends say that we are "not all there," or as
popular slang has it, "Nobody home." When a mood or system of
complexes drives out all other moods, one becomes "a different
person." But if this normal dissociation is carried a step farther, we
may lose the power to put ourselves together again, and then we may
truly be said to be dissociated. Almost any part of us is subject to
this kind of apparent loss. In neurasthenia the happy, healthy
complexes which have hitherto dominated our lives may be split off and
left lying dormant in the subconscious; or the power of will or
concentration may seem to be gone. In hysteria we may seem to lose the
ability to see or feel or walk, or we may lose for the time all
recollection of certain past events, or of whole periods of our lives,
or of everything but one system of ideas which monopolizes the field
of attention. Sometimes great systems of memories, instincts, and
complexes are alternately shifted in and out of gear, leaving first
one kind of person on top and then another.[25] Stevenson's _Dr.
Jekyll_ and _Mr. Hyde_ is not so fantastic a character as he seems.
Any one who doubts the ability of the mind to split itself up into two
or more distinct personalities, entertaining totally different
conceptions of life, disliking each other, playing tricks on each
other, writing notes to each other, and carrying on a perpetual feud
as each tries to get the upper hand, should read Morton Prince's
"Dissociation of a Personality," a fascinating account of his famous
case, Miss Beauchamp.

[Footnote 25: When a memory or system of memories is suddenly lost
from consciousness the person is said to be suffering from amnesia or
pathological loss of memory.]

=Internal Warfare.= Conflict, often accentuated by shock or fatigue,
represses or drives down certain ideas, perceptions, wishes, memories,
or complexes into the subconscious, where they remain, sometimes
dormant and passive but often dynamic, emotional, carrying on an
over-excited, automatic activity, freed from the control of reason and
the modifying influence of other ideas, and able to cause almost any
kind of disturbance. So long as there is team-work between the
various parts of our personality we are able to act as a unit; but
just as soon as we break up into factions with no communication
between the warring camps, so soon do we become quite incapable of
coördination or adjustment, like a nation torn by civil war. Many of
the seemingly fantastic and bizarre mental phenomena of which a human
being is capable are the result of this kind of disintegration.

However, nature has a remarkable power for righting herself, and it is
only under an accumulation of unfortunate circumstances that there
appears a neurosis, which is nothing more than a functioning of
certain parts of the personality with all the rest dissociated. We
shall later inquire more fully into the causes that lead up to such a
result and shall find that the mechanisms involved are these processes
of organization and disorganization by which mind is wont to group
together or separate the various elements within its borders.


SUMMARY

Gathering up our impressions, we find a number of outstanding
qualities which we may summarize in the following way:

The Subconscious is:

_1 Vast yet Explorable_

The fraction that could accurately show the relation of the conscious
to the unconscious part of ourselves would have such a small numerator
and such a huge denominator that we might well wonder where
consciousness came in at all.[26] Some one has likened the
subconscious to the great far-reaching depths of the Mammoth Cave, and
consciousness to the tiny, flickering lamp which we carry to light our
way in the darkness. However, ever the subconscious mind is becoming
explorable, and it may be that science is giving the tiny lamp the
revealing power of a great searchlight.

[Footnote 26: "The entire active life of the individual may be
represented by a fraction, the numerator of which is any particular
moment, the denominator is the rich inheritance of the
past."--Jelliffe: "The Technique of Psychoanalysis," _Psychoanalytic
Review,_ Vol. III, No. 2, p. 164.]

_2 Ancient yet Modern_

The lowest layers of the subconscious, represented by the instincts,
are as old as life itself, with their lineage reaching back in direct
and unbroken line to the first living things on the ooze of the ocean
floor. The higher strata are more modern, full, and accurate records
of our own lifetime, beginning with our first cry and ending with
to-day's thoughts.

_3 Primitive yet Refined_

The lowest level, representing the past of the race, is primitive like
a savage, and infantile, like a child; it is instinctive, unalterable,
and universal; it knows no restraint, no culture, and no prudence. The
higher level, the storehouse of individual experience, bears the
marks of acquired ideals, of cultivated refinement, and represents
among other things the precepts and prudence of civilized society.

_4 Emotional yet Intellectual_

Our records of the past are not dead archives, but living
forces--persistent, urging, dynamic and emotional. They give meaning
to new experiences, color our judgments, shape our beliefs, determine
our interests, and, if wrongly handled, make their way into
consciousness as neurotic symptoms.

However, the subconscious is not all emotion. It is a mind capable of
elaborate thought, able to calculate, to scheme, to answer doubts, to
solve problems, to fabricate the purposeful, fantastic allegories of
dreams and to create from mere knowledge the inspired works of genius.

But the subconscious has one great limitation, it cannot reason
inductively. Given a premise, this mind can reason as unerringly as
the most skilful logician; that is, it can reason deductively, but it
cannot arrive at a general conclusion from a number of particular
facts. However, except for inductive reasoning and awareness, the
subconscious seems to possess all the attributes of conscious mind and
is in fact an intellectual force to be reckoned with.

_5 Organized yet Disorganizable_

The subconscious mind is a highly organized institution, but like all
such institutions it is liable to disorganization when rent by
internal dissension. Ordinarily it keeps its ideas and emotions, its
complexes and moods in fairly accurate order, but when upset by
emotional warfare, it gets its records confused and falls into a
chaotic state which makes regular business impossible.

_6 Masterful yet Obedient_

The subconscious, which is master of the body, is in normal life the
servant of consciousness. One of its outstanding qualities is
suggestibility. Since it cannot reason from particulars to a general
conclusion it takes any statement given it by consciousness, believes
it implicitly and acts accordingly.

The pilot wheel of the ship is, after all, the conscious mind,
insignificant in size when compared with the great mass of the vessel,
but all-powerful in its ability to direct the course of the voyage.

Nervous persons are people who are too much under the sway of the
subconscious; so, too, are some geniuses, who narrowly escape a
neurosis by finding a more useful outlet for their subconscious
energies. While the poet, the inventor, and the neurotic are likely to
be too largely controlled by the subconscious, the average man is to a
greater extent ruled by the conscious mind; and the highest type of
genius is the man whose conscious and subconscious minds work together
in perfect harmony, each up to its full power.

If, as many believe, the next great strides of science are to be in
this direction, it may pay some of us to be pioneers in learning how
to make use of these undeveloped riches of memory, organization, and
surplus energy. The subconscious, which can on occasion behave like a
very devil within us, is, when rightly used, our greatest asset, the
source of powers whose appearance in the occasional individual has
been considered almost superhuman, but which prove to be
characteristically human, the common inheritance of the race of man.



CHAPTER VI

_In which we learn why it pays to be cheerful_

BODY AND MIND

THE MISSING LINK


=Ancient Knowledge.= People have always known that mind in some
strange way carries its moods over into the body. The writer of the
Book of Proverbs tells us, from that far-off day, that "A merry heart
doeth good like a medicine, but a broken spirit drieth the bones."
Jesus in His healing ministry always emphasized the place of faith in
the cure of the body. "Thy faith hath made thee whole," is a frequent
word on His lips, and ever since His day people have been
rediscovering the truth that faith, even in the absence of a worthy
object, does often make whole. Faith in the doctor, the medicine, the
charm, the mineral waters, the shrine, and in the good God, has
brought health to many thousands of sufferers. People have always
reckoned on this bodily result from a mental state. They have
intuitively known better than to tell a sick person that he is looking
worse, but they have not always known why. They have known that a fit
of anger is apt to bring on a headache, but they have not stopped to
look for the reason, or if they have, they have often gotten
themselves into a tangle. This is because there has always been, until
recently, a missing link. Now the link has been found. After the last
chapter, it will not be hard to understand that this connecting link,
this go-between of body and mind, is nothing else than the
subconscious mind. When we remember that it has the double power of
knowing our thoughts and of controlling our bodies, it is not hard to
see how an idea can translate itself into a pain, nor to realize with
new vividness the truth of the statement that healthy mental states
make for health, and unhealthy mental states for illness.

=Suggestion and Emotion.= There are still many gaps in our knowledge
of the ways of the subconscious, but investigation has thrown a good
deal of light on the problem. Two of the principles already discussed
are sufficient to explain most of the phenomena. These are, first,
that the subconscious is amenable to control by suggestion, and
secondly, that it is greatly influenced by emotion. Tracing back the
principles behind any example of the power of mind over body, one
finds at the root of the matter either a suggestion or an emotion, or
both. If, then, the stimulating and depressing effects of mental
states are to be understood, the first Step must be a fuller
understanding of the laws governing suggestion and emotion.


THE CONTAGION OF IDEAS

One of the most important points about the subconscious mind is its
openness to suggestion. It likes to believe what it is told and to act
accordingly. The conscious mind, too,--proud seat of reason though it
may be,--shares this habit of accepting ideas without demanding too
much proof of their truth. Even at his best, man is extremely
susceptible to the contagion of ideas. Most of us are even less immune
to this mental contagion than we are to colds or influenza; for ideas
are catching. They are such subtle, insinuating things that they creep
into our minds without our knowing it at all; and once there, they are
as powerful as most germs.

Let a person faint in a crowded room, and a good per cent. of the
women present will begin to fan themselves. The room has suddenly
become insufferably close. After we have read half a hundred times
that Ivory soap floats, a fair proportion of the population is likely
to be seized with desire for a soap that floats,--not because they
have any good reason for doing so, but simply because the suggestion
has "taken." As for the harbingers of spring, they are neither the
birds nor the wild flowers, but the blooming windows of the
milliners, which successfully suggest in wintry February that summer
is coming, and that felt and fur are out of season. It is evident that
all advertising is suggestion.

The training of children, also, if it is done in the right way, is
largely a matter of suggestion. The little child who falls down and
bumps his head is very likely to cry if met with a sympathetic show of
concern, while the same child will often take his mishaps as a joke if
his elders meet them with a laugh or a diverting remark. Unlucky is
the child whose mother does not know, either consciously or
intuitively, that example and contagion are more powerful--and more
pleasant--than command and prohibition.

=Everything Suggestive.= Human beings are constantly communicating,
one to another. Sometimes they "get over" an idea by means of words,
but often they do it in more subtle ways,--by the elevation of an
eyelid, the gesture of a hand, composure of manner in a crisis, or a
laugh in a delicate situation. A suggestion is merely an idea passed
from one person to another, an idea that is accepted with conviction
and acted upon, even though there may be no logic, no reason, no proof
of its truth. It is an influence that takes hold of the mind and works
itself out to fulfilment, quite apart from its worth or
reasonableness. Of course, logical persuasion and argument have their
place in the communication of ideas; an idea may be conveyed by other
ways than suggestion. But while suggestion is not everything, it is
equally true that there is suggestion in everything. The doctor may
give a patient a very rational explanation of his case, but the
doubtful shake of the head or the encouraging look of his eye is quite
likely to color the patient's general impression. The eyes of our
subconscious are always open, and they are constantly getting
impressions, subtle suggestions that are implied rather than
expressed.

=Abnormal Suggestibility.= While everybody is suggestible, nervous
people are abnormally so. It may be, as McDougall suggests, that they
have so large an amount of submission or negative self-feeling in
their make-up that they believe anything, just because some one else
says it is true. Sometimes it is lack of knowledge that makes us
gullible, and at other times the cause of our suggestibility is
failure to use the knowledge that we have. Sometimes our ideas are
locked away in air-tight compartments with no interaction between
them. The psychologists tell us that suggestion is greatly favored by
a narrowing of the attention, a "contraction of the field of
consciousness," a dissociation of other ideas through concentration.
This all simply means that we forget to let our common sense bring to
bear counter ideas that might challenge a false one; or that worry--a
veritable "spasm of the attention"--has fixed upon an idea to the
exclusion of all others; or that through fatigue or the dissociation
of sleep or hypnosis or hysteria, our reasoning powers have been
locked out and for the time being are unable to act.

It was through experiments on hypnotized subjects that scientists
first learned of the suggestibility of the subconscious mind. In
hypnosis a person can be made to believe almost anything and to do
almost anything compatible with the safety and the moral sense of the
individual. The instinct of self-preservation will not allow the most
deeply hypnotized person to do anything dangerous to himself; and the
moral complexes, laid in the subconscious, never permit a person to
perform in earnest an act of which the waking moral sense would
disapprove. Within these limits, a person in the dissociated hypnotic
state can be made to accept almost any suggestion. We found in the
last chapter how open to suggestion is a person in normal sleep. Of
the dissociation of hysteria we shall have occasion to speak in later
chapters. Although all these special states heighten suggestibility,
we must not forget how susceptible each of us is in his normal waking
state.

=Living Its Faith.= All this gathers meaning only when we realize that
ideas are dynamic. They always tend to work themselves out to
fulfilment. The subconscious no sooner gets a conviction than it tries
to act it out. Of course it can succeed only up to a certain limit.
If it believes the stomach to have cancer, it cannot make cancer, but
it can make the stomach misbehave. One of my patients, on hearing of a
case of brain-tumor immediately imagined this to be her trouble, and
developed a pain in her head. She could not manufacture a tumor, but
she could manufacture what she believed to be the symptoms.

There was another patient who was supposed to have brain-tumor. This
young woman seemed to have lost almost entirely the power to keep her
equilibrium in walking. Her center of gravity was never over her feet,
but away out in space, so that she was continually banging from one
side of the room to the other, only saving herself from injury by
catching at the wall or the furniture with her hands. Several
physicians who had been interested in the case had found the symptoms
strongly suggestive of brain-tumor. There were, however, certain
unmistakable earmarks of hysteria, such as childlike bland
indifference to the awkwardness of the gait which was a grotesque
caricature of several brain and spinal-cord diseases, with no accurate
picture of any single one. This was evidently a case, not of actual
loss of power but a dissociation of the memory-picture of walking. The
patient was a trained nurse and knew in a general way the symptoms of
brain-tumor. When the suggestion of brain-tumor had fixed itself in
her mind she was able subconsciously to manufacture what she believed
to be the symptoms of that disease.

By injecting a keen sense of disapprobation and skepticism into the
hitherto placidly accepted state of disability, by flashing a mirror
on the physical and moral attitudes which she was assuming, I was able
to rob the pathological complex of its (altogether unconscious)
pleasurable feeling-tone, and to restore to its former strength and
poise a personality of exceptional native worth and beauty. After a
few weeks at my house she was able to walk like a normal person and
went back to her work, for good.

We have already learned enough about the inner self to see in a faint
way how it works out its ideas. Since the subconscious mind runs the
bodily machinery, since it regulates digestion, the building up of
tissue, circulation, respiration, glandular secretion, muscular tonus,
and every other process pertaining to nutrition and growth, it is not
difficult to see how an idea about any of these matters can work
itself out into a fact. A thought can furnish the mental machinery
needed to fulfil the thought. Some one catches the suggestion:
"Concentration is hard on the brain. It soon brings on brain-fag and
headache." Not knowing facts to the contrary, the suggestible mind
accepts the proposition. Then one day, after a little concentration,
the idea begins to work. Whereupon the autonomic nervous system
tightens up the blood-vessels that regulate the local blood supply,
too much blood stays in the head, and lo, it aches! The next time, the
suggestion comes with greater force, and soon the habit is
formed,--all the result of an idea. It is a good thing to remember
that constant thought about any part of the body never fails to send
an over-supply of blood to that part; of course that means congestion
and pain.

=Hands Off!= By sending messages directly to an organ through the
nerve-centers or by changing circulation, the subconscious director of
our bodies can make any part of us misbehave in a number of ways. All
it needs is a suggestion of an interfering thought about an organ. As
we have insisted before, the subconscious cannot stand interference.
Sadler well says: "Man can live at the equator or exist at the poles.
He can eat almost anything and everything, but he cannot long stand
self-contemplation. The human mind can accomplish wonders in the way
of work, but it is soon wrecked when directed into the channels of
worry."[27] In other words, hands off!--or rather, minds off! Don't
get ideas that make you think about your body. The surest way to
disarrange any function is to think about it. It is a stout heart that
will not change its beat with a frequent finger on the pulse, and a
hearty stomach that will not "act up" under attention. "Judicious
neglect" is a good motto for most occasions. Take no anxious thought
if you would be well. Know enough about your body to counteract false
suggestions; fulfil the common-sense laws of hygiene,--eight hours in
bed, plenty of exercise and fresh air, and three square meals a day.
Then forget all about it. "A mental representation is already a
sensation,"[28] and we have enough legitimate sensations without
manufacturing others.

[Footnote 27: Sadler: _Physiology of Faith and Fear_.]

[Footnote 28: DuBois: _Psychic Treatment of Nervous Disorders_.]

=From Real Life.= Startling indeed are the tricks that we can play on
ourselves by disregarding these laws. A patient who was unnecessarily
concerned about his stomach once came to me in great alarm, exhibiting
a distinct, well-defined swelling about the size of a match-box in the
region of his stomach. I looked at it, laughed, and told him to forget
it. Whereupon it promptly disappeared. The first segment of the rectus
muscle had tied itself up into a knot, under the stimulus of anxious
attention.

Another patient appeared at my door one day saying, "Look here!"
Examination showed that her abdomen was swollen to the size of more
than a six-months pregnancy. As it happened, this woman had a friend
who a short time before had developed a pseudo, or hysterical
pregnancy which continued for several months. My patient, accepting
the suggestion, was prepared to imitate her. I gave her a punch or
two and told her to go and dress for luncheon. In the afternoon she
had returned to her normal size.

Another woman, suffering from chronic constipation, was firmly
convinced that her bowels could not move without a cathartic, which I
refused to give. However, I did give her some strychnine pills,
carefully explaining that they were not for her intestines and that
they would have no effect there. She did not believe me, and promptly
began to have an evacuation every day. It seems that sometimes two
wrong ideas are equal to a right one.

If doctors fully realized the power of suggestion, they would be more
careful than they sometimes are about suggesting symptoms by the
questions they ask their patients.

A patient of mine with locomotor-ataxia suffered from the usual train
of symptoms incident to that disease. It turned out, however, that
many of the symptoms had been suggested by the questions of former
physicians who had asked him whether he had certain symptoms and
certain disabilities. The patient had answered in the negative and
then promptly developed the suggested symptoms. When I told him what
had happened, these false symptoms disappeared leaving only those
which had a real physical foundation.

Another patient, a young girl, complained of a definite localized
pain in her arm, and told me that she was suffering from angina
pectoris. As we do not expect to find this disease in a young person,
I asked her where she got such an idea. "Dr. ---- told me so last
May." "Did you feel the pain in this same place before that time?" I
asked. She thought a minute and then answered: "Why no, I had a pain
around my heart but I did not notice it in my arm until after that
consultation." The wise physician lets his patients describe their own
symptoms without suggesting others by the implication of his
questions.

=Autosuggestion.= Of course we must remember that an idea cannot
always work itself out immediately. Conditions are not always ripe. It
often lies fallow a long time, buried in the subconscious, only to
come up again as an autosuggestion, a suggestion from the self to the
self. If some one tells us that nervous insomnia is disastrous, and we
believe it, we shall probably store up the idea until the next time
that chance conditions keep us awake. Then the autosuggestion "bobs
up," common sense is side-tracked, we toss and worry--and of course
stay awake. An autosuggestion often repeated becomes the strongest of
suggestions, successfully opposing most outside ideas that would
counteract it,--reason enough for seeing to it that our
autosuggestions are of the healthful variety.

At the base of every psycho-neurosis is an unhealthful suggestion.
This is never the ultimate cause. There are other forces at work. But
the suggestion is the material out of which those other forces weave
the neurosis. Suggestibility is one of the earmarks of nervousness. A
sensible and sturdy spirit, stable enough to maintain its equilibrium,
is a fairly good antidote to attack. "As a man thinketh in his heart,
so is he."


WHY FEELINGS COUNT

=The Emotions Again.= It seems impossible to discuss any psychological
principle without finally coming back to the subject of emotions. It
truly seems that all roads lead to the instincts and to the emotions
which drive them. And so, as we follow the trail of suggestion, we
suddenly turn a corner and find ourselves back at our
starting-point--the emotional life. Like all other ideas, suggestions
get tied up with emotions to form complexes, of which the
driving-power is the emotion.

If we look into our emotional life, we find, besides the true
emotions, with which we have become familiar in Chapter III, a great
number of feelings or feeling-tones which color either pleasurably or
painfully our emotions and our ideas. On the one hand there are
pleasure, joy, exaltation, courage, cheer, confidence, satisfaction;
and on the other, pain, sorrow, depression, apprehension, gloom,
distrust, and dissatisfaction. Every complex which is laid away in
our subconscious is tinted, either slightly or intensely, with its
specific feeling-tone.

=Emotions--Tonic and Poisonous.= All this is most important because of
one vital fact; joyful emotions invigorate, and sorrowful emotions
depress; pleasurable emotions stimulate, and painful emotions burden;
satisfying emotions revitalize, and unsatisfying emotions sap the
strength. In other words, our bodies are made for courage, confidence,
and cheer. Any other atmosphere puts them out of their element,
handicapped by abnormal conditions for which they were never
fashioned. We were written in a major key, and when we try to change
over into minor tones we get sadly out of tune.

There is another factor; painful emotions make us fall to pieces,
while pleasant emotions bind us together. We can see why this is so
when we remember that powerful emotions like fear and anger tend to
dissociate all but themselves, to split up the mind into separate
parts and to force out of consciousness everything but their own
impulse. Morton Prince in his elaborate studies of the cases of
multiple personality, Miss Beauchamp and B.C.A., found repeatedly that
he had only to hypnotize the patient and replace painful, depressing
complexes by healthy, happy ones to change her from a weak, worn-out
person, complaining of fatigue, insomnia, and innumerable aches and
pains, into a vigorous woman, for the time being completely well. On
this point he says:

     Exalting emotions have an intense synthesizing effect, while
     depressing emotions have a disintegrating effect. With the
     inrushing of depressive memories or ideas ... there is suddenly
     developed a condition of fatigue, ill-being and disintegration,
     followed after waking by a return or accentuation of all the
     neurasthenic symptoms. If on the other hand, exalting ideas and
     memories are introduced and brought into the limelight of
     attention, there is almost a magical reversal of processes. The
     patient feels strong and energetic, the neurasthenic symptoms
     disappear and he exhibits a capacity for sustained effort. He
     becomes re-vitalized, so to speak.[29]

[Footnote 29: Prince: _Psycho-therapeutics_, Chap. I.]

In cases like this the needed strength and energy are not lost; they
are merely side-tracked, but the person feels as weak as though he
were physically ill.


BODILY RESPONSE TO EMOTIONAL STATES

=Secretions.= Let us look more carefully into some of the
physiological processes involved in emotional changes. Among the most
apparent of bodily responses are the various external secretions.
Tears, the secretion of the lachrymal glands in response to an
emotion, are too common a phenomenon to arouse comment. It is common
knowledge that clammy hands and a dry mouth betray emotion. Every
nursing mother knows that she dares not become too disturbed lest her
milk should dry up or change in character. Most people have
experienced an increase in urine in times of excitement; recently
physiologists have discovered the presence of sugar in the urine of
students at the time of athletic contests and difficult
examinations.[30] We have seen what an important role the various
internal secretions, such as the adrenal and thyroid secretions play
in fitting the body for flight and combat, and how large a part fear
and anger have in their production. Constant over-production of these
secretions through chronic states of worry is responsible for many a
distressing symptom.

[Footnote 30: Cannon.]

Most graphic evidence of the disturbance of secretions by emotion is
found in the response of the salivary and gastric glands to painful or
pleasurable thinking. As these are the secretions which play the
largest part in the digestive processes, they lead us naturally to our
next heading.

=Digestion.= Everybody knows that appetizing food makes the mouth
water, but not everybody realizes that it makes the stomach water
also. Nor do we often realize the vital place that this watering has
in taking care of our food. "Well begun is half-done," is literally
true of digestion. A good flow of saliva brings the food into contact
with the taste-buds in the tongue. Taste sends messages to the
nerve-centers in the medulla oblongata; these centers in turn flash
signals to the stomach glands, which immediately "get busy" preparing
the all-important gastric juice. It takes about five minutes for this
juice to be made ready, and so it happens that in five minutes after
the first taste, or even in some cases after the first smell, the
stomach is pouring forth its "appetite juice" which determines all the
rest of the digestive process, in intestines as well as in stomach.
Experiments on dogs and cats by Pawlow, Cannon, and others have shown
what fear and anger and even mildly unpleasant emotions do to the
whole digestive process. Cannon tells of a dog who produced 66.7 cubic
centimeters of pure gastric juice in the twenty minutes following five
minutes of sham feeding (feeding in which food is swallowed and then
dropped out of an opening in the esophagus into a bucket instead of
into the stomach). Although there was no food in the stomach, the
juice was produced by the enjoyment of the taste and the thought of
it. On another day, after this dog had been infuriated by a cat, and
then pacified, the sham feeding was given again. This time, although
the dog ate eagerly, he produced only 9 cubic centimeters of gastric
juice, and this rich in mucus. Evidently a good appetite and
attractively served food are not more important than a cheerful mind.
Spicy table talk, well mixed with laughter, is better than all the
digestive tablets in the world. What is true of stomach secretions is
equally true of stomach contractions. "The pleasurable taking of food"
is a necessity if the required contractions of stomach and intestines
are to go forward on schedule time. A little extra dose of adrenalin
from a mild case of depression or worry is enough to stop all
movements for many minutes. What a revelation on many a case of
nervous dyspepsia! The person who dubbed it "Emotional Dyspepsia" had
facts on his side.

=Circulation.= It is not the heart only that pumps the blood through
the body. The tiny muscles of the smallest blood-vessels, by their
elasticity are of the greatest importance in maintaining an even flow,
and this is especially influenced by fear and depression. Blushing,
pallor, cold hands and feet, are circulatory disturbances based
largely on emotions. Better than a hot-water bottle or electric pads
are courage and optimism. A patient of mine laughingly tells of an
incident which she says happened a number of years ago, but which I
have forgotten. She says that she asked me one night as she carried
her hot-water bottle to bed, "Doctor, what makes cold feet?" and that
I lightly answered "Cowardice!" Whereupon she threw away her beloved
water-bag and has never needed it since.

There is a disturbance of the circulation which results in very
marked swelling and redness of the affected part. This is known as
angio-neurotic edema, or nervous swelling. I do not have to go farther
than my own person for an example of this phenomenon. When I was a
young woman I taught school and went home every day for luncheon. One
day at luncheon, some one of the family criticized me severely. I went
back to school very angry. Before I entered the school-room, the
principal handed me some books which she had ordered for me. They were
not at all the books I wanted, and that upset me still more. As I went
into the schoolroom, I found that my face was swollen until my eyes
were almost shut; it was a bright red and covered with purplish
blotches. My fingers were swollen so that I could not bend the joints
in the slightest degree. It was a day or two before the disturbance
disappeared, and the whole of it was the result of anger.

We hear much to-day about high blood pressure. They say that a man is
as old as his arteries, and now it is known that the health of the
arteries depends largely on blood pressure. Since this is a matter
that can be definitely measured at any minute, we have an easy way of
noting the remarkable effect of shifting emotions. Sadler tells of an
ex-convict with a blood pressure of 190 millimeters. It seems that he
was worrying over possible rearrest. On being reassured on this
point, his blood pressure began to drop within a few minutes, falling
20 mm. in three hours, and 35 mm. by the following day.

=Muscular Tone.= A force that affects circulation, blood pressure,
respiration, nutrition of cells, secretion, and digestion, can hardly
fail to have a marked effect on the tone of the muscles, internal as
well as external. When we remember that heart, stomach, and intestines
are made of muscular tissue, to say nothing of the skeletal muscles,
we begin to realize how important is muscular tone for bodily health.
Over and over again have I demonstrated that a courageous mind is the
best tonic. Perhaps an example from my "flat-footed" patients will be
to the point. One woman, the young mother of a family, came to me for
a nervous trouble. Besides this, she had suffered for seven or eight
years from severe pains in her feet and had been compelled to wear
specially made shoes prescribed by a Chicago orthopedist. The shoes,
however, did not seem to lessen the pain. After an ordinary day's
occupation, she could not even walk across the floor at dinner-time. A
walk of two blocks would incapacitate her for many days. She was
convinced that her feet could never be cured and came to me only on
account of nervous trouble. On the day of her arrival she flung
herself down on the couch, saying that she would like to go away from
everybody, where the children would never bother her again. She was
sure nobody loved her and she wanted to die. Within three weeks, in
ordinary shoes, this woman tramped nine miles up Mount Wilson and the
next day tramped down again. Her attitude had changed from that of
irritable fretfulness to one of buoyant joy, and with the moral change
had come new strength in the muscles. The death of her husband has
since made it necessary for her to support the family, and she is now
on her feet from eight to fourteen hours a day, a constant source of
inspiration to all about her, and no more weary than the average
person.

Flabbiness in the muscles often causes this trouble with the feet.
"The arches of the foot are maintained by ligaments between the bones,
supported by muscle tendons which prevent undue stretching of the
ligaments and are a protection against flat-foot."[31] Muscle tissue
has an abundant blood supply, while ligaments have very little and
soon lose their resiliency if unsupported. Any lack of tone in the
calf-muscles throws the weight on the less resistant ligaments and on
the cartilages placed as cushions between the bony structures of the
arch. This is what causes the pain.[32]

[Footnote 31: Grey's Anatomy--"The Articulations."]

[Footnote 32: Actual loss of the arch by downward displacement of the
bones cannot be overcome by restoring muscle-tone. The majority of
so-called cases of flatfoot are, however, in the stage amenable to
psychic measures.]

Flat-footedness is only one result of weak muscles. Eye-strain is
another; ptosis, or falling of the organs, is another. In a majority
of cases the best treatment for any of these troubles is an
understanding attempt to go to the root of the matter by bracing up
the whole mental tone. The most scientific oculists do not try to
correct eye trouble due to muscular insufficiency by any special
prisms or glasses. They know that the eyes will right themselves when
the general health and the general spirits improve. I have found by
repeated experience with nervous patients that it takes only a short
time for people who have been unable to read for months or years to
regain their old faculty. So remarkable is the power of mind.


SUMMARY

We have found that the gap between the body and the mind is not so
wide as it seems, and that it is bridged by the subconscious mind,
which is at once the master of the body and the servant of
consciousness. In recording the physical effects of suggestion and
emotion, we have not taken time to describe the galvanometers, the
weighing-machines and all the other apparatus used in the various
laboratory tests; but enough has been said to show that when doctors
and psychologists speak of the effect of mind on body, they are
dealing with definite facts and with laws capable of scientific
proof.

We have emphasized the fact that downcast and fearful moods have an
immediate effect on the body; but after all, most people know this
already. What they do not know is the real cause of the mood. When a
nervous person finds out why he worries, he is well on the way toward
recovery. An understanding of the cause is among the most vital
discoveries of modern science.

The discussion, so far, has merely prepared us to plunge into the
heart of the question: What is it that in the last analysis makes a
person nervous, and how may he find his way out? This question the
next two chapters will try to answer.



CHAPTER VII

_In which we go to the root of the matter_

THE REAL TROUBLE


PIONEERS

=Following the Gleam.= Kipling's Elephant-child with the "'satiable
curiosity" finally asked a question which seemed simple enough but
which sent him on a long journey into unknown parts. In the same way
man's modest and simple question, "What makes people nervous?" has
sent him far-adventuring to find the answer. For centuries he has
followed false trails, ending in blind alleys, and only lately does he
seem to have found the road that shall lead him to his journey's end.

We may be thankful that we are following a band of pioneers whose
fearless courage and passion for truth would not let them turn back
even when the trail led through fields hitherto forbidden. The leader
of this band of pioneers was a young doctor named Freud.


THE SEARCH FOR TRUTH

=Early Beginnings.= In 1882, when Freud was the assistant to Dr.
Breuer of Vienna, there was brought to them for treatment a young
woman afflicted with various hysterical pains and paralyses. This
young woman's case marked an epoch in medical history; for out of the
effort to cure her came some surprising discoveries of great
significance to the open-minded young student.

It was found that each of this girl's symptoms was related to some
forgotten experience, and that in every case the forgetting seemed to
be the result of the painfulness of the experience. In other words,
the symptoms were not visitations from without, but expressions from
within; they were a part of the mental life of the patient; they had a
history and a meaning, and the meaning seemed in some way to be
connected with the patient's previous attitude of mind which made the
experience too painful to be tolerated in consciousness. These
previous ideas were largely subconscious and had been acquired during
early childhood. When by means of hypnosis a great mass of forgotten
material was brought to the surface and later made plain to her
consciousness, the symptoms disappeared as if by magic.

=A Startling Discovery.= For a time Breuer and Freud worked together,
finding that their investigations with other patients served to
corroborate their former conclusions. When it became apparent that in
every case the painful experience bore some relation to the love-life
of the patient, both doctors were startled. Along with most of the
rest of the world, they had been taught to look askance at the
reproductive instinct and to shrink from realizing the vital place
which sex holds in human life.

Breuer dropped the work, and after an interval Freud went on alone. He
was resolved to know the truth, and to tell what he saw. When he
reported to the world that out of all his hundreds of patients, he had
been unable, after the most careful analysis, to find one whose
illness did not grow from some lack of adjustment of the sex-life, he
was met by a storm of protest from all quarters. No amount of evidence
seemed to make any difference. People were determined that no such
libel should be heaped on human nature. Sex-urge was not respectable
and nervous people were to be respected.

Despite public disapproval, the scorn of other scientists, and the
resistance of his own inner prejudices, Freud kept on. He was forced
to acknowledge the validity of the facts which invariably presented
themselves to view. Like Luther under equal duress, he cried: "Here I
stand. I can do no other."

=Freudian Principles.= Gradually, as he worked, he gathered together a
number of outstanding facts about man's mental life and about the
psycho-neuroses. These facts he formulated into certain principles,
which may be summed up in the following way.

1 There is no _chance_ in mental life; every mental phenomenon--hence
every nervous phenomenon--has a cause and meaning.

2 Infantile mental life is of tremendous importance in the direction
of adult processes.

3 Much of what is called forgetting is rather a repression into the
subconscious, of impulses which were painful to the personality as a
whole.

4 Mental processes are dynamic, insisting on discharge, either in
reality or in phantasy.

5 An emotion may become detached from the idea to which it belongs and
be displaced on other ideas.

6 Sex-interests dominate much of the mental life where their influence
is unrecognized. The disturbance in a psycho-neurosis is always in
this domain of sex-life. "In a normal sexual life, no neurosis." If a
shock is the precipitating cause of the trouble, it is only because
the ground was already prepared by the sex-disturbance.

Freud was perhaps unfortunate in his choice of the word "sex," which
has so many evil connotations; but as he found no other word to cover
the field, he chose the old one and stretched its meaning to include
all the psychic and physical phenomena which spring directly and
indirectly from the great processes of reproduction and parental care,
and which ultimately include all and more than our word "love."[33]

[Footnote 33: Freud and his followers have always said that they saw
no theoretical reason why any other repressed instinct should not form
the basis of a neurosis, but that, as a matter of fact, they never had
found this to be the case, probably because no other instinct comes
into such bitter and persistent conflict with the dictates of society.
Now, however, the Great War seems to have changed conditions. Under
the strain and danger of life at the front there has developed a kind
of nervous breakdown called shellshock or war-neurosis, which seems in
some cases to be based not on the repression of the instinct of
race-preservation but on the unusual necessity for repression of the
instinct of self-preservation. Army surgeons report that wounded men
almost never suffer from shell-shock. The wound is enough to secure
the unconsciously desired removal to the rear. But in the absence of
wounds, a desire for safety may at the same time be so intense and so
severely repressed that it seizes upon the neurosis as the only
possible means of escape from the unbearable situation. In time of
peace, however, the instinct of reproduction seems to be the only
impulse which is severely enough repressed to be responsible for a
nervous breakdown.]

=Later Developments.= Little by little, the scientific world came to
see that this wild theorizer had facts on his side; that not only had
he formulated a theory, but he had discovered a cure, and that he was
able to free people from obsessions, fears, and physical symptoms
before which other methods were powerless. One by one the open-minded
men of science were converted by the overpowering logic of the
evidence, until to-day we find not only a "Freudian school," counting
among its members many of the eminent scientists of the day, but we
find in medical schools and universities courses based on Freudian
principles, with text-books by acknowledged authorities in medicine
and psychology. We find magazines devoted entirely to psycho-analytic
subjects,[34] besides articles in medical journals and even numerous
articles in popular magazines. Not only is the treatment of nervous
disorders revolutionized by these principles but floods of light are
thrown on such widely different fields of study as ancient myths and
folk lore, the theory of wit, methods of child training, and the
little slips of the tongue and everyday "breaks" that have until
recently been considered the meaningless results of chance.

[Footnote 34: _The Psychoanalytic Review_ and the _International
Journal of Psychoanalysis._]

=A Searching Question.= We find, then, that when we ask, "What makes
people nervous?" we are really asking: "What is man like, inside and
out, up and down? What makes him think, feel, and act as he does every
hour of every day?" We are asking for the source of human motives, the
science of human behavior, the charting of the human mind. It is hard
to-day to understand how so much reproach and ridicule could have been
aroused by the statement that the ultimate cause of nervousness is a
disturbance of the sex-life. There has already been a change in the
public attitude toward things sexual.

Training-courses for mothers and teachers, elementary teaching in the
schools, lectures and magazine articles have done much to show the
fallacy of our old hypersensitive attitude. Since the war, some of us
know, too, with what success the army has used the Freudian principles
in treating war-neurosis, which was mistakenly called shell-shock by
the first observers. We know, too, more about the constitution of
man's mind than the public knew ten years ago. When we remember the
insistent character of the instincts and the repressive method used by
society in restraining the most obstreperous impulse, when we remember
the pain of such conflict and the depressing physical effects of
painful emotions, we cannot wonder that this most sharply repressed
instinct should cause mental and physical trouble.

=What about Sublimation?= On the other hand, it has been stated in
Chapter IV that although this universal urge cannot be repressed, it
can be sublimated or diverted to useful ends which bring happiness,
not disaster, to the individual. We have a right, then, to ask why
this happy issue is not always attained, why sublimation ever fails.
If a psycho-neurosis is caused by a failure of an insistent instinct
to find adequate expression, by a blocking of the libido or the
love-force, what are the conditions which bring about this blocking?
The sex-instinct of every respectable person is subject to restraint.
Some people are able to adjust themselves; why not all? The question,
"What makes people nervous?" then turns out to mean: What keeps people
from a satisfactory outlet for their love-instincts? What is it that
holds them back from satisfaction in direct expression, and prevents
indirect outlet in sublimation? Whatever does this must be the real
cause of "nerves."


THE CAUSES OF "NERVES"

=Plural, not Singular.= The first thing to learn about the cause is
that it is not a cause at all, but several causes. We are so well made
that it takes a combination of circumstances to upset our equilibrium.
In other words, a neurosis must be "over-determined." Heredity, faulty
education, emotional shock, physical fatigue, have each at various
times been blamed for a breakdown. As a matter of fact, it seems to
take a number of ingredients to make a neurosis,--a little unstable
inheritance plus a considerable amount of faulty upbringing, plus a
later series of emotional experiences bearing just the right
relationship to the earlier factors. Heredity, childhood reactions,
and later experiences, are the three legs on which a neurosis usually
stands. An occasional breakdown seems to stand on the single leg of
childhood experiences but in the majority of cases each of the three
factors contributes its quota to the final disaster.

=Born or Made?= It used to be thought that neurotics, like poets, were
born, not made. Heredity was considered wholly responsible, and there
seemed very little to do about it. But to-day the emphasis on heredity
is steadily giving way to stress on early environment. There are, no
doubt, such factors as a certain innate sensitiveness, a natural
suggestibility, an intensity of emotion, a little tendency to nervous
instability, which predispose a person to nerves, but unless the
inborn tendency is reinforced by the reactions and training of early
childhood, it is likely to die a natural death.


CHILDHOOD EXPERIENCES

=Early Reactions.= Freud found that a neurotic is made before he is
six years old. When by repeated explorations into the minds of his
patients, he made this important discovery, he at first believed that
the disturbing factor was always some single emotional experience or
shock in childhood,--usually of a sexual nature. But Freud and later
investigators have since found that the trouble is not so often a
single experience as a long series of exaggerated emotional reactions,
a too intense emotional life, a precocity in feeling tending toward
fixation of childhood habits, which are thus carried over into adult
life.

=Fixation of Habits.= Fixation is the word that expresses all
this,--fixation of childish habits. A neurotic is a person who made
such strong habits in childhood that he cannot abandon them in
maturity. He is too much ruled by the past. His unconscious emotional
thought-habits are the complexes which were made in childhood and
therefore lack the power of adaptation to mature life.

We saw in Chapter IV that Nature takes great pains to develop in the
child the psychic and physical trends which he will need later on in
his mature love-life, and that this training is accomplished in a
number of well-defined periods which lead from one to the other. If,
however, the child reacts too intensely, lingers too long in any one
of these phases, he lays for himself action lines of least resistance
which he may never leave or to which he may return during the strain
and stress of adult life.

In either case, the neurotic is a grown-up child. He may be a very
learned, very charming person, but he is nevertheless dragging behind
him a part of his childhood which he should have outgrown long ago.
Part of him is suffering from an arrest of development,--not a leg or
an arm but an impulse.

=Precocious Emotions.= The habits which tend to become fixed too soon
seem to be of four kinds; the habit of loving, the habit of rebelling,
the habit of repressing normal instincts, and the habit of dreaming.
In each case it is the excess of feeling which causes the
trouble,--too much love, too much hate, too much disgust, or too much
pleasure in imagination. Exaggeration is always a danger-signal. An
overdeveloped child is likely to be an underdeveloped man. Especially
in the emotions is precocity to be deplored. A premature alphabet or
multiplication table is not nearly so serious as premature intensity
of feeling, nor so likely to lead later to trouble. Of course fixation
in these emotional habits does not always lead to a serious breakdown.
If the fixation is not too extreme, and if later events do not happen
to accentuate the trouble, the arrest of development may merely show
itself in certain weaknesses of character or in isolated symptoms
without developing a real neurosis.

Let us examine each of these arrested habits and the excess emotion
which sets the mold before it is ready for maturity.

=Too Much Self-Love.= In the chapter on the reproductive instinct, we
found that the natural way to learn to love is by successively loving
oneself, one's parents and family, one's fellows, and one's mate. If
the love-force gets too much pleasure in any one of these phases, it
finds it hard to give up its old love and to pass on to the next
phase. Thus some children take too much pleasure in their own bodies
or, a little later, in their own personalities. If they are too much
interested in their own physical sensations and the pleasure they get
by stimulating certain zones of the body, then in later life they
cannot free themselves from the desire for this kind of satisfaction.
Try as they may, they cannot be satisfied with normal adult relations,
but sink back into some form of so-called sex-perversion.

Perhaps it is another phase of self-love which holds the child too
much. If, like Narcissus, he becomes too fond of looking at himself,
is too eager to show off, too desirous of winning praise, then forever
after he is likely to be self-conscious, self-centered, thinking
always of the impression he is making, unable ever to be at leisure
from himself. He is fixed in the Narcissistic stage of his life, and
is unadapted to the world of social relations.

=Too Much Family-love.= We have already spoken of the danger of
fixation in the second period, that of object-love--the period of
family relationships. The danger is here again one of degree and may
be avoided by a little knowledge and self-control on the part of the
parents. The little girl who is permitted to lavish too much love on
her father, who does not see anybody else, who cannot learn to like
the boys is a misfit. The wise mother will see that her love for her
boy does not express itself too much by means of hugs and kisses. The
mother who shows very plainly that she loves her little boy better
than she loves her husband and the mother who boasts that her
adolescent boy tells her all his secrets and takes her out in
preference to any girl--that deluded mother is trying to take
something that is not hers, and is thereby courting trouble. When her
son grows up, he may not know why, but no girl will suit him, and he
will either remain a bachelor or marry some older woman who reminds
him subconsciously of his mother. His love-requirements will be too
strict; he will be forever trying either in phantasy or in real life
to duplicate his earlier love-experiences. This, of course, cannot
satisfy the demands of a mature man. He will be torn between
conflicting desires, unhappy without knowing why, unable either to
remain a child or to become a man, and impelled to gain
self-expression in indirect and unsatisfactory ways.

Since it is not possible in this space to recite specific cases which
show how often a nervous trouble points back to the father-mother
complex,[35] it may help to cite the opinions of a few of our best
authorities. Freud says of the family complex, "This is the root
complex of the neurosis." Jelliffe: "It is the foot-rule of
measurement of success in life": by which he means that just so far as
we are able at the right time to free ourselves from dependence on
parents are we able to adjust ourselves to the world at large.
Pfister: "The attitude toward parents very often determines for a
life-time the attitude toward people in general and toward life
itself." Hinkle: "The entire direction of lives is determined by
parental relationships."

[Footnote 35: This is technically known as the Oedipus Complex.]

=Too Much Hate.= Besides loving too hard, there is the danger of
hating too hard. If it sounds strange to talk of the hatreds of
childhood, we must remember that we are thinking of real life as it is
when the conventions of adult life are removed and the subconscious
gives up its secrets.

Several references have been made to the jealousy of the small child
when he has to share his love with the parent of the same sex. For
every little boy the father gets in the way. For every little girl the
mother gets in the way. At one time or other there is likely to be a
period when this is resented with all the violence of a child's
emotions. It is likely to be very soon repressed and succeeded by a
real affection which lasts through life. But underneath, unmodified by
time, there may exist simultaneously the old childish image and the
old unconscious reaction to it, unconscious but still active in
indirect ways.

Jealousy is very often united with the natural rebellion of a child
against authority. The rebellion may, of course, be directed against
either parent who is final in authority in the home. In most cases
this is the father. As the impulse of self-assertion is usually
stronger in boys than in girls, and as the boy's impulse in this
direction is reinforced by any existing jealousy toward his father, we
find a strong spirit of rebellion more often playing a subconscious
part in the life of men than of women. The novelist's favorite theme
of the conflict between the young man and "the old man" represents the
conscious, unrepressed complex. More often, however, there is true
affection for the father, while the rebellion which really belongs to
the childish father-image is displaced or transferred to other symbols
of authority,--the state, the law, the king, the school, the teacher,
the church, or perhaps to religion and authority in general.
Anarchists and atheists naturally rationalize their reasons for
dissent, but, for all that, they are not so much intellectual pioneers
as rebellious little boys who have forgotten to grow up.

=Liking to be "Bossed."= There is a worse danger, however, than too
much rebellion, and that is too little rebellion. Sometimes this
yielding spirit is the result of an overdose of negative self-feeling
and an under-dose of positive self-feeling; but sometimes it is
over-compensation for the repressed spirit of rebellion which the
child considers wicked. Consciously he becomes over-meek, because he
has to summon all his powers to fight his subconscious insurrection.
Whether he be meek by nature or by training, he is likely to be a
failure. Everybody knows that the child who is too good never amounts
to anything. He who has never disobeyed is a weakling. Naturally
resenting all authority, the normal individual, if he be well trained,
soon learns that some authority is necessary. He rebels, but he learns
to acquiesce, to a certain degree. If he acquiesces too easily,
represses too severely his rebellious spirit, swings to the other
extreme of wanting to be "bossed," he is very likely to end as a
nervous invalid, unfitted for the battles of life. The neurotic in the
majority of cases likes authority, clings to it too long, wants the
teacher to tell him what to do, wants the doctor to order him around,
is generally over-conscientious, and afraid he will offend the "boss"
or some one else who reminds him of the father-image. All this carries
a warning to parents who cannot manage their children without
dominating their lives, even when the domination is a kindly one.
Perhaps the modern child is in more danger of being spoiled than
bullied, but analysis of nervous patients shows that both kinds of
danger still exist.

=Too Much Disgust.= The third form of excessive emotion is disgust.
The love-force, besides being blocked by a fixation of childish love
and of childish reactions toward authority, is very often kept from
free mature self-expression by a perpetuation of a childish reaction
against sex. We hardly need dwell longer on the folly of teaching
children to be ashamed of so inevitable a part of their own nature.
Disgust is a very strong emotion, and when it is turned against a part
of ourselves, united with that other strong impulse of self-regard and
incorporated into the conscience, it makes a Chinese wall of exclusion
against the baffled, misunderstood reproductive instinct, which is
thrust aside as alien.

=Restraint versus Denial.= Repression is not merely restraint. It is
restraint plus denial. To the clamoring instinct we say not merely,
"No, you _may_ not," but "No, you _are_ not. You do not exist. Nothing
like you could belong to me." The woman with nausea (Chapter V) did
not say to herself: "You are a normal, healthy woman, possessed of a
normal woman's desires. But wait a while until the proper time comes."
Controlled by an immature feeling of disgust, she had said: "I never
thought it. It cannot be."

The difference is just this. When an ungratifiable desire is honestly
faced and squarely answered, it is modified by other desires, chooses
another way of discharge, and ceases to be desire. When a desire is
repressed, it is still desire, unsatisfied, insistent, unmodifiable by
mature points of view, untouched by time, automatic, and capable of
almost any subterfuge in order to get satisfaction. A repressed desire
is buried, shut away from the disintegrating effects of sunlight and
air. While the rest of the personality is constantly changing under
the influence of new ideas, the buried complex lives on in its
immaturity, absolutely untouched by time.

=Childish Birth-theories.= When a child's questions about where babies
come from are met by evasions, he is forced to manufacture his own
theories. His elders would laugh if they knew some of these theories,
but they would not laugh if they knew how often the childish ideas,
wide of the truth, furnish the material for future neuroses. Frink
tells the story of a young woman who had a compulsion for taking
drugs. Although not a drug-fiend in the usual sense, she was
constantly impelled to take any kind of drug she could obtain. It was
finally revealed that during her childhood she had tried hard to
discover how babies were made, and had at last concluded that they
grew in the mother as a result of some medicine furnished by the
doctor. The idea had long been forgotten, only to reappear as a
compulsion. The natural desire for a child was strong in her, but was
repressed as unholy in an unmarried woman. The associated childish
idea of drug-taking was not repellent to her moral sense and was used
as a substitute for the real desire to bear a child.

Many of my patients have suffered from the effect of some such
birth-theories. One young girl, twenty years old, was greatly
afflicted with myso-phobia, or the fear of contamination. She spent
most of her time in washing her hands and keeping her hands and
clothing free from contamination by contact with innumerable harmless
objects. When cleaning her shoes on the grass, she would kneel so that
the hem of her skirt would touch the grass, lest some dust should fly
up under her clothes. After eating luncheon in the park with a girl
who had tuberculosis, she said that she was not afraid of tuberculosis
in the lungs, but asked if something like tuberculosis might not get
in and begin to grow somewhere else. Her life was full to overflowing
of such compulsive fears.

As opportunity offered itself from day to day, I would catch her
compulsive ideas in the very act of expressing themselves, and would
pin her down as to the association and the source of her fear, always
taking care not to make suggestions or ask leading questions. She was
finally convinced out of her own mouth that her real fear was the idea
of something getting into her body and growing there. Then she told
how she had questioned her mother about the reproductive life and had
been put off with signs of embarrassment. For a long time she had been
afraid to walk or talk with a boy, because, not knowing how conception
might occur, she feared grave consequences.

Very soon after the beginning of her conversations with me, the girl
realized that her fear was really a disguised desire that something
might be planted within and grow. With her new understanding of
herself, her compulsions promptly slipped away. She began to eat and
sleep, and to live a happy, natural life.

=Chronic Repression.= It takes first-hand acquaintance with nervous
patients to realize how common are stories like these. Unnecessary
repressions based on false training are the cause of many a physical
symptom and mental distress which a little parental frankness might
have forestalled.[36]

[Footnote 36: Parents who are eager to handle this subject in the
right way are often sincerely puzzled as to how to go about it. No
matter how complete their education, it is very likely to fail them at
this critical point. For the benefit of such parents, let it be said
with all possible emphasis that the first and most important step must
be a change in their own mental attitude. If there is left within them
the shadow of embarrassment on the subject of sex, their children will
not fail to sense the situation at once. A feeling of hesitation or a
tendency to apologize for nature makes a far deeper impression on the
child-mind than do the most beautiful of half-believed words on the
subject. And this impression, subtle and elusive as it may seem, is a
real and vital experience which is quite likely to color the whole of
the child's life. If you would give your children a fair start, you
must first get rid of your own inner resistances. After that, all will
be clear sailing.

In the second place, take the earliest opportunity to bring up the
subject in a natural way. A young father told me recently that his
little daughter had asked her mother why she didn't have any lap any
more. "And of course your wife took that chance to tell her about the
baby that is coming," I said. "Oh, no," he answered, "she did nothing
of the kind. Mary is far too young to know about such things." There
are always chances if we are on the look out for them--and the earlier
the better. It has been noticed that children are never repelled by
the idea of any natural process unless the new idea runs counter to
some notion which has already been formed. The wise parent is the one
who gets in the right impression before some other child has had a
chance to plant the wrong one.

Then, too, we elders are judged quite as much by what we do not say as
by what we do. Happy is the child who is not left to draw his own
conclusions from the silence and evasiveness of his parents. The
sex-instruction which children are getting in the schools is often
good, but it usually comes too late--the damage is always done before
the sixth year.

When it comes to the exact words in which to explain the phenomena of
generation and birth each parent must naturally find his own way. The
main point is that we must tell the truth and not try to improve on
nature. If we say that the baby grows under the mother's heart and
later the child learns that this is not true, he inevitably gets the
idea that there is something not nice about the part of the body in
which the baby does grow. What could be wrong with the simple truth
that the father plants a tiny seed in the mother's body and that this
seed joins with another little seed already there and grows until it
is a real baby ready to come into the world? The question as to how
the father plants the seed need cause no alarm. If brothers and
sisters are brought up together with no artificial sense of false
modesty, they very early learn the difference between the male and the
female body. It is simple enough to tell the little child the function
of the male structure. And it is easy to explain that the seeds do not
grow until the little boy and girl have grown to be man and woman and
that the way to be well and to have fine strong children is to leave
the generative organs alone until that time. A sense of the dignity
and high purpose of these organs is far more likely to prevent
perversions--to say nothing of nervousness--than is an attitude of
taboo and silence.]

A certain amount of repression is inevitable and useful, but a
neurotic is merely an exaggerated represser. He represses so much of
himself that it will not stay down.[37] He builds up a permanent
resistance which automatically acts as a dam to his normal sex
instinct and forces it into undesirable outlets.

[Footnote 37: "A neurosis is a partial failure of repression." Frink:
_Morbid Fears and Compulsions_.]

A resistance is a chronic repression, repression that has become fixed
and subconscious, a habit that has lost its flexibility and outlives
its usefulness. It is a fixation of repression, and is built out of an
over-strong complex or emotional thought habit, acquired during
childhood, incorporated into the conscience and carried over into
maturity, where it warps judgment and interferes with normal
development because it is fundamentally untrue and at variance with
the laws of nature.

=Too Much Day-Dreaming.= The fourth habit which holds back the adult
from maturity and predisposes toward "nerves" is the habit of
imagination. It need hardly be said that a certain kind of imagination
is a good thing and one of man's greatest assets. But the essence of
day-dreaming is the exact opposite; it is the desire to see things as
they are not, but as we should like them to be,--not in order that we
may bring them to pass, but for the mere pleasure of dreaming. Instead
of turning a microscope or a telescope on the world of reality, as
positive imagination does, this negative variety refuses even to look
with the naked eye. To dream is easier than to do; to build up
phantasies is easier than to build up a reputation or a fortune; to
think a forbidden pleasure is easier than to sublimate.
"Pleasure-thinking" is not only easier than "reality-thinking,"--it is
the _older_ way.

Children gratify many of their desires simply by imagining them
gratified. Much of the difficulty of later life might be avoided if
the little child could be taught to work for the accomplishment of his
pleasures rather than to dream of them. The normal child gradually
abandons this "pleasure-thinking" for the more purposeful thinking of
the actual world, but the child who loiters too long in the realm of
fancy may ever after find it hard to keep away from its borders. His
natural interest in sex, if artificially repressed, is especially
prone to satisfy itself by way of phantasy.

=Turning back to Phantasy.= In later life, when the love-force for one
reason or another becomes too strong to be handled either directly or
indirectly in the real world, there comes the almost irresistible
impulse to regress to the infantile way and to find expression by
means of phantasy. After long experience Freud concluded that phantasy
lies at the root of every neurosis. Jung says that a sex-phantasy is
always at least one determiner of a nervous illness, and Jelliffe
writes that the essence of the neurosis is a special activity of the
imagination.

Such a statement need not shock the most sensitive conscience. The
very fact that a neurosis breaks out is proof that the phantasies are
repellent to the owners of them and are thrust down into the
subconscious as unworthy. In fact, every neurosis is witness to the
strength of the human conscience. No phantasy could cause illness. It
is the phantasy plus the repression of it that makes the trouble, or
rather it is the conflict between the forces back of the phantasy and
the repression. The neurosis, then, turns out to be a "flight from the
real," the result of a desire to run away from a difficulty. When a
problem presses or a disagreeable situation is to be faced, it is
easier to give up and fall ill than to see the thing through to the
end. Here again, we find that nervousness is a regression to the
irresponsible reactions of childhood.

=Maturity versus Immaturity.= We have been thinking of the main causes
of "nerves" and have found them to be infantile habits of loving,
rebelling, repressing, and dreaming. We have tried to show that these
habits are able to cause trouble because of their bearing on that
inevitable conflict between the ancient urge of the reproductive
instinct and the later ideals which society has acquired. If this
conflict be met in the light of the present, free from the backward
pull, of outgrown habits, an adjustment is possible which satisfies
both the individual and society. We call this adjustment sublimation.
This is rather a synthesis than a compromise, a union of the opposing
forces, a happy utilization of energy by displacement on more useful
ideas. But if the conflict has to be met with the mind hampered by
immature thinking and immature feeling; if the demands of the
here-and-now are met as if it were long ago; if unhealthy and untrue
complexes, old loves and hates complicate the situation; if to the
necessary conflict is added an unnecessary one; then something else
happens. Compromise of some kind must be made, but instead of a happy
union of the two forces a poor compromise is effected, gaining a
partial satisfaction for both sides, but a real one for neither. The
neurosis is this compromise.


LATER EXPERIENCES

=The Last Straw.= The precipitating cause may be one of a number of
things. It may be entirely within, or it may be external. Perhaps it
is only a quickening of the maturing instincts at the time of
adolescence, making the love-force too strong to be held by the old
repressions. Perhaps the husband, wife, or lover dies, or the
life-work is taken away, depriving the vital energy of its usual
outlets. Perhaps the trigger is pulled by an emotional shock which
bears a faint resemblance to old emotional experiences, and which
stimulates both the repressing and repressed trends and makes the
person at the same time say both "Yes," and "No."[38] Perhaps
physical fatigue lets down the mental and moral tension and makes the
conflict too strong to be controlled. Perhaps an external problem
presses and arouses the old habit of fleeing from disagreeable
reality. Any or all these factors may cooperate, but not one of them
is anything more than a last straw on an overburdened back. No
calamity, deprivation, fatigue, or emotion has been able to bring
about a neurosis unless the ground was prepared for it by the earlier
reactions of childhood.

[Footnote 38: "The external world can only cause repression when there
was already present beforehand a strong initial tension reaching back
even to childhood."--Pfister: _Psychoanalytic Method_, p. 94.]


THE BREAKDOWN ITSELF

="Two Persons under One Hat."= We can understand now why a neurotic
can be described in so many ways. We often hear him called an
especially moral, especially ethical person, with a very active
conscience; an intensely social being, unable to be satisfied with
anything but a social standard; a person with "finer intellectual
insight and greater sensitiveness than the rest of mankind." At the
same time we are told that a neurosis is a partial triumph of
anti-social, non-moral factors, and that it is a cowardly flight from
reality; we hear a nervous invalid called selfish, unsocial, shut in,
primitive, childish, self-deceived. Both these descriptions are true
to life. A neurosis is an ethical struggle between these two sets of
forces. If the lower set had triumphed, the man would have been merely
weak; if the higher set had been victorious, he would have been
strong. As it is, he is neither one nor the other,--only nervous. The
neurosis is the only solution of the struggle which he is able to
find, and serves the purpose of a sort of armed armistice between the
two camps.


SERVING A PURPOSE

If a neurosis is a compromise, if it is the easiest way out, if it
serves a purpose, it must be that the individual himself has a hand in
shaping that purpose. Can it be that a breakdown which seems such an
unmitigated disaster is really welcomed by a part of our own selves?
Nothing is more intensely resented by the nervous invalid than the
accusation that he likes his symptoms,--and no wonder. The conscious
part of him hates the pain, the inconvenience, and the disability with
a real hatred. It is not pleasant to be ill. And yet, as it turns out,
it is pleasanter to be ill than it is to bear the tension of
unsatisfied desire or to be undeceived about oneself. Every symptom is
a means of expression for repressed and forgotten impulses and is a
relief to the personality. It tends to the preservation of the
individual, rather than to his destruction. The nervous invalid is not
short-lived, but his family may be! It has been said that a neurosis
is not so much a disease as a dilemma. Rather might it be said that
the neurosis is a way out of the dilemma. It is a harbor after a
stormy sea, not always a quiet harbor, but at least a usable one.
Unpleasant as it is, every nervous symptom is a form of compensation
which has been deliberately though unconsciously chosen by its owner.

=Rationalizing Our Distress.= Among other things, a nervous symptom
furnishes a seemingly reasonable excuse for the sense of distress
which is behind every breakdown. Something troubles us. We are not
willing to acknowledge what it is. On the other hand, we must appear
reasonable to ourselves, so we manufacture a reason. Perhaps at the
time when the person first feels distress, he is on a railroad train.
So he says to himself, "It is the train. I must not go near the
railway"; and he develops a phobia for cars. Perhaps at the onset of
the fear he happens to have a slight pain in the arm. He makes use of
the pain to explain his distress. He thinks about it and holds on to
it. It serves a purpose, and is on the whole less painful than the
feeling of unexplained impending disaster which is attached to no
particular idea. Perhaps he happens to be tired when the conflict
first gets beyond control. So he seizes the idea of fatigue to explain
his illness. He develops chronic fatigue and talks proudly of
overwork. In every case the symptom serves a real purpose, and is,
despite its discomfort, a relief to the distressed personality.

A neurosis is a subconscious effort at adjustment. Like a physical
symptom, it is Nature's way of trying to cure herself. It is an
attempt to get equilibrium, but it is an awkward attempt and hardly
the kind that we would choose when we see what we are doing.

=Securing an Audience.= Besides furnishing relief from too intense
strain, a nervous breakdown brings secondary advantages that are at
most only dimly recognized by the individual. One of the most intense
cravings of the primitive part of the subconscious is for an audience;
a nervous symptom always secures that audience. The invalid is the
object of the solicitous care of the family, friends, physician, and
specialist. Pomp and ceremony, so dear to the child-mind, make their
appeal to the dissociated part of the personality. The repressed
instincts, hungry for love and attention, delight in the petting and
special care which an illness is sure to bring. Secretly and
unconsciously, the neurotic takes a certain pleasure in all the
various changes that are made for his benefit,--the dismantling of
striking clocks, the muffling of household noises, the banishing of
crowing roosters, and the changes in menu which must be carefully
planned for his stomach.

This characteristic of finding pleasure in personal ministrations is
plainly a regression to the infantile phase of life. The baby demands
and obtains the center of the stage. Later he has to learn to give it
up, but the neurotic gets the center again and is often very loth to
leave it for a more inconspicuous place.

=Capitalizing an Illness.= Then, too, a neurosis provides a way of
escape from all sorts of disagreeable duties. It can be capitalized in
innumerable ways,--ways that would horrify the invalid if he realized
the truth. Much of the resentment manifested against the suggestion
that the neurosis is psychic in origin is simply a resistance against
giving up the unconsciously enjoyed advantages of the illness. An
honest desire to get well is a long step toward cure.

The purposive character of a nervous illness is well illustrated by
two cases reported by Thaddeus Hoyt Ames.[39] A young woman, the
drudge of the family, suddenly became hysterically blind, that is, she
became blind despite the fact that her eyes and optic nerves proved to
be unimpaired. She remained blind until it was proved to her that a
part of her welcomed the blindness and had really produced it for the
purpose of getting away from the monotony of her unappreciated life at
home. She naturally resented the charge but finally accepted it and
"turned on" her eyesight in an instant. The other patient, a man,
became blind in order to avoid seeing his wife who had turned out to
be not at all what he had hoped. When he realized what he was doing,
he decided that there might be better ways of adjusting himself to his
wife. He then switched on his seeing power, which had never been
really lost, but only disconnected and dissociated from the rest of
his mind.

[Footnote 39: Thaddeus Hoyt Ames: _Archives of Ophthalmology_, Vol.
XLIII, No. 4, 1914.]

That the conscious mind has no part in the subterfuge is shown by the
fact that both patients gave up their artificial haven as soon as they
saw how they had been fooling themselves. The fact remains that every
neurosis is the fulfilment of a wish,--a distorted, unrecognized,
unsatisfactory fulfilment to be sure, but still an effort to satisfy
desire. As Frink remarks, "A neurosis is a kind of behaviour." We
always choose the conduct we like. It is a matter of choice. Does not
this answer our question as to why some people always take unhealthy
suggestions? If we take the bad one, it is because it serves the need
of a part of our being.


SIGN LANGUAGE

=Talking in Symbols.= We have several times suggested that a nervous
symptom is a disguised, indirect expression of subconscious impulses.
It is the completeness of the disguise which makes it so hard for us
to realize its true meaning. It takes a stretch of the imagination to
believe that a pain in the body can mean a pain in the soul, or that
a fear of contamination can signify a desire to bear a child. But in
all this we must not forget the primitive, childlike nature of the
instinctive life.

The savage and the child do not think as civilized man thinks. Savage
or child thinks in pictures; he acts his feelings; he groups things
according to superficial resemblances, he expresses an idea by its
opposite; he talks in symbols. We still use these devices in poetic
speech and in everyday thought. A wedding-ring stands for the marriage
bond; the flag for a nation; a greyhound for fleetness; a wild beast
for ferocity; sunrise for youth; and sunset for old age. "The essence
of language consists in the statement of resemblance. The expression
of human thought is an expression of association."[40]

[Footnote 40: Trigant Burrow: _Journal of American Medical
Association_, Vol. LXVI, No. II, 1916.]

The association may be so accidental and superficial as to seem absurd
to another person, or it may be so fundamental as to express the
universal thought of man from the beginning of time. Many of the signs
and symbols which crop out in neurotic symptoms and in normal dreams
are the same as those which appear in myths, fairy tales and folk-lore
and in the art of the earlier races.

=A Secret Code.= When the denied instincts of a man's repressed life
insist on expression, and when the shocked proprieties of his
repressing life demand conformity to social standards, the
subconscious, held back from free speech, strikes a compromise by
making use of figurative language. As Trigant Burrow says, if the
moral repugnance is very strong, the disguise must be more elaborate,
the symbols more far-fetched. The symbols of nervous symptoms and of
dreams are a "secret code," understood by the sender but meaningless
to the censoring conscience, which passes them as harmless.

=The Right Kind of Symbolism.= Sublimation itself is merely a symbolic
expression of basic impulses. It follows the line of our make-up,
which naturally and fundamentally is wont to let one thing stand for
another and to express itself in indirect ways. Sublimation says: "If
I cannot recreate myself in the person of a child, I will recreate
myself in making a bridge, or a picture, or a social settlement,--or a
pudding." It says: "If I cannot have my own child to love, I will
adopt an orphan-asylum, or I will work for a child-labor law." It
merely lets one thing stand for another and transfers all the passions
that belong to the one on to the other, which is the same thing as
saying that it gives vent to its original desire by means of symbolic
expression.

=The Wrong Kind of Symbolism.= A nervous disorder is an unfortunate
choice of symbols. Instead of spiritualizing an innate impulse, it
merely disguises it. The disguise takes a number of forms. One of the
commonest ways is to act out in the body what is taking place in the
soul. The woman with nausea converted her moral disgust into a
physical nausea, which expressed her distress while it hid its
meaning. The girl who was tired of seeing her work, and the man who
wanted to avoid seeing his wife chose a way out which physically
symbolized their real desire. A dentist once came to me with a
paralyzed right arm. He had given up his office and believed that he
would never work again. It turned out that his only son had just died
and that he was dramatizing his soul-pain by means of his body. His
subconscious mind was saying, "My good right arm is gone," and saying
it in its own way. Within a week the arm was playing tennis, and ever
since it has been busy filling teeth. There were, of course, other
factors leading up to the trouble, but the factor which determined its
form was the sense of loss which acted itself out through the body.

Sometimes, as we have seen, the disguise takes another form. Instead
of conversion into a physical symptom, it lets one idea stand for
another and displaces the impulse or the emotion to the substitute
idea. The girl with the impulse to take drugs fooled her conscience by
letting the drug-taking idea stand for the idea of conception. The
girl with the fear of contamination carried the disguise still
farther by changing the desire into fear,--a very common subterfuge.

=The Case of Mrs. Y.= There came to me a short time ago a little woman
whose face showed intense fright. For several months she had spent
much of the time walking the floor and wringing her hands in an agony
of terror. In the night she would waken from her sleep, shaking with
fear; soon she would be retching and vomiting, although she herself
recognized the fact that there was nothing the matter with her
stomach.

Part of the time her fear was a general terror of some unknown thing,
and part of the time it was a specialized fear of great intensity. She
was afraid she would choke her son, to whom she was passionately
devoted. During the course of the treatment, which followed the lines
of psycho-analysis to be described in the next chapter, I found that
this fear had arisen one evening when she was lying reading by the
side of her sleeping child. Suddenly, without warning, she had a sort
of mental picture of her own hands reaching out and choking the boy.
Naturally she was terrified. She jumped out of bed, decided that she
was losing her mind and went into a hysterical state which her husband
had great trouble in dispelling. After that she was afraid to be left
alone with her children lest she should kill them.

During the analysis it was discovered that what she had been reading
on that first night was the thirteenth verse of the ninety-first
Psalm. "Thou shalt tread upon the lion and the adder. The young lion
and the dragon thou shalt trample under foot." To her the adder meant
the snake, the tempter in the Garden of Eden, and hence sex. What she
wanted to choke was her own insistent sex urge of which the child was
the symbol and the result. On later occasions she had the same sort of
hallucinations in connection with another child and on sight of a
brutish kind of man who symbolized to the subconscious mind the
sex-urge, of which she was afraid. Not so much by what her mother had
said as by what she had avoided saying, and by her expression whenever
the subject was mentioned, had she given her little daughter a
fundamentally wrong idea of the reproductive instinct. Later when the
girl was woman grown she still clung to the old conception, deploring
the sex-part of the marriage relation and feeling herself too refined
to be moved by any such sensual urge. But the strong sex-instinct
within her would not be downed. It was so insistent as to be an object
of terror to her repressing instinct, which could not bring itself to
acknowledge its presence. The fear that came to the surface was merely
a disguised and symbolic representation of this real fear which was
turning her life into a nightmare.

The nausea and vomiting in this woman seemed to be symbolic of the
disgust which she felt subconsciously at the thought of her own
sex-desires, but sometimes the physical disturbances which accompany
such phobias are the natural physical reactions to the constant fear
state. Indigestion, palpitation, and tremors are not in themselves
symbolic of the inner trouble but may be the result of an overdose of
the adrenal and thyroid secretions and the other accompaniments of
fear. In such cases the real symptom is the fear, and the physical
disturbance an incidental by-product of the emotional state. In any
case a nervous symptom is always the sign of something else--a
hieroglyph which must be deciphered before its real meaning can be
discovered.


SUMMARY

=Three Kinds of People.= Absurd as it sounds, "nerves" turn out to be
a question of morals; a neurosis, an affair of conscience; a nervous
symptom an unsettled ethical struggle. The ethical struggle is not
unusual; it is a normal part of man's life, the natural result of his
desire to change into a more civilized being. The people in the world
may be divided into three classes, according to the way they decide
the conflict.

=The Primitive.= The first class merely capitulate to their primitive
desires. They may not be nervous, but it is safe to say that they are
rarely happy. The voice of conscience is hard to drown, even when it
is not strong enough to control conduct. Happily it often succeeds in
making us miserable, when we desert the ways that have proved best for
our kind. The "immoral" person has not yet "arrived"; he simply
disregards the collective wisdom of society and gives the victory to
the primitive forces which try to keep man back on his old level. We
cannot break the ideals by which man lives, and still be happy.

=The Salt of the Earth.= The second class of people decide the
conflict in a way that satisfies both themselves and society. They
give the victory to the higher trends and at the same time make a
lasting peace by winning over the energy of the undesirable impulses.
By sublimation they divert the threatening force to useful work and
turn it out into real life, using its steam to make the world's wheels
go round. Their love-force, unhampered by childish habits, is free to
give itself to adult relationships or to express itself symbolically
in socially helpful ways.

=Nervous People.= To the third class belong the people who have not
finished the fight. These are the folk with "nerves," the people in
whom the conflict is fiercest because both sides are too strong. The
victory goes to neither side; the tug of war ends in a tie. Since the
energy of the nervous person is divided between the effort to repress
and the effort to gain expression, there is little left for the
external world. There is plenty of energy wasted on emotion, physical
symptoms, phantasy, or useless acts symbolizing the struggle.

A neurotic is a normal person, "only more so." His impulses are the
same impulses as those of every other person; his complexes are the
same kind of complexes, only more intense. He is an exaggerated human
being. He may be only slightly exaggerated, showing merely a little
character-weakness or a slight physical symptom, or he may be so
intensified as to make life miserable for himself and everybody near
him. It is quantity, not quality, that ails him, for he differs from
his steady-going neighbor not in kind but in degree. More of him is
repressed and a larger part of him is fixed in a childish mold.

=Tricking Ourselves.= A neurosis is a confidence game that we play on
ourselves. It is an attempt to get stolen fruit and to look pious at
the same time,--not in order to fool somebody else but to fool
ourselves.

No nervous symptom is what it seems to be. It is an arch pretender. It
pretends to be afraid of something it does not fear at all, or to
ignore something that interests it intensely. It pretends to be a
physical disease, when primarily it has nothing to do with the body;
and the person most deluded is the one who "owns" the symptom. Its
purpose is to avoid the pain of disillusionment and to furnish relief
to a distracted soul which dares not face itself.

Although the true meaning of a symptom is hidden, there is fortunately
a clue by which it can be traced. Sometimes it takes the art of a
psychic detective to follow the clues down, down through the different
layers of the subconscious mind, until the troublesome impulses and
complexes are found and dragged forth,--not to be punished for
breaking the peace but to be led toward reconciliation. But "that is
another story," and belongs to another chapter. We are approaching THE
WAY OUT.

PART III--THE MASTERY OF "NERVES"



CHAPTER VIII

_In which we pick up the clue_

THE WAY OUT

THE SCIENCE OF RE-EDUCATION


There is a story of an Irishman at the World's Fair in Chicago.
Although his funds were getting low, he made up his mind that he would
not go home without a ride on a camel. For several minutes he stood
before a sign reading: "First ride 25¢, second ride 15¢, third ride
10¢." Then, scratching his head, he exclaimed, "Faith, and I'll take
the third ride!" Should there by any chance be a reader who, eager to
find the way out without paying the price of knowledge, is tempted to
say to himself "Faith, and I'll begin with Part III," we give him fair
warning that if he does so, he will in all probability end by putting
down the book in a confused and skeptical frame of mind.

It is difficult to find our way out of a maze without some faint idea
of the path by which we got in. He who brings to this chapter the
popular notion that nervousness is the result of worn-out
nerve-cells, can hardly be expected to understand how it can be cured
by a process of mental adjustment. Suggestion to that effect can
scarcely fail to appear to him faddish and unpractical. But once a
person has grasped the idea that "nerves" are merely a slip in the cog
of hidden mental machinery, and has acquired at least a
working-knowledge of "the way the wheels go round," he can scarcely
fail to understand that the only logical cure must consist in some
kind of readjustment of this underground machinery. If "nerves" were
physical, then only physical measures could cure, but as they are
psychic, the only effective measures must be psychic.

=Gross Misconceptions.= Nervousness is caused by a lack of adjustment
to the world as it is; therefore the only possible cure must be some
sort of readjustment between the person's inner forces and the demands
of the social world. As this lack of adjustment is concerned chiefly
with the repressed instinct of reproduction, it is only natural that
there should be people who believe that "the way out" lies in some
form of physical satisfaction of the sex-impulse--in marriage, in
changing or ignoring the social code, in homo-sexual relations or in
the practice of masturbation. But we have only to look about us to see
that this prescription does not cure. Freud naïvely asks whether he
would be likely to take three years to uncover and loosen the psychic
resistances of his patients, if the simple prescription of sex-license
would give relief.

Since there are as many married neurotics as single, it is evident
that even marriage is not a sure preventive of nervousness. License,
on the other hand, can satisfy only a part of the individual's
craving. Freud insists that the sex-instinct has a psychic component
as well as a physical one, and that it is this psychic part which is
most often repressed. He maintains that for complete satisfaction
there must be psychic union between mates, and that gratification of
the physical component of sex when dissociated from psychic
satisfaction, results in an accumulation of tension that reacts badly
on the whole organism.

The psychic tension accumulating in adult sex-relations has its
inception in the mistaken attitude on the part of the wife, who
remains true to her childhood training that any pleasure in sex is
vulgar; or on the part of the man, who reacts to the mood of the wife,
or is held by his own unbroken mother-son complex; or on the part of
both the tension piles up because of society's taboo upon rearing
large families. As the first two factors in this lack of adjustment
grew largely out of some kind of faulty education or from faulty
reaction to early experiences, the only effective way to secure a
better adaptation must be through a re-education which reaches down
to that part of the personality that bears the stamp of the
unfortunate early factors.

=Remaking Ourselves.= As a matter of fact, the science of
psychotherapy or mental treatment is simply the science of
re-education,--a process designed to break up old unhealthy complexes
which disrupt the forces of the individual, and to build up healthy
complexes which adjust him to the social world and enable him to use
his energy in useful ways.

Fortunately, minds can be changed. It is easier to make over an
unhealthy complex than to make over a weak heart, to straighten out a
warped idea than to straighten a bent back. Remarkable indeed have
been some of the transformations in people who are supposed to have
passed the plastic period in life. While it is true that some persons
become "set" in middle life, and almost impervious to new ideas, it is
also true that a person at fifty has more richness of experience upon
which to draw, more appreciation of the value of the good, than has a
person at twenty. If he really wants to change himself, he can do
wonderful things by re-education.

The first step in this re-education is a grasp of the facts. If you
want to pull yourself out of a nervous disorder, first of all learn as
much as you can about the causes of "nerves," about the general laws
of mind and body, and about your own mental quirks. If this is not
sufficient, go to a specialist trained in psychotherapy and let him
help you uncover those trouble-making parts of your personality which
you cannot find for yourself. It is the purpose of this book to
summarize the facts which most need to be known. Let us now consider
those methods which the psychopathologist finds most useful in helping
his patients to self-knowledge and readjustment.

=Various Methods.= As there are a number of schools of medicine, so
there are a number of distinct methods of psychotherapy, each with its
own theories and methods of procedure, and each with its ardent
supporters. These methods may be classified into two groups. The first
group includes those methods, hypnosis and psycho-analysis, which make
a thorough search through the subconscious mind for the buried
complexes causing the trouble, and might, therefore, be called
"re-education with subconscious exploration." The other group,
includes so-called explanation and suggestion, or methods of
"re-education without subconscious exploration," which content
themselves with making a general survey and building up new complexes
without going to the trouble of uncovering the buried past. Although
the theory and the technique vary greatly, the aim of all these
methods is the same,--the readjustment of the individual to life.

RE-EDUCATION WITH SUBCONSCIOUS EXPLORATION

=Hypnosis.= The method by which most of the important early
discoveries were made is hypnosis, or artificial sleep, a method by
which the conscious mind is dissociated and the subconscious brought
to the fore. It was through hypnosis that Freud, Janet, Prince, and
Sidis made their first investigations into the nature of nervousness
and worked their first cures. With the conscious mind asleep and its
inhibitions out of the way, a hypnotized patient is often able to
remember and to disclose to the physician hidden complexes of which he
is unaware when awake. Hypnosis may thus be a valuable aid to
diagnosis, enabling the physician to determine the cause of
troublesome symptoms. He may then begin to make suggestions calculated
to break up the old complexes and to build new ones, made up of more
healthful ideas, desirable emotions and happy feeling-tones. As we
have seen, a hypnotized subject is highly suggestible. His
counter-suggestions inactivated, he believes almost anything told him
and is extremely susceptible to the doctor's influence.

The dangers of hypnosis have been much exaggerated. Indeed, as an
instrument in the hands of a competent physician, it is not to be
feared at all. It has, however, its limitations. Many times the very
memories which need to be unearthed refuse to come to the surface.
Stubborn resistances are more likely to be subconscious than
conscious, and may prove too strong to be overcome in this way.
Moreover, the road to superficial success is very inviting. It is easy
to cure the symptom, leaving the ultimate cause untouched and ready to
break out in new manifestations. The drug and drink habits may be
broken up without making any attempt to discover the unsatisfied
longings which were responsible for the habit. A pain may be cured
without finding the mental cause of the pain or initiating any
measures to guard against its return, and without giving the patient
any insight into the inner forces with which he still has to deal.

Since nervousness is a state of exaggerated suggestibility and
abnormal dissociation, many psychologists believe that it is unwise to
employ a method which heightens the state of suggestibility and
encourages the habit of dissociation. They feel that it is wiser to
use less artificial methods which rest on the rational control of the
conscious mind and make the patient better acquainted with his own
inner forces and more permanently able to cope with new manifestations
of those forces. They believe that the character of the patient is
strengthened and his morale raised by methods which increase the
sovereignty of reason and decrease the role of unreasoning
suggestibility.

=Psycho-Analysis.= Freud's contribution has been not only a discovery
of the general causes of nervousness, but a special means of locating
the cause in any particular case. Abandoning hypnosis, he developed
another method which he called psycho-analysis. What chemical analysis
is to chemistry, psycho-analysis is to the science of the mind. It
splits up the mental content into its component parts, the better to
be examined and modified by the conscious mind. Psycho-analysis is
merely a technical process for discovering repressed complexes and
bringing them into consciousness, where they may be recognized for
what they are and altered to meet the demands of real life. It is a
device for finding and removing the cause of nervousness,--for
bringing to light hidden desires which may be honestly faced and
efficiently directed instead of being left to seethe in dangerous
insurrection. In order permanently to break up a real neurosis, a man
must first know himself and then change himself. He must gain insight
into his own mental processes and then systematically set to work to
change those processes that unfit him for life.

We shall later find that a detailed self-discovery through
psycho-analysis is not always necessary, and that a more general
understanding of oneself is sufficient for the milder kinds of
nervousness. But because of the promise which psycho-analysis holds
out to those stubborn cases before which other methods are powerless;
because of the invaluable understanding of human nature which it
places at the disposal of all nervous people, who may profit by its
findings without undergoing an analysis; and because of the flood of
light which it sheds on the motives, conduct, and character of every
human being, no educated person can afford to be without a general
knowledge of psycho-analysis.[41]

[Footnote 41: It is unfortunate that the records of an analysis are
too voluminous for use in so brief an account as this. Since the
report of one case would fill a book, and a condensed summary would
require a chapter, we must refer to some of the volumes which deal
exclusively with the psychoanalytic principles. For a list of these
books, see Bibliography.]

=A Chain of Associations.= Psycho-analysis is not, like hypnosis,
based on dissociation; it is based on the association of ideas. Its
main feature is a process of uncritical thinking called "free
association." To understand it, one must realize how intricately woven
together are the thoughts of a human being and how trivial are the
bonds of association between these ideas. One person reminds us of
another because his hair is the same color or because he handles his
fork in the same way. Two words are associated because they sound
alike. Two ideas are connected because they once occurred to us at the
same time. A subtle odor or a stray breeze serves to remind us of some
old experience. Connections that seem far-fetched to other people may
be quite strong enough to bind together in our minds ideas and
emotions which have once been associated, even unconsciously, in past
experience.

In this way, thoughts in consciousness and in the upper layers of the
subconscious are connected by a series of associations, forming links
in invisible chains that lead to the deepest, most repressed ideas.
Even a dissociated complex has some connection with the rest of the
mind, if we only have the patience to discover it. Therefore, by
adopting a passive attitude, by simply letting his thoughts wander, by
talking out to the physician everything that comes to his mind without
criticizing or calling any thought irrelevant or far-fetched, and
without rejecting any thought because of its painful character, the
patient is helped to trace down and unearth the troublesome complex
which may have been absolutely forgotten for many years. He is helped
to relive the childhood experiences back of the over-strong habits
which lasted into maturity.

=Resisting the Probe.= Naturally, it is not all fair sailing. The
subconscious impulses which repressed the painful complex in the first
place still shrink from uncovering it. In many cases the resistance is
very strong. It, therefore, often happens that after a time the
patient becomes restive; he begins to criticize the doctor and to
ridicule the method. His mind goes blank and no thought will come; or
he refuses to tell what does come. The nearer the probe comes to the
sore spot, the greater the pain of the repressing impulses and the
stronger the resistance. Usually a strange thing happens; the patient,
instead of consciously remembering the forgotten experiences, begins
to relive them with his original emotions transferred on to the
doctor. Depending upon what person of his childhood he identifies with
him, the patient develops either a strong affection or an intense
antagonism to the physician, attitudes called in technical terms
positive and negative transference. If the analyst is skilful, he is
able to circumvent all the subterfuges of the resisting forces and to
uncover and modify the troublesome complexes. Sometimes this can be
accomplished at one sitting, but more often it requires long hours of
conversation. Freud has spent three years on a single difficult case,
and very frequently the analysis drags out through weeks or months.
The amount of mental material is so great, especially in a person who
is no longer young, that every analysis would probably be an
interminable affair if it were not for three valuable ways of finding
the clue and picking up the scent somewhere near the end of the trail.
The first of these clues is nothing else than so despised a phenomenon
as the patient's own night-dreams, which turn out to be not
meaningless jargon, as we have supposed, but significant utterances of
the inner man.

=The Message of the Dream.= When Freud rescued dreams from the mental
scrap-basket and learned how to piece them together so that their
message to man about himself became for the first time intelligible,
he furnished the human race with what will probably be considered its
most valuable key to the hidden mysteries of the mind. Freeing the
dream from the superstition of olden times and from the neglect of
later days, Freud was the first to discover that it is part and parcel
of man's mental life, that it has a purpose and a meaning and that the
meaning may be scientifically deciphered. It then invariably reveals
itself to be not a prophecy for the future but an interpretation of
the present and of the past, an invaluable synopsis of the drama which
is being staged within the personality of the dreamer.

As modern man has swung away from the idea of the dream as a warning
or a prophecy, he has accepted the even more untrue conception of
dreaming as the mere sport of sleep,--the "babble of the mind," the
fantastic and insignificant freak-play of undirected mental processes,
or the result of physical sensations without relation to the rest of
mental life. No wonder, then, that Freud's startling dictum, "A dream
is a disguised fulfilment of a repressed wish," should be met with
astonishment and incredulity. When a person is confronted for the
first time with this statement, he invariably begins to cite dreams in
which he is pursued by wild beasts, or in which his loved ones are
seen lying dead. He then triumphantly asserts that no such dream
could be the fulfilment of a wish.

The trouble is that he has overlooked the word "disguised." Like wit
and some figures of speech, a dream says something different from what
it means. It deals in symbols. Its "manifest content" may be merely a
fantastic and impossible scene without apparent rhyme or reason, but
the "latent content," the hidden meaning, always expresses some urgent
personal problem. Although the dream may seem to be impersonal and
unemotional, it nevertheless deals in every case with some matter of
vital concern to the dreamer himself. It is a condensed and composite
picture of some present problem and of some related childish repressed
wish which the experiences of the preceding day have aroused.

As Frink says, a dream is like a cartoon with the labels
omitted--absolutely unintelligible until its symbols are interpreted.
Although some dreams whose symbolism is that which man has always
used, can be easily understood by a person who knows, many dreams are
meaningless, even to an experienced analyst, until the patient himself
furnishes the labels by telling what each bit of the picture brings to
his mind. The dream, as a rule, merely furnishes the starting-point
for free association.

Each symbol is an arrow pointing the way to forbidden impulses which
are repressed in waking life but which find partial expression during
sleep. The subconscious part of the conscience is still on the job, so
the repressed desires can express themselves only in distorted ways
which will not arouse the censor and disturb sleep. The purpose of the
dream is thus two-fold,--to relieve the tensions of unsatisfied
desire, and to do this in such a subtle way as to keep the dreamer
asleep. Sometimes it fails of its purpose, but when there is danger of
our discovering too much about ourselves, we immediately wake up,
saying that we have had a bad dream.

It is at first difficult to believe that we are capable of this
elaborate mental work while we are fast asleep. However, a little
investigation shows us to be more clever than we realize. The
subconscious mind, in its effort to satisfy both the repressing and
the repressed impulses, carries on very complicated processes,
disguises material by allowing one person to stand for another, two
persons to stand for one, or one person to stand for two; it shifts
emotion from important to trivial matters, dramatizes, condenses, and
elaborates, with a skill that is amazing. We are all of us very clever
playwrights and makers of allegories--in our sleep. Also, we are all
very clever at getting what we want, and the dream secures for us, in
a way, something which we want very much indeed and which the world
of social restraint or our own warped childish notion denies us.

Not every one can become an interpreter of dreams. It takes a skilled
and patient specialist thoroughly to understand the process. But it is
fortunate indeed that we possess such a valuable means of diagnosis
when extraordinary conditions make it necessary to explore the
subconscious in the search for trouble-making complexes.[42]

[Footnote 42: For further study of the dream, see Freud:
_Interpretation of Dreams_; and _General Introduction to
Psycho-Analysis_.]

=The Word-Test.= Although dreams furnish the main clues to buried
complexes, they are by no means the only instrument of the
psycho-analyst. Another device, called the association word-test, has
been developed by Dr. Carl Jung of Switzerland. The analyst prepares a
list of perhaps one hundred words, which he reads one by one to the
patient, hoping in this way to strike some of the emotional reactions
of which the patient himself is unaware. The latter responds with the
first word that comes into his mind, no matter how absurd it may seem.
The responses themselves are often significant, but the time that
elapses is even more so. It usually happens that it takes very much
longer for some responses than for others. If a patient's average time
is one or two seconds, some responses may take five or ten or twenty
seconds. Sometimes no word comes at all and the patient says that his
mind is a blank. He coughs or blushes, grows pale or trembles, showing
all the signs of emotion even when he himself has no notion of the
cause. The significant word has hit upon a subconscious association
with some emotional complex. The blocking of the mind is an effort of
the resistance to keep the painful ideas out of consciousness. The
telltale word then furnishes a starting point for further
associations.

One of my patients blocked on the word "long." Instead of saying
"short" or "pencil" or "road" or "day" or any other word which might
naturally be associated with "long," she laughed and said that no word
would come. Finally an emotional memory came to light. It seems that
this woman had been courted by a man whom she unconsciously loved, but
whom she had "turned down" because she was ambitious for a career.
After the man had moved to another town, my patient heard that he was
engaged to another girl. She then realized that she loved him and
began to long for him with her whole heart. The meaningful word "long"
thus led us to one of the emotional memories for which we were
seeking.

="Chance" Signs.= There are other clues to hidden inner processes,
other sign-posts pointing to the cause of a neurosis. Not only through
dreams and through emotional reactions to certain words does the
subconscious reveal its desires, but also through the little slips of
the tongue and of the pen, the "chance" acts and unconscious
mannerisms which are usually ignored as entirely insignificant. When
we "make a break" and say what we secretly mean but wish to hide from
ourselves or others; when we forget an appointment which part of us
really wishes to avoid, or forget a name with which we are perfectly
familiar; when we lose the pen so that we cannot write or the desk key
so that we cannot work; when we blunder and drop things and do what we
did not mean to do; then we may know--the normal as well as the
nervous person--that our subconscious minds with their repressed
desires are trying to get the reins and are partially succeeding.

An example from my own life may illustrate the point. In building a
number of houses, I had occasion often to use the word studding, but
on every occasion, I forgot the word and always had to end lamely by
saying "those pieces of timber that go up and down." Each time the
builder supplied the word, but the next time it was no more
accessible. Finally, the reason came to me. One day when I was a
little child I looked out of the window and cried, "Oh, see that great
big beautiful horse." My grandmother exclaimed, "Sh! sh! that is a
stud horse." Over-reaction to that impression repressed the word stud
so successfully that as a grown woman I could not recall another word
which happened to contain the same syllable.

During an analysis a patient of mine who had a mother-in-law situation
on her hands told me a dream of the night before. "I dreamed that my
mother-in-law, who has really been very ill, was taken with a
sinking-spell. I rushed to the telephone to call the doctor, but found
to my terror that I could not remember his number." "What is his
number?" I asked, knowing that she ought to know it perfectly.
"Two-eight-nine-six," she answered at once. The number really was
2876. Asleep and awake, her repressed desire for release from the
mother-in-law's querulous presence was attempting to have its way. In
the dream, she avoided calling the doctor by forgetting his number
entirely. Awake, she evaded the issue by remembering a wrong number.
In the dream she thinly disguised her desire by displacing the anxious
emotion from the sense of her own guilty wishes to the idea of the
mother-in-law's death. When confronted with this interpretation, the
woman readily acknowledged its truth.

Even stammering, which has always been considered a physical disorder,
has been proved, by psycho-analysis, to be the sign of an emotional
disturbance. H. Addington Bruce reports the case of one of Dr. Brill's
patients, a young man who had been stammering for several years.
Observation revealed the fact that his chief difficulty was with
words beginning with K and although at first he firmly denied any
significance to the letter, he later confessed that his sweetheart
whose name began with K had eloped with his best friend and that he
had vowed never to mention her name again. Upon Dr. Brill's suggestion
he tried to think of the unfaithful lover as Miss W., but soon
returned, saying that he was stammering worse than ever. Investigation
showed that the additional unpronounceable words contained the letter
W. When he was induced to renounce his oath never to call the girl's
name again, he found that he had no more difficulty with his
speech.[43]

[Footnote 43: H. Addington Bruce; "Stammering and Its Cure,"
_McClure's_, February, 1913.]

Thus we see that even the halting tongue of a stammerer may point the
way to the buried complex for which search is being made.

Since there is no accident in mental life, and since there is behind
every action a force or group of forces, no smallest action is
insignificant to the person trained to understand.

If this at first seems disturbing, it is only because we do not
realize that there is nothing within of which we need be ashamed.
People are very much alike, especially in the deeper layers of their
being. What belongs to the whole human race does not need to be
hidden away in darkness. There is nothing to lose and everything to
gain by an increasing understanding of the chance signals which reveal
the forces at work within the depths of the mind. To the analyst every
little unconscious act is a valuable clue pointing toward the end of
his quest.[44]

[Footnote 44: For further discussion of this subject, see Freud's
_Psycho-pathology of Everyday Life_, translated by A.A. Brill.]

=The Aim of Psycho-Analysis.= As we have seen, the object of all this
technique is the discovery and the removal of the resistances which
have been keeping the emotional conflicts in the dark. It is a long
step just to learn that there are resistances; and by reliving, bit by
bit, the earlier experiences responsible for unfortunate habits, we
find that the habits themselves lose much of their old power. They can
be seen for what they are, and changed to suit present conditions. A
wish is incomparably stronger when unconscious than when conscious;
and the old stereotyped, automatic reactions tend to cease when once
they have been seen for what they are. They become assimilated with
the rest of the personality and modified by the mature attitudes of
the conscious mind. The person then re-educates himself by the very
act of discovering himself. In other cases, the uncovering is merely
the first step in the process of re-education. The analyst then
assumes the rôle of educator, cutting away old shackles, breaking down
false standards, building up new complexes, showing the patient the
naturalness of his desires, inducing him to look at them as biologic
facts, and showing him how to sublimate those which may not find
direct expression; in fact, leading him out into the self-expression
of a free, unhampered life.[45]

[Footnote 45: "It will be readily understood that in the
reconstruction of the shattered purposes, the frustrated hopes and the
outraged instincts which are found to lie at the source of those human
woes we call 'nervous disorders,' there takes place a gradual
transposition of values, a total recasting of ideas, and that through
the whole process, education in the deepest meaning of the word,
enters at last into its full sovereign rights."--Trigant Burrow.]

Among my patients at one time was a woman subject to terrible fits of
despondency. She was happily married and enjoyed the marriage
relationship, but could not free herself from a terrible sense of
guilt and degradation, a sense which was so acute that she wanted to
end her life. Although she was an active member of a church, she was
starving for the real message of the church, continually bound by a
feeling of aloofness which made her a stranger in the midst of
friends. Psycho-analysis revealed an experience of her childhood which
she had kept a secret all these years. It seems that when she was
seven years of age an old minister had driven her into town and had
made some sort of sex-approach on the way. Although ignorant of its
significance, the child was badly frightened and overcome with a sense
of guilt. She had already inferred that such subjects were not to be
mentioned and she hesitated long before telling even her mother.
Smoldering within her through the years had been this emotional
complex about the sex-life and about people connected with a church,
so that even as a grown woman the relationships of her mature years
were completely ruined by her old childish reaction. With insight as
to the cause of her trouble, she was able to modify her attitudes and
to live a free and happy life.

Several years ago there came to me a man of exceptional intellectual
ability, who for years had been totally incapacitated because of blind
resistances built up in childhood. Although married to a woman whom he
thoroughly liked and admired, he was absolutely miserable in his
married life. He had, in fact, a deep-rooted complex against marriage,
and had only allowed himself to be captured because the woman, with
whom he had been good friends, had cried when he refused to marry her.
During analysis it transpired that as a little boy of four he had
often seen his silly young mother cry because she could not have a new
dress. He had taken her side and bitterly felt that she was abused by
his father. Later, at six, he had heard some coarse stories about sex
to which he had over-reacted. Still later he had heard the workmen on
the farm say that they could not go to the gold-fields because they
had wives and were held back by marriage. "There are no idle words
where children are," and this little boy had built up such a strong
complex against marriage that he could not possibly be happy as a
grown man. He was as much crippled by the old scar as is an arm which
is bent and stunted from a deep scar in the flesh. After the analysis
had broken up the adhesions, he found himself free, able to give
mature expression to his repressed and dissatisfied love-instincts.

Psycho-analysis is not a process of addition, but one of subtraction.
Like a surgical operation, it undoes the results of old injuries,
removes foreign material, and gives nature a chance to develop freely
in her own satisfactory way.


RE-EDUCATION WITHOUT SUBCONSCIOUS EXPLORATION

=Simple Explanation.= So far, "the way out" sounds rather involved. It
seems to require a special kind of doctor and a complicated, lengthy
process before the exact trouble can be determined. But, fortunately
for the average nervous patient, this lengthy process of analysis is
by no means always necessary. People with troublesome nervous
symptoms, and even those who have had a serious breakdown, are
constantly being cured by a kind of re-education which breaks up
subconscious complexes without trying to bring them to the surface. If
the dead past can be let alone, so much the better. Sometimes a
bullet buried in the flesh sends up a constant stream of discomfort
until it is dug out and removed; but if it has carried in no infection
and the body can adjust itself, it is usually considered better to let
it remain.

The subconscious makes its own deductions. If resistances are not too
strong it is often possible to introduce healthy ideas by way of the
conscious reason, to break up old habits, and make over the mentality
without going to the trouble of uncovering some of the reactions which
are responsible for the difficulty.

=Moral Hygiene.= Because this is true, there has grown up a kind of
psychotherapy which is known as simple explanation, or persuasion. As
usually practised, this kind of re-education pays very little
attention to the ultimate cause of "nerves." It has little to say
about repressed instincts or the real reasons for fearful emotions and
physical symptoms. Instead, it attacks the symptom itself, contenting
itself with teaching the patient that his trouble is psychic in
origin; that it is based on exaggerated suggestibility and
uncontrolled emotionalism; that it is made out of false ideas about
the body, illogical conclusions, and unhealthy feeling-tones; and that
it may be cured by a kind of moral hygiene, which breaks up these old
habits and replaces them with new and better ones. It tries to
inculcate the cheerful attitude of mind; to give the patient the
conviction of power; to correct his false ideas about his stomach, his
heart, or his head; to train him out of his emotionalism; to lead him
into a state of mind more largely controlled by reason; and to make
him find some useful and absorbing work.

This kind of mental and moral treatment has been sufficient to cure
many neuroses of long standing. In cases that are helped by this
method, the patient's love-force, robbed of the material out of which
it has woven its disguise, and trained out of its bad habits by
re-education, automatically makes its own readjustments and forces new
channels for itself out into more useful activities. Very many nervous
persons seem to need nothing more than this simple kind of help.

=When Simple Explanation Does not Explain.= For very many cases,
however, this procedure, good as it is, does not go deep enough.
Although it gives a sound objective education about the facts of one's
body, it furnishes only the most superficial subjective knowledge of
one's inner life. If the inner struggle be bitter, the competing
forces will hold on to their poor refuge in the symptom, despite any
number of explanations that the symptom can have no physical cause.
Sometimes it is enough for a person to be shown that he is too
suggestible, but often it is far more helpful for him to get an
inkling as to why he likes unhealthy suggestions, and to understand
something of his starved instincts which he may learn to satisfy in
better ways.


PSYCHOLOGICAL EXPLANATION

Between the two extremes of the cases which need a real analysis and
those which are cured by simple explanation, I have found the great
bulk of nervous cases. To simple explanation with its highly useful
information, I therefore add what might be called psychological
explanation, a re-education which makes use of all that illuminating
material unearthed by the explorations of hypnosis and especially of
psycho-analysis. Along with correct ideas about such matters as
digestion, sleep, and fatigue, I give, so far as the patient is able
to understand, a comprehension of the rights of the denied instincts,
the ways of the subconscious, the fettering hold of unfortunate
childish habits, the various mental mechanisms by which we fool
ourselves, and the ways by which we may make better adaptations.

=According to the Patient.= The treatment varies according to the
nature of the trouble, and is somewhat dependent on the mentality of
the patient. There are many people who would only be confused by being
forced into a study of mental phenomena. Not being students, they
would be more bewildered than helped by the details of their inner
mechanisms. Others, of studious habits and inquiring minds, are
encouraged to browse at will in a library of psychotherapy and to
learn all that they can from the best authorities.

In any case, I give the patients as much as they are able to take of
my own understanding of the subject. There are no secrets in this
method. The patient is treated as a rational human being who has
nothing to lose and everything to gain by the fullest knowledge that
he is able to acquire. Without forcing him to plunge in over his
depth, I encourage him to understand himself to the fullest possible
extent. Besides individual private conferences, we have twice a day an
informal gathering of all the patients in my household--"the family"
as we like to call ourselves--for a reading or talk on the various
ways of the body and the mind, which need to be understood for normal
living and for the cure of nerves. Very often people of only average
education, long without the opportunity of study, gain in a
surprisingly short time enough insight to make new adaptations and
cure themselves. For this, a college education is not nearly so
important as an open mind. It is because of the success of this method
that I have been encouraged to reach a larger number of people by
means of a book, based on the same plan of re-education.

=Explanation vs. Suggestion.= Re-education through this kind of
explanation is simply a matter of learning the truth and acting upon
it. It is a process of real enlightenment, and is very different from
suggestion which trades upon the patient's credulity, increasing his
already exaggerated suggestibility.

Freud illustrates the difference between suggestion and
psycho-analysis by saying that suggestion is like painting and
psycho-analysis like sculpture. Painting adds something from the
outside, plastering over the canvas with extraneous matter, while
sculpture cuts away the unnecessary material and reveals the angel in
the marble. So suggestion covers over the real trouble by crying,
"Peace, peace, when there is no peace." Without attempting to remove
the cause, it says to the patient: "You have no pain. You are not
tired. You will sleep to-night. You will be cheerful." Sometimes the
suggestion works and sometimes it does not, but at best the relief is
likely to be a mere temporary makeshift. The symptom may be relieved,
but the character is not changed and therefore no permanent relief is
assured. It is far better for a nervous person to say to himself,
"There is something wrong and I am going to find it," than to keep
repeating over and over, "There is nothing wrong," and so on through a
list of half-believed autosuggestions.

On the other hand, psycho-analysis, and this kind of re-education
based on psycho-analytic principles, do not pay a great deal of
attention to the individual symptom. Instead of adding from without
they try to take away whatever has proved a hindrance to normal
growth and development, and to remove unnecessary resistances which
are responsible for the symptom, and which have been holding the
patient back from the fullest self-expression.

=Incantation vs. Knowledge.= There came to me one day a well-known
public woman who had suffered from nervous indigestion for many years.
As she was able to be with me for only one night, we had time for just
one conversation, but in that time she discovered what she was doing
and lost her indigestion. In the course of the conversation she turned
to me, saying: "Doctor, I know what a force suggestion is. I believe
in its power. Will you tell me why I have not been able to cure myself
of this trouble? Every night after I go to bed I repeat over and over
these Bible verses," naming a number of passages relating to God's
goodness and care for His children. My answer was something like this:
"You are too intelligent a woman to be cured by an incantation. When
you feel surging up within you the sense of God's goodness, or when
you actually want to realize His loving kindness, then by all means
repeat the verses. But don't prostitute those wonderful words by
making them into a charm and then expect them to cure your
indigestion. It is a desecration of the words and a denial of your own
intelligence. Autosuggestion is a powerful force, but real
psychotherapy is based not on the mechanical repetition of any set of
words, but on a knowledge of the truth."

=The "Bullying Method."= Sometimes, to be sure, explanation is not
enough. The brain paths between the associated ideas are so deeply
worn that no amount of persuasion avails. It is easy for the doubter
to say: "Well, that sounds very well, but my case is different. I have
tried over and over again and I know." With people of this sort, an
ounce of demonstration is worth a pound of argument.

By way of illustration we might mention the man who couldn't eat eggs.
To be sure, he had tried many times but always had suffered the most
intense cramps in his stomach, and no amount of talk could make him
believe that an egg was not poison to him. I took the straight road of
simply proving to him that he was mistaken, and had him eat an egg.
After a time of apprehension and retching, he vomited the egg,
thinking, of course, that he had proved his point. To his
astonishment, I said, "Now, let's go and eat another." With great
consternation, he finally complied, evidently expecting to die on the
spot; but as I immediately prescribed a game of tennis, he scarcely
had time to think of the pain, which in fact failed to appear.
However, as he thereafter insisted on eating four eggs a day,--with
eggs at top-notch price I decided that the joke was on the doctor!

=Enjoying the Right Things.= In substituting healthful complexes for
unhealthful ones, psychotherapy not only changes ideas and emotions,
but alters the feelings of pleasure or pain that are bound up with the
ideas. Dr. Tom A. Williams writes: "The essence of psychotherapy and
education is to associate useful activities with agreeable
feeling-tones and to dissociate from injurious acts the agreeable
feeling-tones that may have been acquired." Right character consists
not so much in enjoying things as in enjoying the right things.

Some people enjoy being martyrs. They love to tell about the terrible
strain they have been under, the amount of work they have done, or the
number of times they have collapsed. One of my patients gave every
evidence of satisfaction as he told about his various breakdowns. "The
last time I was ill," or "That time when I was in the sanatorium,"
were frequent phrases on his lips. Finally, after I had asked him if
he would boast about the number of times he had awkwardly fallen down
in the street, and had shown him that a neurosis is not really a
matter to be proud of, he saw the point and stopped taking pleasure in
his mistakes.

Such signs of pleasure in the wrong things are evidence of suppressed
wishes which we do not acknowledge but try to gratify in indirect
ways.[46] The pleasure which ought to be associated with the idea of
good work well done has somehow been switched over to the idea of
being an invalid. The satisfaction which ought to go with a sense of
power and ability to do things has attached itself to the idea of
weakness and inability. The pleasurable feeling-tone which normally
belongs to ministering to others, regresses in the nervous invalid to
the infantile satisfaction of being ministered unto.

[Footnote 46: For a further elaboration of this theme, see Holt: _The
Freudian Wish_.]

But these things are only a habit. A good look in the mirror soon
makes one right about face and start in the other direction. Once
started, a good habit is built up with surprising ease. It is really
much more satisfying to cook a good dinner for the family's comfort
than to think about one's ills; much pleasanter to enjoy a good meal
than to insist on hot water and toast. Once we have satisfied our
suppressed longings in more desirable ways, or by a process of
self-training have initiated a new set of habits, we feel again the
old zest in normal affairs, the old interest and pleasure in
activities which add to the joy of life. Thus does re-education fit a
man to take his place in the world's work as a socially useful being,
no longer a burden, but a contributor to the sum total of human
happiness.


SUMMARY

=Knowing and Doing.= Having set out to learn how to outwit our
nerves, we are now ready to sum up conclusions and in the following
chapters to apply them to the more common nervous symptoms. It has
been shown that a nervous person is in great need of change,--not,
indeed, a change in climate or in scene, in work or in diet, but a
change in the hidden recesses of his own being. Outwitting nerves
means first and foremost changing one's mind, an inner and spiritual
process very different from the kind of change which used to be
prescribed for the nervous invalid.

As Putnam says, the slogan of the suggestion-school of psychotherapy
has always been, "You can do better if you try"; while that of the
psycho-analytic school is, "You can do better when you know." Refuting
the old adage, "Where ignorance is bliss 'tis folly to be wise," the
best methods of psychotherapy insist that the first step in any
thorough-going attempt to change oneself must be the great step of
self-knowledge. As the conflicts which result in "nerves" are always
far beyond those mental regions which are open to scrutiny, a real
self-knowledge requires an examination of the half-conscious or wholly
unconscious longings which are usually ignored. A real understanding
of self comes only when one is willing, to analyze his motives until
he sees the connection between them and his nervous symptoms, which
are but the symbolic gratification of desires he dares not
acknowledge.

Although these deeply buried complexes are the real force behind a
nervous illness, the material out of which the symptoms are
manufactured is taken largely from superficial misconceptions
concerning the bodily functions. It is therefore a great help, also,
to possess a fund of information,--not technical nor detailed but
accurate as far as it goes,--about the more important workings of the
bodily machinery. A little knowledge about the actual chemistry of
fatigue and the way it is automatically cared for by the body is
likely to do away with the idea of nervous exhaustion as resulting
from accumulation of fatigue. A simple understanding of the biological
and physiological facts concerning the assimilation of food and the
elimination of waste material leaves the intelligent person less ready
to convert his psychic discomfort into indigestion and constipation.
Chapters IX to XIII in this book, which at first glance may seem to
belong to a work on physiology rather than on psychology are designed
to give just such needed insight.

But knowing the truth is only the first half of the way out. Every
neurosis is a deliberate choice by a part of the personality.
Self-discovery is helpful only when it leads to better ways of
self-expression. The final aim of psychotherapy is the happy
adjustment of the individual to the demands of society and the
establishment of useful outlets for his energy. This phase of the
subject will be discussed more fully in Chapter XVI.

=The Future Hope.= Much has been said about the cure of a neurosis.
There are enough people already in the maze of nervousness to warrant
the setting up of numerous signs reading, "This way out." But after
all, is not a blocking of the way in of vastly more importance? As it
is always easier to prevent than to cure, so it is easier to train
than to reform. If re-education is the cure, why is not education the
ounce of prevention which shall settle the problem for all time?

If the general public understood what "nerves" are, it is hardly
conceivable that there could be so many breakdowns as there are at
present. If a man's family and friends, to say nothing of himself,
understood what he is doing when he suddenly collapses and has to quit
work, it is not likely that he would choose that way out of his
difficulties.

Most important of all, when parents know that the foundation of
nervousness is laid in childhood, they will see to it that their
children are started right on the road to health. When fathers and
mothers realize that an over-strong bond between parents and children
is responsible for a large proportion of nervous troubles, most of
them will make sure that such exaggeration is not allowed to develop.

And, finally, when parents are freed from their "conspiracy of
silence" by a reverent attitude toward the whole of life, their very
saneness will impart to their children a wholesome respect for the
reproductive instinct. There will then be found in the next generation
fewer half-starved men and women carrying the burden of unnecessary
repressions and the pain of unsatisfied yearnings.

Not that such a day will usher in the millennium. We are not
suggesting a panacea for all the social ills. There is an inevitable
conflict between the instinctive urge of the life-force and the
demands of society, a conflict which makes men and women either finer
or baser, according to the way they handle it. What is claimed is that
the right kind of education--using the word in its largest, deepest
sense--will remove the most fruitful cause of nervousness by taking
away the extra burden of misconception and making it easier for people
to be "content with being moral."[47]

[Footnote 47: Frink: _Morbid Fears and Compulsions._]



CHAPTER IX

_In which we discover new stores of energy and learn the truth about
fatigue_

THAT TIRED FEELING

UNFAILING RESOURCES


"They that wait upon the Lord shall renew their strength. They shall
mount up with wings as eagles. They shall run and not be weary. They
shall walk and not faint."

It is safe to say that many a person loves this promise of the prophet
Isaiah without taking it in anything like a literal sense. The words
are considered to be so figurative and so highly spiritualized that
they seem scarcely to relate at all to this earthly life, much less to
the possibilities of these physical bodies.

Besides the nervous folk who feel themselves so weary that they
scarcely have strength to live, there are thousands upon thousands of
men and women who are called normal but who have lost much of the joy
of life because they feel their bodies inadequate to meet the demands
of everyday living.

To such men and women the Biblical promise, "As thy day, so shall thy
strength be," comes now as the message of modern science. Nature is
not stingy. She has not given the human race a meager inheritance. She
did not blunder when she made the human body, nor did she allow the
spirit of man to develop a civilization to whose demand his body is
not equal. After its long process of development through the survival
of the fittest, the human body, unless definitely diseased, is a
perfectly adequate instrument, as abundantly able to cope with the
complex demands of modern society as with the simpler but more
strenuous life of the stone age. The body has stored within its cells
enough energy in the shape of protein, carbohydrate and fat to meet
and more than meet any drains that are likely to be made upon it,
either through the monotony of the daily grind or the excitement of
sudden emergency. Nature never runs on a narrow margin. Her motto
seems everywhere to be, "Provide for the emergency, enough and to
spare, good measure, pressed down, running over." She does not start
her engines out with insufficient steam to complete the journey. On
the contrary, she has in most instances reserve boilers which are
almost never touched. As a rule the trouble is not so much a lack of
steam as the ignorance of the engineer who is unacquainted with his
engine and afraid to "let her out."

="The Energies of Men."= Perhaps nothing has done so much to reveal
the hidden powers of mankind as that remarkable essay of Professor
William James, "The Energies of Men."[48] Listen to his introductory
paragraph as he opens up to us new "levels of energy" which are
usually "untapped":

[Footnote 48: James: _On Vital Reserves_.]

     Every one knows what it is to start a piece of work, either
     intellectual or muscular, feeling stale--or _cold_, as an
     Adirondack guide once put it to me. And everybody knows what it
     is to "warm up to his job." The process of warming up gets
     particularly striking in the phenomenon known as the "second
     wind." On usual occasions we make a practice of stopping an
     occupation as soon as we meet the first effective layer (so to
     call it) of fatigue. We have then walked, played or worked
     "enough," so we desist. That amount of fatigue is an efficacious
     obstruction on this side of which our usual life is cast. But if
     an unusual necessity forces us to press onward, a surprising
     thing occurs. The fatigue gets worse up to a certain critical
     point, when gradually or suddenly it passes away, and we are
     fresher than before. We have evidently tapped a level of new
     energy, masked until then by the fatigue-obstacle usually obeyed.
     There may be layer after layer of this experience. A third and
     fourth "wind" may supervene. Mental activity shows the phenomenon
     as well as physical, and in exceptional cases we
     may find, beyond the very extremity of fatigue-distress, amounts
     of ease and power that we never dreamed ourselves to own, sources
     of strength habitually not taxed at all, because habitually we
     never push through the obstruction, never pass those early
     critical points.

Again Professor James says:

     Of course there are limits; the trees don't grow into the sky.
     But the plain fact remains that men the world over possess
     amounts of resource which only very exceptional individuals push
     to their extremes of use. But the very same individual, pushing
     his energies to their extreme, may in a vast number of cases keep
     the pace up day after day, and find no "reaction" of a bad sort,
     so long as decent hygienic conditions are preserved. His more
     active rate of energizing does not wreck him; for the organism
     adapts itself, and as the rate of waste augments, augments
     correspondingly the rate of repair.[49]

[Footnote 49: Ibid., pp. 6-7.]

Another psychologist, Boris Sidis, writes: "But a very small fraction
of the total amount of energy possessed by the organism is used in its
relation with the ordinary stimuli of its environment."[50] These
men--Professor James and Dr. Sidis--represent not young enthusiasts
who ignorantly fancy that every one shares their own abundant
strength, but careful men of science who have repeatedly been able to
unearth unsuspected supplies of energy in "worn out" men and women,
supposed to be at the end of their resources. Every successful
physician and every leader of men knows the truth of these statements.
What would have happened in the great war if Marshal Foch had not
known that his men possessed powers far beyond their ken, and had not
had sublime faith in the "second wind"?

[Footnote 50: Sidis: P. 112 of the composite volume
_Pychotherapeutics_.]

=What about Being Tired?= If all these things are true, why do people
need to be told? If man's equipment is so adequate and his reserves
are so ample, why after all these centuries of living does the human
race need to learn from science the truth about its own powers? The
average man is very likely to say that it is all very well for a
scientist sitting in his laboratory to tell him about hidden
resources, but that he knows what it is to be tired. Is not the crux
of the whole question summed up in that word "tired"? If we do not
need to rest, why should fatigue exist? If the purpose of fatigue
seems to be to slow down our efforts, why should we disregard it or
seek to evade its warnings? The whole question resolves itself into
this: What is fatigue? In view of the hampering effect of
misconception on this point, it is evident that the question is not
academic, but intensely practical. We shall find that fatigue is of
two kinds,--true and false, or physical and moral, or physiological
and nervous,--and that while the two kinds feel very much alike,
their origin and behavior are quite different.


PHYSIOLOGICAL FATIGUE

=Fatigue, not Exhaustion.= In the first place, then, fatigue very
seldom means a lack of strength or an exhaustion of energy. The
average man in the course of a lifetime probably never knows what it
is to be truly exhausted. If he should become so tired that he could
in no circumstances run for his life, no matter how many wild beasts
were after him, then it might seem that he had drained himself of all
his store of energy. But even in that case, a large part of his
fatigue would be the result of another cause.

=A Matter of Chemistry.= True fatigue is a chemical affair. It is the
result of recent effort,--physical, mental, or emotional,--and is the
sum of sensations arising from the presence of waste material in the
muscles and the blood. The whole picture becomes clear if we think of
the body as a factory whose fires continuously burn, yielding heat and
energy, together with certain waste material,--carbon dioxide and ash.
Within man's body the fuel, instead of being the carbon of coal is the
carbon of glycogen or animal starch, taken in as food and stored away
within the cells of the muscles and the liver. The oxygen for
combustion is continuously supplied by the lungs. So far the factory
is well equipped to maintain its fires. Nor does it fail when it comes
to carrying away waste products. Like all factories, the body has its
endless chain arrangement, the blood stream, which automatically picks
up the debris in its tiny buckets--the blood-cells and serum--and
carries it away to the several dumping-grounds in lungs, kidneys,
intestines, and skin.

Besides the products of combustion, there are always to be washed away
some broken-down particles from the tissues themselves, which, like
all machinery, are being continuously worn out and repaired. By
chemical tests in the laboratory, the physiologist finds that a muscle
which has recently been in violent exercise contains among other
things carbon dioxid, urea, creatin, and sarco-lactic acid, none of
which are found in a rested muscle. Since all this debris is acid in
reaction and since we are "marine animals," at home only in salt water
or alkaline solution, the cells must be quickly washed of the fatigue
products, which, if allowed to accumulate, would very soon poison the
body and put out the fires.

=No Back Debts.= The human machine is regulated to carry away its
fatigue products as fast as they are made, with but slight lagging
behind that is made good in the hours of sleep, when bodily activities
are lessened and time is allowed for repair. Unless the body is
definitely diseased, it virtually never carries over its fatigue from
one day to another. In the matter of fatigue, there are no old debts
to pay. Nature renews herself in cycles, and her cycle is twenty-four
hours,--not nine or ten months as many school-teachers seem to
imagine, or eleven months as some business men suppose. In order to
make assurance doubly sure, many set apart every seventh day for a
rest day, for change of occupation and thought, and for catching up
any slight arrears which might exist. But the point is that a healthy
body never gets far behind.

If through some flaw in the machine, waste products do pile up, they
destroy the machine. If the heart leaks or the blood-cells fail in
their carrying-power, or if lungs, kidneys or skin are out of repair,
there is sometimes an accumulation of fatigue products which poisons
the whole system and ends in death. But the person with tuberculosis
or heart trouble does not usually allow this to happen. The body
incapacitated by disease limits its activities as closely as possible
within the range of its power to take care of waste matter. Even the
sick body does not carry about its old toxins. The man who had not
eliminated the poisons of a month-old effort would not be a tired man.
He would be a dead man.

=A Sliding Scale.= If all this be true, real fatigue can only be the
result of recent effort. If one is still alive, the results of earlier
effort must long since have disappeared. The tissue-cells retain not
the slightest trace of its effects. Fatigue cannot possibly last,
because it either kills us or cures itself. Up to a certain point, far
beyond our usual high-water mark, the more a person does the more he
can do. As Professor James has pointed out, the rate of repair
increases with the rate of combustion. Under unusual stress, the rate
of the whole machine is increased: the heart-pump speeds up,
respirations deepen and quicken, the blood flows faster, the endless
chain of filling and emptying buckets hurries the interchange of
oxygen and carbon dioxid, until the extreme capacity is reached and
the organism refuses to do more without a period of rest.

The whole arrangement illustrates the wonderful provisions of Nature.
Although each individual is continuously manufacturing enough
carbonic-acid gas to kill himself in a very few minutes, he need not
be alarmed for fear that he may forget to expel his own poisons.
Nobody can hold his breath for more than a few minutes. The naughty
baby sometimes tries, but when he begins to get black in the face, he
takes a breath in spite of himself. The presence of carbonic-acid gas
in the circulation automatically regulates breathing, and the greater
the amount of gas the deeper the breath. The faster we burn the faster
we blow. As with breathing, so with all the rest of elimination and
repair. The body dares not get behind.

="Second Wind."= A city man frequently sets out on a mountain tramp
without any muscular preparation for the trip. He walks ten or fifteen
miles when his average is not over one or two. Sometimes after a few
hours he feels himself exhausted, but a glorious view opens out before
him and he goes on with new zest. He has merely increased his rate of
repair and drawn on a new stock of energy. That night he is tired, and
the next day he is likely to be stiff and sore. There is a little
fatigue left in him, but it takes only a day or two for the body to be
wholly refreshed, especially if he hastens the process by another good
walk. Up to a certain point, far beyond our usual limit, the more we
do, the more we can do.

One day after a long walk my little daughter said that she could go no
farther and waited to be carried. But she soon spied a dog on ahead
and ran off after him with new zest. She followed the dog back and
forth, running more than a mile before she reached home, and then in
the exuberance of her spirits, ran around the house three times.

=The Emotions Again.= What is the key that unlocks new stores of
energy and drives away fatigue? What is it in the amateur
mountain-climbers that helps the body maintain its new standard? What
keeps indefatigable workers on the job long after the ordinary man has
tired? Is it not always an invigorating emotion,--the zest of
pursuit, the joy of battle, intense interest in work, or a new
enthusiasm? All great military commanders know the importance of
morale. They know that troops can stand more while they are going
forward than while running away, that the more contented and hopeful
they are, the better fighters they make; discouragement, lack of
interest, the fighting of a losing game, dearth of appreciation,
futility of effort, monotony of task, all conspire in soldier or
civilian to use up and to lock up energy which might have been
available for real work. Approaching the matter from a new angle, we
find once more that the difference between strength and weakness is in
many cases merely a difference in the emotions and feeling-tones which
habitually control.

Fatigue is a safety-device of nature to keep us within safe limits,
but it is a device toward which we must not become too sensitive. As a
rule it makes us stop long before the danger point is reached. If we
fall into the habit of watching its first signals, they may easily
become so insistent that they monopolize attention. Attention
increases any sensation, especially if colored by fear. Fear adds to
the waste matter of fatigue little driblets of adrenalin and other
secretions which must somehow be eliminated before equilibrium is
reestablished. This creates a vicious circle. We are tired, hence we
are discouraged. We are discouraged, hence we are more tired. This
kind of "tire" is a chemical condition, but it is produced not by work
but by an emotion. He who learns to take his fatigue philosophically,
as a natural and harmless phenomenon which will soon disappear if
ignored, is likely to find himself possessed of exceptional strength.
We can stand almost any amount of work, provided we do not multiply it
by worry. We can even stand a good deal of real anxiety provided it is
not turned in on ourselves and directed toward our own health.

="Decent Hygienic Conditions."= If fatigue products cannot pile up,
why is extra rest ever needed? Because there is a limit to the supply
of fuel. If the fat-supply stored away for such emergencies finally
becomes low, we may need an extra dose of sleeping and eating in order
to let the reservoirs fill again. But this never takes very long. The
body soon fills in its reserves if it has anything like common-sense
care. The doctrine of reserve energy does not warrant a careless
burning of the candle at both ends. It presupposes "decent hygienic
conditions,"--eight hours in bed, three square meals a day, and a fair
amount of fresh air and exercise.

="Over There."= On the other hand, the stories that floated back to us
from the war zone illustrate in the most powerful way what the human
body can do when necessity forbids the slightest attention to its
needs. One of the best of these stories is Dorothy Canfield's account
of Dr. Girard-Mangin, "France's Fighting Woman Doctor." Better than
any abstract discussion of human endurance is this vibrant narrative
of that little woman, "not very strong, slightly built, with some
serious constitutional weakness," who lived through hardships and
accomplished feats of daring which would have been considered beyond
the range of possibility--before the war.

Think of her out there in her leaky makeshift hospital with her twenty
crude helpers and her hundreds of mortally sick typhoid patients; four
hundred and seventy days of continuous service with no place to
sleep--when there was a chance--except a freezing, wind-swept attic in
a deserted village. Think of her in the midst of that terrible Battle
of Verdun, during four black nights without a light, among those
delirious men, and then during the long, long ride with her dying
patients over the shell-swept roads. Listen to her as she speaks of
herself at the end of that ride, without a place to lay her head: "Oh,
then I did feel tired! That morning for the first time I knew how
tired I was, as I went dragging myself from door to door begging for a
room and a bed. It was because I was no longer working, you see. As
long as you have work to do you can go on." Then listen to her as she
receives her orders to rush to a new post, before she has had time to
lay herself on the bed she has finally found. "Then at once my
tiredness went away. It only lasted while I thought of getting to bed.
When I knew we were going into action once more, I was myself again."
Watch her as she rides on through the afternoon and the long dangerous
night; as she swallows her coffee and plum-cake, and operates for five
hours without stopping; as she sleeps in the only place there is--a
"quite comfortable chair" in a corner; and as she keeps up this life
for twenty days before she is sent--not on a vacation, mind you, but
to another strenuous post.[51]

[Footnote 51: Dorothy Canfield: _The Day of Glory._]

This brave little woman is not an isolated example of extraordinary
powers. The human race in the great war tapped new reservoirs of power
and discovered itself to be greater than it knew. Professor James's
assertions are completely proved,--that "as a rule men habitually use
only a small part of the powers which they actually possess," and that
"most of us may learn to push the barrier (of fatigue) further off,
and to live in perfect comfort on much higher levels of power."

=How?= The practical question is: how may we--the men and women of
ordinary powers, away from the extraordinary stimulus of a crisis like
the great war--attain our maximum and drop off the dreary mantle of
fatigue which so often holds us back from our best efforts? It may be
that the first step is simply getting a true conception of physical
fatigue as something which needs to be feared only in case of a
diseased body, and which is quite likely to disappear under a little
judicious neglect.

In the second place, fatigue shows itself to be closely bound up with
emotions and instincts. The great releasers of energy are the
instincts. What but the mothering instinct and the love of country
could uncover all those unsuspected reserves of Dr. Girard-Mangin and
others of her kind? What is it but the enthusiasm for work which
explains the indefatigable energy of Edison and Roosevelt? If the
wrong kind of emotion locks up energy, the right kind just as surely
unlocks great stores which have hitherto lain dormant. If most people
live below their possibilities, it is either because they have not
learned how to utilize the energy of their instinctive emotions in the
work they find to do, or because some of their strongest instincts
which are meant to supply motive power to the rest of life are locked
away by false ideas and unnecessary repressions, and so fail to feed
in the energy which they control. In such a case, the "spring tonic"
that is needed is a self-knowledge which shall release us from
hampering inhibitions and set us free for enthusiastic
self-expression.


NERVOUS FATIGUE

_What of the Nervous Invalid?_ If the normal man lives constantly
below his maximum, what shall we say of the nervous invalid?
Fatigability is the very earmark of his condition. In many instances
he seems scarcely able to raise his hand to his head. Sometimes he can
scarcely speak for weariness. Frequently to walk a block sends him to
bed for a week. I once had a patient who felt that she had to raise
her eyelids very slowly for fear of over-exertion. She could speak
only about two or three words a day, the rest of the time talking in
whispers. She could not raise a glass to her lips if it were full of
water, but could manage it if only half full. A person nearly dead
with some fatal disease does not appear more powerless than a typical
neurasthenic.

If it he true that accumulation of fatigue is promptly fatal, what
shall we say of the woman who says that she is still exhausted from
the labor of a year ago,--or of ten years ago? What of the business
man who travels from sanatorium to sanatorium because five years ago
he went through a strenuous year? What of the college student who is
broken down because he studied too hard, or the teacher who is worn
out because of ten hard years of teaching? There can be but one
answer. No matter what their feelings, they can be suffering from no
true physiological fatigue. Something very real has happened to them,
but only through ignorance and the power of suggestion can it be
called fatigue and attributed to overwork.

=Stories of Real People.= Perhaps if we look over the stories of a few
people who have been members of my household, we may work our way to
an understanding of the truth. We give only the barest outline of the
facts, thinking that the cumulative effect of a number of cases will
outweigh a more detailed description of one or two. The most casual
survey shows that whatever it was that burdened these fine men and
women, it was not lack of energy. No matter how extreme had been their
exhaustion, they were able at once, without rest or any other physical
treatment, to summon strength for exertions quite up to those of a
normal person.

The second point that stands out clearly to any one acquainted with
these inner histories is the conviction that in each case the trouble
was related in some way to the unsatisfied love-life, to the insistent
and thwarted instinct of reproduction. In some cases no search was
made for the cause. The simple explanation that there was no lack of
power was sufficient to release inhibited energy. But in every case
where the cause was sought, it was found to be some outer lack of
satisfaction, or some inner repression of the love-force.

=From Prostration to Tennis.= One young woman, Miss A., had suffered
for ten years from the extremest kind of fatigue. She could not walk a
block without support and without the feeling of great exhaustion.
Before her illness she had had a sweetheart. Not understanding her
normal physical sensations when he was near, she had felt them
extremely wicked and had repressed them with all her strength. Later,
she broke off the engagement, and a little while after developed the
neurosis. Within a week after coming to my house, she was playing
tennis, walking three miles to church, and generally living the life
of a normal person.

=Making Her Own Discoveries.= Then there was Miss B. who for four
years had been "exhausted." She had such severe pains in her legs that
she was almost helpless. If she sewed for half an hour on the sewing
machine, she would be in bed for two weeks. Although she was engaged
to be married, she could not possibly shop for her trousseau. Two
years before, a very able surgeon had been of the opinion that the
pain in the legs was caused by an ovarian tumor. He removed the tumor,
assuring the patient that she would be cured. However, despite the
operation and the force of the suggestion, the pains persisted.

After she had been with me for a few days, she sewed for an hour on
the machine. In a day or so she took a four-mile walk in a cañon near
the house and, on returning in the afternoon, walked two and a half
miles down town to do some shopping. I did not make an analysis in
her case because she recovered so quickly,--going home well within two
weeks. But she declared that she had found the cause while reading in
one of the books on psychology. I had my suspicions that the
long-drawn-out engagement had something to do with the trouble, but I
did not confirm my opinion. A long engagement, by continually
stimulating desire without satisfying it, only too often leads to
nervous illness.

=Afraid of Heat.= Professor X., of a large Eastern college, had been
incapacitated for four years with a severe fatigue neurosis and an
intense fear of heat. Constantly watching the weather reports, he was
in the habit of fleeing to the Maine coast whenever the
weather-prophet predicted warm weather. After a short reëducation, he
discovered that his fatigue was symbolic of an inner feeling of
inadequacy, and that it bore no relation to his body. Discarding his
weariness and throwing all his energies into the Liberty Loan
Campaign, he found himself speaking almost continuously throughout one
of the hottest days in the history of California, with the thermometer
standing at 107 degrees. After that he had no doubt as to his cure.

=In Bed from Fear.= Miss C. was carried into my house rolled in a
blanket. She had been confined to her bed except for fifteen minutes a
day, during which time she was able to lie in a hammock! It seems
that her illness was the result of fear, an over-reaction to early
teaching about self-abuse. Her mother had frightened her terribly by
giving her the false idea that this practice often leads to insanity.
Having indulged in self-abuse, she believed herself going insane, and
very naturally succumbed to the effects of such a fear. After a few
days of re-education, she was as strong as any average person. Having
no clothing but for a sick-room, she borrowed hat, skirt, and shoes,
and walked to church, a three-mile walk.

=Empty Hands.= Miss Y., a fine woman of middle age, suffering from
extreme fatigue could neither sleep nor eat. She could only weep. She
had spent her life taking care of an invalid girl who had recently
died. Now her hands were empty. Like many a mother whose family has
grown up, she had no outlet for her mothering instinct, and her sense
of impotency expressed itself in the only way it knew how,--through
her body. As there is never any lack of unselfish work to be done, or
of people who need mothering, she soon found herself and learned how
to sublimate her energy in useful activities.

=Defying Nature.= One young man from Wyoming had felt himself obliged
to give up his business because he could neither work nor eat. It soon
cropped out that he and his wife had decided that they must not have
any children. With a better understanding of the great forces which
they were defying, his strength and his appetite came back and he went
back to work, rejoicing.

=Left-over Habits.= Often a state of fatigue is the result of a
carried-over habit. One of my patients, a young girl, had several
years before been operated on for exophthalmic goiter. This is a
disease of the thyroid gland, and is characterized by rapid heart,
extreme fatigue, and numerous other symptoms. Although this girl's
goiter had been removed, the symptoms still persisted. She could not
walk nor do even a little work, like wiping a few dishes. I took her
down on the beach, let her feel her own pulse and mine and then ran
with her on the sand. Again I let her feel our pulses and discover for
herself that hers had quickened no more than was normal and had slowed
down as soon as mine. After a few such lessons, she was convinced that
her symptoms were reverberations for which there was no longer any
physical cause.

Another young girl, Miss L., had had a similar operation for goiter
six years before. Since that time she had been virtually bedridden.
During the first meal she had at my house her sister sat by her couch
because she must not be left alone. By the second meal the sister had
gone, and Miss L. ate at the table with the other guests. That night
she managed to crawl upstairs, with a good deal of assistance and
with great terror at the probable results of such an effort. After
that, she walked up-stairs alone whenever she had occasion to go to
her room. Her heart will always be a little rapid and her body will
never be very strong, but she now lives a helpful happy life at home
and among her friends.

In cases like this the exaggeration proves the counterfeit. Nobody
could have been so down and out _physically_ without dying. The
exaggeration secures attention and gives the little satisfaction to
the natural desires which are denied expression, and which gain an
outlet through habit along the lines previously worn by the real
disease. Many a person is still suffering from an old pain or an old
disability whose cause has long since disappeared, but which is
stamped on the mind and believed in as a present reality. Since the
sensation is as real as ever, it is sometimes very hard to believe
that it is not legitimate, but if the person is intelligent, a little
explanation and re-education usually suffices.

=Twenty Years an Invalid.= Mr. S., from Ohio, had spent much of his
time for twenty years going from one sanatorium to another. There was
scarcely a health resort in the country with which he was not
familiar. The day he came to me he felt himself completely exhausted
by the two-block walk from the car. He explained that he could
scarcely listen to what I was saying because his brain was so fagged
that concentration was impossible. When asked to read a book, he
dramatically exclaimed, "Books and I have parted company!" I set him
to work reading "Dear Enemy" but it was not a week before he was
devouring the deeper books on psychology, in complete forgetfulness of
the pains in his head. Playing golf and walking at least six miles
every day, he rejoiced in a new sense of strength in his body, which
for twenty years he had considered "used up." He is now doing a
man-sized job in the business and philanthropic life of his home city.

=Brain-fag.= This feeling of brain-fag is one of the commonest nervous
symptoms; and almost always it is supposed to be the result of
intellectual overwork. Some people who easily accept the idea that
physical work cannot cause nervous breakdown can scarcely give up the
deep-rooted notion that intense mental work is harmful. Intellectual
effort does give rise to fatigue in exactly the same way as does
physical exertion, but the body takes care of the waste products of
the one just as it does those of the other. Du Bois says that out of
all his nervous cases he has not found one which can be traced to
intellectual overwork. I can say the same thing, and I know no case in
all the literature of the subject whose symptoms I can believe to be
the result of mental labor.

The college students who break down are not wrecked by intellectual
work. In some cases, one strong factor in their undoing is the strain
and readjustment necessary because of the discrepancies between some
of their deepest religious beliefs and the truth as they learn it in
the class-room. The other factors are merely those which play their
part in any neurosis.

=Re-educating the Teacher.= School-teachers are prone to believe
themselves worn out from the mental work and the strain of the
strenuous life of teaching. Many a fine, conscientious teacher has
come to me with this story of overwork. But the school-teacher is as
easily re-educated as is any one else. I usually begin the process by
stating that I taught school myself for ten years and can speak from
experience. After I explain that there is no physical reason why the
teachers of some cities are fagged out at the end of nine months while
those in other cities whose session is longer can hold on for ten
months, and stenographers who lead just as strenuous a life manage to
exist with only a two-weeks' vacation, they begin to see that perhaps
after all they have been fooling themselves by a suggestion, "setting"
themselves for just so long and expecting to be done up at the end of
the term. Many of these same teachers have gone back to their work
with a new sense of "enough and to spare" and some of them have
written back that they have passed triumphantly through especially
trying years with no sense of depletion.

In any work, it is the feeling of strain which tells, the emotionalism
and feeling sorry for oneself because one has a hard job. It is
wonderful what a sense of power comes from the simple idea that we are
equal to our tasks.

=Sudden Relief.= The story of Mr. V. illustrates Professor James's
statement that often the fatigue gets worse up to a certain critical
point, and then suddenly passes away. Mr. V. was another patient who
was "physically exhausted." When the rest of "the family" went
clamming on the beach, he felt himself too weak for such exertions, so
I left him on the sand to hold the bag while the rest of us dug for
clams. The minute I turned my back he disappeared. I found him lying
flat on his back, resting, behind the bulk-head. I decided that he
needed the two-mile walk home and we all set out to walk. "Doctor,
this is cruel. It is dangerous. My knees can never stand this. I shall
be ill!" ran the constant refrain for the first mile. Then things went
a bit better. Toward the last he found, to his absolute astonishment,
that the fatigue had entirely rolled away. The last half-mile he
accomplished with perfect ease. Needless to say, he never again
complained of physical exhaustion.

=False Neuritis.= Miss T. was suffering from fatigue and very severe
pains in her arms, pains which were supposed to be the result of real
neuritis, but which did not correspond to the physiological picture of
that disease. A consultation revealed the fact that her love-instinct
had been repeatedly stimulated, and then at the last, when it had
expected satisfaction, had been disappointed. A discussion of her
life, its inner forces, and her future aims helped to pull her
together again and give her instinct new outlets. The pains and the
fatigue disappeared at once.

=Something Wrong.= These cases are chosen at random and are typical of
scores of others. In no single case was the trouble feigned or
imaginary or unreal. But in every case it was a mistake. _The sense of
loss of muscular power was really a sense of loss of power on the part
of the soul._ Some inner force was reaching out, reaching out after
something which it could never quite attain. As it happened, in every
case that I analyzed, the force which felt itself defeated and
inadequate was the thwarted instinct of reproduction. Like a man
pinned to the ground by a stronger force, it felt itself most helpless
while struggling the hardest. Just as we feel a thrill of fright when
we step up in the dark and find no step there, so this instinct had
gotten itself ready for a step which was not there. Inner repressions
or outer circumstances had denied satisfaction and left only an
undefined sense that something was wrong. The life-force, feeling
itself helpless, limp, tired, had no way of expressing itself except
in terms of the body. Since expression is itself a relief and an
outlet for feeling, the denied desire had seized on suggestions of
overwork to explain its sense of weariness, and had symbolized its
soul-pain by converting it into a physical pain. The feeling of
inadequacy was very real, but it was simply displaced from one part of
the personality to another,--from an unknown, inarticulate part to one
which was more familiar and which had its own means of expression.

=Locked-up Energy.= We do not know just how the soul can make its pain
so intensely real to the body, but we do know that any conviction on
the part of the subconscious mind is quickly expressed in the physical
machine. A conviction of pain or of powerlessness is very soon
converted into a feeling which can scarcely be denied. The mere
suggestion that the body is overworked is enough to make it tired.

We know, too, that the instincts are the great releasers of energy. So
it happens that when our most dynamic instinct--that for the
reproduction of the race--is repressed, we lack one of the greatest
sources of usable energy. The energy is there, but it is not
accessible. Inhibited and locked away, it is not fed into the engine,
and we feel exactly as though it were _nil_. Despite its name, the
disease neurasthenia does not signify a real asthenia or weakness.
Rather, it is a disorder in which there is plenty of energy that has
somehow been temporarily misplaced. Then, too, we must remember that
under the depressing influence of chronic fear, not quite so much
energy is stored away as would otherwise be. All the bodily functions
are slowed down; food is not so completely assimilated, the heart-beat
is weakened, the breathing is more shallow, and fatigue products are
more slowly eliminated. As Du Bois says, "An emotion tires the
organism more than the most intense physical or intellectual work."

=Avoid the Rest-Cure.= It is a healthful sign that the rest-cure is
fast going out of style. Wherever it has helped a nervous patient, the
real curative agent has been the personality of the doctor and the
patient's faith in him. The whole theory was based on ignorance of the
cause of nerves. People suffering from "nervous exhaustion" are likely
to be just as "tired" after a month in bed as they were before. Why
not? Physical fatigue is quickly remedied, and what can rest do after
that? What possible effect can rest have on the fatigue of a
discouraged instinct? Since the best releaser of energy is enthusiasm,
don't try to get that by lying around in bed or playing checkers at a
health resort.


SUMMARY

If you are chronically and perpetually fatigued, or if you tire more
easily than the other people you know, consult a competent physician
and let him look you over. If he tells you that you have neither
tuberculosis, heart trouble, Bright's disease, nor any other
demonstrable disease, that you are physically fit and "merely
nervous," give yourself a good shake and commit the following
paragraphs to memory.


     A CATECHISM FOR THE WEARY ONE

     WHAT?

     Q. What is fatigue?

     A. It is a chemical condition resulting from effort that is very
     recent.

     Q. What else creates fatigue?

     A. Worry, fear, resentment, discontent, and other depressing
     emotions.

     Q. What magnifies fatigue?

     A. Attention to the feeling.

     Q. What makes us weary long after the cause is removed?

     A. Habit.

     WHY?

     Q. Why do many people believe themselves over-worked?

     A. Because of the power of suggestion.

     Q. Why do they take the suggestion?

     A. Because it serves their need and expresses their inner feelings.

     Q. Why are they willing to choose such an uncomfortable mode of
     expression?

     A. Because they don't know what they are doing, and the
     subconscious is very insistent.

     WHO?

     Q. Who gets up tired every morning?

     A. The neurotic.

     Q. Who fancies his brain so exhausted that a little concentration
     is impossible?

     A. The neurotic.

     Q. Who still believes himself exhausted as the result of work that
     is now ancient history?

     A. The neurotic.

     Q. Who lays all his woes to overwork?

     A. The neurotic.

     Q. Who complains of fatigue before he has well begun?

     A. The neurotic.

     Q. Who may drop his fatigue as soon as he "gets the idea?"

     A. The neurotic.

     HOW?

     Q. How can he get the idea?

     A. By understanding himself.

     Q. How may he express his inner feelings?

     A. By choosing a better way.

     Q. How can he forget his fatigue?

     A. By ignoring it.

     Q. How can he ignore it?

     A. By finding a good stiff job.

     If he wants advice in a nutshell, here it is: Get understanding!
     Get courage! Get busy!



CHAPTER X

_In which the ban is lifted_

DIETARY TABOOS

MISUNDERSTOOD STOMACHS


=Modern Improvements.= Most people have heard the story of the little
girl who wanted to know what made her hair snap. After she had been
informed that there was probably electricity in her hair, she sat
quiet for a few minutes and then exclaimed: "Our family has all the
modern improvements! I have electricity in my hair and Grandma has gas
on her stomach!" Judged by this standard many American families are
well abreast of the times; and if we include among the modern
improvements not only gas on the stomach but also nervous dyspepsia,
acid stomach, indigestion, sick-headache, and biliousness, we must
conclude that a good proportion of the population is both modern and
improved.

Despite all this the stomach is one of the best-equipped mechanisms in
the world. It, at least, is not modern. After their age-long
development the organs of the body are remarkably standardized and
adapted to the work required of them. It is safe to say that ninety
per cent. of all so-called "stomach trouble" is due not to any
inherent weakness of the organ itself but to a misunderstanding
between the stomach and its owner.

=Organic Trouble.= Unfortunately, there are a few real organic causes
for trouble. There are a few cancers of the stomach and a certain
number of ulcers. But if the patients whom I have seen are in any way
typical, the ulcers that really are cannot compare in number with the
ulcers that are supposed to be. Patients go to physicians with so many
tales of digestive distress that even the best doctors are fooled
unless they are especially alert to the ways of "nerves." They must
find some explanation for all the various functional disturbances
which the patients report, and as they are in the habit of taking only
the body into account, they find the diagnosis of stomach ulcer as
satisfactory as any.

There is, of course, such a thing as an enlarged or sagging stomach.
But it is only in the rarest of cases that such a condition leads to
any functional disturbances unless complicated by suggestion. In most
cases a person can go about his business as happily as ever unless he
gets the idea that ptosis must inevitably lead to pain and discomfort.

Confusion sometimes arises when the stomach is blamed for
disturbances which originate elsewhere. One day a very sick-looking
girl came to me with eager expectation written all over her face. Her
stomach was misbehaving and she had heard that I could cure nervous
indigestion. It needed little more than a glance to know that she was
suffering from organic heart trouble. A boy of sixteen had been taking
a stomach-tonic for three months, but the thin, wiry pulse pointed to
a different ailment. His digestive disturbances were merely the echo
of an organic disease of the kidneys. When the body is burdened by
disease, it may have little energy left for digesting food, but in
that case the trouble must be sought in other quarters than the
stomach.

Aside from a few organic difficulties, there is almost no real disease
of the stomach. Its misdoings are not matters of food and chemistry,
muscle-power and nerve supply, but are the end results of slips in the
mental and emotional life of its owner.

=Fads Dynamogenic.= What is it that gives the impetus to fads about
eating, or about religious belief? Are they advocated by the
individual whose libido is finding abundant expression in the natural
channels of business and family life, or by his less fortunate brother
who can gain a sense of power only by means of some unaccustomed idea?
William James says:

     This leads me to say a word about ideas considered as dynamogenic
     agents or stimuli for unlocking what would otherwise be unused
     reservoirs of individual power.... In general, whether a given
     idea shall be a live idea depends more on the person into whose
     mind it is injected than on the idea itself. Which is the
     suggestive idea for this person and which for that one? Mr.
     Fletcher's disciples regenerate themselves by the idea (and the
     fact) that they are chewing and re-chewing and super-chewing
     their food. Dr. Dewey's pupils regenerate themselves by going
     without their breakfast--a fact, but also an ascetic idea. Not
     every one can use these ideas with the same success.

Because it is so adaptable and sturdy, the stomach lends itself
readily to these devices for gaining self-expression; but the danger
lies in bringing the process of digestion into conscious attention
which interferes with automatic functioning. Still further, the
disregard of physiological chemistry is likely to deprive the body of
food-stuffs which it requires.

The average person is too sensible to be carried off his feet by the
enthusiasm of the health-crank, but as most of us are likely to pick
up a few false notions, it may be well to be armed with the simple
principles of food chemistry in order to combat the fads which so
easily beset us and to know why we are right when we insist on eating
three regular meals of the mixed and varied diet which has proved
best for the race through so many years of trial and experience.


WHAT WE NEED TO EAT

=The Essence of Dietetics.= To the layman the average discussion of
food principles is, to say the least, confusing. Dealing largely, as
it does, with unfamiliar terms like carbohydrate and hydrocarbon and
calories, it is hard to translate into the terms of the potatoes left
over from dinner and the vegetables we can afford to buy. But the
practical deductions are not at all difficult to understand. Boiled
down to their simplest terms, the essential principles may be stated
in a few sentences. The body must secure from the food that we eat,
tissue for its cells, energy for immediate use or to be stored for
emergency, mineral salts, vitamins, water and a certain bulk from
fruits and vegetables,--this latter to aid in the elimination of waste
matter.

Food for repairing bodily tissue is called protein and is secured from
meat, eggs, milk, and certain vegetables, notably peas. Fuel for heat
and energy is in two forms--carbohydrate (starch and sugar) and fat.
We get sugar from sugar-cane and beets, and from syrups, fruit, and
honey. Starch is furnished from flour products--mainly bread--from
rice, potatoes, macaroni, tapioca, and many vegetables. Fats come from
milk and butter, from nuts, from meat-fat--bacon, lard and suet--and
from vegetable oils. The mineral salts are obtained mainly from fruit
and vegetables, which also provide certain mysterious vitamins
necessary for health, but as yet not well understood.

=What the Market Affords.= The moral from all this is plain. The human
body needs all the foods which are ordinarily served on the table.
Whenever, through fad or through fear, we leave out of our diet any
standard food, we are running a risk of cutting the body down on some
element which it needs. They say that variety is the spice of life. In
the matter of food it is more than that, it is the essence of life.
Eat everything that the market affords and you will be sure to be well
nourished. If you leave out meat you will make your body work overtime
to secure enough tissue material from other foods. If you leave out
white bread, you will lose one of the greatest sources of energy. If
you leave out tomatoes and cucumbers and strawberries, you deprive
your body of the salts and vitamins which are essential.

=A Simple Rule.= There is one point that is good to remember. The
average person needs twice as much starch as he needs of protein and
fat together. That is, if he needs four parts of protein and three of
fat, he ought to eat about fourteen parts of starch. This does not
mean that we need to bother ourselves with troublesome tables of what
to eat, but only to keep in mind in a general way that we need more
bread and potatoes than we do meat and eggs. The body does not have
to rebuild itself every day. It is probable that a good many people
eat too much protein food. If a man is doing hearty work he must have
a good supply of meat, but the average person needs only a moderate
amount. Here again, the habits of the more intelligent families are
likely to come pretty near the dictates of science.

=For the Children.= The mother of a family ought to know that the
children need plenty of bread, butter, and milk. Despite all the
notions to the contrary, good well-baked white bread is neither
indigestible nor constipating. It is indeed the staff of life. Two
large slices should form the background of every meal, unless there is
an extraordinary amount of other starchy food or unless the person is
too fat. Milk-fat (from whole milk, cream, and butter) is by far the
best fat for children. Besides fat, it furnishes a certain
growth-principle necessary for development. As the dairyman cannot
raise good calves on skimmed milk, so we cannot raise robust children
without plenty of butter and milk. The pity of it is that poor people
are forced to try! Milk is also the best protein for children, whose
kidneys may be overstrained by trying to care for the waste matter
from an excessive quantity of eggs and meat. Bread and butter, milk,
fruit, vegetables, and sugar in ample quantities and meat and eggs in
moderate quantities are pretty sure to make the kind of children we
want. Above all things, let us train them not to be afraid of normal
amounts of any regular food or of any combination of foods.

=The Fear of Mixtures.= There are many people who can without
flinching face almost any single food, but who quail before mixtures.
Perhaps there is no notion which is more firmly entrenched in the
popular mind than this fear of certain food-combinations, acquired
largely from the advertisements of certain so-called "food
specialists."

The most persistent idea is the fear of acid and milk. It is
interesting to watch the new people when they first come to my table.
Confronted with grape-fruit and cream at the same meal, or oranges and
milk, or cucumbers and milk, they eat under protest, in consternation
over the disastrous results that are sure to follow. Out of all these
scores of people, many of whom are supposed to have weak stomachs, I
have never had one case of indigestion from such a combination. When a
person knows that the stomach juices themselves include hydrochloric
acid which is far more acid than any orange or grapefruit, that the
milk curdles as soon as it reaches the stomach, and that it must
curdle if it is to be digested, he has to be very "set" indeed if he
is to cling to any remnant of fear.

Of course to say that the stomach is well prepared chemically,
muscularly, and by its nerve supply to handle any combination of
ordinary food in ordinary amounts is not the same thing as saying that
we may devour with impunity any amount of anything. It is a good thing
for every one to know when he has reached his limit, and a person with
organic heart disease should avoid eating large quantities at one
time, or when he is extraordinarily fatigued or emotionally disturbed,
lest at such a time he may put a fatal strain on the pneumogastric
nerve that controls both stomach and heart.


THE FEAR OF CERTAIN FOODS

=Physical Idiosyncrasies.= Most of our false fears on food subjects
come from some tradition--either a social tradition or a little
private, pet tradition of one's own. Some one once was ill after
eating strawberries and cream. What more natural than to look back to
those little curdles in the dish and to start the tradition that such
mixtures are dangerous? The worst of it is that the taboo habit is
very likely to grow. One after another, innocent foods are thrown out
until one wonders what is left. A patient of mine, Mr. G., told me
that he had a short time before gone to a physician with a tale of woe
about his sour stomach. "What are you eating?" asked the doctor. "Bran
crackers and prunes." "Then," said the learned doctor, "you will have
to cut out the prunes!" Needless to say, this man ate everything at my
table, and flourished accordingly.

There may be such a thing as physical idiosyncrasies for certain
foods. I have often heard of them, but I have never seen one. I have
often challenged my patients to show me some of the "spells" which
they say invariably follow the eating of certain foods, but I have
almost never been given an exhibition. The man who couldn't eat eggs
did throw up once, but he couldn't do it a second time. Many people
have threatened to break out with hives after strawberries. One woman
triumphantly brought me what looked like a nice eruption, but which
proved to be the after-results of a hungry flea! After that she ate
strawberries,--without the flea and without the hives.

=Not Miracles but Ideas.= Conversions on food subjects are so common
at my table that I should have difficulty in remembering the
individual stories. Scores of them run together in my mind and make a
sort of composite narrative something like this: "Oh, no, thank you, I
don't eat this. You really must excuse me. I have tried many times and
it is invariably disastrous." Then a reluctant yielding and a day or
two later some talk about miracles. "It really is wonderful. I don't
understand," etc. Experiences like these only go to show the power of
the subconscious mind, both in building up wrong habit-reactions and
in quickly substituting healthy ones, once the false idea is removed.

Among my stomach-patients there were two men, brothers-in-law,
immigrants from the Austrian Tyrol, and now resident in one of the
cow-boy states. Leonardo spoke little English, and though Giovanni
understood a very little, he spoke only Italian.

Several years before I knew them, Giovanni had developed a severe case
of stomach trouble and had finally gone to a medical center for
operation. The disturbance, however, was not relieved by the operation
and before long his brother-in-law fell into the same kind of trouble.
For several years the two had spent much of their time dieting,
vomiting, and worrying over their sour stomachs. Giovanni finally
became so ill that his sick-benefit society had actually assessed its
members to pay for his funeral expenses. About this time a business
man of their town, impressed by the cure of a former patient who had
made a quick recovery after seven years of invalidism, persuaded the
two men to take their little savings and come to California to be
under my care. The evening meal and breakfast went smoothly enough,
although the menu included articles which they had been taught to
avoid. However, as I left the house on a necessary absence soon after
breakfast, I saw Leonardo weeping in the garden and Giovanni spitting
up his breakfast, out at the entrance gate. On my return, I found one
of "the family" literally sitting on the coat-tails of Leonardo, while
Giovanni hovered at a distance, safe from capture. Leonardo upbraided
me bitterly for having undone all the gain they had made in the long
months of rigid dieting, for now the vomiting had returned, because
they had eaten sugar on their oatmeal at breakfast! I made Leonardo
drink an egg-nog, took him into the consultation-room and held my hand
on his knee to keep him in his chair, while explaining to him as best
I could the physiologic action of the hydrochloric acid on the
digestive juice, which he feared as a sour stomach, the sign of
indigestion.

During the conversation I said, "I suppose Giovanni imitated you in
this mistaken fear about your health." The reply was, "No, I got it
off him!" Nearly two hours later he exclaimed in astonishment: "Why,
that milk hasn't come up! Maybe I am cured!" "Of course you are
cured," I answered; "there never was anything really the matter with
your stomach, so you are cured as soon as you think you are."

Later Giovanni was inveigled into the house by the promise that he
would have to eat nothing more than milk soup. All was smooth sailing
after this. For my own part I feared for the permanency of the cure,
for they were returning to the old environment. But more than three
years have passed, and grateful letters still come telling of their
continued health.

Another patient, a teacher of domestic science in a big Eastern
university, had lived on skimmed milk and lime-water from Easter to
Thanksgiving. Several attempts to enlarge the dietary by adding cream
or white of egg had only served to increase the sense of discomfort.
Finding nothing in the history of the case to warrant a diagnosis of
organic disease of the stomach, I served her plate with the regular
dinner, bidding her have no hesitancy even over the pork chops and
potato chips. She gained nine pounds in weight the first week, and in
two and a half months was forty pounds to the good.

=When Re-education Failed.= But there is one patient who has had to
have his lesson repeated at intervals. This man laughingly calls
himself a disgrace to his doctor because he is a "repeater." His story
illustrates the power of an autosuggestion and the disastrous effect
of attention to a physiological function. When Mr. T. came first to me
he weighed only 120 pounds, although he is over six feet tall and of
large frame. From the age of sixteen he had followed fads in eating
and thought he had a weak stomach. I treated his "weak stomach" to
everything there was in the market, including mince-pies, cabbage,
cheese, and all the other so-called indigestibles. He gained 16-1/2
pounds the first week and 31 pounds in five weeks. One would think
that the idea about the weak stomach would have died a natural death,
but it did not. Again and again he came back to me like a living
skeleton, the last time weighing only 105 pounds, and again and again
he has gone back to his home in the Middle West plump and well. Twice
while he was at home he underwent unnecessary operations, once for an
ulcer that was not there and once for supposed chronic spasm of the
pylorus. Needless to say, the operations did not help. You cannot cut
out an idea with a knife. Neither can you wash it out with a
stomach-pump; else would Mr. T. long ago have been cured! This
particular idea of his seems to be proof against all my best efforts
at re-education. Psycho-analysis is impracticable, partly because of
the duration of the habit of repression, but the history, and certain
symbolic symptoms, indicate the Freudian mechanisms at work. All I can
do is to feed him up, bully him along, and keep him from starving to
death. Just now he is doing very well at home, although he has moved
to California so as not to be too far away from "the miracle-worker."

If Mr. T.'s case had been typical, I should long ago have lost my
faith in psychotherapy. Keeping people from starving is worth while,
but is less satisfactory than curing them of what ails them. The
nervous patient who has a relapse is no credit to his doctor. It is
only when the origin of his trouble is not removed that the bond of
transference tends to become permanent. The neurotic who is well only
while under the influence of his physician is still a neurotic.
However, as most people's complexes are neither so deeply buried nor
so obstinate as this, a simple explanation or a single demonstration
is usually enough to loose the fettering hold of old misconceptions.


COMMON AILMENTS

="Gas on the Stomach."= We all know people who suffer from "gas."
Indeed, very few of us escape an occasional desire to belch after a
hearty meal. But the person with nervous indigestion rolls out the
"gas" with such force that the noise can sometimes be heard all over
the house. He may keep this up for hours at a time, under the
conviction that he is freeing himself from the products of fermenting
food. He may exhibit a well-bloated stomach as proof of the disastrous
effect of certain articles of diet. The gas and the bloating are
supposed to be the sign and the seal of indigestion, a positive
evidence that undigested food is fermenting in the stomach.

But what is fermentation? It is, necessarily, a question of the growth
of bacteria and is a process which we may easily watch in our own
kitchens. Bread rises when the yeast-cells have multiplied and acted
on the starch of the flour, producing enough gas to raise the whole
mass. Potatoes ferment because bacteria have multiplied within them.
Canned fruit blows up because enough bacteria have developed inside to
produce sufficient gas to blow open the can. Every housewife knows
that it takes time for each of these processes. Bread has to stand
several hours before it will rise; potatoes do not ferment under
twelve hours, and canned fruit is not considered safe from the
fermenting process under three days. Evidently there is some mistake
when a person begins to belch forth "gas" within an hour or two after
a meal. As a matter of fact, it is not gas at all but merely air that
is swallowed with the food or that was present in the empty stomach.

When the food enters the stomach it necessarily displaces air, which
normally comes out automatically and noiselessly. But if, through fear
or attention, a certain set of muscles contract, the pent-up air may
come forth awkwardly and noisily or it may stay imprisoned until we
take measures to let it out. A hearty laugh is as good as anything,
but if that cannot be managed, we may have to resort to a cup of hot
water which gives the stomach a slap and makes it let go. Two belches
are enough to relieve the pressure. After that we merely go on
swallowing air and letting it out again, a habit both awkward and
useless.

If the emotion which ties the muscle-knot is very intense, and the
stomach refuses to let go under ordinary measures, the pain may be
severe. But a quantity of hot water or a dose of ipecac is sure to
relieve the situation. If the person is able to give himself a good
moral slap and relax his unruly muscles, he reaches the same end by a
much pleasanter road.

Some people are fond of the popular remedy of hot water and soda.
Their faith in its efficacy is likely to be increased by the good
display of gas which is sure to follow. As any cook knows, soda and
acid always fizz. The soda is broken up by the hydrochloric acid of
the stomach and forms salt and carbon dioxid, a gas. However, as the
avowed aim of the remedy is the relief of gas rather than its
manufacture, and as the soda uses up the hydrochloric acid needed in
digestion, the practice cannot be recommended as reasonable.

=Gastritis.= I once knew a woman who went to a big city to consult a
fashionable doctor. When she returned she told with great satisfaction
that the doctor had pronounced her case gastritis. "It must be true,"
she added, "because I have so much gas on my stomach!" The diagnosis
of gastritis used to be very common. The ending _itis_ means
inflammation,--gastritis, enteritis, colitis, each meaning
inflammation of the corresponding organ. An inflammation implies an
irritant. There can be no kind of _itis_ without the presence of
something which irritates the membrane of the affected part. If we
get unusual and irritating bacteria in some spoiled food, we are
likely to have an acute inflammation until the offending bacteria are
expelled. But an inflammation of this kind never lasts. People who
have had ptomaine poisoning sometimes assert that they are afterwards
susceptible to poisoning by the kind of food which first made them
ill. Such a susceptibility is not so much a hold-over effect from the
poison as a hold-over fear which tends to repeat the physical reaction
whenever that food is eaten. I, myself, have had ptomaine poisoning
from canned salmon, but I have never since had any trouble about
eating salmon.

=Sour Stomach.= Sometimes when a person lies down an hour or so after
a meal, some of the contents of his stomach comes up in his throat.
Then if he be ignorant of physiology, he may be very much alarmed
because his stomach is "sour." Not knowing that he would have far
greater cause for alarm if his stomach were _not_ sour, he may, if the
idea is interesting to him, begin to restrict his diet, to take
digestive tablets, and to develop a regular case of nervous dyspepsia.
Sometimes when the specialists measure the amount of hydrochloric acid
in the stomach, they do find too much or too little acid; but this
merely means that an emotion has made the glands work overtime or has
stopped their action for a little while. The functions of the body
are so very, very old that there is little likelihood of permanent
disturbance.

=Biliousness.= The stomach is not the only part of the body concerning
which we lack proper confidence. Next to it the liver is the most
maligned organ in the whole body. Although the liver is about as
likely to be upset in its process of secreting bile as the ocean is
likely to be lacking in salt, many an intelligent person labels every
little disturbance "biliousness" and lays it at the door of his
faithful, dependable liver.

As a matter of fact, the liver is liable to injury from virtually but
three sources--alcohol, bacterial infection, and cancer--and even a
liver hardened by alcohol goes on secreting bile as usual. The patient
dies of dropsy but not of "liver complaint."

Some people act as if they thought bile were a poison. On the
contrary, it is a very useful digestant; it aids in keeping down the
number of harmful bacteria and helps to carry the food from intestines
to blood. Every day the liver manufactures at least a pint of this
important fluid. The body uses what it needs and stores the surplus
for reserve in the gall-bladder. The flow is continuous and, despite
all appearances to the contrary, there is no such thing as a torpid or
an over-active liver.

It is true that after a "bilious" person has vomited for a few minutes
he is likely to throw up a certain amount of bile, which is supposed
to have been lying in his stomach and causing the nausea. In fact,
however, this bile is merely a part of the usual supply stored away in
the gall-bladder. By the very act of retching, the bile is forced out
of the bile channels into the stomach and thence up into the mouth.
Anybody can throw up bile at any time if he only tries hard enough.

One of the favorite habits of certain people is the taking of calomel
and salts. After such a dose they view with satisfaction the green
character of the stools and conclude that they have rid themselves of
a great amount of harmful matter. As a matter of fact, the greater
part of the coloring in the stools is from the calomel itself, changed
in the intestines from one salt of mercury to another. Any excess bile
is the result of the irritating action of the calomel on the
intestinal wall, an irritation which makes the bowel hurry to cast out
this foreign substance without waiting for the bile to be absorbed as
usual.

A patient once told me that he had bought medicine from a street fakir
and by his direction had followed it with a dose of salts. He saved
the bowel movement, washed it in a sieve, and discovered a great
number of "gall-stones," which the medicine had so effectively washed
from his system. He was much astonished when I told him that his
gall-stones were merely pieces of soap. He did not know that
everybody manufactures soap in his body every day, and that by taking
an extra quantity of oil in the shape of the fakir's medicine and an
extra quantity of potash in the salts, he had merely augmented a
normal physiological process. The supposed action of calomel belongs
to the same class of phenomena, and has no slightest effect on the
liver or on real gall-stones, which are the precipitate of bile-salts
in the gall-bladder, and which cannot be reached by any medicine.

If the popular notions about biliousness are ill founded, what then
causes the disturbances which undoubtedly do occur and which show
themselves in attacks of nausea or sick headache? The answer can be
given in a word of four letters; a coated tongue, a bilious attack and
a sick headache are all the outcome of a mood. Stocks have gone down
or the wife is cranky or the neighbors are hateful. Adrenalin and
thyroid secretions are poured out as the result of emotion; digestion
is stopped, circulation disturbed, and the whole apparatus thrown out
of gear.

=Sick-Headache.= Sick-headache is primarily a circulatory disturbance;
and although the disturbance may have been inaugurated by some
chemical unbalance, the sum total of the force that makes a
sick-headache is emotional. The emotion, of course, need not be
conscious in order to be effective. If we picture the arteries all
over the body as being supplied with, among other things, a wall of
circular muscles, and then imagine messages of emotion being flashed
to the nerves controlling this muscle wall, we may get an idea of what
happens just before a sick-headache. Some parts of the arteries
contract too much and other parts relax. The arteries to the head
tighten up at the extremities and become loose lower down. The force
of the blood-stream against the constricted portion can hardly fail to
cause pain. The sick part of the headache is merely a sympathetic
strike of the nerves which control circulation and stomach.

The moral of all this is plain. If a sick-headache is the result of an
emotional spasm of the blood-vessels, the obvious cure is a change of
the emotion. Some people manage it by going to a party or a picnic,
others by ignoring the symptoms and keeping on with their work. A
woman physician whom I know was in the midst of a violent headache
when called out on an obstetrical case. She felt sorry for herself,
but went on the case. In the strenuous work which followed, she quite
forgot the headache, which disappeared as if by magic.

Sometimes it happens that a headache recurs periodically or at regular
intervals. It is easy to see that in such cases the exciting cause is
fear and expectation. At some time in the past, headaches have
occurred at an interval of, say, fourteen days; as the next
fourteenth day approaches the sufferer says to himself: "It is about
time for another headache. I am afraid it will come to-morrow," and of
course it comes. One man told me that if he ate Sunday-night supper he
inevitably had a headache on Monday morning. We were about to sit down
to a simple Sunday supper and he refused very positively to join us. I
told him he could stay all night and that I would take care of him if
the Monday sickness appeared. He accepted my challenge but was unable
to produce a headache. In fact, he felt so unusually flourishing the
next morning that he insisted on frying the bacon for my entire
family. That was the end of the Monday headaches.

=A Few Examples.= As sick-headache has always been considered a rather
stubborn difficulty, not amenable to most forms of treatment, it may
be well to cite a few cases which were helped by educational methods.
A patient came home from a walk one day and announced that he was
going to bed. When questioned, be said: "I am tired and I have a
sick-headache. Isn't it logical to go to bed?" To which I answered
that it would be far more logical to put some food into his stomach
and change the circulation than to lie in bed and think about his
pain. This man was completely cured. I have had patients throw up one
meal, and very rarely two, but I have never had to supply more than
three meals at a time. The waste of food I consider amply justified by
the benefit to the patient.

There once came to me an elderly woman, the wife of a poor minister.
She was suffering from attacks of nausea, which recurred every five to
ten days with intense pain through the eyes, and with photo-phobia or
fear of light. I found that she had by dint of heroic efforts raised a
large and promising family on the salary of an itinerant
minister--from four hundred to six hundred a year! All the time she
had been feeling sorry for herself because her husband did not
appreciate her. One day, after reading one of his letters which seemed
to show an utter lack of appreciation of all that she was doing, she
fell down in the field beside her plow, paralyzed. From that time on
she had been more or less of an invalid, continually nursing her
grudge and complaining that she ought not to have been made to bear so
many children.

After I had heard this plaint over and over for about a week, I said:
"Perhaps you ought not to have had that little daughter, the little
ewe-lamb. Maybe she was one too many." "Oh, no," came the quick
response. "I couldn't have spared _her_." Then I went down the line of
the fine stalwart sons. Perhaps she could have spared John or Tom or
Fred? Finally she saw the whole matter in a different light,--saw
herself as a queen among women, the mother of such a family.

As to the husband, I tried to show her that she was not very clever
to live with a man all those years without discovering that he was not
likely to change. "You can't change him but you can change your
reaction to him. If something keeps hurting your hand, you don't keep
on being sore. You grow callous. Isn't it about time you grew a moral
callous, too?"

I put her on the roof to sleep, on account of her fear of light. Only
once did she start a headache, which I quickly nipped in the bud by
making her get up and dress. She had come to stay "three months or
four,--if I get along well." At the end of four weeks she left, an
apparently well woman. The last I heard of her she was stumping the
state for temperance, the oldest of an automobile party of speakers,
and the sturdiest physically. With the emotional grievance,
disappeared also the physical effects in stomach and head.

Miss S., a very brilliant woman, ambitious to make the most of her
life, had been shelved for twenty-five years because of violent
sick-headaches which made it impossible for her to undertake any kind
of work. She had not been able to read a half-hour a day without
bringing on a terrible headache. I insisted on her reading, and very
soon she was so deep in psychological literature that I had difficulty
in making her go to bed at all. After learning the cause of her
headaches and gaining greater emotional control, she succeeded so
well in freeing herself from the old habit, that she now leads the
busiest kind of useful life with only an occasional headache, perhaps
once in six months.

A certain minister suffered constantly from a dull pain in his head,
besides having violent headaches every few days. He started in to have
a bad spell the day after his arrival at my house. As I was going out
of the door, he caught my sleeve. "Doctor," he said, "would it be bad
manners to run away?" "Manners?" I answered. "They don't count, but
morals, yes." He stayed--and that was his last bad headache. Both
chronic and periodic pains disappeared for good.

One woman who had suffered from bad headaches for eighteen years lost
them completely under a process of re-education. On the other hand, I
have had patients who were not helped at all. The principles held good
in their cases, but they were simply not able to lose the old habit of
tightening up the body under emotion.

=Hysterical Nausea.= Sometimes nausea is merely the physical symbol of
a subconscious moral disgust. We have already told the stories of "the
woman with the nausea" (Chapter V) and of Mrs. Y. (Chapter VII). These
cases are typical of many others. Their bodies were perfectly normal,
and when, through psycho-analysis and re-education, they were helped
to make over their childish attitudes toward the sex-life, the nausea
disappeared.

=Loss of Appetite.= A nervous patient with a good appetite is "the
exception that proves the rule." The neurotic is usually under weight
and often complains that he feels satiated almost as soon as he begins
to eat. Loss of appetite may, of course, mean that the body is busy
combating toxins in the blood, but in a nervous person it usually
means a symbolic loss of appetite for something in life, a struggle of
the personality against something for which he has "no stomach."
Psycho-analysis often reveals the source of the trouble, and a little
bullying helps along the good work. By simply taking away a harmful
means of expression, we may often force the subconscious mind to find
a better language.


SUMMARY

Since the stomach seems to be an organ which is much better fitted to
care for food than to care for a depressing emotion or a false idea,
it seems far more sensible to change our minds than to keep enlarging
our list of eatables which are taboo.

And since most indigestion is in very truth nothing more nor less than
an emotional disturbance, worked up by fear, anger, discontent, worry,
ignorance, suggestion, attention to bodily functions which are meant
to be ignored, love of notice and the conversion of moral distress
into physical distress, the best diet list which can be furnished to
Mr. Everyman in search of health must read something like this:

                              MENU

     Monday, Tuesday, Wednesday, Thursday, Friday, Saturday,
                             Sunday

  A Calm Spirit                            Plenty of Good Cheer
      A Varied Diet                           Commonsense
                          Good Cooking
                 Judicious Neglect of Symptoms
            Forgetfulness of the Digestive Process
                   A Little Accurate Knowledge
                       A Determination to
                         BE LIKE FOLKS



CHAPTER XI

_In which we relearn an old trick_

THE BUGABOO OF CONSTIPATION

POPULAR SUPERSTITIONS


In line with the taboos connected with the taking of food are the
ceremonials attendant upon its elimination. Taking anxious thought
about functions well established by nature is a feature of
conversion-hysteria, the displacement of emotional desire from its
psychic realm into symbolic physical expression. Whatever other
symptoms nervous people may manifest, they are almost sure to be
troubled with chronic constipation. It is true that there are many
constipated people who do not seem to be nervous and who resent being
classed among the neurotics. Everybody knows that the occasional
individual who has difficulty in swallowing his food is nervous and
that the, trouble lies not in the muscles of his throat but in the
ideas of his mind. But very few people seem to realize that the more
common individual who makes hard work of that other simple
process--elimination of his intestinal waste matter--is suffering
from the same kind of disturbance and giving way to a nervous trick.
When all the facts are in, the constipated person will have hard work
to clear himself of at least one count on the charge of nerves.

=An Oft-told Tale.= Sooner or later, then, the neurotic, whether he
calls himself a neurotic or not, is very likely to begin worrying over
his diet or his sedentary occupation. He imagines himself the victim
of autointoxication, afflicted with paralysis of the colon or dearth
of intestinal secretions. He leaves off eating white bread, berries,
cheese, chocolate, and many another innocent food, and insists on a
diet of bran-biscuit, flaxseed breakfast-foods, prunes, spinach,
cream, and olive-oil with doses of mineral oil between meals. In all
probability, he begins a course of massage or he starts to take extra
long walks and to exercise night and morning, pulling his knees up to
his chin and touching his fingers to his toes. When all these measures
fail, he gives in to the morning enema or the nightly pill, in
imminent danger of succumbing to a life-long habit.


THE TRUTH ABOUT CONSTIPATION

=What the Colon Is For.= It is well, then to have a fair understanding
of the structure and purpose of our intestinal machinery. Contrary to
general opinion, the intestines are not a dumping-ground but a
digestive organ. After the food is partly digested in the stomach, it
passes through a twenty-two foot tube (the small intestine) into a
five-foot tube (the large intestine or colon) where digestion is
completed, the nutriment is absorbed, and the waste matter is passed
on and out through the rectum. As the food passes along the colon,
pushed slowly ahead by the peristaltic wave, or rhythmic muscular
contractions of the intestinal wall, it is seized upon by the four
hundred varieties of friendly bacteria which inhabit the intestines of
every healthy person, and is changed into a form which the body can
assimilate. Digestion in the stomach and small intestine is carried on
by means of certain digestive juices, but in the large intestine it is
the bacteria which do the work. Without them we could not live.

Around the colon is a thick network of little blood vessels, all of
which lead straight to the liver, the storehouse of the body. After
the food is fully digested, it is passed through the thin intestinal
wall into these tiny vessels and carried away to liver and muscles for
storage or for immediate use.

This process of absorption is carried on throughout the whole length
of the colon. Not until the very end of the intestine is reached is
all the nutrition abstracted. The bowel-content can properly be called
waste matter only after it has reached the rectum or pouch at the
lower end of the colon. Even then, this waste matter is not poison,
but merely indigestible material which the body cannot handle.

=Food, not Poison.= The colon is not a cesspool but a digestive and
assimilating organ. Its content is not poison but food. Active
elimination is important not so much because delay causes
autointoxication or poisoning as because too large a mass is hard to
manage and irritates the intestinal wall. The problem is not so much
one of toxicology as of simple mechanics. If Nature had put within the
body five feet of tubing which could easily become a cesspool and a
breeder of poison, it is not at all likely that she would have laid
alongside an elaborate system of blood vessels leading not out to the
kidneys but into the storehouse of the liver; and if civilized man's
changed manner of living had so upset Nature's plans as easily to
transform his internal machinery into a chronic source of danger, we
may be sure that he would long ago have gone the way of the unfit and
succumbed to his own poisons.

=Possible Invasions.= It is true that the intestinal tract, like the
rest of the body, is open to attack by harmful bacteria. But in a
great majority of cases, these enemy bacteria are either quickly
destroyed by the beneficent microbes within or are immediately cast
out as unfit. Any germs irritating to the intestinal wall cause the
mucous membrane to produce an unusual flow of mucus which washes away
the offending bacteria in what we call a diarrhea.[52]

[Footnote 52: If the invading army proves obstinate and the diarrhea
continues a day or so, it is wise to assist Nature by a dose of
castor-oil, which gives an additional insult to the intestinal wall,
spurs it on to a desperate effort, and hastens the cleansing process.
In severe cases the more promptly the castor-oil is administered the
better. Such emergency measures are very different from the habitual
use of insulting drugs.]

Sometimes the wrong kind of bacteria do persist, causing anemia,
rheumatism, sciatica, or neuritis. When these disorders are not the
result of infection from teeth, tonsils, or other sources of poison,
but are really caused by intestinal bacteria, I have found that a diet
of buttermilk (lactic acid bacteria), with turnip-tops or spinach to
supply the necessary mineral salts, often succeeds in planting the
right bacteria and driving out the disturbing ones. These disorders
are invasions from without, like tuberculosis or malaria, and are as
likely to attack the person with easy bowel movements as the one with
the most chronic constipation.

=Autointoxication.= A good deal of the talk about autointoxication is
just talk. It sounds well and affords an easy explanation for all
sorts of ills, but in a large majority of cases the diagnosis can
hardly be substantiated. Uninformed writers of newspaper articles on
the care of the body, or purveyors of purgatives or apparatus for
internal baths are fond of dilating on the "foulness of the colon" as
a leading cause of disease. As a rule, they advise either a strict
diet, some kind of cathartic, or an elaborate process of washing out
the colon to clear the body of its terrible accumulation of poisons.

=Cathartics and Enemas.= He who makes a practice of flushing out his
intestinal tract with high enemas and internal baths is like a person
who eats a good dinner and then proceeds to wash out his stomach. In
the mistaken idea that he is making himself clean, he is washing what
was never intended to be washed and robbing the body of the nutrition
which it needs. And the man who persists in the pill habit is making a
worse mistake, adding insult to injury and forcing the mucous membrane
to toughen itself against such malicious attacks.

=Cathartics and Operations.= Even in emergencies, the use of
purgatives as a routine measure is happily decreasing year by year.
For many years I have deplored the use of purgatives before and after
operations. That other practitioners are coming to the same conclusion
is witnessed by a number of papers recently read in medical societies
condemning purgation at the time of operation.

Among the most favorably received papers of the California Medical
Societies have been one by Emmet L. Rixford, surgeon of the Stanford
University Medical College, read before the Southern California
Medical Society at Los Angeles December 8, 1916, and one by W.D.
Alvarez at the California Medical Society, Del Monte, 1918,--both
condemning the use of purgatives as a routine measure before
operations. An article entitled the "Use and Abuse of Cathartics" in
the "Journal of the American Medical Association" admirably summarizes
the disadvantages of purgation at such a time.[53]

[Footnote 53: "1 Danger of dissemination of infection throughout the
peritoneal cavity, in case localized infection exists.

"2 Increased absorption of toxins and greater bacterial activity by
reason of the fact that undigested food has been carried down into the
colon to serve as pabulum for bacteria, and that liquid feces form a
better culture medium than solid feces.

"3 Increased distention of the intestine with gas and fluid, when it
should be empty....

"4 Psychic and physical weakness produced by dehydration of the body,
disturbance in the salt balance of the system, and the loss of sleep
occasioned by the frequent purging during the night preceding the
operation. As Oliver Wendell Holmes says: 'If it were known that a
prize fighter were to have a drastic purgative administered two or
three days before a contest, no one will question that it would affect
the betting on his side unfavorably. If this be true for a powerful
man in perfect health, how much more true must it be of the sick man
battling for life.'

"5 Increase in postoperative distress and danger: thirst, gas pains,
and even ileus...."--_Journal of American Medical Association_, Vol.
73, No. 17, p. 1285, Oct. 25. 1919.]

Four years ago I was called to a near-by city to see a former patient
who two days before had had a minor operation,--removal of a cyst of
the breast. She was dazed, almost in a state of surgical shock and
very near collapse. I found that she had been put through the usual
course of purgation before operation and starvation afterward, and I
diagnosed her condition as a state bordering on acidosis, or lowering
of the alkaline salts of the body. I ordered food at once. She rallied
and recovered.

A few months later this same woman had to undergo a much more serious
operation for multiple fibroids of the uterus and removal of the
appendix. This time I advised the surgeon against the use of any
purgative, and he took my remarks so seriously that he did not even
allow an enema to be given. This time the patient showed no signs of
exhaustion and had very few gas pains. I firmly believe that the day
will soon come when a patient under operation, or a patient after
childbirth, will no longer be depleted by a weakening and dehydrating
cathartic and by a period of starvation, at a time when he needs all
the energy he can summon.

=Cathartics and Childbirth.= The article referred to in the "Journal
of the American Medical Association" cites the experiences of Dr. R.
McPherson of the Lying-in Hospital of New York, "who showed that the
routine purgation after confinement is not only useless but harmful.
Of 322 women who were not purged, only three had fever (and one of
them a mammary abscess); most of them had normal bowel movements and
those who did not were given an enema every third day. Of 322 women
who were delivered by the same technique and the same operators but
were purged in the usual routine manner, twenty-eight had some fever."
This experience of one physician is corroborated by that of others who
find that the more we tamper with the natural functions in time of
stress the harder do we make the recuperative process. There are
certainly times when catharsis is necessary but "one thing is certain,
the day for routine purgation is past."[54] Even in emergencies we
need to know why we administer cathartics and in chronic cases we may
be sure that they are always a mistake.

[Footnote 54: Ibid, p. 1286.]

="An Old Trick."= Before we make a practice of interfering with
Nature's processes, it is well to remember how old and stable those
processes are. As long as there has been the taking in of food, there
has been also the casting out of waste matter. The sea-anemone closes
in on the little mollusk that floats against its waving petals,
assimilates what it can and rejects the rest. In the long line from
sea-anemone to man, this automatic process of elimination has gone on
without a hitch, adapting itself with perfect success to the changing
habits of the varying types of life. So old a process is not easily
upset. And, be it noted, in the human body this automatic, involuntary
process still goes on with very little trouble until it reaches a
point in the body where man, the thinking animal, tries to control it
by conscious thought.

=A Question of Evacuation.= Much of the misconception about
constipation arises from the mistaken idea that this is a disorder of
the whole intestine or at least of the whole colon. As a matter of
fact, the trouble is almost wholly in the rectum. There is no trouble
with the general traffic movement, but only with the unloading at the
terminus. In my experience, the patient reports that he feels the
fecal mass in the lower part of the rectum, but that he is unable to
expel it. Examination by finger or by X-ray reveals a mass in the
rectal pouch. If there is a piling up of freight further back on the
line, it is only because the unloading process has been delayed at the
terminus.

So long as the bowel-content is in the region of automatic control,
there is very little likelihood of trouble. An occasional case of
organic trouble--appendicitis, lead-colic, mechanical obstruction, new
growths or spinal-cord disease--may cause a real blockade, but in
ninety-nine cases out of every hundred there is little trouble so long
as the involuntary muscles, working automatically under the direction
of the subconscious mind, are in control. By slow or rapid stages, on
time or behind time, the bowel-content reaches the upper part of the
rectum and passes through a little valve into the lower pouch. Here is
where the trouble begins.

=Meddlesome Interference.= In the natural state the little human, like
the other animals, empties his bowel whenever the fecal mass enters
the lower portion of the rectum. The presence of the mass in the
rectum constitutes a call to stool which is responded to as
unthinkingly as is the desire for air in the taking of a breath. But
the tiny child soon has to learn to control some of his natural
functions. At the lower end of the rectum there is a purse-string
muscle called the _Sphincter-ani_, an involuntary muscle which may
with training be brought partly under voluntary control. Under the
demands of civilization, the baby learns to tighten up this muscle
until the proper time for evacuation. Then, if he be normal, he lets
go, the muscles higher up contract and the bowel empties itself
automatically, as it always did before civilization began.

There is, however, a possibility of trouble whenever the conscious
mind tries to assume control of functions which are meant to be
automatic. Under certain conditions necessary control becomes
meddlesome interference. If the child for one reason or another takes
too much interest in the function of elimination; if he likes too much
the sense-gratification from stimulation of the rectal nerves and
learns to increase this gratification by holding back the fecal mass;
if he gets the idea that the function is "not nice" and takes the
interest that one naturally feels in subjects that are taboo; or if he
catches from his elders the suggestion that the bowel movement is a
highly important process and that something disastrous is likely to
happen unless it is successfully performed every day; then his very
interest in the matter tends to interfere with automatic regulation,
and to cause trouble.

Just as people often find it hard to let go the bladder muscle and
urinate when in a hurry or under observation, and just as an
apprehensive woman in childbirth tightens up the purse-string muscle
of the womb, so the little child, or the grown up who catches the
suggestion of difficulty in the bowel movement, loses the trick of
letting go. Instead of merely exercising control by temporarily
inhibiting the function, he tries to carry through the process itself
by voluntary control--and fails. Constipation is a perfect example of
the power of suggestion, and of the troublesome effect of a fear-idea
in the realm of automatic functions.


FOOD AND CONSTIPATION

Since the waste matter from all foods finally reaches the rectum, and
since constipation is merely a difficulty in the forces of expulsion,
it is hard to see how any normal food in the quantities usually eaten
could have the slightest effect on the problem. When we remember that
it takes food from twelve to twenty-four hours to reach the rectum,
and that it has during all that time been subjected to the action of
the powerful chemicals of the digestive tract, it is hard to imagine a
piece of cheese, of whatever variety, strong enough to stop the
contraction of the muscles of the upper rectum or to tie the
sphincter-muscle into a knot. It would be difficult to find a food
which could pass without effect through twenty-seven feet of
intestinal tubing only to become suddenly effective on the wall of the
rectum. If the wrong kind of food is the cause of constipation, why
does the rectum prove to be the most refractory portion of the tube?
On what principle could a piece of chocolate inhibit the call to stool
or contract the sphincter muscle? On the other hand, even if it should
be conceded that constipation were the result of lack of lubricating
secretions in the colon, how could two tablespoonfuls of mineral oil
be a sufficient lubricant after being mixed with liquid and solid food
through many feet of the intestinal tract?

=An Adaptable Apparatus.= The lining of the intestines has plenty of
secretions to take care of its function. It is as well adapted to the
vicissitudes of life as are the other parts of the body. The muscular
coat is no more liable to paralysis or spasm than are the voluntary
muscles. As the skin adapts itself to all waters and all weathers,
and as the lungs adjust themselves to varying air-pressures, so the
intestinal wall makes ready adaptation to any common-sense demands,
adjusting itself with ease to an athletic or a sedentary life, and to
the normal variations of diet. What man has eaten throughout the
centuries man may eat to-day. If you will but believe it, your
intestines will make no more objection to white bread, blackberries,
and cheese, along with all other ordinary articles of food, than the
skin makes to varying kinds of water. Naturally, the suggested idea
that a food will constipate tends to carry itself out to fulfilment
and to prevent the call to stool from rising to the level of
consciousness; but the real force lies not in the food but in the
suggestion.

=The Bran Fad.= It is when we try to improve on the normal human diet
that we really insult the body. He who leaves off eating nourishing
white bread and takes to bran muffins is simply cheating his body.
Bran has a small food value, but the human body is not made to extract
it. Not only does bran fail to give us any nourishment itself, but it
lessens the power of the intestines to care for other food.[55] The
fad for bran is based on the well-known fact that we need a certain
quantity of bulk in order to stimulate the intestinal wall to normal
peristalsis. We do need bulk, but not more than we naturally get from
a normal and varied diet including a reasonable amount of fruit and
vegetables.

[Footnote 55: See an article entitled "Bread and Bran," _Journal of
American Medical Association_, July 5, 1919, p. 36.]

It is true that the suggestion of the efficacy of bran, dates,
spinach, or any other food is frequently quite sufficient to give
relief, temporarily, just as massage, manipulation of the vertebrae,
the surgeon's knife, or mineral oil may be enough to carry the
conviction of power to a suggestible individual. But who wants to take
his suggestions in such inconvenient forms as these?

=Change of Water.= Another popular superstition centers around
drinking-waters. There are people who cannot move from one town to
another, much less take an extensive trip, without a fit of
constipation--or a box of pills. If they only knew it, there is no
water on earth which could make a person constipated. A new water,
full of unusual minerals, might hasten the bowel movement, but on what
possible principle could it retard it? Constipation has nothing to do
with food or with water, but solicitous care about either can hardly
fail to create the trouble which it tries to avoid.


THE CURE

=Taking off the Brakes.= Since constipation is wholly due to the
acceptance of a false suggestion, the only logical cure must be
release from the power of that suggestion. "He is able as soon as he
thinks he is able"; not that thought gives the power, but that the
right thought releases the inhibition of the mistaken thought. As soon
as the brakes are taken off, the internal machinery is quite able to
make the wheels go round. The bowel will empty itself if we let it.
The function of elimination is not a new trick learned with difficulty
by the aged, but a trick as old and as elemental as life itself. Like
balancing on a bicycle, it may not be done by any voluntary muscular
effort, but it just does itself when one learns how.

Once the sense of power comes, once the mind forgets to be doubtful or
afraid, then the old automatic habit invariably reasserts itself.
Meddlesome interference may throw the mechanism out of gear, but
fortunately it cannot strip the gears. Constipation is an inhibition
or restraint of function, but is never a loss of function. No one is
too old, no one is too fixed in the bad habit to relearn the old
trick. I have had a good many patients with chronic constipation, but
I have never had one who failed to learn. Real conviction speedily
brings success, and in many cases success seems to outrun conviction.
So efficient is Nature if she has only half a chance!

=Some People Who Learned.= Unless you are over ninety-two, do not
despair. One old lady of that age, a sort of patient by proxy, was
able to cure herself without even one consultation. Her daughter had
been a patient of mine and had been cured of the constipation with
which she had been busy for many years. The mother, who believed her
own bowel paralyzed, had been in the habit of lying on the bed and
taking a copious enema every second day of her life. When, however,
she heard of her daughter's cure, the bright old woman gave up her
enemas and let her bowels do their own functioning. She stayed cured
until her death at ninety-five.

=A Fifty-year Habit.= Another old lady was not quite so easily
convinced. She ridiculed the idea that her son of fifty, who had been
"constipated in his cradle" could be cured of his lifelong habit, but
he was cured. As long as there is life and the light of reason, so
long may Nature's functions be reëstablished.

=The Whole Family.= Nor is any one too young to learn. A tiny baby is
easily taught. There came to me for two consultations a mother and her
two babies, all three constipated. The four-year-old child, mentally
deficient, had been fed on milk of magnesia from his infancy, and the
four-months-old baby had been started on the same path. I explained to
the mother the mechanism of elimination, told her to give up
cathartics, and to set a regular time for herself and the baby, but
was a little dubious about the mentally deficient four-year-old.
However she soon reported that they had all three promptly acquired
the new habit. Four years later she told me that they had never had
any more trouble.

=A Record History.= When Miss H. first came to my house, she told a
story that was almost incredible. She said that for many months she
had been taking eight tablespoonfuls of mineral oil three times a day
besides a cathartic at night, and an enema in the morning. No wonder
she was a little dubious over such mild treatment as mine seemed to
be!

Constipation was only one of this young woman's troubles. She could
not sleep and was so fatigued that she believed herself at the end of
her physical capital. When she first came to me she had tears in her
eyes most of the time and used to confide to various people that she
was sure she was a patient that I could not cure,--a very common
belief among nervous invalids! She was sure that I did not understand
her case, and that she could not get anything out of this kind of
treatment.

It was only a very short time, however, before her bowels were
functioning like those of a normal person. She lost her insomnia and
her fatigue and went away as well as ever. When she got back to her
office, she found that her old position, which she had believed secure
to her, had been given to another. She had to go out and hunt a new
job and face conditions harder than she had had before, but she came
through with flying colors. A short time ago Miss H. came back to see
me,--a happy, robust young woman, very different from the person I had
first known. She assured me that she had never had any return of her
old symptoms and that she was as well as a person could be.

=Living up to a Suggestion.= Mrs. T. had not had a natural movement of
the bowels in twenty-five years. After the birth of a child,
twenty-five years before, her physician had told her that her muscles
had been so badly torn in labor that they could not carry through a
natural movement. After that she had never gone a day without a pill
or an enema. I explained to her that when any muscle of the rectum is
injured in childbirth, it is the sphincter-ani, and that since this is
the muscle whose contraction holds back the bowel content, its injury
would tend to over-free evacuation rather than to constipation. She
saw the point and within two or three days regained her old power of
spontaneous evacuation.

=Practical Steps.= The first step, then, in acquiring normal habits is
the conviction of the integrity of our physical machines and a
determination not to interfere by thought, or by physical meddling,
with the elemental functions of our bodies. After this all-important
step, there are a few practical suggestions which it is well to
follow. Most of them are nothing more than the common-sense habits of
personal hygiene which are so obvious as to be almost axiomatic, but
which are nevertheless often neglected:

1 Eat three square meals a day.

2 Drink when thirsty, having conveniently at hand the facilities for
drinking.

3 Heed the call to stool as you heed the call of hunger. When the
stool passes the little valve between the upper and lower portions of
the rectum, it gives the signal that the time for evacuation has come.
If this signal is always heeded, it will automatically start the
machinery that leads to evacuation. If it is persistently ignored
because one is too busy, or because the mind is filled with the idea
of disability, the call very soon fails to rise to the level of
consciousness. The feces remain in the rectum, and the bad habit is
begun.

4 Choose a regular time and keep that appointment with yourself as
regularly as possible. In all the activities of Nature, there is a
rhythm which it is well to observe.

5 Take time to acquire the habit. Do not be in a hurry. Do not strain.
No amount of effort will start the movement. Just let it come of
itself.

6 Finally, should the unconscious suggestion of lack of power
stubbornly remain in force, take a small enema on the third day. If
the waste matter accumulates for three or more days, the bulk becomes
so great that the circular muscles of the rectum are unable to handle
it, just as the fingers cannot squeeze down to expel water from too
large a mass of wet blankets. Take only a small enema--never over a
quart at a time--and expel the water immediately. One or two such
measures will bring away the mass in the rectum. The material farther
up still contains food elements and is not yet ready for expulsion.
Lessen the amount of water each time until no outside help is needed.
Once you get the right idea, all enemas will be superfluous.


SUMMARY

If you would have in a nutshell an epitome of the truth about
constipation, indigestion, insomnia, and the other functional
disturbances common to nervous folk, you can do, no better than to
commit to memory and store away for future reference that choice
limerick of the centipede, which so admirably sums up the whole matter
of meddlesome interference:

    A centipede was happy quite
    Until a frog in fun
    Said, "Pray, which leg comes after which?"
    This raised her mind to such a pitch,
    She lay distracted in the ditch,
    Considering how to run.

Whoever tries to consider "which leg comes after which" in any line
of physiological activity, is pretty sure to find himself in the ditch
considering how to run. Wherefore, remember the centipede!



CHAPTER XII

_In which handicaps are dropped_

A WOMAN'S ILLS

"THE FEMALE OF THE SPECIES"


If ever there was a man who wished himself a woman, he has hidden away
the desire within the recesses of his own heart. But one does not have
to wait long to hear a member of the female sex exclaim with evident
emotion, "Oh, dear, I wish I had been born a man!" It is probable that
if these same women were given the chance to transform themselves
overnight, they would hesitate long when it actually came to the
point. The joys of being a woman are real joys. However, in too many
cases these joys seem hardly to compensate for the discomforts of the
feminine organism. It is the body that drags. Painful menstrual
periods, the dreaded "change of life," various "female troubles" with
a number of pregnancies scattered along between, make some of the
daughters of Eve feel that they spend a good deal of their lives
paying a penalty merely for being women. Brought up to believe
themselves heirs to a curse laid on the first woman, they accept their
discomforts with resignation and try to make the best of a bad
business.

="Since the War."= Nothing is quite the same since the war. Among
other things we have learned that many of our so-called handicaps were
nothing but illusions,--base libels on the female body. Under the
stern necessity of war the women of the world discovered that they
could stand up under jobs which have until now been considered quite
beyond their powers. Society girls, who were used to coddling
themselves, found a new joy in hard and continuous work; middle-aged
women, who were supposed to be at the time of life when little could
be expected of them, quite forgot themselves in service. Ambulance
drivers, nurses, welfare workers, farmerettes, Red-Cross workers,
street-car conductors and "bell-boys," revealed to themselves and to
the world unsuspected powers of endurance in a woman's body. Although
some of the heavier occupations still seem to be "man's work," better
fitted for a man's sturdier body, we know now that many of these
disabilities were merely a matter of tradition and of faulty training.

There still remains, however, a goodly number of women who are
continuously or periodically below par because of some form of
feminine disability. Some of these women are suffering from real
physical handicaps, but many of them need to be told that they are
disabled not by reason of being women but by reason of being nervous
women.

="Nerves" Again.= Despite the organic disturbances which may beset the
reproductive organs, and despite the havoc wrought by venereal
diseases, it may be said with absolute assurance that the majority of
feminine ills are the result neither of the natural frailty of the
female body, nor even of man's infringement of the social law, but are
the direct result of false suggestion and of false attitudes toward
the facts of the reproductive life. The trouble is less a difficulty
with the reproductive organs than a difficulty with the reproductive
instinct. "Something wrong" with the instinct is translated by the
subconscious mind into "something wrong" with the related generative
organs, and converted into a physical pain.

That this relation has always been dimly felt is shown by the fact
that the early Greeks called nervous disorders _hysteria_, from the
Greek word for womb. It is only lately, however, that the blame has
been put in the right place and the trouble traced to the _instinct_
rather than to the _organs_ of reproduction.

=Why Women Are Nervous.= Although women hold no monopoly, it must be
conceded that they are particularly prone to "nerves." The reason is
not hard to find. Since the leading factor in a neurosis is a
disturbance of the insistent instinct of reproduction, a disturbance
usually based on repression, then any class of persons in whom the
instinct is particularly repressed would, in the very nature of the
case, be particularly liable to nervousness.

No one who thoroughly knows human nature would attempt to deny that
woman is as strongly endowed as man with the great urge toward the
perpetuation of the race, or that she has had to repress the instinct
more severely than has man. The man insists on knowing that the
children he provides for are his own children. Whatever the degree of
his own fidelity, he must be sure that his wife is true to him. Thus
has grown up the insistence that, no matter what man does, woman, if
she is to be counted respectable, shall control the urge of the
instinct and live up to the requirements of continence set for her by
society.

Unfortunately, however, there is more often blind repression than
rational control. The measures taken to prevent a girl's becoming a
tom-boy are measures of sex-repression quite as much as of
sex-differentiation. Over-reaction of sensitive little souls to
lessons in modesty often causes distortion of normal sex-development.
Ignorance concerning the phenomena of life is commended as innocence,
while it really implies a sex-curiosity which has been too severely
repressed. The young woman blushes at thoughts of love, while the
young man is filled with a sense of dignity. We smile at the picture
of "Miss Philura's" confusion as she hesitatingly sends up to her
Creator a petition for the much-desired boon of a husband. But really,
why shouldn't she want one? Many a young woman, in order to deaden her
senses to the unsuspected lure of the reproductive instinct by what is
really an awkward attempt at _sublimation_, makes a fetish of dress
and social position and considers only the marriage of convenience;
or, on the other hand, she scorns men altogether and throws herself
into a "career."

Young men are not so often taught to repress, but neither are they
taught to swing their vital energies into altruistic channels through
sublimation. Since the woman of his class will not marry him until he
has money, the young man too often satisfies his undirected instincts
in a commercial way. The statistics of venereal diseases prove that
here, as elsewhere, goods subject to barter are subject to
contamination. In a late marriage, too often a contaminated body
accompanies the material possessions which the standards of society
have demanded of a husband.

But the woman pays in still other coin for the repressions arising
from faulty childhood training. Unable to find expression for herself
either in marriage or in devotion to work, because some old childish
repression is still denying all outlet to her legitimate desire, she
frequently falls into a neurosis; or if she escapes a real breakdown,
she gives expression to unsatisfied longings in some isolated nervous
symptoms which in many cases center about the organs of generation.
There then results any one of the various functional disturbances
which are only too often mistaken for organic disease. What is needed
in cases like this is not a gynecologist nor a surgeon, but a
psycho-pathologist--or perhaps only a grasp of the facts. Let us look
at the more common of these disturbances in order to gain an
understanding of the situation.


THE MENSTRUAL PERIOD

=Potential Motherhood.= Among the normal phenomena of a woman's life
is the recurring cycle of potential motherhood. Every three or four
weeks a new ovum or egg matures in the ovary and undergoes certain
chemical changes, which send into the blood a substance called a
hormone. This hormone is a messenger, stimulating the mucous membrane
of the womb into making its velvet pile longer and softer, and its
nutrient juices more abundant in readiness for the ovum.

The same stimulus causes the whole organism to make ready for a new
life. As in hunger, the chemistry of the body produces the
muscle-tension that is felt as a craving for food, so this recurring
chemical stimulus produces a definite craving in body and mind. This
craving brings about an increased irritability or sensitiveness to
stimuli which may result either in a joyous or a fretful mood.

During sleep the social inhibitions are felt less distinctly and the
sleeper dreams love-dreams woven from messages coming up from all the
minute nerve-endings in the expectant reproductive organs. But if no
germ-cell travels up the womb-canal and tube to meet and impregnate
the ovum, the womb-lining rejects the egg as chemically unfit. All the
furbishings are loosened from the walls and slowly cast out,
constituting the menstrual flow. The phenomenon as a whole is a
physiological function and should be accompanied by a sense of
well-being and comfort as is the exercise of any other function, such
as digestion or muscular activity. Only too often, however, it is
dreaded as an unmitigated disaster, a time for giving up work or fun
and going to bed with a hot-water bottle until "the worst is over."
Let us see how this perversion comes about.

=Why Menstruation Is Painful.= What sort of atmosphere is created for
the young girl as she attains puberty? Most girls get their first
inkling of the menstrual period from the periodic "sick spells" of
mother or sister. This knowledge comes without conscious thought and
is a direct observation of the subconscious mind, which records
impressions with the accuracy and completeness of a photographic
plate. Hearing the talk about a "sick-time" and observing the signs of
"cramps" among older friends, the young girl's subconscious mind plays
up to the suggestion and recoils with fear from the newly experienced
sensations in the maturing organs of reproduction.

This recoil of fear interferes with the circulation in the functioning
organs, just as fear blanches the face or hinders digestion. There is
several times as much blood in the stomach when it is full of food as
there is between meals, but we do not for this reason fancy that we
have a pain after each meal. There is more blood in the generative
organs during their functioning, but this means pain only when fear
ties up the circulation and causes undue congestion. Fear acts further
on the sturdy muscle of the womb, tying it up into just such knots as
we feel in the esophagus when we say that we have a lump in the
throat. It is safe to say that ninety-five cases of painful
menstruation out of every hundred are caused by fear and by the
expectation of pain. The cysts and tumors responsible for pain are so
rare as to be fairly negligible, when compared with these other
causes.

Dr. Clelia Duel Mosher of Stanford University has for many years
carried on careful investigations among the students of the
university. After describing in detail certain physical exercises
which she has found of value, she continues:

     But more important even than this is an alteration of the morbid
     attitude of women themselves toward this function; and almost
     equally essential is a fundamental change in the habit of mind on
     our part as physicians; for do we not tend to translate too much,
     the whole of a woman's life into terms of menstruation? If every
     young girl were taught that menstruation is not normally a "bad
     time" and that pain or incapacity at that period is as
     discreditable and unnecessary as bad breath due to decaying
     teeth, we might almost look for a revolution in the physical life
     of women.... In my experience the traditional treatment of rest
     in bed, directing the attention solely to the sex-zone of the
     body, and the accepted theory that it is an inevitable illness
     while at the same time the mind is without occupation, produces a
     morbid attitude and favors the development and exaggeration of
     whatever symptoms there may be.[56]

[Footnote 56: Clelia Duel Mosher: _Health and the Woman Movement_, pp.
25, 26, 19.]

=Pre-Menstrual Discomfort.= If it be objected that women often feel
badly for a day or two before the period begins, before they know that
it is due, and that this feeling of discomfort could not be caused by
fear and expectation, it is easy to reply that the subconscious mind
knows perfectly what is happening within the body. The emotion of
fear, working within the subconscious, is able to translate all the
varying bodily sensations into feelings of distress without any
knowledge on the part of the conscious mind.

Sometimes before the period begins, a girl feels blue and upset for a
day or two, a sign that the instinct is getting discouraged. The whole
body is saying, "Get ready, get ready," but it has gotten ready many
times before, and to no purpose. Unsatisfied striving brings
discouragement. What reaches consciousness is a feeling of pessimism
and a general dissatisfaction with life as a whole. If, instead of
giving in to the blues or going to bed and predicting a pain, the girl
finds other outlets for her energy, she finds that after all, her
instinct may be satisfied in indirect ways and that she has strangely
come into a new supply of _vim_.

=The Purpose of the Pain.= Although suggestion is behind all nervous
symptoms, there is a deeper reason for the disturbance. When an
unhealthy suggestion is seized and acted upon, it is because some
unsatisfied part of the personality sees in it a chance for
accomplishing its own ends. The pre-menstrual period is the
blooming-time, the mating-time, the springtime of the organism. That
means eminently a time for coming into notice, that one's charms may
attract the desired complement. But if the rightfully insistent
instinctive desires are held in check by unnatural repressions and
misapplied social restrictions, the starved instinct can obtain
expression only by a concealment of purpose. The disguise assumed is
often one of indifference or positive distaste for the allurements of
the other sex. But, as we know, an instinctive desire will not be
denied. In this case, the misguided instinct which has been given the
suggestion that menstruation means illness, fits this conception into
the scheme of things and obtains notice in a roundabout way by the
attention given to the invalid.

=The Treatment.= To find that the symptom has a purpose rather than a
cause gives the indication for the treatment. Judicious neglect causes
the symptom to cease by defeating its very purpose,--that of drawing
attention to itself. The person who never mentions her discomfort,
thinks about it as little as possible, and goes about her business as
usual, is likely to find her trouble gone before she realizes it.[57]

[Footnote 57: Violent exercise at this time is unwise, but continuing
one's usual activity helps the circulation and keeps the mind from
centering on the affected part. The physiological congestion is unduly
intensified by standing; therefore all employments should afford
facilities for the woman to sit at least part of the time while
continuing work.]

A little explanation gives the patient insight into the workings of
her own mind, and usually causes the pain to disappear in short order.
Astonished, indeed, and filled with gratitude have been some of my
young-women patients who had all their lives been unable to plan any
work or social engagements for the time of this functioning. Many of
them were the worst kind of doubters when they were told that to go to
bed and center their attention on the generative organs only made the
muscles tighten up and the circulation congest. They could not
conceive themselves up and around, pursuing their normal life during
such a time. However, as they have found by experience that this point
of view is not an optimistic dream, they have broken up the
confidence-game which their subconscious had been playing on them, and
have gone on their way rejoicing.

There was one young girl, a doctor's daughter, who suffered
continuously from pain in the abdomen, and from back-pain which
increased so greatly at the time of the menses that she was in the
habit of going to bed for several days, to be waited on with
solicitous care by her family. In an attempt to cure the trouble she
had undergone an operation to suspend the uterus, but the pain had
continued as before. When she came to me, I explained to her that
there was no physical difficulty and that her trouble was wholly
nervous. I made her play tennis every day and she had just finished a
game when her period came on. She stayed up for luncheon, went for a
walk in the afternoon, ate her dinner with the family, and behaved
like other people. Her mother telephoned that evening and when I told
her what her daughter had been doing, she gasped in astonishment. She
had difficulty in believing that the new order was not miracle but
simply the working out of natural law. Since that time her daughter
has had no more trouble.

=The Ounce of Prevention.= If young girls had wiser counselors in
their mothers and physicians, the misconception would never occur, and
such an indirect outlet would not be needed; the organic sensations
incident to puberty and the recurring menstrual period would have
something of the significance of the annunciation to Mary, bringing
wonder and a sense of well-being.

When your little daughter arrives at maturity, give her a joyous
initiation into the noble order of women. She will welcome the new
function as a badge of womanhood and as a harbinger of wonderful
things to come.

A girl of fifteen came under my care to be helped out of a mood of
increasing depression and uneasiness. Her glance was furtive, yet
anxiously expectant. Tears came unbidden as she sat alone or fingered
the keys of the piano. Tactful questioning elicited no response as to
reasons for her unhappiness. Opportunities for giving confidence were
not accepted. At a chance moment our talk drifted to the subject of
menstruation. "Your periods are regular and easy; and do you know what
they are for?" Then I painted for her a picture of the preparations
that are made throughout the whole organism, for the germ-cell that
comes each month and has in it all the possibilities of a new little
life.

The result of this confidential talk may seem fanciful to any one but
an eye-witness. We had only a week's association, but the depression
ceased, the furtive look and deprecatory manner were replaced by a
joyous buoyancy. In a few weeks the thin neck and awkward body rounded
out into the symmetry which usually precedes the establishment of
puberty, but which was delayed in this case until the unconscious
conflict resolved itself.

=In the Large.= Looked at from any angle, this subject is an important
one. There are involved not only the physical comfort and convenience
of the sufferers themselves, but also the economic prospects of women
as a whole. If women are to demand equal opportunity and equal pay,
they must be able to do equal work without periodic times of illness.
When employers of women tell us that they regularly have to hire extra
help because some of their workers lose time each month, we realize
how great is the aggregate of economic waste, a waste which would
assuredly be justified if the health of the country's womanhood were
really involved, but which is inefficient and unnecessary when caused
merely by ignorant tradition. "Up to standard every day of every
week," is a slogan quite within the range of possibility for all but
the seriously ill. When reduced to their lowest terms, the
inconveniences of this function are not great and are not too dear a
price to pay for the possibilities of motherhood.


THE "CHANGE OF LIFE"

=Another Phantom Peril.= As the young girl is taught to fear the
menstrual period, so the older woman is taught to dread the time when
the periods shall cease. Despite the general enlightenment of this day
and age, the menopause or "change of life" is all too frequently
feared as a "critical period" in a woman's life, a time of distressing
physical sensations and even of danger to mental balance.

As a matter of fact, the menopause is a physiological process which
should be accomplished with as little mental and physical disturbance
as accompanies the establishment of puberty. The same internal
secretion is concerned in both. When the function of ovulation ceases
the body has to find a new way to dispose of the internal secretion of
the ovary. Its presence in the blood is the cause of the sudden
dilatation of the blood-vessels that is known as the "hot flash."

The matter is altogether a problem of chemistry, with the necessity
for a new adjustment among the glands of internal secretion. The body
easily manages this if left to itself, but is greatly interfered with
by the wrong suggestion and emotion. We have already seen how quickly
emotion affects all secretions and how easily the adrenal and thyroid
glands are influenced by fear. This is the root of the trouble in many
cases of difficult "change." If an occasional body is not quite able
to regulate the chemical readjustment, we may have to administer the
glands of some other animal, but in the majority of cases, the body,
unhampered by an extra burden of fear, is quite able to make its own
adjustments. The hot flash passes in a moment, if not prolonged by
emotion or if not converted into a habit by attention.

One source of trouble in the menopause is that it comes at a time in a
woman's life when she is likely to have too much leisure. In no way
can a woman so easily handicap her body at this time as by stopping
work and being afraid. Those women who have to go on as usual find
themselves past the change almost before they know it,--unless they
consider themselves abused, and worry over the necessity for working
through such a "critical time."

=Three Rules.= Here are a few pointers which have have been of help to
a number of women:

1 Remember that this is a physiological process and therefore
abundantly safeguarded by Nature. If you don't expect trouble you will
not be likely to find it.

2 Remember that the sweating and flushing are made worse by notice.

3 Do everything in your power to keep from the public the knowledge
that you are no longer a potential mother. If you are past forty, do
not mop your face or gasp for breath or carry a fan to the theater!
Shun attention and fear, and you will be surprised at the ease with
which the "change" is effected.

=Nature's Last Chance.= While we are on the subject of the middle-aged
woman, it may be well to mention a phenomenon sometimes noticed in the
early forties. Often an "old maid" who has considered herself settled
for life in her bachelor estate, suddenly takes to herself a husband.
(I use the verb advisedly!) Mothers who have thought their
child-bearing days long past sometimes find themselves pregnant. "The
child of her old age" is not an uncommon occurrence. Unmarried women
who have "kept straight" all their lives sometimes go down before
temptation at this late time. There is a reason. It is as though
Nature were making a last desperate attempt to produce another life
before it is too late, speeding up all the internal secretions and
flashing insistent messages throughout the whole organism.

It may help some woman who feels herself inexplicably impelled toward
the male sex to know that she is not being "tempted by the devil" but
merely driven by the insistent chemicals within her body. She is
likely to rationalize and tell herself that it is too bad for a
worth-while person like herself to leave no progeny behind her; or she
may say, as one of my patients did when contemplating running away
with another woman's husband,--that she could make that man so much
happier than his wife did, and that she really owed it to him as well
as to herself. When a woman knows what is the matter with her, it
makes it easier to bide her time and wait for the demands of Nature to
subside. Chemicals may not be so romantic as love, but neither are
they so melodramatic!


OTHER TROUBLES

="Speaking of Operations."= Physicians are often called upon to
diagnose some such vague symptom as pain in the abdomen, back and
head; ache in the legs; constipation, or loss of appetite. Since the
patient is very insistent that something shall be done, the physician
may be driven to operate, even when he has an uneasy feeling that the
trouble is "merely nervous." Sixty per cent. of the operations on
women are necessitated by the results of gonorrheal infection. Next in
frequency up to recent date, have been operations for nervous symptoms
which could in no way be reached by the knife. Only too often a
nerve-specialist hears the tale of an operation which was supposed to
cure a certain pain but which left it worse rather than better. It is
a pleasure to see some of these pains disappear under a little
re-education, but one cannot help wishing that the re-education had
come before the knife instead of after it.

A skilled surgeon can cut almost anything out of a person's body, but
he cannot cut out an instinct. It sometimes takes great skill to
determine whether the trouble is an organic affection or a functional
disturbance caused by the misdirected instinct of reproduction. Often,
however, the clinical pictures are so different as to leave no room
for doubt, provided the diagnostician has his eyes open and is not
over-persuaded by the importunity of the poor neurotic, who insists
that the surgeon shall remove her appendix, her gall-bladder, her
genital organs, and her tonsils, and who finally comes back that he
may have a whack at the operation scar.

=The Bearing of Children.= A number of years ago I became acquainted
with a charming young married woman who had all her life recoiled with
fear from the phenomena of sex. She had been afraid of menstruation
and of marriage, and had at this time almost a phobia for pregnancy
and childbirth. Before long she came to me in terror, telling me that
she had become pregnant. I explained to her that pregnancy is the time
when most women are at their best, that the nausea which is often
troublesome in the beginning is caused merely by a mixing of messages
from the autonomic nerves, which refer new sensations in the womb to
the more usual center of activity in the stomach; and that after the
body has become accustomed to these sensations, most women experience
a greater sense of well-being and peace than at any other time in
life. We had a conversation or two on the subject and everything
seemed to go well for a while.

As it happened, this young woman and her husband came to call on me
one afternoon just before the baby was expected. During the visit she
began to show signs of being in labor. Again she was in terror. Again
I explained the phenomena of labor, telling her that the
womb-contractions are caused by the presence in the blood of a
chemical secretion (hormone) which continues its good work as long as
there is a state of confidence, but which sometimes stops under fear
or apprehension. I explained that these womb-efforts are a peristaltic
movement, a contraction of the upper muscles and a letting go of the
purse-string muscle at the mouth of the womb, and that fear only tends
to tie up this purse-string muscle, making a difficult process out of
one which was intended by Nature to be much more simple. She seemed to
understand and to lose a good deal of her fright.

About six o'clock the couple went home on the street car from the
upper end of Pasadena to the far end of Los Angeles. The next morning
I had a jubilant telephone message from the happy father, announcing
that the boy-baby had arrived at midnight and that, wonderful to
relate, he had come without the mother's experiencing any pain
whatever.

I give this account for what it is worth, without of course contending
that labor could always be as easy as this. It happened that this girl
was a normal, healthy woman and that there were no complications of
any kind in the process of childbirth. A right attitude of mind could
not have corrected any physical difficulty, but it did seem to help
her let go of her fear, which would of itself have caused long and
painful labor.

A patient once told me that when her first baby came, she happened to
be out in the country where she had to call in a doctor whom she did
not know. He was an uncouth sort of fellow who inspired fear rather
than confidence. She soon found that labor stopped whenever he came
into the room, and started again when he went out. She had the good
sense to send him out and complete her labor with only the help of her
mother. Unfortunate is the obstetrician who does not know how to
inspire a feeling of confidence in his patients. Even childbirth may
be mightily helped or hindered by the mother's state of mind.


SUMMARY

A woman's body has more stability than she knows. It is sometimes out
of order, but it is more often misunderstood; usually it is an
unobtrusive and satisfactory instrument, quite fit for its daily
tasks. The average woman is really well put together. We hear about
the ones who have difficulty, but not about the great majority who do
not. We notice the few who are upset during the menopause, and forget
all the others. To be comfortable and efficient most of the time is,
after all, merely to be "like folks."

The special functions which Nature has been perfecting in a woman's
body are as a rule, easily carried through unless complicated by false
ideas or by fear.

If the woman who has no organic difficulty but who still finds herself
handicapped by her body, will cease being either resigned to her
languishing lot or envious of her stalwart brothers; if instead she
will set out to learn how to be efficient as a woman, she will find
that many of her ills are not the blunders of an inefficient Creator,
but are home-made products, which quickly vanish in the light of
understanding.



CHAPTER XIII

_In which we lose our dread of night._

THAT INTERESTING INSOMNIA

THE FEAR OF STAYING AWAKE


To sleep or not to sleep! That is the question. In all the world there
is nothing to equal it in importance,--to the man with insomnia. His
days are mere interludes between troubled nights spent in restless
tossing to and fro and feverish worry over the weary day to come. His
mind filled with ideas about the disastrous effects of insomnia, he
imagines himself fast sliding down hill toward the grave or the
insane-asylum. It is true that his conversation very often politely
begins something like this: "Good morning. Did you sleep well last
night?" but if we fail to respond by an equally polite "and I hope you
had a good night?" he seems restless until he has somehow
disillusioned us by stating the exact number of hours and minutes
during which he was able to lose himself in slumber.

We must not ridicule the man who doesn't sleep. We are all very much
alike. If any one of us happens to lie awake for a night or two, he is
likely to get into a panic, and if the spell should last a week, he
begins looking up steamship agents and talking of voyages to Southern
seas. The fact is that most people are dreadfully afraid of insomnia.
Knowing the effects of a few nights of enforced wakefulness, and
having had a little experience with the fagged feeling after a
restless night, they believe themselves only logical when they fall
into a panic over the prospect of persistent insomnia.

=Two Kinds of Wakefulness.= As a matter of fact, insomnia is a phantom
peril. There is not the slightest danger from lying awake nights,
provided one is not kept awake by some irritating physical stimulus.
All fear of insomnia is based on ignorance of the difference between
enforced wakefulness and deliberate wakefulness, or insomnia. The man
who has acquired the habit may stay awake almost indefinitely without
appreciable harm, but the one who is kept awake for a week by a pain,
by a chemical poison from infection, or by the necessity for staying
up on his job, may easily be in a state of exhaustion. Even in cases
of prolonged pain or over-exertion, the body tends to maintain its
equilibrium by hastening its rate of repair and by falling asleep
before the danger point is reached. It is almost impossible to impair
permanently the tissue of the brain except in the presence of a
chemical irritant. In case of infection we often have to give medicine
to neutralize the effect of the poison or to resort to narcotics which
make the brain cells less susceptible to irritation. But nervous
insomnia is another story.


A HARMLESS HABIT

=Long-Lived Insomniacs.= A man of my acquaintance once said in all
seriousness and with evident alarm: "I am following in the footsteps
of my mother. She lived to be seventy years old and she had insomnia
all her life." If this man had been preaching a sermon on the
harmlessness of chronic insomnia, he could not have chosen a better
text, but he seemed just as much concerned about himself as if his
mother had died from the effects of three months' wakefulness. People
can live healthy lives during twenty or thirty years of insomnia
because chronic insomnia is nothing more or less than a habit, and
"habit spells ease." The brain cells are not irritated by either
internal or external stimuli; there is no effort to keep awake;
virtually no energy is expended,--except in restless tossing and
worry. If the body is kept still and emotion eliminated, fatigue
products are washed away and the reserves are filled in with perfect
ease.

=Thinking in Circles.= Habit means automatic, subconscious activity,
with the least expenditure of energy and the least amount of fatigue.
We have already noted the ease with which heart and diaphragm muscles
carry on their work from the beginning of life to its end. Anything
relegated to the subconscious mind can be kept up almost indefinitely
without tire, and to this subconscious type of activity belong the
thoughts of a chronic insomniac. Despite all assertions to the
contrary, his conscious mind is not really awake. If he is questioned
about the happenings of the night, he is likely to have been unaware
of the most audible noises. The thoughts that run through his brain
are not new, constructive, energy-consuming thoughts, but the same old
thoughts that have been going around in circles for days and weeks at
a time.

It is true that a person sometimes chooses to wake up and do his
constructive planning in the night. This kind of thought does bring
fatigue, up to a certain point. After that the body hastens its rate
of repair or automatically goes to sleep. Activity of this kind is
always a matter of choice. He who really prefers sleep will shut the
drawers containing the day's business and leave them shut until
morning.

=Day-Dreaming at Night.= However, the man who makes a practice of
staying awake rarely does much real thinking. He lets the thoughts run
through his mind as they will, builds air-castles of things he would
like to do and can't, or other kinds of air-castles about the
disastrous effects of his insomnia on the day that is to come; he
worries over his health, or his finances, and grieves over his
sorrows. He is really indulging himself, thinking the thoughts he
likes most to think, and these consume but little energy. Like a horse
that knows the rounds, they can go jogging on indefinitely without
guidance from the driver.


WHAT CAUSES THE FATIGUE

=Tossing and Fretting.= The thing that tires is not the insomnia but
the emotion over the insomnia. If people who fail to sleep are
perpetually fagged out, it is not from loss of sleep, but from worry
and tossing. Often they spend a good deal of the night feeling sorry
for themselves. They turn and toss, exclaiming with each turn: "Why
don't I sleep? How badly I shall feel to-morrow! What a night! What a
night!" Such a spree of emotionalism can hardly fail to tire, but it
is not fair to blame the insomnia.

He who makes up his mind to it can rest almost as well without sleep
as with it, provided he keeps his mind calm and his body relaxed.
"Decent hygienic conditions" demand not necessarily eight hours of
sleep but eight hours of quiet rest in bed. Tossing about drives away
sleep and uses up energy. I make it a rule that my patients shall not
turn over more than four times during the night. This is more
important than that they should sleep. To be sure, I do not stay awake
to enforce the rule, but most people catch the idea very quickly and
before they know it they are sleeping.


HOW TO GO TO SLEEP

=Ceasing to Care.= The best way to learn to sleep is not to care
whether you do or not. Nothing could be better than DuBois's advice:
"Don't look for sleep; it flies away like a pigeon when one pursues
it."[58] Attention to anything keeps the mind awake, and most of all,
attention to sleep. More than one person has waked up to see whether
or not he was going to sleep. We cannot, however, fool ourselves by
merely pretending indifference. The only sensible way is to get the
facts firmly fixed in our minds so that we actually realize that we do
not need more sleep than our bodies take. As soon as it is realized
that insomnia is really of no importance, it tends to disappear.

[Footnote 58: DuBois: _Psychic Treatment of Nervous Disorders_, p.
339.]

=Catching the Idea.= There came one day for consultation a very
healthy-looking woman, a deaconess of the Lutheran Church. "Doctor,"
she said, "I came to get relief from insomnia. For twenty years I have
not slept more than one or two hours a night." "Why do you want more?"
I asked. "Why, isn't it very unhealthy not to sleep?" she exclaimed
in astonishment. "Evidently not," I answered.

This woman had tried every doctor she could think of, including the
splendid S. Weir Mitchell. Her insomnia had become a preoccupation
with her, her chief thought in life. All I did was to explain to her
that her body had been getting all the sleep it needed, and that
neither body nor mind was in the least run down after twenty years of
sleeplessness. "When you cease being interested in your insomnia, it
will go away, although from a health standpoint it matters very little
whether it does or not." We had two conversations on the subject, and
a week later she came back to tell me that she was sleeping eight
hours a night.

One woman had had insomnia for thirty years. After I had explained to
her that her body had adjusted itself to this way of living and that
she need not try to get more sleep, she snored so loud all night and
every night that the rest of the family began to complain!

A certain banker proved very quick at catching the idea. He had been
so troubled with insomnia and intense weakness that his doctors
prescribed a six-months voyage in Southern waters. Knowing that my
prescriptions involved a change in point of view rather than in scene,
he came to me. Although he had been getting only about half an hour's
sleep a night, he went to sleep in his chair the first evening, and
then went upstairs and slept all night. He resumed his duties at the
bank, walking a mile and a half the first day and three miles the
second. During the months following, he reported, "No more insomnia."

=Keeping Account.= A bright young college graduate came to me for a
number of ailments, chief among them being sleeplessness. She was also
overcome by fatigue, having spent four months in bed. A four-mile walk
in the cañon and a few other such outings soon dispelled the fatigue,
but the insomnia proved more obstinate. After she had been with me for
a week or two, I took her aside one day for a little talk. "Well?" I
said as we sat down. Then she began: "Sunday night I was awake from
half-past one to four, Monday from twelve to one, Tuesday from one to
three, Wednesday from two to four, Thursday--" By this time she became
aware of the quizzical expression on my face and began to be
embarrassed. Then she stopped and laughed. "Well," she said, "I did
not know that I was paying so much attention to my sleep." She was
bright enough to see the point at once, gave up her preoccupation in
the all-absorbing topic and promptly forgot to have any trouble with
so natural a function as sleep.

=Making New Associations.= Examples like this show how natural is
childlike slumber when once we take away the inhibitions of a
hampering idea. Age-old habits like sleep are not lost, but they may
easily be interfered with by a little too much attention. When a
person who can scarcely keep his eyes open all the evening is
instantly wide awake as soon as his head touches the pillow, we may be
sure that a part of his trouble comes from the wrong associations
which he has built up with the thought of night. When a dear little
old lady told me of her constant state of apprehension about going to
bed, I said to her: "When I go to my room, the darkness says sleep.
When I take off my clothes, the very act says sleep. When I put my
head on the pillow, the pillow says sleep." She liked that and found
herself able to sleep all night. The next evening she wanted another
"sleeping-potion" but as I did not want her to become dependent on
anybody's suggestion, I put my mouth up close to her ear and
whispered, "Abra ca dabra, dum, dum, dum." She laughed, but saw the
point. After that she slept very well. She merely broke the habit by
making a new kind of association with the thought of bed. Nature did
the rest.

It seems hardly necessary to remark that drug-taking is the most
inefficient way of handling the situation. Everybody knows that
narcotics are harmful to the delicate cells of the brain and that the
dose has to be continuously increased in cases of chronic insomnia.
If a person realizes that the drug is far more harmful than the
insomnia itself, he is weak indeed to yield to temptation for the sake
of a few nights of sleep. As the cause of insomnia is psychic, so the
only logical cure is a new idea and a new attitude of mind.


THE PURPOSE OF INSOMNIA

Like all nervous symptoms, insomnia is not an affliction but an
indulgence. Somehow, and in ways unknown to the conscious mind, it
brings a certain amount of satisfaction to a part of the personality.
No matter how unpleasant it may be, no matter how much we consciously
fear it, something inside chooses to stay awake.

Started, as a rule, through suggestion or imitation, insomnia is
sometimes kept up as a means of making ourselves seem important,--to
ourselves and to others. It at least provides an excuse for thinking
and talking about ourselves, and furnishes a certain feeling of
distinction. If something within us craves attention, even staying
awake may not be too dear a price to pay for that attention. Strange
to say, there are other times when the insomnia is chosen by the
primitive subconscious mind with the idea of doing penance for
supposed sins whose evil effects might possibly be avoided by this
kind of expiation. Analysis shows that motives like this are not so
uncommon as might be supposed. In other cases insomnia is chosen for
the chance it gives for phantasy-building. A person denied the right
kind of outlet for his instincts may so enjoy the day-dreaming habit
that he prolongs it into the night, really preferring it to sleep.
Such a state of affairs is not at all incompatible with an intense
conscious desire to sleep and a real fear of insomnia. So strange may
be the motives hidden away within the depths of the most prosaic
individual!


SUMMARY

Nervous insomnia is something which a part of us makes use of and
another part fears. It is a mistake on both sides. Although not in the
least dangerous, the habit can hardly be considered a satisfactory
form of amusement. Nature has provided a better way to spend the
night, a way to which she speedily brings us when we choose to let her
do it.

We do not have to ask for sleep as for a special boon which may be
denied. We simply have to lie down in trust, expecting to be carried
away like a child. If our expectation is not at once realized we can
still trust, as with relaxed mind and body we lie in calm content,
knowing that Nature is, minute by minute, restoring us for another
day.



CHAPTER XIV

_In which we raise our thresholds_

FEELING OUR FEELINGS

FINELY STRUNG VIOLINS


The young girl had been telling me about her symptoms. "You know,
Doctor," she said. "I am a very sensitive person. In fact, I have
always been told that I am like a finely strung violin." There was
pride in every tone of her voice,--pride and satisfaction over
possessing an organization so superior to the common clay of the
average person. It was a typical remark, and showed clearly that this
girl belonged among the nervous folk. For the nervous person is not
only over-sensitive, but he accepts his condition with a secret and
half-conscious pride as a token of superiority.

It seems that there are a good many kinds of sensitiveness. Whether it
is a good or bad possession depends entirely on what kind of things a
person is sensitive to. If he is quick to take in a situation, easily
impressed with the needs of others, open-doored to beauty and to the
appeal of the spiritual, keenly alive to the humorous, even when the
joke is on himself and the situation uncomfortable, then surely he has
a right to be glad of his sensitiveness. But too often the word means
something else. It means feeling, intensely, physical sensations of
which most people are unaware, or reacting emotionally to situations
which call for no such response. It means, in short, feeling our
feelings and liking to feel them. There seems to be nothing
particularly praiseworthy or desirable about this kind of
sensitiveness. If this is what it means to be a "finely-wrought
violin," it might even be better to be a bass drum which can stand a
few poundings without ruin to its constitution.

"But," says the sensitive person, "are we not born either violins or
drums? Is not heredity rather than choice to blame? And what can a
person do about it?" These questions are so closely bound up with the
problems of nervous symptoms of indigestion, fatigue, a woman's ills,
hysterical pains and sensations, and with all the problems of
emotional control, that we shall do well to look more carefully into
this question of sensibility, which is really the question of the
relation of the individual to his environment.


SELECTING OUR SENSATIONS

=Reaction and Over-Reaction.= Every organism, if it is to live, must
be normally sensitive to its environment. It must possess the power
of response to stimuli. As the sea-anemone curls up at touch, and as
the tiny baby blinks at the light, so must every living thing be able
to sense and to react to the presence of a dangerous or a friendly
force. Only by a certain degree of irritability can it survive in the
struggle for existence. The five senses are simply different phases of
the apparatus for receiving communications from the outside world.
Other parts of the machinery catch the manifold messages continually
pouring into the brain from within our bodies themselves. These
communications cannot be stopped nor can we prevent their impress on
the cells of the brain and spinal cord, but we do have a good deal to
say as to which ones shall be brought into the focus of attention and
receive enough notice to become real, conscious sensations.

=Paying Attention.= If a human being had to give conscious attention
to every stimulus from the outer world and from his own body, to every
signal which flashes itself along his sensory nerves to his brain, he
would need a different kind of mind from his present efficient but
limited apparatus. As it is, there is an admirable provision for
taking care of the messages without overburdening consciousness. The
stream of messages never stops, not even in sleep. But the conscious
mind has its private secretary, the subconscious, to receive the
messages and to answer them.

During any five minutes of a walk down a city street a man has
hundreds of visual images flashed upon the retina of the eye. His eye
sees every little line in the faces of the passers-by, every detail of
their clothing, the decorations on the buildings, the street signs
overhead, the articles in the shop-windows, the paving of the
sidewalks, the curbings and tracks which he crosses, and scores of
other objects to most of which the man himself is oblivious. His ear
hears every sound within hearing distance,--the honk of every horn,
the clang of every bell, the voices of the people and the shuffle of
feet. Some part of his mind feels the press of his foot on the
pavement, the rubbing of his heel on his stocking, the touch of his
clothing all over his body, and all those so-called kinesthetic
sensations,--sensations of motion and balance which keep him in
equilibrium and on the move, to say nothing of the never-ending stream
of messages from every cell of every muscle and tissue of his body.

Out of this constant rush of stimuli our man gives attention to only
the smallest fraction. Whatever is interesting to him, that he sees
and hears and feels. All other sensations he passes by as indifferent.
Unless they come with extraordinary intensity, they do not get over
into his consciousness at all.

="Listening-in" on the Subconscious.= The subconscious mind knows and
needs to know what is happening in the farthermost cell of the body.
It needs to know at any moment where the knees are, and the feet;
otherwise the individual would fall in a heap whenever he forgot to
watch his step. It needs to know just how much light is entering the
eye, and how much blood is in the stomach. To this end it has a system
of communication from every point in the body and this system is in
constant operation. Its messages never cease. But these messages were
never meant to be in the focus of attention. They are meant only for
the subconscious mind and are generally so low-toned as to be easily
ignored unless one falls into the habit of listening for them. Unless
they are invested with a significance which does not belong to them,
they will not emerge into consciousness as real sensations.

=Psychic Thresholds.= Boris Sidis has given us a word which has proved
very useful in this connection. The limit of sensitivity of a
cell--the degree of irritability--he calls the stimulus-threshold.[59]
As the wind must come in gusts to drive the rain in over a high
doorsill, so must any stimulus--an idea or a sensation--come with
sufficient force to get over the obstructions at the doorway of
consciousness. These psychic thresholds do not maintain a constant
level. They are raised or lowered at will by a hidden and automatic
machinery, which is dependent entirely on the ideas already in
consciousness, by the interest bestowed upon the newcomer. The
intensity of the stimuli cannot be controlled, but the interest we
feel in them and the welcome given them are very largely a matter of
choice.

[Footnote 59: Sidis: _Foundations of Normal and Abnormal Psychology_,
Chap. XXX.]

Each organism has a wide field of choice as to which ideas and which
physical stimuli it shall welcome and which it shall shut out. We may
raise our thresholds, build up a bulwark of indifference to a whole
class of excitations, shut our mental doors, and pull down the shades;
or we may lower the thresholds so that the slightest flicker of an
idea or the smallest pin-prick of a sensation finds ready access to
the center of attention.

=Thresholds and Character.= There are certain thresholds made to shift
frequently and easily. When one is hungry any food tastes good, for
the threshold is low; but the food must be most tempting to be
acceptable just after a hearty meal. On the other hand, a fairly
constant threshold is maintained for many different kinds of stimuli.
These stimuli are always bound together in groups, and make appeal
depending upon the predominating interest. As anything pertaining to
agriculture is noticed by a farmer, or any article of dress by a
fashionable woman, so any stimulus coming from a "warm" group is
welcomed, while any from a "cold" group is met by a high threshold.
The kind of person one is depends on what kind of things are "warm"
to him and what kind are "cold." The superman is one who has gained
such conscious control of his psychic thresholds that he can raise and
lower them at will in the interests of the social good.

=Thresholds and Sensations.= The importance of these principles is
obvious. The next chapter will show more of their influence on ideas
and emotions; but for the present we will consider their lessons in
the sphere of the physical. Psychology speaks here in no uncertain
terms to physiology. Whoever becomes fascinated by the processes of
his own body is bound to magnify the sensations from those processes,
until the most insignificant message from the subconscious becomes a
distressing and alarming symptom. The person whose mental ear is
strained to catch every little creaking of his internal machinery can
always hear some kind of rumble. If he deliberately lowers his
thresholds to the whole class of stimuli pertaining to himself, there
is small wonder that they sweep over the boundaries into consciousness
with irresistible force.

=The Motives for Sensitiveness.= Sensitiveness is largely a matter of
choice, but what determines choice? Why is it that one person chooses
altruism as the master threshold that determines the level of all the
others, while another person who ought to be equally fine lowers his
thresholds only to himself? What makes a person too interested in his
own sensations and feelings? As usual there is a cause.

The real cause back of most cases of chronic sensitiveness is an
abnormal desire for attention. Sometimes this love of attention arises
from an under-developed instinct of self-assertion, or "inferiority
complex." If there is a sense of inadequacy, a feeling of not being so
important as other people, a person is quite likely to over-compensate
by making himself seem important to himself and to others in the only
way he knows. All unconsciously he develops an extreme sensitiveness
which somehow heightens his self-regard by making him believe himself
finely and delicately organized, and by securing the notice of his
associates.

Or, again, the love of attention may be simply a sign of arrested
development, a fixation of the Narcissistic period of childhood which
loves to look at itself and make the world look. Or there may be lack
of satisfaction of the normal adult love-life, a lack of the love and
attention which the love-instinct naturally craves. If this instinct
is not getting normal outlet, either directly through personal
relationships or indirectly through a sublimated activity, what is
more natural than that it should turn in on itself, dissociate its
interest in other things and occupy itself with its own feelings, and
at the same time secure the coveted attention through physical
disability, with its necessity for special ministration?

In any case there is likely to develop a general overreaction to all
outside stimulation, a hypersensitiveness to some particular kind of
stimulus, or a chronic hysterical pain which somehow serves the
personality in ways unknown to itself. No one "feels his feelings"
unless, despite all discomfort, he really enjoys them. A hard
statement to accept perhaps, but one that is repeatedly proved by a
specialist in "nerves"!


DETERMINING CAUSES

=Accidental Association.= In many cases, the form which the
sensitiveness takes is merely a matter of accident. Often it is based
on some small physical disability, as when a slight tendency to take
cold is magnified into an intense fear of fresh air.

Sometimes a past fleeting pain which has become associated with the
stream of thought of an emotional moment--what Boris Sidis calls the
moment-consciousness--is perpetuated in consciousness in place of the
repressed emotion. "In the determination of the pathology of hysteria,
the accidental moment plays a much greater part than is generally
recognized; if a painful affect--emotion--originates while eating but
is repressed, it may produce nausea and vomiting and continue for
months as an hysterical symptom."[60]

[Footnote 60: Freud: _Selected Papers_, p. 2.]

One of Freud's patients, Miss Rosalie H----, found while taking
singing-lessons that she often choked over notes of the middle
register, although she took with ease notes higher and lower in the
scale. It was revealed that this girl, who had a most unhappy home
life, had, during a former period, often experienced this choking
sensation from a painful emotion just before she went for her music
lesson. Some of the left-over sensations had remained during the
singing, and as the middle notes happen to involve the same muscles as
does a lump in one's throat, she had often found herself choking over
these notes. Later on, while living in a different city and in a
wholly different environment, the physical sensations from her throat
muscles, as they took these middle notes, brought back the associated
sensations of choking,--without, however, uncovering the buried
emotion.[61] Many a painful hysterical affliction is based on just
such mechanisms as these. As Freud remarks, "The hysteric suffers
mostly from reminiscences."[62]

[Footnote 61: Ibid, p. 43.]

[Footnote 62: Ibid, p. 5.]

=Subconscious Symbolism.= Sometimes, as we have seen, the form which
a hypersensitiveness assumes is not determined by any physical
sensation, either past or symbolism which acts out in the body the
drama of the soul.

=Facing the Facts.= Whatever the motives and whatever the determining
causes, hypersensibility is in any case a feeling of feelings which is
not warranted by the present situation. Hypersensitiveness is never
anything but a makeshift kind of satisfaction. Despite certain
subconscious reasoning, it does not make one more important nor more
beloved. Neither does it furnish a real expression for that great
creative love-instinct whose outlet, if it is to bring satisfaction,
must be a real outlet into the external world. An understanding of the
motives is helpful only when it makes clear that they are
short-sighted motives and that the real desires back of them may be
satisfied in better ways.


SOME LOWERED THRESHOLDS

As the public appetite for specific cases appears to be insatiable, we
will give from real life some examples of low thresholds which were
raised through re-education. One hesitates to write down these
examples because when they are on paper they sound like advertisements
of patent medicines. However, there is no magic in any of these cures,
but only the working out of definite laws which may be used by other
sufferers, if they only know. Re-education through a knowledge of
oneself and the laws at work really does remarkable things when it has
a chance.

="Danger-Signals" without the Danger.= There was the man who had queer
feelings all over his body, especially in his head and stomach, and
who considered these sensations as danger-signals warning him to stop.
This man had worked up from messenger boy to a position next to the
president in one of the transcontinental railroad systems. On the
appearance of these "danger-signals" he had tried to resign but had
been given a year's leave of absence instead. Half the year had gone
in rest-cure, but he was still afraid to eat or work, and believed
himself "done for." After three weeks of re-education he saw that
instead of having overdrawn his capital, he had in another sense
overdrawn his sensations. He went away as fit as ever, finished his
leave of absence doing hard labor on his farm, and then went back to
even harder tasks, working for the Government in the administration of
the railroads during the war. He is still at work.

=Enjoying Poor Health.= There was the woman who had been an invalid
for twenty years, doing little else during all that time than to feel
her own feelings. Because of the distressing sensations in her
stomach, she had for a year taken nothing but liquid nourishment. She
had queer feelings in her solar-plexus and indeed a general luxury of
over-feeling. She could not leave her room nor have any visitors. She
was the star invalid of the family, waited on by her two hard-working
sisters who earned the living for them all.

Her sisters had inveigled her to my house under false pretenses,
calling it a boarding-house and omitting to mention that I was a
doctor, because "she guessed she knew more about her case than any
doctor." For the first week I got in only one sentence a day,--just
before I slipped out of the door after taking in her "liquid
nourishment." But at the end of the week I announced that thereafter
her meals would be served in the dining-room. When she found that
there was to be no more liquid nourishment, she had to appear at the
family table. After that it was only a short time before she was at
home, cooking for her sisters. When she saw the role she had been
unconsciously playing, she could hardly wish to go on with it.

=Feeling His Legs.= Mr. R. suffered from such severe and distressing
pains in his legs that he believed himself on the verge of paralysis.
He was also bothered by a chronic emotional state which made him look
like a "weepy" woman. His eyes were always full of tears and his chin
a-quiver, and he had, as he said, a perpetual lump in his throat.
Under re-education both lump and paralysis disappeared completely and
Mr. R. took his wife across the continent, driving his machine with
his own hands--and feet.

=A Subconscious Association.= Mr. D.'s case admirably illustrates the
return of symptoms through an unconscious association. He was a
lawyer, prominent in public affairs of the Middle West, who had been
my patient for several weeks and who had gone home cured of many
striking disabilities. Before he came to me, he had given up his
public work and was believed by all his associates to be afflicted
with softening of the brain, and "out of the game" for good. From
being one of the ablest men of his State, he had fallen into such a
condition that he could neither read a letter nor write one. He could
not stand the least sunshine on his head, and to walk half a mile was
an impossibility. He was completely "down and out" and expected to be
an invalid for the rest of his life.

But these symptoms had one by one disappeared during his five-weeks
stay with me. He had done good stiff work in the garden, carried a
heavy sack of grapefruit a mile in the hot sun, and was generally his
old self again. Now he was back in the harness, hard at work as of
old. Suddenly, as he sat reading in his home one evening, all his old
symptoms swept over him,--the pains in his head and legs, the pounding
of the heart, the "all-gone" sensations as though he were going to die
on the spot. He became almost completely dissociated, but through it
all he clung to the idea which he had learned,--namely that this
experience was not really physical as it seemed but was the result of
some idea, and would pass. He did not tell any one of the attack,
ignored it as much as possible, and waited. In a few minutes he was
himself again. Then he looked for the cause and realized that the
article he was reading was one he had read several months previous,
when suffering most severely from the whole train of symptoms. When
the familiar words had again gone into his mind, they had pressed the
button for the whole physiological experience which had once before
been associated with them. This is the same mechanism as that involved
in Prince's case, Miss Beauchamp, who became completely dissociated at
one time when a breeze swept across her face. When Dr. Prince looked
for the cause, he found that once before she had experienced certain
distressing emotions while a breeze was fanning her cheek. The
recurrence of the physical stimulation had been sufficient to bring
back in its entirety the former emotional complex.

=Another Kind of Association.= One of my women patients illustrates
another kind of association-mechanism, based not on proximity in time
but proximity of position in the body. This woman had complained for
years of "bladder trouble" although no physical examination had been
able to reveal any organic difficulty. She referred to a constant
distress in the region of the bladder and was never without a certain
red blanket which she wrapped around her every time she sat down.
During psycho-analysis she recounted an experience of years before
which she had never mentioned to anybody. During a professional
consultation her physician, a married man, had suddenly seized her and
exclaimed, "I love you! I love you!" In spite of herself, the woman
felt a certain appeal, followed by a great sense of guilt. In the
conflict between the physiological reflex and her moral repugnance,
she had shunted out of consciousness the real sex-sensation and had
replaced it with a sensation which had become associated in her
subconscious mind with the original temptation. Since the nerves from
the genital region and from the bladder connect with the same segment
of the spinal cord, she had unconsciously chosen to mix her messages,
and to cling to the substitute sensation without being in the least
Conscious of the cause. As soon as she had described the scene to me
and had discerned its connection with her symptoms, the bladder
trouble disappeared.

=Afraid of the Cold.= Patients who are sensitive to cold are very
numerous. Mr. G.--he of the prunes and bran biscuits--was so afraid of
a draft that he could detect the air current if a window was opened a
few inches anywhere in a two-story house. He always wore two suits of
underwear, but despite his precautions he had a swollen red throat
much of the time. His prescription was a cold bath every morning, a
source of delight to the other men patients, who made him stay in the
water while they counted five. He was required to dress and live like
other folks and of course his sensitiveness and his sore throat
disappeared.

Dr. B----, when he came to me, was the most wrapped-up man I had ever
met. He had on two suits of underwear, a sweater, a vest and suit
coat, an overcoat, a bear-skin coat and a Jaeger scarf--all in
Pasadena in May!

Besides this fear of cold, he was suffering from a hypersensitiveness
of several other varieties. So sensitive was his skin that he had his
clothes all made several sizes too big for him so that they would not
make pressure. He was so aware of the muscles of the neck that he
believed himself unable to hold up his head, and either propped it
with his hands or leaned it against the back of a chair.

He had been working on the eighth edition of his book, a scientific
treatise of nation-wide importance, but his eyes were so sensitive
that he could not possibly use them and had to keep them shaded from
the glare. He was so conscious of the messages of fatigue that he was
unable to walk at all, and he suffered from the usual trouble with
constipation. All these symptoms of course belonged together and were
the direct result of a wrong state of mind. When he had changed his
mind, he took off his extra clothes, walked a mile and a half at the
first try, gave up his constipation, and went back to work. Later on I
had a letter from him saying that his favorite seat was an overturned
nail-keg in the garden and that he was thinking of sawing the backs
off his chairs.

Miss Y---- had worn cotton in her ears for a year or two because she
had once had an inflammation of the middle ear, and believed the
membrane still sensitive to cold. There was Miss E----, whose
underwear always reached to her throat and wrists and who spent her
time following the sun; and Dr. I----, who never forgot her heavy
sweater or her shawl over her knees, even in front of the fire. The
procession of "cold ones" is almost endless, but always they find that
their sensitiveness is of their own making and that it disappears when
they choose to ignore it.

=Fear of Light.= Fear of cold is no more common than fear of light.
Nervous folk with half-shut eyes are very frequent indeed. From one
woman I took at least seven pairs of dark glasses before she learned
that her eye was made for light. A good example is furnished by a
woman who was not a patient of mine at all, but merely the sister of a
patient. After my patient had been cured of a number of distressing
symptoms--pain in the spine, sore heels, a severe nervous cough,
indigestion and other typical complaints,--she began to scheme to get
her sister to come to me.

This sister, the wife of a minister in the Middle West, had a constant
pain in her eyes, compelling her to hold them half-shut all the time.
When she was approached about coming to me, she said indignantly, "If
that doctor thinks that my trouble is nervous, she is much mistaken,"
and then proceeded to get well. Once the subconscious mind gets the
idea that its game is recognized, it is very apt to give it up, and it
can do this without loss of time if it really wants to.

=Pain at the Base of the Brain.= Of all nervous pains, that in the
back of the neck is by all odds the most common. It is rare indeed to
find a nervous patient without this complaint, and among supposedly
well folk it is only too frequent. Indeed, it almost seems that in
some quarters such a pain stands as a badge of the fervor and zeal of
one's work.

But work is never responsible for this sense of discomfort. Only an
over-sensitiveness to feelings or a false emotionalism can produce a
pain of this kind, unless it should happen to be caused by some poison
circulating in the blood. The trouble is not with the nerves or with
the spine, despite the fad about misplaced vertebræ. When a doctor
examines a sensitive spine, marking the sore spots with a blue pencil,
and a few minutes later repeats the process, he finds almost
invariably that the spots have shifted. They are not true physical
pains and they rarely remain long in the same place.

Pain in the spine and neck is an example of exaggerated sensibility or
over-awareness. Since all messages from every part of trunk and limb
must go through the spinal cord, and since very many of them enter the
cord in the region of the neck and shoulder blades, it is only natural
that an over-feeling of these messages should be especially noticed in
this zone.

Sometimes a false emotionalism adds to the discomfort by tensing the
whole muscular system and making the messages more intense. When a
social worker or a business man gets tense over his work or ties
himself into knots over a committee meeting, he not only foolishly
wastes his energy but makes his nerves carry messages that are more
urgent than usual. Then if he is on the look-out for sensations, he
all the more easily becomes aware of the central station in the spine
where the messages are received. By centering his attention on this
station and tightening up his back-muscles, he increases this
over-awareness and easily gets himself into the clutch of a vicious
habit.

Sometimes a tenseness of the body is the result, not of a false
attitude toward one's work, but of a lack of satisfaction in other
directions. If the love-force is not getting what it wants, it may
keep the body in a state of tension, with all the undesirable results
of such tension. The person who keeps himself tense, whether because
of his work or because of tension in other directions, has not really
learned how to throw himself into his job and to forget himself, his
emotions, and his body.

=Various Pains.= Tender spots may appear in almost any part of the
body. There was the girl with the sore scalp, who was frequently so
sensitive that she could not bear to have a single hair touched at its
farthermost end, and who could not think of brushing her hair at such
a time. There was the man whose wrists and ankles were so painful that
the slightest touch was excruciating; the woman with the false
sciatica; the man with the so-called appendicitis pains; and the man
with the false neuritis, who always wore jersey coats several sizes
too large. Each one of these false pains was removed by the process of
re-education.

=Low Thresholds to Fatigue.= Mr. H. was habitually so overcome by
fatigue that he could not make himself carry through the slightest
piece of work, even when necessity demanded it. On Sunday night, when
there was no one else to milk the cow, he had had to stop in the
middle of the process and go into the house to lie down. To carry the
milk was impossible, so low were his thresholds to the slightest
message of fatigue. It turned out that things were not going right in
the reproductive life. His threshold was low in this direction, and it
carried down with it all other thresholds. After a general revaluation
of values, he found himself able to keep his thresholds at the normal
level.

A fine, efficient missionary from the Orient had been so overcome with
fatigue that he was forced to give up all work and return to this
country. He had been with me for a while and was again ready to go to
work. He came one day with a radiant face to bid me good-by. "Why are
you so joyous?" I asked. "Because," he answered, "before I came home I
was so fatigued that it used me up completely just to see the native
servants pack our luggage. Now we are taking back twice as much, and I
not only packed it all myself but made the boxes with my own hands. No
more fatigue for me!"

A charming young girl who in many ways was an inspiration to all her
associates fell into the habit of over-feeling her fatigue. "You know,
Doctor," she said, "that I give out too much of myself; everybody
tells me so." That was just the trouble. Everybody had told her so,
and the suggestion had worked. It did not take her long to learn that
in scattering abroad she was enriching herself, and that her "giving
out" was not exhausting to her but rather the truest kind of
self-expression. It is only when a "giving out" is accompanied by a
"looking in" that it can ever deplete. The "See how much I am
giving," and "How tired I shall be," attitude could hardly fail to
exhaust, but a real self-expression and the fulfilment of a real
desire to give are never anything else than exhilarating. There is
something wrong with the minister who is used up after his Sunday
sermons. If his message and not himself is his real concern, he will
have only a normal amount of fatigue, accompanied by a general sense
of accomplishment and well-being, after he has fed his flock. To be
sure, I have never been a minister, but I have had a goodly number
among my patients and I speak from a fairly close acquaintance with
their problems.

=Stopping Our Ears.= Roosters seem to be a perpetual source of
annoyance to the folk whose thresholds are not under proper control.
But as roosters seem to be necessary to an egg-eating nation, it seems
simpler to change the threshold than to abolish the roosters. There
was one woman who complained especially about being disturbed by
early-morning Chanticleers. I explained that the crowing called for no
action on her part, and that therefore she should not allow it to come
into consciousness. "Do you mean," she said, "that I could keep from
hearing them?" As it happened, she was sitting under the clock, which
had just struck seven. "Did you hear the clock strike?" I asked. "No,"
she said; "did it strike?"

This poor little woman, who suffered from a very painful back and
other distressing symptoms, had been married at sixteen to a roué of
forty; and, without experiencing any of the psychic feelings of sex,
had been immediately plunged into the physical sex-relations. Since
sex is psycho-physical and since any attempt to separate the two
elements is both desecrating and unsatisfactory; it is not surprising
that misery, and finally divorce, had been her portion. Another
equally unpleasant experience had followed, and the poor woman in the
strain and disappointment of her love-life, and in the lowering of the
thresholds pertaining to this thwarted instinct, had unconsciously
lowered the thresholds to all physical stimuli, until she was no
longer master of herself in any line. When she saw the reason for her
exaggerated reactions, she was able to gain control of herself, and to
find outlet in other ways.

Too many persons fall into the way of being disturbed by noises which
are no concern of theirs. As nurses learn to sleep through all sounds
but the call of their own patients, so any one may learn to ignore all
sounds but those which he needs to hear. Connection with the outside
world can be severed by a mental attitude in much the same way as this
is accomplished by the physical effect of an anaesthetic. Then the
usual noises, those which the subconscious recognizes as without
significance, will be without power to disturb. The well-known New
York publisher who spent his last days on his private yacht, on which
everything was rubber-heeled and velvet-cushioned, thought that he
couldn't stand noises; but how much more fun he would have had, if
some one had only told him about thresholds!


SUMMARY

There are two kinds of people in the world,--masters and puppets.
There is the man in control of his thresholds, at leisure from himself
and master of circumstance, free to use his energy in fruitful ways;
and there is the over-sensitive soul, wondering where the barometer
stands and whether people are going to be quiet, feeling his feelings
and worrying because no one else feels them, forever wasting his
energy in exaggerated reactions to normal situations.

This "ticklish" person is not better equipped than his neighbor, but
more poorly equipped. True adjustment to the environment requires the
faculty of putting out from consciousness all stimuli that do not
require conscious attention. The nervous person is lacking in this
faculty, but he usually fails to realize that this lack places him in
the class of defectives. A paralyzed man is a cripple because he
cannot run with the crowd; a nervous individual is a cripple, but only
because he thinks that to run with the crowd lacks distinction.
Something depends on the accident of birth, but far more depends on
his own choice. Understanding, judicious neglect of symptoms,
whole-souled absorption in other interests, and a good look in the
mirror, are sure to put him back in the running with a wholesome
delight in being once more "like folks."



CHAPTER XV

_In which we learn discrimination_

CHOOSING OUR EMOTIONS

LIKING THE TASTE


It was a summer evening by the seaside, and a group of us were sitting
on the porch, having a sort of heart-to-heart talk about
psychology,--which means, of course, that we were talking about
ourselves. One by one the different members of the family spoke out
the questions that had been troubling them, or brought up their
various problems of character or of health. At length a splendid Red
Cross nurse who had won medals for distinguished service in the early
days of the war, broke out with the question: "Doctor, how can I get
rid of my terrible temper? Sometimes it is very bad, and always it has
been one of the trials of my life." She spoke earnestly and sincerely,
but this was my answer: "You like your temper. Something in you enjoys
it, else you would give it up." Her face was a study in astonishment.
"I don't like it," she stammered; "always after I have had an
outburst of anger I am in the depths of remorse. Many a time I have
cried my eyes out over this very thing." "And you like that, too," I
answered. "You are having an emotional spree, indulging yourself first
in one kind of emotion and then in another. If you really hated it as
much as you say you do, you would never allow yourself the indulgence,
much less speak of it afterward." Her astonishment was still further
increased when several of the group said they, too, had sensed her
satisfaction with her moods.

Hard as it is to believe, we do choose our emotions. We like emotion
as we do salt in our food, and too often we choose it because
something in us likes the savor, and not because it leads to the
character or the conduct that we know to be good.


THE POWER OF CHOICE

Whether we believe it or not, and whether we like it or not, the fact
remains that we ourselves decide which of all the possible emotions we
shall choose, or we decide not to press the button for any emotion at
all.

To a very large extent man, if he knows how and really wishes, may
select the emotion which is suitable in that it leads to the right
conduct, has a beneficial effect on the body, adapts him to his social
environment, and makes him the kind of man he wants to be.

=The Test of Feeling.= The psychologist to-day has a sure test of
character. He says in substance: "Tell me what you feel and I will
tell you what you are. Tell me what things you love, what things you
fear, and what makes you angry and I will describe with a fair degree
of accuracy your character, your conduct, and a good deal about the
state of your physical health."

Since this test of emotion is fundamentally sound, it is not
surprising that the nervous man is in a state of distress.
Indigestion, fatigue, over-sensibility, sound like problems in
physiology, but we cannot go far in the discussion of any of them
without coming face to face with the emotions as the real factors in
the case. When we turn to the mental characteristics of nervous folk,
we even more quickly find ourselves in the midst of an emotional
disturbance. Worried, fearful, anxious, self-pitying, excitable, or
melancholy, the nervous person proves that whatever else a neurosis
may be, it is, in essence, a riot of the emotions.

There is small wonder that a riot at the heart of the empire should
lead to insurrection in every province of the personality. It is only
for the purpose of discussion that we can separate feeling from
thinking and doing. Every thought and every act has in it something of
all three elements. An emotion is not an isolated phenomenon; it is
bound up on the one hand with ideas and on the other with bodily
states and conduct. Whoever runs amuck in his emotions runs amuck in
his whole being. The nervous invalid with his exhausted and sensitive
body, his upset mind and irrational conduct is a living illustration
of the central place of the emotions in the realm of the personality.

But it is not the nervous person only who needs a better understanding
of his emotional life. The well man also gets angry for childish
reasons; he is prejudiced and envious, unhappy and suspicious for the
very same reason as is the nervous man. Since the working-capital of
energy is limited to a definite amount, the control of the emotions
becomes a central problem in any life,--a deciding factor in the
output and the outcome, as well as in comfort and happiness by the
way.

Nothing is harder for the average man to believe than this fact that
he really has the power to choose his emotions. He has been
dissatisfied with himself in his past reactions, and yet he has not
known how to change them. His anger or his depression has appeared so
undesirable to his best judgment and to his conscious reason that it
has seemed to be not a part of himself at all but an invasion from
without which has swept over him without his consent and quite beyond
control.


A HOUSE DIVIDED AGAINST ITSELF

Most of the confusion comes from the fact that we know only a part of
ourselves. What we do not consciously enjoy we believe we do not enjoy
at all. What we do not consciously choose we believe to be beyond our
power of choice,--the work of the evil one, or the natural depravity
of human nature, perhaps; but certainly not anything of our choosing.

The point is that a human being is so constituted that he can, without
knowing it, entertain at the same time two diametrically opposite
desires. The average person is not so unified as he believes, but is,
in fact, "a house divided against itself."

The words of the apostle Paul express for most of us the truth about
ourselves: "For what I would, that I do not; but what I hate that I
do." What Paul calls the law of his members warring against the law of
his mind is simply what we call to-day the instinctive desires coming
into conflict with our conscious ideal.

=Hidden Desires.= Although we choose our emotions, we choose in many
cases in response to a buried part of ourselves of which we are wholly
unaware, or only half-aware. When we do not like what we have chosen,
it is because the conscious part of us is out of harmony with another
part and that part is doing the choosing. If the emotions which we
choose are not those that the whole of us--or at least the
conscious--would desire, it is because we are choosing in response to
hidden desires, and giving satisfaction to cravings which we have not
recognized. Repeated indulgence of such desires is responsible for the
emotional habits which we are too likely to consider an inevitable
part of our personality, inherited from ancestors who are not on hand
to defend themselves. When we form the habit of being afraid of things
that other people do not fear, or of being irritated or depressed, or
of giving way to fits of temper, it is because these habit-reactions
satisfy the inner cravings that in the circumstances can get
satisfaction in no better way.

These hidden desires are of several different kinds, when squarely
looked at. Some of the cravings are found to be childish, and so out
of keeping with our real characters that we could not possibly hold on
to them as conscious desires. Others turn out to be so natural and so
inevitable that we wonder how we could ever have imagined that they
ought to be repressed. Still others, legitimate in themselves, but
denied because of outer circumstances, are found to be easily
satisfied in indirect ways which bear no resemblance to their old
unfortunate forms of outlet.


WHEN KNOWLEDGE HELPS

The way to get rid of an undesirable emotion is not by working at the
emotion itself, but by realizing that this is merely an offshoot of a
deeper root, hidden below the surface. The great point is to recognize
this deeper root.

=Childish Anger.= It helps to know that uncalled-for anger is a
defense reaction--a sort of camouflage or smoke cloud which we throw
out to hide from ourselves and others the fact that we are being
worsted in an argument, or being shown up in an undesirable light.
Better than any amount of weeping over a hot temper is an
understanding of the fact that when we fly into unseemly rage we are
usually giving indulgence to a childhood desire to run away from
unpleasant facts and to cover up our own faults.

=Enjoying the Blues.= It helps to know that the easiest way to fight
the blues is by realizing that they are a deliberate, if unconscious,
attempt to gain the pity of ourselves and others. There seems to be in
undeveloped human nature something that really enjoys being pitied,
and if we cannot get the commiseration of other people, we can,
without much trouble, work up a case of self-pity. Most of us would
have to acknowledge that we seldom find tears in our eyes except when
our own woes are under consideration. "Whatever else the blues
accomplish, they certainly afford us a chance to submerge ourselves
in a sea of self-engrossment."[63]

[Footnote 63: Putnam: _Human Motives_.]

=The Chip on the Shoulder.= It helps to know that irritability and
over-sensitiveness are usually the result of tension from unsatisfied
desires which must find some kind of outlet. If a person is secretly
restive under the fact that he cannot have the kind of clothes he
wants, cannot shine in society, or secure a college education or a
large fortune,--all of which minister to our insistent and rarely
satisfied instinct of self-assertion,--or if he is secretly yearning
for the satisfaction of the marriage relation, or for the sense of
completion in parenthood; then the tension from these unsatisfied
desires shows itself in a hundred little everyday instances of lack of
self-control. These mystify him and his friends, but they are
understandable when the whole truth is known.

=Anxiety and Fear.= Nowhere is understanding more valuable than when
we approach the subject of anxiety and fear. Whenever a person falls
into a state of abnormal fear, his friends and his physician spend a
good deal of time in attempting to prove to him that there is no cause
for apprehension, and in exhorting him to use his reason and give up
his fear. But how can a person help himself when he is fighting in the
dark? How can he free himself when the thing he thinks he fears is
merely a symbol of what he really fears? The woman who was afraid she
would choke her child had been several months in the hands of
Christian Scientists, and had earnestly tried to replace fear with
courage. But in the circumstances, and without further knowledge, this
was as impossible as it is for a man to lift himself by his own
boot-straps. She had no point of contact with her real fear, as the
man has no leverage contact with the earth from which he wishes to
lift himself.

To be sure there are many cases in which an assumed cheerfulness and
courage do have a mighty effect on the inner man. The forces of the
personality are not set, but plastic, and are constantly acting and
interacting upon one another. Surface habits do influence the forces
below the surface. William James's advice, "Square your shoulders,
speak in a major key, smile, and turn a compliment," is good for most
occasions, but sometimes even a little understanding of the cause is
far more effective.

It helps to know that persistent anxiety, lacking obvious cause, is
found to be the anxiety of the thwarted instinct of reproduction. When
the sex-instinct is repeatedly stimulated and then checked it sets in
motion some of the same glands that are activated in fear. What comes
up into consciousness is therefore very naturally a fear or dread of
impending disaster, very like the poignant anxiety that one feels
when stepping up in the dark to a step that is not there.

Simultaneous with the fear lest these repressed desires should not be
satisfied, there is an intense fear lest they should. The more
insistent the repressed desire, and the more it seems likely to break
through into consciousness, the keener the anguish of the ethical
impulses. Abnormal fear, however it may seem to be externalized,
always implies at the bottom a fear of something within. There is no
truth which is harder to believe on first hearing but which grows more
compelling with further knowledge, than this truth that an exaggerated
fear always implies a desire which somehow offends the total
personality. When we observe the various distressing phobias, such as
the common fear of contamination, a woman's fear to undress at night,
a fear that the gas was not turned off, or that one's clothing is out
of order; fear lest the exact truth has not been told, or that the
uttermost farthing of one's obligations has not been met,--then we may
know that there is something in the fear situation which either
directly or symbolically refers to some hidden desire; a desire which
the individual would not for the world acknowledge to himself, but
which is too keen to be altogether repressed.

The close connection between fear and desire is often shown in the
unfounded fear of having committed a crime. Both doctors and lawyers
in their professional work occasionally come upon individuals who
believe that they have committed some heinous crime of which they are
really innocent, and who insist upon their guilt despite all evidence
to the contrary. A quiet, gentle youth who at the age of twenty was
under my medical care, is still not sure in his own whether he, at
twelve years of age, was the burglar who broke into the village store
and killed the owner. It is difficult for the normally self-satisfied
individual to understand the appeal of heroics to a person whose
starved instinct of self-assertion makes him choose to be known as a
villain rather than not to be known at all.

=Breaking the Spell.= When once we bring up into consciousness these
hidden desires that manifest themselves in such troublesome ways, we
find that we have robbed them of much of their power over our lives.
Sometimes, it is true, a detailed and thorough exploration by
psycho-analysis is necessary, but in many cases it is sufficient just
to know that there are underlying causes. To know these things is far
from excusing ourselves because of them. Even though emotions are
determined by forces that are deep in the subconscious, we may still
choose in opposition to those forces, if we but know that we can do
so. The fact that some of the roots of our bad habits reach down into
the subconscious is no excuse for not digging them up. As Dr. Putnam
says, "It is the whole of us that acts, and we are as responsible for
the supervision of the unseen as for the obvious factors that are at
work. The moon may be only half illumined and half visible, but the
invisible half goes on, none the less, exerting its full share of
influence on the motion of the tides and earth."[64]

[Footnote 64: Putnam: _Freud's Psychoanalytic Method and Its
Evolution_, p. 34.]


THE HIGHEST KIND OF CHOICE

There is no easier way to enliven any conversation than by dropping
the remark that a human being always does what he wants to do. Simple
as the statement seems, it is quite enough to quicken the dullest
table-talk and loosen the most reticent tongue.

"I don't do what I want to do," says the college student. "I want to
play tennis every afternoon; but what I do is to sit in a stuffy room
and study."

"I don't do what I want to do," says the mother of a family. "At night
I want to sit down and read the latest magazine, but what I do is to
darn stockings by the hour."

Nevertheless we shall see that, even in cases like these, each of us
is acting in accordance with his strongest desire. There may be--there
often is--a bitter conflict, but in the end the desire that is really
stronger always conquers and works itself out into action.

It is possible to imagine a situation in which a man would be
physically unable to do what he wanted to do. Bound by physical cords,
held by prison walls, or weakened by illness, he might be actually
unable to carry out his desires. But apart from physical restraint, it
is hard to imagine a situation in real life in which a person does not
actually do what he wants to do; that is, what _in the circumstances
he wants to do_. This is simply saying in another way that we act in
accordance with the emotion which is at the moment strongest.

=Will Is Choice.= Just here we can imagine an earnest protest: "But
why do you ignore the human will? Why do you try to make man the
creature of feeling? A high-grade man does--not what he wants to do
but what he thinks he ought to do. In any person worthy of the
adjective 'civilized' it is conscience, not desire, which is the
motive power of his life."

It is true: in the better kind of man the will is of central
importance; but what is "will"? Let us imagine a raw soldier in the
trenches just before a charge into No-Man's Land. He is afraid, but
the word of command comes, and instantly he is a new creature. His
fear drops away and, energized by the lust of battle, he rushes
forward, obviously driven by the stronger emotion. He goes ahead
because he really wants to, and we say that he does not have to use
his will.

Imagine another soldier in the same situation; with him fear seems
uppermost. His knees shake and his legs want to carry him in the wrong
direction, but he still goes forward. And he goes forward, not so much
because there is no other possibility as because, in the
circumstances, he really wants to. All his life, and especially during
his military training, he has been filled with ideals of loyalty and
courage. More than he fears the guns of the enemy or of his
firing-squad does he fear the loss of his own self-respect and the
respect of his comrades. Greater than his "will to live" is his desire
to play the man. There is conflict, and the desire which seems at the
moment weaker is given the victory because it is reinforced by that
other permanent desire to be a worthy man, brave, and dependable in a
crisis. He goes forward, because in the circumstances, he really wants
to, but in this case we say that he had to use his will.

Is it not apparent that will itself is choice,--the selection by the
whole personality of the emotion and the action which best fit into
its ideals? Will is choice by the part of us which has ideals.
McDougall points out that will is the reinforcement of the weaker
desire by the master desire to be a certain kind of a character.[65]

[Footnote 65: "The essential mark of volition is that the personality
as a whole, or the central feature or nucleus of the personality, the
man himself, is thrown upon the side of the weaker
motive."--McDougall: _Introduction to Social Psychology_, p. 240.]

Each human being as he goes through life acquires a number of moral
ideals and sentiments which he adopts as his own. They become linked
with the instinct of self-assertion, which henceforth acts as the
motive power behind them, and attempts to drive from the field any
emotion which happens to conflict.

Men, like the lower animals, are ruled by desire, but, as G.A. Coe
says, "Men mold themselves. They form desires not merely to have this
or that object, but to be this or that kind of a man."[66]

[Footnote 66: Coe: _Psychology of Religion_.]

If a man be worthy of the name, he is not swayed by the emotion which
happens for the moment to be strongest. He has the power to reinforce
and make dominant those impulses which fit into the ideal he has built
for himself. In other words, he has the power to choose between his
desires, and this power depends largely upon the ideals which he has
incorporated into his life by the complexes and sentiments which
compose his personality.

_Ideas and Ideals_. If emotion is the heart of humanity, ideas are its
head. In our emphasis on emotion, we must not forget that as emotion
controls action, so ideas control emotion. But ideas, of themselves,
are not enough. Everybody has seen weaklings who were full of pious
platitudes. Ideas do control life, but only when linked up with some
strong emotion. No moral sentiment is strong enough to withstand an
intense instinctive desire. If ideas are to be dynamic factors in a
life, they must become ideals and be really desired. They must be
backed up by the impulse of self-assertion, incorporated with the
sentiment of self-regard, and so made a permanent part of the central
personality.

Parents and teachers who try to "break a child's will" and to punish
every evidence of independence and self-assertion little know that
they are undermining the foundations of morality itself, and doing
their utmost to leave the child at the mercy of his chance whims and
emotions. There can be no strength of character without self-regard,
and self-regard is built on the instinctive desire of self-assertion.

=Education and Religion.= It is easy to see how important education is
in this process of giving the right content to the self-regarding
sentiment. The child trained to regard "temper" as a disgrace,
self-pity as a vice, over-sensitiveness as a sign of selfishness, and
all forms of exaggerated emotionalism as a token of weakness, has
acquired a powerful weapon against temptation in later life.
Indulgence in any of these forms of gratification he will regard as
unworthy and out of keeping with his personality.

It is easy, too, to see how central a place a vital religious faith
has in enriching and ennobling the ego-ideal, and in giving it
driving-power. A force which makes a high ideal seem both imperative
and possible of achievement could hardly fail to be a deciding factor.
Every student of human nature knows in how many countless lives the
Christian religion has made all the difference between mere good
intentions and the power to realize those intentions; how many times
it has furnished the motive power which nothing else seemed able to
supply. Moral sentiments which have been merely sentiments become,
through the magic of a new faith, incorporated into conscience and
endowed with new power.

Just here lies the value of any great love, or any intense devotion to
a cause. As Royce says: "To have a conscience, then, is to have a
cause; to unify your life by means of an ideal determined by this
cause, and to compare this ideal and the life."[67]

[Footnote 67: Royce: _Philosophy of Loyalty_, p. 175.]

=Avoiding the Strain.= It seems that a human being is to a large
extent controlled by will, and that will is in itself the highest kind
of choice. But too often will is crippled because it does not speak
for the whole personality. Knowledge helps a person to relate
conscience with hitherto hidden parts of himself, to assert his will,
and to choose only those emotions and outlets which the connected-up,
the unified personality wants. Sometimes, indeed, a little knowledge
makes the exercise of the will power unnecessary. Using will power
is, after all, likely to be a strenuous business. It implies the
presence of conflict, and the strain of defeating the desire which has
to be denied.[68] Why struggle to subdue emotional bad habits when a
little insight dispels the desire back of them, and makes them melt
away as if by magic? For example, why use our will to keep down fear
or anger when a little understanding dissipates these emotions without
effort?

[Footnote 68: Freud: _Introduction to Psychoanalysis_, p. 42.]

Whatever we do with difficulty we are not doing well. When it requires
effort to do our duty this means that a great part of us does not want
to do it. When we get rid of our hidden resistances we work with ease.
As a strong wind, applied in the right way, drives the ship without
effort, just so the forces in our lives, if they are adjusted to one
another, will without strain or stress easily and naturally work
together to carry us in the direction we have chosen. When we get rid
of blind conflicts, even the business of ruling our spirits becomes
feasible.


SUMMARY

=Various "Sprees."= The human animal has a constitutional dislike for
dullness and will seize upon almost any device which promises to lift
him out of what he considers the monotony of daily grind. An elaborate
essay might be written on the means which human beings have taken to
create the sense of _aliveness_ which they so much crave. Some of
them--we call them savages--have found satisfactory certain wild
orgies in primitive war-dances; others--we shall soon call them "out
of date"--have found simpler a bottle of whisky or a glass of
champagne; still others find a cold shower more invigorating, or a
brisk walk or a good stiff job which sets them aglow with the sense of
accomplishment. But there are always those who, for one reason or
another, find most satisfactory of all a chronic emotional tippling,
or a good old-fashioned emotional spree. Persons who would be shocked
at the idea of whisky or champagne allow themselves this other kind of
indulgence without in the least knowing why.

Nor is the connection between alcoholism and emotionalism so
far-fetched as it seems. Psycho-analytic investigations have
repeatedly revealed the fact that both are indulged in because they
remove inhibitions, give vent to repressed desires, and bring a sense
of life and power which has somehow been lost in the normal living.
Both kinds of spree are followed by the inevitable "morning after"
with its proverbial headache, remorse, and vows of repentance but
despite all this, both are clung to because the satisfaction they
bring is too deep to be easily relinquished.

Whenever an emotion quite out of keeping with conscious desire is
allowed to become habitual, we may know that it is being chosen by a
part of the personality which needs to be uncovered and squarely
faced. Nervous symptoms and exaggerated emotionalism are alike
evidence of the fact that the wrong part of us is doing the choosing
and that the will needs to be enlightened on what is taking place in
the outer edge of its domain. In the choice between emotionalism and
equanimity, the selection of the former can only be in response to
unrecognized desire.

A nervous person is invariably an emotional person, and as a rule lays
the blame for his condition upon past experiences. But experience is
what happens to us _plus_ the way we take it. We cannot always ward
off the blow, but we can decide upon our reaction. "Even if the
conduct of others has been the cause of our emotion, it is really we
ourselves who have created it by the way in which we have
reacted."[69]

[Footnote 69: DuBois: _Psychic Treatment of Nervous Disorders_, p.
155.]

    One ship drives east, another drives west,
    While the self-same breezes blow;
    'Tis the set of the sail, and not the gale
    That bids them where to go.
    Like the winds of the sea are the ways of fate,
    As we journey along through life;
    'Tis the set of the soul that decides the goal,
    And not the calm or the strife.
    REBECCA R. WILLIAMS.



CHAPTER XVI

_In which we find new use for our steam_

FINDING VENT IN SUBLIMATION

THE RE-DIRECTION OF ENERGY


A child pent up on a rainy day is a troublesome child. His energy
keeps piling up, but there is no opportunity for him to expend it. The
nervous person is just such a pent-up child. A portion of his
personality is developing steam which goes astray in its search for
vent; this portion is found to be the psychic side of his sex-life.
Something has blocked the satisfactory achievement of instinctive ends
and turned his interest in on himself.

Perhaps he does not come into complete psychic satisfaction of his
love-life because his wife is out of sympathy or is held back by her
own childish repressions. Perhaps his love-instinct is baffled by
finding itself thwarted in its purpose of creating children,
restrained by the social ban and the desire for a luxurious standard
of living. Perhaps he is jealous of his chief, or of an older
relative whose business stride he cannot equal.

Jung has pointed out how frequently introversion or turning in of the
life-force is brought about by the painfulness of present reality and
by the lack of the power of adaptation to things as they are. But this
lack always has its roots in childhood. The woman who is shocked at
the thought of sex is the little girl who reacted too strongly to
early impressions. The man of forty who is disgruntled because he is
not made manager of a business created by others is the little boy who
was jealous of his father and wanted to usurp his place of power. The
man who suffers from a sense of inferiority because his friend has a
handsomer or more intellectual wife is the same little boy who strove
with his father for possession of the mother, the most desired object
in his childish environment. The measure of escape from these childish
attitudes means the measure of success in life.

Fortunately for society, the average person achieves this success. The
normal person in his childhood learned how to switch the energy of his
primitive desires into channels approved by society. Stored away in
his subconscious, this acquired faculty carries him without conscious
effort through all the necessary adjustments in maturity. The nervous
person, less well equipped in childhood, may fortunately acquire the
faculty in all its completeness, although at the cost of genuine
effort and patient self-study.

=Sublimation the Key Word.= In the prevention and in the cure of
nervous disorders there is one factor of central importance, and that
factor is sublimation--or the freeing of sex-energy for socially
useful, non-sexual ends. To sublimate is to find vent for oneself and
to serve society as well; for sublimation opens up new channels for
pent-up energy, utilizing all the surplus of the sex-instinct in
substitute activities. When the dynamic of this impulse is turned
outward, not inward, it proves to be one of man's greatest
possessions, a valuable contribution of energy to creative activities
and personal relationships of every kind.

=The Failure to Sublimate.= A neurosis is nonconstructive use of one's
surplus steam. The trouble with a nervous person is that his
love-force is turned in on himself instead of out into the world of
reality. This is what his friends mean when they say that he is
self-absorbed; and this is what the psychologists mean when they say
that a neurotic is introverted. A person, in so far as he is nervous,
does not see other people at all--that is, he does not see them as
real persons, but only as auditors who may be made to listen to the
tale of his woes. His own problems loom so large that he becomes
especially afflicted with what Cabot calls "the sin of impersonality";
or to use President King's words, he lacks that "reverence for
personality" which enables one to see people vividly as real persons
and not as street-car conductors or servants or merely as members of
one's family. To be sure, many a so-called normal individual is
afflicted with this same kind of blindness; here as elsewhere the
neurotic simply exaggerates. Engrossed in his own mental conflicts and
physical symptoms, he is likely to find his interest withdrawing more
and more from other people and centering upon himself.

=Sublimation and Religion.= We do not need psychology to tell us that
engrossment in self is a disastrous condition. When the psycho-analyst
says that the life-force must be turned out, not in, he is approaching
from a new angle the truth as it is found in the gospel,--"Thou shalt
love the Lord thy God with all thy heart," and "thy neighbor as
thyself." Religion provides the love-object in the Creator; altruism
provides it in the "neighbor." Christianity and psychology agree that
as soon as love ceases to be an outgoing force, just so soon does the
individual become an incomplete and disrupted personality.[70]

[Footnote 70: For emphasis on religion as a means to sublimation, see
Freud, Putnam, Pfister, James, and DuBois.]

=Carlyle's Doctrine of Work.= "Produce! produce! produce!" Life for a
social being involves not only rich personal relationships, but
absorbing, creative work. No nervous person is cured until he is
willing to take and to keep a "man-size job." A good piece of work is
not only the sign of a cure; it is the final step without which no
cure is complete.

=Along Nature's Lines.= If the psychologist is asked what kind of task
this is to be, he answers that each person must decide for himself his
own life-work. An individual may not know why, but he does know that
there are certain things which he most likes to do. Sublimation is
more readily accomplished if his energy is directed toward self-chosen
interests. Parents or teachers or physicians who try to force another
person into any definite plan of action are making a grievous blunder.
Help may be given toward self-knowledge and the understanding of
general principles, but advice should never be specific.

Taken in the large, it is found that men and women choose different
ways of sublimation. Man and woman differ in the psychic components of
the sex-life even as they differ in the physical. Sublimation to be
successful must follow the lines laid down by nature. The urge of the
average man is toward construction, domination, mastery. The urge of
the average woman is toward mothering, protection, nurture. The
masculine characteristics find ready sublimation in a career; the man
builds bridges, digs canals, harnesses mountain streams, conquers
pests, overcomes gravity, brings the ends of the earth together by
"wireless" or by rail; he provides for the weak and the helpless--his
own progeny--or, incarnated in the body of a Hoover, he gives life to
the children of the world.

In woman, the dominant force is the nurturing instinct. Child and man
of her own come first, but when these are lacking, to paraphrase
Kipling, in default of closer ties, she is wedded to convictions;
Heaven help him who denies! Only as a career opens up full vent for
this nurturing instinct, will it provide satisfactory substitute in
sublimation. Its natural trend can be seen in the recent tidal wave of
social legislation--for prohibition, child-labor laws, sanitation,
recognition and control of venereal disease, acknowledgment of
paternity to the illegitimate child.

Since the women of the day, in numbers up to the million, have been
compelled to sacrifice both man and unformed babe to the grim
Juggernaut of war, this nurturing urge may press hard against many of
the social and business barriers now impeding its flow. But if society
understands and readjusts these barriers, making it possible for its
citizens--women as well as men--to approximate the natural instinctive
bent, it will not only save itself much unrest but will also go far
toward preventing the spread of nervous invalidism.


SUMMARY

That which a nervous invalid most needs is a redirection of energy.
Since, in spite of appearances, there is never any real lack of
energy, no time is needed for the making of strength, and a cure can
take place just as soon as the inner forces allow the energy to flow
out in the right direction. Sometimes, indeed, an outer change may
start the inner process. Often the "work cure" does cure; occasionally
the sudden necessity to earn one's living or to mother a little child
frees the life-force from its old preoccupation and forces it into
other channels. In most cases, however, the nervous invalid is
suffering not from lack of opportunities for outside interest but from
an inner inability to meet the opportunities which present themselves.
The great change that has to be made is not in external conditions and
habits but in the hidden corners of the mind; a change that can be
accomplished only by self-knowledge and re-education.

But if self-knowledge is the first step in any cure, so self-giving
must be the final step. Sooner or later in the life of every nervous
invalid there comes a time when nothing will serve to unify his
disorganized forces but steady and unswerving responsibility for a
good stiff piece of work. Happy for him that this is so and that he is
living in a day when science no longer tells him to fold his hands and
wait.



GLOSSARY


_Autonomic nervous system:_ The vegetative nervous system which
controls vital functions,--as digestion, respiration, circulation.

_Censor:_ A hypothetical faculty of the fore-conscious mind which
resists the emergence into consciousness of questionable desires.

_Common path:_ In physiology, the final route over which response is
made to physical stimulation; similarly in psychology, the one outlet
for the finally dominant impulse.

_Compensation:_ Exaggerated manifestation of one character-trend as a
defense against its opposite which is painfully repressed; relief in
substitute symptom formation.

_Complex:_ A group of ideas held together by emotion (usually
referring to a group which is wholly or in part unconscious).

_Compulsion:_ A persistent compelling impulse to perform some
seemingly unreasonable (but really substitute or symbolic) act, or to
hold some irrational fear or idea; an emotional force which has been
separated from the original idea.

_Conflict:_ (Special) Struggle between instincts (unconscious).

_Conversion:_ (Special) The process by which a repressed mental
complex expresses itself through a physical symptom.

_Displacement:_ 1. Transposition of an emotion from its original idea
to one more acceptable to the personality. 2. The shifting of
emphasis, in dreams, from essential to less significant elements.

_Dissociation:_ 1. The state of being shut out from taking active part
(applied to a group of ideas), as in normal forgetfulness. 2.
(Abnormal) An exaggerated degree of separation of groups of ideas,
with loss to the personality of the forces or memories which these
groups contain, as in double personality.

_Fixation:_ Establishment in childhood of over-strong habit-reactions.

_Free Association:_ A device for uncovering buried complexes by
letting the mind wander without conscious direction.

_Homo-sexual:_ The quality of being more attracted by an individual of
the same sex (abnormal) than by one of the opposite sex
(hetero-sexual, normal).

_Hysteria:_ That form of functional nervous disorder which manifests
itself in physical symptoms; an attempt to dramatize unconscious
repressed desires.

_Inhibition:_ Restraint (Special) limitation of function, physical or
ideational, due to unconscious emotional attitudes.

_Libido:_ Life-force, élan vital, or (restricted) the energy of the
sex-instinct.

_Neurosis:_ Used loosely for psycho-neurosis or nervous disorder.

_Obsession:_ A compulsive idea inaccessible to reason.

_Oedipus Complex:_ Over-strong bond between mother and son, or (more
loosely) between father and daughter.

_Over-determined:_ Used of an impulse made over-strong by lack of
discharge, with accumulation of emotional tension from added factors.

_Phobia:_ A persistent, unreasoning fear of some object or situation.

_Psycho-neurosis:_ "A perversion of normal (psychic) reactions,"
(Prince); a general term for functional dissociation of the
personality, resulting in: psychasthenia--disturbed ideation;
neurasthenia--disturbed emotions; hysteria--disturbed motor or sensory
activity.

_Psychotherapy:_ Treatment by psychic or mental measures.

_Rationalization:_ The process of substituting a plausible, false
explanation for a repressed, unconscious desire.

_Repression:_ Expulsion from consciousness of a pain-provoking mental
process.

_Resistance:_ The force which impedes the return of a repressed
complex to consciousness.

_Subconscious:_ That part of the mind of which one is unaware; the
storehouse of memories ancestral and personal.

_Sublimation:_ The act of freeing sex-energy from definitely sexual
aims; utilization of sex-energy for nonsexual ends.

_Suggestion:_ The process by which any idea, true or false, takes hold
of one; the idea may enter the mind consciously or unconsciously,
through reason or through impulse.

_Symbol:_ An object or an attitude which stands for an ides or a
quality; (Special) that which stands for or represents some
unconscious mental process.

_Threshold_ (door-sill): A figure which represents the level of the
barrier erected by the mind against the perception of an idea or
sensation.

_Transference:_ Unconscious identification of a present personal
relationship with an earlier one, with conveyance of the earlier
emotional attitudes (hostile or affectionate) to the present
relationship.



BIBLIOGRAPHY


BOOKS ON THE GENERAL LAWS OF BODY AND MIND

Cannon, Walter B: Bodily Changes in Pain, Hunger,
Fear and Rage.

Crile, George W.: The Origin and Nature of the Emotions.

Coe, George Albert: The Psychology of Religion.

Hudson, Thomas Jay: The Law of Psychic Phenomena.

Janet, Pierre: The Major Symptoms of Hysteria; The
Mental State of Hystericals.

James, William: Psychology; Talks to Teachers on Psychology;
Varieties of Religious Experience.

Jastrow, Joseph: The Subconscious.

Kempf, Edward J.: The Tonus of Autonomic Segments
in Psychopathology.

Long, Constance: Psychology of Fantasy.

McDougall, William: Social Psychology.

Mosher, Clelia Duel: Health and the Woman Movement.

Phillips, D. E.: Elementary Psychology.

Prince, Morton: The Unconscious; The Dissociation of
a Personality; My Life as a Dissociated Personality.

Sherrington, Charles L.: The Integrative Action of the
Nervous System.

Sidis, Boris: The Foundations of Normal and Abnormal
Psychology; Psychopathological Researches.

Tansley, A. G.: The New Psychology.

Thomson, William Hanna: Brain and Personality.

White, William A.: Principles of Mental Hygiene;
  The Mental Hygiene of Childhood.

Proceedings of the International Conference of Women Physicians.
(National Board, Y.W.C.A., 600 Lexington Avenue, New York City.)


BOOKS ON MENTAL HYGIENE

Brown, Charles R.: Faith and Health.

Bruce, H. Addington: Scientific Mental Healing.

Cabot, Richard: What Men Live By;
  Social Service and the Art of Healing.

DuBois, Paul: The Psychic Treatment of Nervous Disorders.

Huckel, Oliver: Mental Medicine.

James, William: Vital Reserves.

Prince, Morton, and others: Psychotherapeutics.

Sadler, William S.: The Physiology of Faith and Fear.

Worcester, Elwood    }
McComb, Samuel       }  Religion and Medicine.
Coriat, Isador H.    }


BOOKS ON PSYCHO-ANALYSIS

Brill, A. A.: Fundamentals of Psychoanalysis.

Emerson, L. E.: Nervousness.

Freud, Sigmund: The Interpretation of Dreams;
  The Psychopathology of Everyday Life;
  Wit and the Unconscious;
  Selected Papers and Sexual Theory;
  A General Introduction to Psychoanalysis.

Frink, H. W.: Morbid Fears and Compulsions.

Hitschmann, E.: Freud's Theories of the Neuroses.

Holt, E. B.: The Freudian Wish.

Jung, Carl G.: The Psychology of the Unconscious; Analytical
Psychology.

Jones, Ernest: Psycho-analysis; Treatment of the Neuroses, Including
Psychoneuroses--in Modern Treatment of Nervous and Mental
Diseases--White and Jelliffe.

Pfister, Oskar: The Psychoanalytic Method.

Putnam, James Jackson: Addresses on Psychoanalysis--Human
Motives.

Tridon, André: Psychoanalysis.

White, William A.: The Mechanisms of Character
Formation.


JOURNALS DEVOTED TO THE SUBJECT OF NERVOUS DISORDERS

Journal of Abnormal Psychology, published in Boston.

Psychoanalytic Review, published in Washington, D.C.

International Journal of Psychoanalysis, published in
London.



INDEX


A

Acid and Milk, 21, 257

Acidosis, 285

Adjustment
  a neurosis an effort at, 169
  to new conditions causes consciousness, 82
  of the race, in subconscious, 78
  to the social whole, 164, 216, 380

Adolescence, 59

Adrenal Secretion, 42, 48, 133, 229, 270

Alcoholism, relation to unconscious desires, 377

Alvarez, W.D., 284

Ames, Thaddeus Hoyt, 170

Amnesia, 113

Anaemia, buttermilk in, 282

Anger, 47 ff.

Anxiety and Fear, 366, 367, 368

Anxiety Neurosis, 7, 109

Anxious thought in conversion hysteria, 277

Appetite, symbolic loss of, 276

Association
  accidental, 341
  a chain of, 191
  free, 101, 191
  making new, 329, 330
  of ideas, 106
  subconscious, 346
  word test, 197, 198

Audience, secured in a neurosis, 169

Auto-eroticism, 57

Auto-intoxication, 279, 282

Automatic writing, 96, 97

Autonomic nervous system, 86, 126, 319

Auto-suggestion, 129, 210


B

Bacteria, in anaemia, sciatica, rheumatism, 281

Bashfulness, 46

Bergson, 90

Biliousness, 268

Birth-Theories, 158, 160, 161

Blocking, in word association, 198

Bodily Response to Emotional States, 134

Brain,
  diseased in insanity, sound in neurosis, 13
  fag, 125, 241
  records, 89

Bran fad, 291

Breuer, Joseph, 142

Brill, A.A., 58, 69, 201, 202

Bruce, H. Addington, 200, 201

Burrow, Trigant, 173, 203

Buttermilk in anaemia, 282


C

Cabot, Richard, 27, 381

Canfield, Dorothy, 231

Cannon, Walter B., 49, 134

Capitalizing an Illness, 170

Catechism, 247

Cathartics, 283
  and acidosis, 286
  and bacterial infection, 282
  and child birth, 285, 286
  and operations, 284

Causes of Nerves, 146, 164

Censor, psychic, 104, 195

Change of life, 314

Character and health, 24, 25, 362

Chemistry, 61, 190, 224, 225, 230, 247, 306, 315, 317, 324

Child,
  birth-theories of, 158
  father to the man, 90
  habit-fixation of, 150
  love-life, four periods 54, 55
  questions, 158
  too much bossing of, 154
  too much petting of, 57
  training, 160

Childhood,
  bonds too strong, 72
  determines future character, 91, 148
  experiences, 149
  reactions, 148

Choosing our Emotions, 360
  a neurosis, 122, 169, 216
  our Sensations, 339

Christian religion, 74, 374

Coe, George A., 71, 373

Colon, function of, 279, 280

Common Path, 52

Compensation, 168, 340

Complex,
  against marriage, 204
  and conditioned reflex, 108
  and personality, 105
  breaking up of, 109, 186
  buried, 187, 192, 197, 201, 202, 215
  chance signs of, 198
  definition, 107
  dissociated, 111
  emotional, 198, 345
  father-mother, 152
  feeling-tone of, 130
  formation of, 129
  forming a resistance, 159
  making over, 187, 190
  mother-son, 185
  physiological, 108
  repressed, 112, 157, 190
  unconscious, 108

Compromise, 163, 164, 165

Compulsion neuroses, 7, 109, 156

Conditioned reflex, 108

Conduct, kind of, 168, 191, 360

Conflict, 59, 64, 112, 145, 154, 164, 178, 200, 218, 313, 372, 376

Conscience, 164, 173, 177, 196, 376

Consciousness,
  displaced threshold of, 91
relation to the subconscious, 82
  rise of, 82

Constipation, 277 ff.
  and food, 289, 290
  cure of, 294
  due to suggestion, 294
  purpose of, 288

Conversion-hysteria, 174, 236, 237, 238, 245, 277, 302

Crile, George W., 41, 44

Curiosity,
  child's concerning sex, 58
  displacement over to scientific investigation, 45


D

Day-dreaming, 162, 325, 326

Defence-reaction, 365

Desire
  energy of, 78
  in dreams, 194
  in emotional habits, 364
  in nervous disorders, 167
  instinctive, 38
  instinctive and ideals, 363
  tensions of, 196

Diarrhoea, bacterial, 281

Dietetics, essence of, 254

Digestion, 86, 133, 250, 251

Disease,
  of the ego, 15
  physical, 12, 13, 28
  psychic, 12, 13, 14, 28

Disorders, functional and organic, 13

Displacement, 109, 110, 165, 174

Dissociation, 111
  abnormal, 189
  an example of, 92, 347
  in hypnosis, 123
  in hysteria, 111, 123
  in neurasthenia, 111
  increases suggestibility, 122
  normal, 111
  of a "Personality," 113
  of memory picture of walking, 125
  of power of sight, 170

Dreams, 193 ff.
  Freud's dictum, 193
  latent content, 195
  manifest content, 195
  purpose of, 195
  work of, 196

DuBois, Paul, 4, 127, 246, 327, 382


E

Education, 202, 218
  in Emotional Control, 374

Emotion, 35, 360 ff.
  and complexes, 108
  and fatigue, 229, 247
  and instincts, 40 ff.
  and muscle tone, 137
  blood-pressure in, 136
  bodily response to, 133
  feeling tones in, 130
  precocious, 150
  repressed (see repression)
  secretions in, 132
  the strongest cement, 107
  tonic and poisonous, 131
  unrecognized desire in, 364

Energy,
  adaptable, 67
  creative, 34, 69, 71
  inhibited, 235
  libido, 36, 252
  misdirected, 28, 379
  new level of, 221
  physiological reserve, 117
  redirection of, 385
  releasers of, 245
  three uses of, 23
  utilization of, 68, 165

"Energies of Men", 221

Environment, 33, 96, 149, 334

Evolution, 73

Exhaustion, nervous, 216, 224, 243, 246

Explanation vs Suggestion, 206 ff.


F

Fads-dynamogenic, 252

Faith, 118

Family complex, 153

Fatigue, 219 ff.
  a Matter of Chemistry, 225
  and insomnia, 326, 327
  and moral tension, 166
  and sex-repression, 235, 244
  true and false, 223

Fear, 40 ff.
  exaggerated, 368
  externalized, 368
  of cold, 348
  of fatigue, 219, 354
  of food, 133, 251
  of heat, 237
  of noise, 355
  physical effects of, 41
  purpose of, 41
  symbolic of desire, 368

Feeling our Feelings, 333 ff.

Feeling-tones, 130, 206, 213, 229

Fermentation, 264

Finding New Vents, 379

Fixation of Habits, 150, 151, 162

Flat-foot, 138

Food, 254 ff.
  and constipation, 289, 290
  for the children, 256
  idiosyncrasies, 258
  mixtures, 255
  variety essential, 255

Foreconscious, 79

Free Association, 101, 191, 195

Freud, Sigmund, 69, 74, 83, 84, 104, 142, 149, 153, 163, 185, 188, 193,
  210, 342, 376, 382

Freudian principles, 143, 144, 147
  misconceptions concerning, 184, 185

Frink, H.W., 89, 107, 158, 162, 171, 195, 218


G

Gall-stones, 269

Gas on the stomach, 264

Gastric juice, 86, 134

Gastritis, 266

Genius, 116

Girard-Mangin, Dr., 231

Goitre, 239


H

Habit,
  defined, 150
  dissociation, 189
  dreaming, 162
  fixation of, 150, 152
  of insomnia, 322
  of loving, 150, 164
  of rebelling, 150, 164
  of repressing normal instincts, 151
  reactions, 364

Heredity, 148

Hidden desires, 363, 368

Hinkle, Bertha M., 154

Holt, E.B., 213

Homosexuality, 184

Hoover, Herbert A., 384

Hormone, 305, 319

Hudson, J.W., 91, 95

Hydrochloric Acid, 267

Hygiene,
  laws of, 127
  moral, 206

Hygienic conditions, 222, 230

Hypersensitiveness, 342

Hypnosis, 84 ff.
  aid to diagnosis, 187
  its drawbacks, 188
  suggestibility in, 189

Hysteria, 7, 111

Hysterical pains, 353

Hysterical pregnancy, (case), 127


I

Ideas,
  and emotions, 23
  ascetic, 253
  contagion of, 120
  dynamogenic, 253
  not surgical, 262

Idiosyncrasies, physical, 258

Identification, 110

Imagination, 162

Incantation, 211

Indigestion; 211, 250

Inferiority complex, 340, 380

Inhibition, 188, 245, 293, 306, 330, 377

Insomnia, 322 ff.

Instincts and their Emotions, 33 ff., 51 ff.

Instincts,
  beneficent, 85
  energy releasers, 233
  race-inheritance, 85
  repressed, 28, 103, 147, 169, 172
  sex (see under sex)
  thwarted, 235, 244, 340, 356, 367, 379

Internal Secretion,
  of ovary, 316, 317
  (see Adrenal)
  (see Thyroid)

Introspection, 26

Introversion, 380, 381


J

James, William, 49, 221, 227, 243, 253, 347, 382

Janet, Pierre, 188

Jealousy, 154, 380

Jelliffe, Smith Ely, 98, 114, 153, 163

Jones, Ernest, 69

Judicious neglect, 127

Jung, C.G., 8, 64, 69, 163, 197, 380


K

Kempf, Edward J., 86

Kinaesthetic sensations, 336


L

Latency period, 60

Libido, 36, 147, 252

Liver trouble, 268


M

Masturbation, 184

McDougall, Wm., 49, 122, 372

Memories, 84 ff.

Menopause, 314

Menstruation, 306

Mind (see Consciousness and Subconscious)

Misconceptions,
  about the body, 21, 22
  about theory of sex, 184

Mixtures, fear of, 257

Monogamy, 63

Moral hygiene, 206

Mosher, Clelia Duel, 308

Muscle-tone, 137, 244

Myth, 146


N

Narcissus, 55, 152, 340

Nausea, 101, 177, 275
  of pregnancy, 319

Nerves,
  attitude toward, 3
  causes of, 28, 148
  drama of, 10, 29
  medical schools and, 16
  not physical, 14
  prevention of, 385

Neurasthenia, 111, 246

Neuritis, 14, 244

Neurosis,
  a compromise, 167
  a confidence game, 179
  a failure of sublimation, 381
  a flight from reality, 170
  an ethical struggle, 177
  an introversion, 381
  and shell-shock, 147
  and suggestion, 129
  anxiety, 7, 109
  awkwardness of, 213
  compulsion, 109
  caused by buried complexes, 108, 190
  definition 112
  origin in childhood, 149, 157, 217
  purpose of, 167
  root-complex of, 153


O

Obsession, 7, 204

Oedipus Complex, 154

Organic trouble, 11, 12, 251

Ouija Board, 97

Over-awareness, 352

Over-compensation, 67

Over-determined, 148


P

Pain,
  at base of the brain, 351
  chronic hysterical, 341
  menstrual, 306

Personality,
  alterations of, 7, 15, 20
  and emotions, 362, 369
  and will, 372
  choice by, 216
  complexes and, 107
  disrupted, 382
  multiple, 111, 131
  nervousness a disorder of, 15
  reverence for, 383
  unified, 375

Persuasion, 206

Pfister, Oskar, 153, 166, 382

Phantasy, 153, 163

Phobia, 7, 368

Plagiarism, 98

Popular Misconceptions, 21

Prince, Morton, 79, 84, 89, 95, 97, 112, 132, 188, 347

Psycho-analysis, 189 ff.

Psychological explanation, 208

Psychology, 25, 27, 94

Psycho-neurosis, 144, 147, 163, 169 (see also neurosis)

Psycho-therapy, 74, 187, 216

Ptosis, 139, 251

Putnam, James J., 3, 34, 69, 215, 366, 370, 382


R

Race-memories, 84

Rationalization, 90, 155, 168, 317

Reaction and over-reaction, 149, 198, 202, 238, 335

Reality, flight from, 164, 379

Re-education, 183 ff.

Reflex,
  conditioned, 108
  physiological, 349

Regression to infantile state, 163, 164
  case of, 92

Religion, 74, 89, 374, 382

Reminiscences, hysteric suffers from, 7

Repression, 104, 156, 160, 162, 235, 245, 304

Resistance, 160, 188, 192, 202, 211

Rest-cure, 246

Rheumatism, buttermilk treatment of, 282

Rixford, Emmet L., 283

Royce, Josiah, 375


S

Sadler, Wm., 126, 136

School, four grade, 54

Second wind, 221

Self-abuse, 184, 238

Self-pity, 365

Self-regard, 45, 103, 157, 374

Sensations, lowered threshold to, 333 ff.

Sensitiveness, 333, 340

Sex,
  and artistic creation, 379
  and "Nerves," 141 ff.
  glands, secretion of, 305, 314, 316
instinct organically aroused, 65
  instinct thwarted, 161, 367, 379
  instruction, 160
  license, 184
  life, 143, 146, 157
  perversion, 152
  phantasy, 163
  psychic component of, 185, 356, 379, 383
  repressed, 104
  sublimation of, 233, 379

Shell-shock, (see foreword)
  also 145, 147

Sherrington, Chas., 39

Sick-headache, 270

Sidis, Boris, 24, 84, 188, 222, 337, 341

Slips of tongue, etc., 199

Slogan,
  of psychoanalytic school, 215
  woman's, 314

Social code, 184

Soda, misuse of, 266

"Sour-stomach," 260, 266

Sprees, 376

Stammering, 200

Standard,
  double, 66
  single, 62

Stomach, 133
  and conversion hysteria, 250 ff.
  fads, 252
  gas on, 252

Subconscious mind, 77 ff.
  amenable to control by suggestion, emotion, 119
  functions of, 85, 335, 337
  habits of, 105, 259
  physical expression of, 245
  playing confidence game, 311
  store-house of memories, 84, 89
  tireless, 325

Sublimation, 379 ff.
  a synthesis, 164
  and religion, 74, 382
  definition (Freud), 69, 70
  failure of, 71, 147, 381
  in a career, 385
  in artistic creation, 68
  natural trends of, 383
  of energy, 178, 238, 309

Success, measure of, 380

Sugar in urine, 133

Suggestion,
  a method of psychotherapy, 208
  constipation the result of, 289, 298
  definition, 121
  false, 302
  in child training, 121
  in hypnosis, 99, 188
  in sleep, 99
  inconvenient forms of, 296
  power of, 45
  unhealthy, 310

Suggestibility, 122, 189, 206

Superman, 339

Symbolism, 171, 176, 275, 342

Symptoms, purpose of, 168


T

Taboos,
  dietary, 250 ff.
  interest in, 289

Tensions, psychic, 69, 85, 353, 366

Thresholds, psychic, 337 ff.

Thyroid secretion, 42, 133, 185, 270

Transference, 109, 193, 264

Trotter, W., 46


U

Unconscious, (see subconscious)


V

Venereal disease, 304, 317

Vitamins, 255


W

White, Wm. A., 69, 82, 83, 98

Will, 371

Williams, Tom A., 21, 213

Wish fulfilment, 171, 194, 200, 214

Word-association test, 197

Work-cure, 385



ILLUSTRATIONS FROM CASES


A

Adolescence and depression, 312, 313

Anger and circulation, 136

Angina pectoris, false, 129

Anxiety-neurosis, 175


B

Bearing children, 318

Brain fag, 241

Bran crackers and prunes, 258


C

Cathartics, abuse of, 284

Childhood sex-reactions, 203

Constipation and lacerations in labor, 296

Constipation and Mineral Oil, 295

Constipation, recovery from, (some cases), 294

Contamination, fear of, 159

Conversion of moral distress to physical, 348


D

Danger-signals and the railroad man, 344

Dissociated state, memories in, 92


E

Emotion and sick-headache, 273

"Enjoying" poor health, 213, 345

"Exhaustion," 243

Eye-strain, twenty-five years, 274


F

Fatigue, 228, 234, (two cases), 239

Fatigue and emotion, (three cases), 354

Fear, 237,
  of heat, 237

Fear of air, 348, 349

Fear of cold, (three cases), 348, 349

Fear of light, (two cases), 350

Fear complicating labor, 320

"Flat-foot," 137

Forgetting and repressed wish, 200

Free-love, chemical cause of, 317


G

Gall-stones, 269


I

Idiosyncrasy for eggs, 212

Insomnia and attention, 329

Insomnia and point of view, 328

Insomnia and wrong associations, 330

Insomnia, chronic, 328


L

Library, child fear of, 100

Locomotor Ataxia, exaggeration of symptoms, 128


M

Menstrual pain, unnecessary, 220

Muscle-tumors, phantom, 127, 128


N

Nausea, in sex-repression, 101, 177

Nervous indigestion, 211

"Neuritis," 174,
  false, 244

Noise, fear of, 355


O

Obsession against marriage, 204


P

Paralysis, fear of, 345, 346

Physical illness mistaken for functional, 252

Plagiarism, 98


R

Recovering lost word, 80

Repression and disgust, 199


S

Sick-headache, 271, 274

Skim-milk diet, 262

"Sour stomach" and two Tyrolese, 260

T

Temper, an indulgence, 359

The "Repeater" gains in weight, 263

Thyroid disturbance, fatigue in, 239, 240


U

Unconscious Association and symptoms, 346


W

Walking, lost power of, 124

Word Association test, 198


Transcriber's Notes

The following typographical errors were noted and corrected:

On page 146 of the book: Heading changed from "A Searching Queston"
  to "A Searching Question".
On page 152, "Narcisstic" changed to "Narcissistic".
On page 276, "..the nausea disappearaed." changed to "disappeared".
On page 294, "...Nature's functions re reëstablished" changed to "be".
On page 302, "...nor even of man's infringment..." changed to
  "infringement".
On page 330, "I put my mouth up close to to her ear...", removed the
  duplicate "to".
On page 346, for the paragraph starting "But these symptoms...",
  "disappeaared" changed to "disappeared".
In the Index, page 401, "Thesholds" changed to "Thresholds".





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