An Unfulfilled Premonition.—There is an excellent story of a strong but unfulfilled premonition told by Carl Schurz in his "Recollections," which seems to me such a good antidote to the influence of supposed premonitions, that every physician should know its details for their psychotherapeutic value with patients prone to be troubled in this way. The ease with which the depression consequent upon the premonition was relieved as soon as another forcible suggestion that the danger was past took possession of him, shows how such states of mind can be altered with no more real reason for the alteration than there was for the original depression.
On the morning of the battle of Chancellorsville General Schurz awoke with the absolute persuasion that at last his time had come and he was to be killed that day. He had never had such a premonition before. He had heard of many cases in which such premonitions proved the forerunner of death. He realized how ridiculous was the idea that he should know anything about what the future held for him, even vaguely, and he tried to shake it off. He found it impossible to do so. He thought that after he took up the routine work of the day the force of the premonition would be lost. It was not, but, on the contrary, seemed to increase in power over him. Finally the idea became so imperative that he sat down and wrote letters of farewell to his wife and friends, telling them that he had been tempted to do so because of this premonition of danger. When he went into battle—and it may be recalled that the Eleventh Corps did some fighting at Chancellorsville that day—he was sure that now the end was not far off. It did not take away his courage, however, and though he was well in the zone of danger, he issued his orders and kept his troops well in hand as we know from the history of the battle.
Finally his aide-de-camp, riding toward the front of the line beside him, was killed by a cannon ball. All in an instant the thought came over him that this was the only danger that was likely to be near him for the day. The burden of premonition lifted from him as if the fact that a friend had been killed beside him gave him an assurance that he himself was not to be taken. There was absolutely no reason for his thinking so, but his feelings of solicitude with regard to himself and his fate faded completely and at once. He continued in the thick of the fight and of danger and was untouched. He himself called attention to the fact that if his premonition had come true, as well it might in the midst of the very serious danger which he faced, it would have seemed a strong confirmation of the impression that premonitions have a meaning other than that of coincidence. It was, however, a magnificent example of a failed premonition quite as striking as any of the stories that are told about premonitions that came true.
Rôle of Coincidence.—This must be remembered in many of our arguments in medical and other scientific matters. Most diseases are self-limited, therefore anything that is given as a remedy for them just about the time that nature has succeeded in conquering the virulence of the disease and bringing about the cure of the patient, seems to be curative. Such cures, often remedies of supposed wonderful potency, come and go in medicine by the hundred every ten years. Such curious doctrines as that of the influence of maternal impressions in producing deformities and defects in the unborn child are founded on nothing better than these coincidences. They are often very startling, but the rule by which they must be judged is the number of times in which in spite of similar conditions no premonition takes place. Literally thousands of people go to bed every night who are to be waked by the danger of fire before morning and yet have no premonition of it. Literally millions of people have gone to bed in recent years without any premonition of earthquake, yet have been wakened before morning with their houses tumbling around them. If a few people have premonitions in these cases it is easy to understand that it is coincidence and not anything else, for these are exceptions, and this again is a case of the exception proving the rule.
Premonitions and Superstitions—Thirteen.—Occasionally premonitions are connected with certain events that are themselves, even though happening quite accidentally, supposed to be portentous. How many people, for instance, feel quite uncomfortable if they sit down thirteen at a table. The very fact of the gathering of thirteen is supposed to be a spontaneous or automatic premonition that is a forewarning of evil that has to come to some of them. Unfortunately, this superstition continues to have a vogue and an influence over people's minds because stories are told that are supposed to confirm it. Needless to say, when these stories are true, they are merely coincidences. Out of any baker's dozen of people who sit down to dinner it is not surprising if one should die or be killed during the year. Some of the stories, however, are merely sensational inventions worked up to be given to the public because a number of people are interested in this sort of thing. Probably one of the stories that has gone the rounds most and that has served to confirm many people in their uneasiness over the number 13 is that which is told as happening to Matthew Arnold and some friends, supposedly the year the great English litterateur died.
The story runs that just as Mr. Arnold and his friends were about to sit down to the table it was discovered that there were thirteen present. According to the old tradition in the matter it is the one who first gets up from table under these circumstances that is likely to be affected by the malignant influence. When the end of the dinner had arrived, by previous arrangement Mr. Arnold and two very healthy friends, brothers, arose simultaneously. According to the widely diffused newspaper account of years afterward, Mr. Arnold himself died within the year and one of the brothers was lost in the wreck of an English passenger vessel off the coast of Australia in six months, while the other brother committed suicide before the end of the year. Careful investigation of the details has shown, however, that the story was made out of whole cloth. Mr. Arnold himself, who was suffering from heart trouble towards the end of his life, was not likely to take part in any such arrangement because of the constant danger, well-known to himself, of sudden death in his case. This might happen at any time and might seem to confirm the superstition. The dates of the story, moreover, are all wrong. Matthew Arnold's death and the loss of the English passenger vessel in Australian waters, referred to, do not occur within five years of each other. The story has gone round the world. The correction will never reach so far. The story is startling; the explanation commonplace. Many people will continue to believe that here, at least, was one striking confirmation of their superstition.
It is curious how the force of this "13" superstition has continued in spite of education and enlightenment. Most passenger vessels now built have no staterooms numbered thirteen. On certain streets in large cities one finds the number 12-1/2 (until this year it was so on my own) substituted for thirteen. Sometimes one finds "twelve a" or something similar. In the large hotels, where they have immense banquet halls with the tables numbered so that guests may be able to find their places, I have often noted that there was no table number thirteen. It is said that in some of the new skyscraper buildings twenty stories and more in height there has been question of skipping the thirteenth floor as a designation, because while most {640} people would be quite undisturbed about it, some do not care to have an office on the thirteenth floor, giving as an excuse that clients or patrons do not care to come to the thirteenth floor. In automobile races men are willing to risk their lives by going a hundred miles an hour on roads never intended for such performances, but they refuse to race behind the fell number thirteen. This, after all, can be readily understood. The slightest thing that takes away a man's complete confidence in himself may be serious in an automobile going as fast as these. Men must not think of fear or they lose some of their power and control over themselves and their machine. They must simply forget everything except the task before them.
The belief in the thirteen superstition is one form of acceptance of premonitions. That of itself should be enough to enable sensible people to throw them off. Above all, it must be remembered that such supposed malignant influence, when allowed to affect people, impairs their presence of mind and may thus lead up to the accident or mishap which it is supposed to foreshadow. This is the serious feature of such premonitions and dreads. Unless people can be persuaded sensibly to be rid of them they handicap themselves whenever they are placed in danger that causes them to recur to the thought of the premonition or dread. While there is absolutely nothing but coincidence in even the supposed true stories, and many of the stories are merely sensational inventions, yet people need to be persuaded to rid themselves of the incubus that settles over them because of such ideas.
Premonitions and Telepathy.—There are many people who think that premonitions have something to do with telepathy. Somehow the future event is supposed to be able to send some message to specially susceptible minds. Either that, of course, or there is some being in another world whose interest is sufficient to convey some inkling of the future. A little consideration of this subject, however, shows the utter lack of rationality in any such opinion. Future events, having as yet no existence, cannot in any way influence intelligence. Such future events, when dependent on human free will, are quite impossible of being foretold and, as has been said, no being except the Creator Himself knows anything about them. It would be only from Him, then, that information might be supposed to come and it would be hard to think such information would be so vague and indefinite as to leave room for doubt and, besides, often defeat its purpose of protection by seriously disturbing patients and lessening their presence of mind. There is no reasonable explanation by which a human being can be supposed to obtain knowledge of a future event unless there is a complete overturning of the ordinary laws of nature and then it would be reasonably supposed that no doubt of the significance of the event would be left.
Nearly all of us have premonitions that fail. Only a few especially introspective people who are constantly afraid of what will happen to them, and who are sure that the worst is always preparing for them, have their premonitions come true more than once or twice in life. The striking fulfillments of a few premonitions could be paralleled by an endless number of just as striking failures, only that most people dismiss the idea completely from their minds as too foolish to be further talked about. It is quite the same with dreams. All the world dreams and there would be a serious violation of the theory of probabilities if some dreams did not come true. The great {641} majority of mankind, especially after the age of thirty, is fearful lest something ill is going to happen to them and their premonitions are rather frequent. If some of these did not come true then the mathematics of coincidences as based on the theory of probabilities would prove false.
Fits of periodical depression, familiarly known as "the blues," occur in the experience of practically everyone. In some people they are only slight and passing. In others they last for hours and make the individual quite miserable. In still others, without actually running into melancholia, they produce serious discouragement and continuous discomfort which persists even for days and makes life intolerable. They come and go quite unaccountably. During their occurrence all vitality is lowered, appetite lessened, aches and pains are emphasized, sleep may be disturbed, exercise becomes distasteful, and they usually present an interval when health is at a low ebb. Ordinarily when described as "the blues" they have no definite connection with any known physical cause. They are passing incidents which seem to recur at irregular intervals. When connected with physical ills they are thought of directly as symptoms of these ills. All forms of disease may be associated with such fits of depression and many physical symptoms seem to be due to the fact that during these periods there is a distinct lowering of physical vitality so that the nerve impulses which ordinarily enable functions to be performed without interference are interrupted, or at least are inhibited, to a noteworthy degree. While to a certain extent the condition is a mental disease, it may be modified by the correction of physical derangements, by stimulation and, above all, by suggestion and a change in the point of view.
Serious Pathological Conditions.—Of course, such periodical fits of depression are associated with various serious progressive ailments and then are primarily physical, and are only secondarily psychic. From the standpoint of psychotherapy it is important to remember that certain serious organic lesions may show their first signs in the patient's mental state. It is not unusual, for instance, for the disposition of a patient suffering from kidney disease to change so materially that the attention of friends is called to the change before any physical symptom of the nephritis has been noted. Sometimes for a year there will be a progressive clouding of what had previously been a rather happy disposition. Decisions will be made more slowly than before. The judgment will be impaired. There are some striking examples of this in history, of which the unfortunate Athenian general, Nicias, put to death for incapacity that was undoubtedly pathological, is one. Pleasures will be taken half-heartedly; men who have been bright and jovial will now become saturnine. Men who have been the life of parties will try to hold the place they acquired before, though all around them will perceive how difficult it is for them to maintain the role they have set for themselves. Whenever there is a notable change in disposition, it is well not to attribute it to some passing mental condition and, above all, not to dismiss {642} it as a peculiarity unamenable to treatment, but to look for the underlying pathological basis of the new condition.
In this way physical disease will sometimes be discovered long before it otherwise would be. This must be particularly noted when there have been a series of worries. Occasionally it seems enough to many people to ascribe a change of disposition to the troubles that have come over a patient. If a business man fails or passes through a crisis in his affairs in which failure is very near, or he has many business worries over a prolonged period, these are sometimes thought to be quite enough to explain a change of disposition. They are, but not to the degree that is often noted, for, in excess, melancholic tendencies are always pathological, that is, they have some basis in a serious mental or physical change. If there is an insidious nephritis already at work, its symptoms will be much exaggerated and its progress accelerated by the worries and disquietude of such a time. If a wife loses her husband, or an only son, or a favorite child, the occurrence of a prolonged period of depression should lead to a careful investigation of physical conditions and of the underlying mental state in the hope of guarding against serious developments.
Heart Disease.—Periods of depression are also common in heart disease and are often the first symptom of the beginning of a break in compensation. This effect is not so simple and direct, however, as in the case of the kidneys. Probably the first physical symptom of a break in compensation, where there is real valvular heart disease, is a decrease in the amount of urine. This points to an insufficient elimination of the products of metabolism and to the retention in the circulation of toxic substances. The reason for this is the lessened circulation through the kidneys because of the diseased heart. There is also a lessened circulation through the brain. This impairs the function of the brain and quite naturally leads to mental depression, slowness of decision, and unwillingness to occupy one's self with many things. Besides, because of the lessened function of the kidney the circulating blood not only does not nourish so well but it tends still further to depress the brain cells by the toxic substances that are in it. Depression in such cases is rather to be expected and at the beginning is not continuous but comes in ever longer periods with shortening intervals as the disturbance of the circulation progresses. At first, like other diminutions of function, it is conservative in order to spare the heart work.
Respiratory Affections.—Very curiously an affection of the lungs has exactly the opposite effect and is likely to create in the patient an artificial sense of well-being. Spes phthisica, the characteristic hope of consumptive patients, is well known, and has been described by many a careful observer from Hippocrates and Galen to our own time. A lessened amount of oxygen in the blood produces a certain sleepiness, but this seems to be preceded by a period of slight excitation. The most familiar example of this occurs at the beginning of the inhalation of laughing gas. Practically the only direct physical effect of the inhalation of nitrous-dioxide is to shut off our oxygen and it is a slight period of deoxygenation that produces the anesthesia by this agent. Whether we have not in this the explanation of the feeling of the consumptive, so that often on the day before his death he plans a number of things that he is going to do next year, may require more careful {643} investigation, but the suggestion may serve to show how much disposition, both lively and serious, depends on physical factors as well as on the natural state of mind.
Quite apart from these serious ailments, however, there are passing phases of depression that come to nearly everyone after adult life is reached that are likely to be somewhat more frequent as years go on, but that are not entirely unknown even in early years. They are more likely to come to those who feel that life has been somewhat of a failure and that they have accomplished very little in spite of all that they have tried to do. Not infrequently they come, however, to those who in the estimation of other people have made a magnificent success of life. The rich man, after he has made his fortune, unless he continues to engross himself with some time-taking and interest-claiming work, may be the subject of repeated attacks of mental depression. Social leaders among women who begin to feel something of the emptiness of social striving, after they have made what is called a success in society and at the time when they are the envy of many on the social ladder below them, are particularly likely to be subject to attacks of "the blues." The only men and women who are free from them to a great extent, and even they not absolutely, are those who are busily engaged with some occupation not entirely selfish in which they can see that what they are doing is accomplishing something for the people around them.
Very often an attack of depression is ushered in by some small disappointment. As a rule, however, this is not the causative factor but is only an occasion which makes manifest the depressed state that has existed for some time and that now declares itself openly. In the same way only a slight occasion is necessary apparently to dispel clouds that hang over a person in the milder attacks of depression, because, for some time before, relief has been preparing itself and a livelier phase of existence has been gradually coming on. Relief can be promised with absolute assurance, but freedom from relapse cannot be assured and the only true source of consolation that is helpful is the frank recognition of the fact that these are successive phases of existence quite as likely to be periodic as certain physical facts in life. Depression is likely to be a little more manifest in the morning than at other times, partly because the interests of the day have not yet come to occupy the mind, but mainly because the physical life as indicated by the pulse and the temperature is lower during the morning hours than in the afternoon and evening. Just as soon as people realize the physical nature of certain dispositional changes they give much less depressive significance to them.
Occupation of Mind.—The most important feature of the treatment of depression of mind is to secure somehow such occupation as will catch the attention and arouse the interest. This is not always an easy matter. How effective it is, however, can be best judged from what one notes of the effect of such things as physical pain or great solicitude for someone else besides themselves. I have known a mother, whose fits of "the blues" were getting deeper and the intervals growing shorter to be roused from her condition when all means had failed by the elopement of a daughter who had been partly pushed into leaving because things had become so unpleasant around home {644} during her mother's depression, and any change seemed welcome. On the other hand, I had a doctor friend who felt quite alarmed about his growing depression and who even had some fears lest, if it continued to deepen, he might commit suicide. He was completely lifted out of his increasing depression by the occurrence of pneumonia in his boy of sixteen. The pneumonia did not end by crisis but by lysis and for weeks he had very little sleep. He confessed that the intense preoccupation of mind had completely driven away his blues and had even done much to relieve him of various digestive symptoms to which he had previously attributed his depression.
Again and again I have known men who, in the midst of prosperity, found life dull and rather hard to bear, and who just as soon as a crisis in their affairs compelled them to pay attention to other things than themselves and the state of their feelings, grew better mentally and physically. It seems almost a contradiction in terms to say that it is the man of little occupation, as a rule, or at least of occupations that are not insistent, who is likely to be troubled with insomnia, while the very busy man, especially the man busy not about one or two narrow interests, but about a number, is seldom so bothered. Nothing contributes more to the depression of mind than loss of sleep or supposed loss of sleep. Even women who, while living in ease and comfort, had much to complain of as regards depression, often lose entirely their tendencies to "the blues" or have fits of them at much longer intervals, when necessity compels them either to earn their own living or, at least, to occupy themselves much more with absolutely necessary duties.
Provision of Occupation.—It is a hard matter to create such occupation of mind as will be satisfactory. Patients have to be tried by various suggestions. The tendency to periodic fits of depression deep enough to be called to the physician's attention is much more noticeable in recent years than it used to be, and seems to me at least to bear a corresponding ratio to the decrease of home life. Home duties usually mean joys and of late there has been a neglect of the joys of life while seeking its pleasures. Certain phases of city life are responsible for much dissatisfaction with existence and depression of spirits. Most of the women who live in apartment hotels have practically no serious occupation of mind. They need not get up if they do not feel quite right or quite rested—and who after the age of forty ever does feel quite all right in the morning hours unless sleep has been in the open air? Nothing is so likely to start a day of depression than failure to get up promptly, lounging around with forty winks here and there, reading in bed, and the like. If breakfast is taken in bed, then some reading indulged in, and then some sleeping, and only an hour or two of dawdling around comes before lunch, that meal is not properly enjoyed and the afternoon is started badly; unless there is some special diversion of mind depression is almost sure to get the upper hand.
Place of Children in Psychotherapy.—Where there are children the interests are much more urgent and there is little time for such preoccupation with self as gives one "that tired feeling." We are very interesting to ourselves, but just as soon as we have no other subject to occupy us than ourselves we soon grow very tired of the subject. Children are the best interest that one can think of, for women particularly. When they have none of their own an interest in orphan asylums, in day nurseries, in various children's {645} institutions, and, above all, in the adoption of a child, will do more than anything else to relieve the tendency to blues. Of late years the adoption of children has been much less frequent than used to be the case in childless families, and doctors see the result in mental depression. Children are a great care, but they are a great blessing to women, and while the present trend of social life eliminates them as far as possible, this elimination, beginning with their relegation to nurses when they are infants, to nursemaids as they grow a little older, and then to the kindergarten up to six years of age, far from adding to comfort rather increases the discomfort of many mothers. Nature takes her revenge. The reason why the mothers of past generations could stand the suffering that they must have borne with patience before gynecology developed to relieve them, was that they had their children around them, and their minds and their hearts and their hands were so full that they had no time to think of themselves, to brood over their ills, and consequently these troubled them much less than would otherwise have been the case.
Delicate mothers really interested in their children undoubtedly suffer very little compared to delicate women who are alone in life, and what is thus true of the mother is true also of those who have the care of children. It is not alone a satisfaction of the maternal instinct, but it is an occupation of mind and heart with cares for little ones. Other people's children serve just as good a therapeutic purpose, if only their necessities are imposed on the attendant. The reason why women in religious orders have such happy peaceful lives and are happier in spite of a routine of life that would seem to be fatal to happiness, is that their minds are filled with the interests of others, every moment of their time is occupied, and, above all, they have to care for children, the ailing, the poor, sometimes the vicious, who make many demands on them, many calls on their sympathies and keep them from thinking about themselves.
Occupation with Living Things.—After occupation with human beings the most important therapeutic factor against periods of depression is occupation with living things of various kinds. Horseback riding is an excellent remedy for the blues and the outside of a horse in the old axiom is literally very good for the inside of man or woman. There is a sympathy between man and animal that in itself means much, but the most important element is the absolute impossibility of preoccupation with oneself and one's little troubles and worries while one is trying to manage a somewhat restive animal. If the horse, however, is old and very quiet—so that one can throw the reins on his neck and allow him to jog on for himself, then horseback riding may mean very little. Where the care of the animal is entirely taken off the rider's shoulders by a groom who brings him to a particular place and takes him afterwards, then, also, much of the benefit of horseback riding is lost. Care for other animals as well as the horse is of great service and especially is this true if the owners feel the duty of exercising the animals. Many a downhearted person finds that to take an animal out for a stroll will do much to lift the clouds of depression.
With the disappearance of children from the families of the better-to-do classes, pet dogs have grown in favor mainly because of this influence. They awaken sympathies and so keep people from thinking too much about themselves, For many an elderly woman who is alone in the world her dogs or her {646} cats or a combination of both are the best possible remedies for depression. At times it will be found necessary to prescribe them. There is no better way to get an elderly person to go out at certain times than to have them feel that their pets need exercise.
Garden Cures.—After animals the next best thing is the care of a garden. Here once more human sympathies with living things are aroused and it is easier to cultivate a forgetfulness of self while cultivating flowers and plants. Growing plants do not arouse the interest that growing animals do, but still they have advantages over things that do not vary, and their growth is a subject of day-to-day interest and the effect on them of vicissitudes of the weather arouses feelings of solicitude which help to dissipate the little insistent cares for self that depress. The care of a garden is the very best thing for the "pottering old." Younger people are too impatient to get much benefit out of a garden, but after middle life many an hour of depression will be saved in the care of plants.
Intellectual Occupations.—It might be expected that intellectual occupations would serve to brush away "the blues" for educated people. They are perfectly capable of doing so, but they must be of the kind that grip attention and must be undertaken seriously, usually with an appeal quite apart from mere cultural interests. Hobbies of various kinds, especially the making of collections, even of such trivial things as stamps, will often serve the purpose of distraction from gloomier thoughts. Unfortunately, a hobby cannot be created all at once and usually does not take a strong enough hold to be available for mental therapeutic purposes unless it was acquired when the person was comparatively young and has been indulged in for many years. Reading and study utterly fail unless there is some end in view apart from the reading and study itself. The reading of novels and newspapers is particularly likely to be a failure. The gloomier thoughts obtrude themselves in the midst of the reading and very often what is read proves suggestive of melancholic thoughts and all the time the mind and the person are not occupied seriously enough to push away the state of depression which exists. The mind must be interested, not merely occupied superficially, or the depression will continue.
It might be thought that the reading of books that concerned human suffering might have a similar appeal to that to be obtained from real touch with human suffering. This is true to a certain extent when the books concern real and not fictitious suffering. For this reason the trials and hardships of travelers at the North and South poles or in the heart of tropical Africa—Nansen and Peary and Stanley and Livingston—have all been excellent therapeutic agents. The stories of mountain climbers have something of the same effect. Adventures in Alaska and in the Far North, especially, come in the same category. Novels, however, even though they use the same material, soon fail to have a corresponding effect. Even when the novel does touch the emotions deeply it is prone to make the reader forget the suffering around him and does not prove a good diversion from his own feelings. In his play, "The Night Asylum," Maxim Gorky, the Russian novelist and playwright, brings this out very well. One of his characters, a young scrubwoman, wears her fingers to the bone during the day for a miserable pittance and sleeps in a squalid night lodging house, yet this comparatively young creature, {647} crouched near the only light in the room, sheds tears over the imaginary sufferings of the fictitious people that she reads about, while the real human suffering around her fails entirely to arouse her sympathy or affect her emotions, except to anger her if lodgers come in between her and the light or when the complaints made by some of those who are suffering around her annoy and distract her from her reading.
In younger folks, study, provided there is some definite object to be attained by it, is often helpful. Correspondence schools are of value by setting a definite purpose before the mind. In a number of cases I have found that the suggestion to make translations from a foreign language when the patient knew that language even tolerably well, afforded excellent relief from that over-occupation with self which was the real cause of the depression. There are many people who know enough French to be able to translate fairly well and there are many articles and books a translation of which may at least be submitted to editors and often proves available for publication. To have some such end as this in view is of itself one of the best means that can be provided for these people to relieve their tendency to depression. Occasionally even the suggestion to write stories may prove helpful. One hesitates to add to the number of story-writers in this country, but it may be remembered as a last resort. I know at least two people saved from themselves by even a very moderate success as writers of short stories.
Consolation from History.—Perhaps the most serious thing about depression is the feeling of those afflicted by it that they are singular in this respect and that other people who seem gay never have depressed states. There is probably no one who has not periods of depression. They may not be very deep and "the blues" may be only of a light tinge, but they are there. The higher the intelligence, as a rule, the more tendency there is to feelings of discouragement and depression at intervals when one is not occupied. Those who have the artistic temperament and the striving after the expression of the beautiful as they see it, whether it be in art or in letters or in the betterment of humanity, usually suffer more than others because they realize poignantly their failure to reach their ideals. This is well illustrated by the experience of writers and artists. As a rule, most men and women look forward to the completion of any intellectual work with confidence that after it is finished they will have a period of rest and peace. Commonly just the opposite is true. The completion of any work leaves one with a sense of dissatisfaction with what has been done, for no man of real intelligence ever thinks that he has so realized his ideals as to be satisfied, and only the foolishly conceited fail to feel the many defects that there are in their work.
There is abundance of evidence, however, that it is not alone artists and writers who thus feel the hollowness of life and the tears there are in things. Many of the men who have accomplished great things in science and in politics have been prone to times of depression. Virchow told me there were moments when life seemed very empty to him and that he had to shake off feelings of depression in order to be able to go on with his work. At one time in the sixth decade of his life he suffered considerably from what we would now call neurasthenic symptoms, gave up his medical work and spent a long time with Schliemann in the Troad. His presence was valuable to the excavator in his work at Troy, and the change gave Virchow back his health.
Even more striking is what we know of Von Moltke, who seemed in many ways to have an ideally happy life. He had had the fulfillment of all his desires or, at least, the fruition of all his hopes, and the successful accomplishment of what he worked for beyond what is usually given to man. He had come to be one of the most highly respected men of Europe and was the subject of veneration on the part of his own German people and of intimate affection from his sovereign, who loaded him with honors. He was a man who had probably no enemies and many, many firm friends. It was said that "he could keep silence in eleven languages" and so he had avoided most of the pitfalls of life. His domestic life was ideally happy and his letters to his wife for over fifty years read like those of a lover, before all his great battles his last thought and written word was for her, after them his first thought and message was for her. In spite of this, towards the end of his life, when the question of reincarnation was a subject of discussion in Berlin and it was brought particularly to his attention, he declared that looking back on his career, in spite of all its good fortune, there seemed to him to be so many chances in life, so many possible sources of failure, so many springs of discouragement, that he would prefer not to have to live again. Surely, if anyone, he might be expected to be ready to take the chances of re-incarnation after such happy experiences of life, yet he was not. Such an expression could only come from a man who had looked depression often in the face, who had shaken off the blue devils and who knew that even the joy of success was followed by the gloom of uncertainty as to the future and solicitude as to the real significance of accomplishment.
Literature and Life.—We have many examples of this tendency to depression that come to the literary man in the lives and letters of distinguished writers that have been published so frequently in recent years. Perhaps one of the most striking is to be found in the life of Robert Bulwer Lytton, the second Lord Lytton, so well known as a diplomatist in European circles and throughout the English-speaking world as a poet, under the pen name of "Owen Meredith." [Footnote 51] It might be thought that Lytton would be one of the men safely harbored from storms of depression and discouragement, for his life seemed ideally situated to enable him to get the best out of himself without worry or dissipation of energy in occupation with mere personal matters. His father had made a distinguished success as a literary man and a politician, had been raised to the peerage and the son began life with every possible advantage. He made a distinguished success in literature so that he even converted his father to praise him and as a diplomatist he occupied nearly every important post in English diplomacy and had hosts of friends all over the world.
[Footnote 51: Personal and Literary Letters of Lord Lytton, edited by Lady Betty Balfour. New York, 1909.]
It is all the more surprising, then, to have many passages in his letters refer to periodic attacks of depression. He says, for instance, "My physical temperament has a great tendency to beget blue devils and when those imps lay siege to my soul they recall those words of Schopenhauer's and say to me 'thou art the man.'" Perhaps the price that the artistic temperament pays for the satisfaction that it gets out of life in other directions is this occasional tendency {649} to depression because achievement does not equal aspiration. Certainly the price often seems excessive to those who have to pay it. In the same letter to his daughter, Lytton continues:
When my blue devils are cast out, and I recover sanity of spirits, then I say to myself just what you say to me in your letter—that the main thing is not to do but to be; that the work of a man is rather in what he is than in what he does; that one may be a very fine poet yet a very poor creature; that my life has at least been a very full one, rich in varied experiences, touching the world at many points; that had I devoted it exclusively to the cultivation of one gift, though that the best, I might have become a poet as great at least as any of my contemporaries, but that this is by no means certain to me for my natural inclination to, and unfitness for, all the practical side of life are so great that I might just as likely have lapsed into a mere dreamer; that the discipline of active life and forced contact with the world has been specially good for me, perhaps providential, and that what I have gained from it as a man may be more than compensation for whatever I may have lost by it as an artist.
It is surprising to think of a man of this kind becoming so depressed by the death of a son that all the world and the meaning of life took on a somber hue for him. In 1871 Lord Lytton lost a young boy by a very painful illness which had probably been more painful for sympathetic onlookers than for the patient himself. The incident proved sufficient, however, to make the father think that there could not be a beneficent Providence ruling over the world. He felt sure that somehow God's power must be shortened, if such suffering, for which he could see no reason, had to be permitted. He was much depressed after this and never was quite the same in his outlook upon the world and the significance of life. It was easy to understand that this was due rather to his character than his intellect, but it illustrates forcibly how much a deeply intelligent man may be affected by something that seems after all, only the course of nature.
It is sometimes surprising to find from the life stories of men how often those who would be thought least likely to suffer from periodical depression were victims of it. Few Americans in our time have apparently had a more satisfying career than that of James Russell Lowell, a successful author as a young man, then a successful editor, a teacher whom his students appreciated very much, and in later life the subject of many honors and such honors as provided him with splendid opportunities for the exhibition of his special genius. He would seem to be the last who should suffer from depression. His post as Minister to Spain gave him an opportunity which he took magnificently to study the great Spanish authors and to store up material for writing about them. As Minister to England few men were so popular. He was constantly in demand for occasional addresses and his special style enabled him to respond to these demands with brilliant success. Here in America no great occasion was complete without Lowell. In spite of all this that would surely seem ample to satisfy the aspirations of any man, Lowell was often depressed and sometimes even talked about the possibility of suicide. Life seemed at times very empty to him. The story of the lives of such men, if made familiar to patients, proves a source of consolation, for it makes them realize that they are not alone in their experiences, that depression at some times is the lot of man, and that very few people are without the sphere of its influence.
Depression an Incident, not a State.—This suggestion may, in the case of some of those inclined to longer periods of depression, lead to indulgence in the luxury of being depressed and so putting off the doing of things. It must be pointed out, however, that just inasmuch as depression has this effect it is pathological. It seems to be natural to man to suffer from periods of discouragement and depression which keep him from devoting himself too persistently to lines of work that may be insignificant and make him take cognizance of the real values of what he is doing. Depression, however, that continues after the recognition of this takes place is morbid and must be actively resisted. Just inasmuch as depression precedes and prepares patients for a reaction, it is an incident in practically all lives. Indulged in as a luxury, it is abnormal.
Suggestive Treatment.—The most important thing for patients who suffer from periodic depression is to make them understand that this state of mind, far from being personal to them or very rare, or even uncommon, is an extremely frequent experience of men and women. There are certain men and a few women eminently occupied with the external life, busy with many things, though often they are trivial enough, and even when they are important, significant only in a financial or a social way, but meaning nothing for the great realities of life, who seem during their younger active years to escape the periodical attacks of depression that come to most people and come almost without exception to people who think seriously. Some of the best thoughts and inspirations of men come to them as the result of the serious mood that follows an attack of depression. A butterfly existence lacks these sources of inspiration. Far from being objectionable then, attacks of depression, if not allowed to proceed too far, and if kept from paralyzing activity, prove to be intervals when life values are seriously weighed and when a proper estimation of such values is come to. Men are prone without such interruptions to get too interested in trivial concerns that seem to them important because they are occupied with them to the exclusion of other ideas, but that prove to be of no real import when seen on the background of a certain hollowness that there is in human life, if lived merely for its own sake.
The occurrence of periodical depression is a part of the mystery of life and it affords us a better opportunity to get a little closer to the heart of the mystery than almost anything else. It is out of such periods that men have risen "on stepping-stones of their dead selves to higher things" and have even risen to the highest that there is in life. Geniuses have nearly always had deep periods of depression, but in the midst of them have read new meanings into life and have read the lessons of humanity in their own souls better than at any other time. Depression throws a man back on himself and makes him think deeper than in his mind—in what has been called his heart. "The fascination of trifles obscures the good things in life" are words of old-time wisdom and men are weaned from this by fits of depression that are really moods of precious dissatisfaction with their work inasmuch as it falls short of the best accomplishment. Without periodic depression, apparently, a man never gets as close to the heart of life as he otherwise would. Far from being an unwelcome visitant, it should be rather welcome as a stimulus to the possibility of further study of self and the realities of life.
To the minds of many people insomnia is one of the most serious ills to which human nature is heir. Most of this quite false impression is due to the sensational cultivation of dreads with regard to insomnia by newspapers and in general conversation. If we were to credit such impressions, there is a certain number of unfortunates who, for some unknown reason, find it impossible to sleep and who, night after night, drag out the weary hours wooing sleep that does not come, until when daylight dawns they are in despair, distracted by lack of rest. This is presumed to occur night after night, until finally the worn-out mind succumbs to the intolerable anguish of being kept constantly on the rack of wakefulness and the patient becomes insane or saves himself from that by suicide. No wonder, then, that many a one of these patients takes to the use of habit-forming drugs to produce sleep. These, though effective only to a small degree, soothe him for the time, but finally render him such a wreck that there is not even will power enough for him to take his own life and end his intolerable suffering.
Such gruesome pictures of the awful effects of insomnia run rife and produce dreads in the community until just as soon as the ordinary nervous supersensitive person loses an hour or two of sleep two or three nights in a month, he begins to conjure up the specter of insomnia with its awful terrors and still more awful possibilities, and begins to bewail the fate that has chosen him as an unfortunate victim. This exaggerated dread that slight losses of sleep, for which there are often excellent reasons, will develop into an incurable condition of persistent wakefulness has more to do than any other single factor with the production of the state called insomnia which is, however, never half as bad as it is pictured.