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.
[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.
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.
[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]
[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]
[61] Ibid, p. 43.
[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."