“never shrink from telling a doctor what is the matter with us merely through the fear that he will hurt us. We let him do his worst upon us and stand it without a murmur, because we are not scouted for being ill, and because we know that the doctor is doing his best to cure us and that he can judge our case better than we can; but we should conceal all illness if we were treated as the Erewhonians are when they have anything the matter with them; we should do the same as with moral and intellectual diseases—we should feign health with the most consummate art till we were found out....”
This convention inevitably influences the “straightener’s” attitude towards his patients, as we are told by the traveller in a description of an interview between his host and an Erewhonian doctor:—
“I was struck with the delicacy with which he avoided even the remotest semblance of inquiry after the physical well-being of his patient, though there was a certain yellowness about my host’s eyes which argued a bilious habit of body. To have taken notice of this would have been a gross breach of professional etiquette. I was told, however, that a straightener sometimes thinks it right to glance at the possibility of some slight physical disorder if he finds it important in order to assist him in his diagnosis; but the answers which he gets are generally untrue or evasive, and he forms his own conclusions upon the matter as well as he can. Sensible men have been known to say that the straightener should in strict confidence be told of every physical ailment that is likely to bear upon the case, but people are naturally shy of doing this, for they do not like lowering themselves in the opinion of the straightener, and his ignorance of medical science is supreme. I heard of one lady, indeed, who had the hardihood to confess that a furious outbreak of ill-humour and extravagant fancies for which she was seeking advice was possibly the result of indisposition. ‘You should resist that,’ said the straightener, in a kind, yet grave voice, ‘we can do nothing for the bodies of our patients; such matters are beyond our province, and I desire that I may hear no further particulars.’ The lady burst into tears and promised faithfully that she would never be unwell again.”
FOOTNOTES:
[50] Hart, op. cit., p. 7.
[51] Cf. Dr. Bedford Pierce’s statement, (op. cit., p. 43), “I have met persons otherwise level-headed who cannot be persuaded to enter the grounds of an asylum. Not infrequently all sorts of excuses are made to escape the duty of visiting a relative who is under care, and so real is the danger of neglect that the State has decreed that no order for reception shall be granted without an undertaking that the patient shall be visited at least every six months.”
[52] p. 5. The italics are ours.
[53] pp. 77 and 78.
[54] We have in mind throughout the discussion, not the richer members of the community, for whom a relatively expensive holiday or period spent in the nursing home is easily possible, but the great majority of the public, to whom even the ordinary doctor’s bill may be a source of financial embarrassment for months or years.
[55] R. G. Rows, Journal of Mental Science, January, 1912.
[56] pp. 77 and 78.
[57] Analytic Psychology, London, 1916, p. 318.
[58] “Everybody agrees,” say Déjerine and Gauckler (op. cit., p. 214f), “that neurasthenia is a neurosis, i.e., a nervous disease without any known lesions.... Neurasthenia is due wholly to psychological factors which are essentially, if not exclusively determined by emotion.” They then proceed to compare the “materialistic” theories of neurasthenia, showing that they are all still merely speculative.
[59] Cf. pp. 19 et seq.
[60] Cf. Déjerine and Gauckler, op. cit., p. 214f.
[61] As Professor Kraepelin says, “Nervenkranker sind Geisteskranker” (“Those ‘suffering from nerves’ are sick in spirit.”).
[62] The reader should consult Mr. W. McDougall’s excellent treatment of this subject in his Introduction to Social Psychology—especially pp. 45-89.
[63] The remarks of Mr. George Bernard Shaw on Max Nordau’s “Degeneration” (The Sanity of Art, especially p. 88) might be consulted in this connection.
[64] Cf. E. Régis, “Les Troubles Psychiques et Neuro-Psychiques de la Guerre,” Presse Médicale, 23, p. 177, May 27th, 1915.
[65] This term is derived from the Greek word for the womb. Hysteria was once thought to be due to the wanderings of the uterus about the body. The term well deserves its place beside that other ornament of psychological medicine—the word “lunacy.”
[66] The Diagnosis of Nervous Diseases, 3rd Edition, London, 1911, p. 355.
[67] Italics ours.
[68] p. 355.
[69] This was seen repeatedly in the treatment of the relatively uneducated soldiers who had become slightly neurasthenic as a result of the war, especially of those whose life had been spent in open-air manual work, or in the strict and healthy routine of the regular army. They complained of emotional irritability, minor lapses of memory such as the forgetting of relatively unimportant names or of errands, disturbed sleep, soon “getting fed up” with their amusements (e.g., “jig-saws,” or billiards for hours every day, month after month in a converted schoolroom or outhouse!). Not only did these phenomena disturb them, but in a great many cases they seemed to prove to these unfortunate men that they were insane, or rapidly becoming so. They would anxiously ask such questions as, “What is it that makes me so irritable at a slight noise, or at being brushed against by another patient? I used not to be like that.” Their conduct was also regarded as unusual by their companions. Now would not the head of a business firm, an over-worked medical man, a university professor or an army officer in a position of responsibility, confidently expect to be allowed ex-officio a certain number of these eccentricities without being called “diseased?” But let him drop the privileges and shelter of his rank, live for a few weeks as a private in a barracks with a number of high-spirited and thoroughly healthy soldiers and his behaviour might certainly be considered by them to be queer, if nothing worse.
[70] Reform of this state of affairs is urgently needed. The matter is of such fundamental and far-reaching importance that we have devoted part of the next chapter to the further consideration of its bearings.
[71] “Tough-minded,” “matter-mongers,” modern writers have called this type, contrasting it with that of the “tender-minded,” “reason-mongers.”
[72] Of a brilliant teacher of physiology, one who was himself intensely interested in the sciences bordering on his own subject, it was related that when, in lecturing upon the functions of the nervous system in man, he approached difficult problems, he used to say, “But that is a matter for the psychologist.” Whereupon the class heaved a sigh of relief and prepared to take notes upon the next subject.
[73] “... strong electric shocks, cold douches, and other decorous substitutes for a sound birching.” W. McDougall, Psychology, London, 1912.